This week, across the country, healthcare professionals are speaking out against Hostile Environment immigration policies in the British health service. These policies, at the heart of which sit the NHS charging regulations, defy the human right to health and undermine the very values upon which the NHS was founded. This week I will join these protests because I believe it is my duty as a doctor and researcher to use my knowledge and power to benefit the people I am committed to care for.
In 1967 Noam Chomsky wrote an essay entitled ‘The Responsibility of Intellectuals’. In it, he argued it was our duty to speak truth to power, uncover lies, lift the veil of ideology and provide a foundation for action. Last week Fiona Godlee, the editor of the British Medical Journal, made a similar point in an editorial which highlighted the work of Independent Sage to show why we need ‘rebels’ in medicine. Rebels are required, she wrote, “to spot what’s wrong and champion what’s right, and to push for greater openness, constructive discussion, and evidence-based change.”
Working as a doctor, I see how many of the people in my care are impacted by their disadvantages each and every day. This was my motivation to undertake research – research that centred on their voices and exposed the structures which shaped their experiences. I was particularly interested in how people not born in the UK access healthcare. Reading through document after document of policies which sought to restrict NHS access to many of the people I looked after showed me these were politically motivated restrictions. They were designed to show a ‘strong’ stance on immigration with little evidence of benefit to anyone, yet huge potential to harm. It was clear something had to change. My resolve only strengthened after analysing the narratives of people affected – revealing racism, xenophobia, delayed care and suffering. This harm not only extended to people born outside the UK but others who are racialised as foreign or outsiders, a fact laid bare through the Windrush scandal.
I have presented my data at conferences, published in academic journals, responded to public policy enquiries and contributed expert witness statements to support legal challenges. However, my impact using these methods alone has been limited. I was once brought into a meeting with a senior politician to present my evidence – I spoke truth to power, and power said back to me “the issue here is that our values differ”. The denial of healthcare is not about values. I realised that the evidence alone wasn’t enough. To effect change, I needed to persuade, I needed power, I needed to organise.
During my research I became increasingly involved with grassroots activist organisations campaigning for the rights of migrants and against racism in the NHS. I hold a public and overtly political position that healthcare should be free at the point of access, regardless of immigration status. Speaking out and raising awareness in public has drawn calls for me to “get back to my day job”, to “stay out of politics”. Healthcare workers themselves, brought up within the seemingly objective world of biomedicine, echo this concern. Some think we should not compromise our position of neutrality by entering the world of activism. But my day job is to advocate for my patients – to champion their case. Sitting on the fence or turning a blind eye takes on a political positioning all of its own – silence is complicity.
I do not come from a background in activism or political protest. My desire to do the best for patients led me first to research and then to campaigning. I would argue it is our responsibility as healthcare workers to use the insights we gain through our privileged position as intimate witnesses of suffering.
When you read between the lines of NHS charging policy, when you analyse its implementation in practice and when you listen to the experiences of those it affects, the harm is clear. There’s an underlying anti-immigrant, colonial, racist ideology for all to see – the foundation for action is concrete. With this knowledge, and in a world whose attention has finally shifted to shine a light on inequality and injustice and its relationship to health, our obligation as healthcare workers is undeniable – to act, to speak up, to protest. There is power in us acting together, and the more of us there are, the stronger and louder our message is: we are healthcare workers, not border guards, and we reject the hostile environment.
I therefore call on you to join us this week to demand #NoBordersInTheNHS, an end to the NHS Charging Regulations, and an end to all Hostile Environment policies in healthcare.
Dr Jess Potter is a Respiratory Doctor working in London. She recently completed an MRC-funded PhD exploring access to healthcare for migrants with TB in the UK. In 2019, she won the Champion Award at the Women on the Move Awards for her work campaigning for universal healthcare and fighting the hostile environment with the #PatientsNotPassports campaign.