The NHS at 70, by the immigrants who make it

When I say I have the NHS in my blood, I don’t just mean the various blood transfusions, operations, medications, and check-ups that have kept me alive since I was born. My Malaysian dad came to the UK to study when he was 17, trained to be a doctor, and ended up working in a Northern Irish hospital where he met my mum, a children’s nurse who had moved north from the Republic of Ireland. The NHS is made up of stories like my parents: about people who came to the UK to study, train, or work in one of the thousands of hospitals across four countries. Last year it was reported that 18% of NHS workers are non-UK nationals and 30% of NHS doctors are from countries outside the UK. This year the NHS turns 70 and to celebrate seven decades of universal healthcare, we speak to some of the immigrants who have chosen to make a life for themselves in the UK about what the NHS means to them. 

Through a series of both fortunate and unfortunate events, Matthew unintentionally fell into the NHS. An Australia-native, he was travelling around Europe before becoming stuck in Scotland. Through the kindness of strangers, he was put in touch with the head of human resources at an Edinburgh hospital. “One thing led to another and while working as a nursing assistant I discovered that, even though I had been to five different high schools and somehow not graduated from any of them, I was encouraged by senior staff who saw some value in me to start on the path of tertiary education. Being a high school drop-out, I needed to start by doing a SVQ 2 then a HNC before going into second year at university. I felt so amazed and grateful that the country I’d simply gotten lost in offered me a chance to be a ‘real’ and relevant part of society, one that could hopefully allow me to reciprocate the gratitude I felt for being so included.”

Despite the fact that he would have a better salary if he had returned to work in Australia, Matthew made the decision to stay in Scotland as a staff nurse. “Yeah, I could be making double the money for the same job back in my home country (as my mum likes to tell me), but for now I’m extremely proud to be part of something which I see as genuinely approaching – and regularly achieving – what I don’t think is too exuberant to say [are] the highest ideals of an egalitarian approach to life that demonstrates the best parts of human nature.”

Denis, from Kerala in India, has been working as a domestic porter in an NHS hospital for the past six months. A mechanical engineering student, Denis is working part-time to support himself through these studies. While he isn’t likely to stay in the UK when he graduates, the NHS means a great deal to him. “As well as myself, both my parents are employed by the NHS and it is essentially their lifeline. Unlike in India, it provides free healthcare for my family and others, which I have always thought is amazing. I’m amazed that they have provided this service for 70 years.”

Set up after the Second World War, the UK was one of the first European countries to aim for free healthcare for its citizens. It remains one of only 58 countries in the world to provide universal healthcare. For people who grew up in countries where healthcare is an expensive privilege, the UK’s NHS is not something to be taken lightly. Born in the Philippines, Emily has worked as an NHS nurse since 2009. She calls the NHS “the greatest social reform ever created which should serve as a role model for every country in this world. Being an immigrant I can see how fortunate the people here in the UK are to have the NHS. Access to free medical and health services whether you’re rich or poor! How wonderful it could be if this was the same in the Philippines or any other countries.”

Emily completed her nursing qualification in the Philippines and, after graduating, had to volunteer as a nurse in exchange for experience in the field. “Getting a paid nursing job in the Philippines was quite hard at the time if you didn’t have experience, so you had to 'volunteer' at first for at least six months to apply for probation.” She says a desire to travel and for a better paid job led her to want to work abroad. In 2002, she moved to an American hospital in Yemen before making her way to the UK in 2004. 

Emily is upfront about the challenges of being an immigrant and working for the NHS. “Although I can say my English is good, I had some struggles understanding the way people speak here with accents and use of English terms and words,” she says. “There’s also an issue of belonging. I feel that no matter what I do to fit in, there is always a feeling that you don’t belong or people from here make you feel that you’re not one of them. It’s up to you how you react to every situation when you feel this way. It’s a matter of acceptance.” On a larger scale, she says that there is a major imbalance between workload and pay. “This is a big challenge now for nurses. I said before that my plan was to work in the NHS until I retire but that has changed now because of the imbalance of workload versus pay. Working in the NHS, especially in Accident and Emergency, is tough with the amount of patients coming in with a shortage of staff – the pay isn’t enough. This is true in different areas of the NHS.”

The NHS is suffering from a lack of government funding, something that is affecting both NHS workers and patients. The Leave campaign manipulated this fact during the lead-up to the Brexit referendum last year, infamously plastering “We send the EU £350 million a week, let’s fund our NHS instead” on the side of a red bus. The morning after the referendum, Nigel Farage, at that time UKIP’s leader, backtracked on Good Morning Britain, saying: “No I can’t [guarantee it], and I would never have made that claim.” After the Brexit vote last July, a 23% increase in hate crime involving racial and religious discrimination was reported. Whether it’s feeling unwelcome in the UK or uncertain about whether staying will even be an option for EU nationals living in the UK, the uncertain consequences of Brexit loom over.  

Meabh, a junior doctor working between acute medicine and A&E, is from County Donegal in Ireland and has worked in Belfast for the past year. Like many Irish and Northern Irish people, Meabh is concerned about the possibility of a hard border between the north and south and how that will affect health services in both countries. “A hard border would completely change life in Donegal. I'm worried about how Brexit is going to affect the north west. Some services are cross-border, including some of the cancer services. I hope that this will continue, even in the event of a hard border, as this massively benefits people in Donegal.”

The NHS is under threat. Whether it’s the government’s increasing and unrelenting cuts to funding, the threat of Brexit or overworking underpaid staff, the future of universal, free healthcare in the UK is becoming more uncertain. As Matthew, Denis, Emily, and Meabh all express, the NHS is a rare privilege in the world. “Free healthcare that treats on the basis of need rather than income or status should be the norm everywhere,” says Meabh. So, as we celebrate 70 years of the NHS, we should also be fighting to ensure that we get to celebrate another 70 more.