The Conservative prime minister, Boris Johnson, has recently proclaimed himself the champion of our NHS. He told the Tory Party Conference last month:
... as we get Brexit done, so we will re-energise and unite our country. If there is one great British institution that has the emotional force to bring our country together, it is our NHS. It is sacred in our nation precisely because at its heart is the simple beauty of the principle that whoever you are, no matter where you come from, if you fall sick the whole country gathers figuratively at your bedside.
And the prime minister repeated this statement word for word in his introduction to last week’s Queen’s Speech.
So can we believe these claims? Is there really a u-turn on a decade of Conservative attacks on the NHS? An end to PFI, an end to NHS privatisation more generally, proper funding for our healthcare services, an end to the hostile environment in our hospitals, and an end to Boris Johnson’s long history of racist and discriminatory comments?
Johnson isn’t the first Conservative prime minister to make the preposterous claim that “the Conservatives are the party of the NHS” (Thatcher, Cameron, and May all made similar claims while pursuing privatisation and underfunding).
But his recent comments ring particularly hollow for patients who have been denied healthcare, who are unable to pay for treatment, some of whom have died, and for healthcare workers who are forced to act as border guards. Johnson’s comments are vastly out of step with the reality of the NHS.
This 23rd October marks two years since Theresa May’s government introduced upfront charges for secondary NHS treatment if patients are unable to prove their eligibility for free care. A number of vulnerable groups – including failed asylum-seekers, under-or undocumented migrants and those who had overstayed their visa – became “chargeable” upfront (rather than after treatment, as had been the case previously), if their condition is deemed ‘non-urgent’. This situation applies to an estimated 600,000 people, including 120,000 children, 65,000 of whom were born in the UK.
These charging regulations have ripped up the principle that the NHS will treat you “whoever you are, no matter where you come from” - and it doesn’t look like Johnson has any plans to reverse the policy. Instead, under Johnson’s government, NHS Trusts have been instructed to prepare to ramp up checks and charges on EU nationals. Though government claims EU nationals resident in the UK won’t be affected, The3million – which represents them – has described the government’s approach as “reckless”, arguing it would expand the “mass discrimination under the Hostile Environment”. Johnson’s approach is revealed in comments by NHS England’s EU exit strategic commander, Keith Willett, who has said “from a government perspective, they will want to see a visible change… what we’re saying to NHS organisations is you will need to beef up your overseas management teams”. Meanwhile, extending charges for GP and A&E services form part of government plans.
If – as Johnson says – it doesn't matter who you are, why was Sylvester Marshall (known in initial reporting as Albert Thompson) presented with a £54,000 bill and denied cancer treatment for six months? Marshall had lived in the UK continuously since arriving from Jamaica as a teenager in 1973. When asked about his case in parliament, Theresa May insisted he needed to “evidence his settled status” in the UK, and refused to intervene until the Windrush scandal had gained further media attention. Boris Johnson had nothing to say about the “simple beauty” of NHS principles then.
If it doesn’t matter where you come from, why was Nasar Ullah Khan denied a heart transplant - a procedure which may have been able to save his life? Instead of a figurative gathering of the whole country around his bedside, he was presented with a £32,000 bill for end-of-life care, having been denied the treatment he needed because of his immigration status.
It shouldn’t have mattered for Saloum, an anti-FGM campaigner who had fled Gambia only to become a victim of modern slavery. But he too was deemed ineligible for free NHS care. After receiving a bill for £8,397 for initial treatment from University Hospitals of Derby and Burton NHS Foundation Trust, he was he was sent away from Royal Derby Hospital, unable to pay upfront for further treatment. Diagnosed with two brain tumours and lung cancer, Saloum died earlier this year.
Esayas Welday’s blood cancer treatment was halted when he couldn't pay a £33,000 bill for treatment. As he says,
it’s horrible and inhuman to have a person who is sick like me dumped onto the street without food or shelter or medication… They said they couldn’t continue to treat me because I couldn’t afford to pay the £33,000 bill for treatment they had given me. They decided that they didn’t care about my life, or my health and my illness, so they sent me back to the street. I thought they were killing me.
The experience of so many seeking healthcare is no longer one of compassion from our NHS, of a country ‘gathering figuratively by your bedside’. It is of a world of debt collectors and immigration enforcement. The regulations are deterring immigrants from seeking treatment, including from serious illnesses. Government ministers have admitted that patients are being wrongly charged for care under the regulations, whilst private bailiffs are being employed to chase and harass patients who are unable to pay for their care.
Healthcare workers themselves are hit too. Being forced to determine patients’ immigration status undermines their duty of care. They now have to negotiate substandard treatment plans with people that can’t afford the care that they need. Of course, many of these NHS workers are themselves migrants. As GP Roghieh Dehghan says, “No amount of ‘You can stay’... is enough to protect me and my patients from racial profiling and the everyday microaggressions that these policies encourage.”
Far from working to “unite our country”, these policies scapegoat migrants, and encourage racial profiling within hospitals. One of the “overseas visitors managers” confirmed on an episode of Victoria Derbyshire’s TV programme, that “The way it’s being done is discriminatory”, with people with “foreign-sounding” names being targeted.
The racism of the hostile environment in our NHS is deadly. Imperial Hospital demanded a £30,000 upfront deposit before Elfreda Spencer’s urgent cancer treatment could begin. Though the family offered to pay through instalments, the NHS Trust demanded the sum in full. For nearly 12 months she received no treatment beyond paracetamol for pain, before she died at the Royal Free hospital in January 2018 (the treatment she finally received resulting in unpayable bills). Her daughter, Barbara Wright, sums up the experience:
They said no, "It’s £30,000 upfront or nothing." It was just horrible – really disgusting, horrible. They wouldn’t look at mum, she was in so much pain. I said to them, "If mum was a dog, you lot would be tripping over each other to help her, but because she is a black woman from a different country, you lot treat her worse than a piece of nothing."
The principle that “whoever you are, no matter where you come from”, you are not only deserving of treatment but feel “the whole country” figuratively “gathering at your bedside” goes back to the health secretary who founded the NHS, Aneurin Bevan. He wrote:
... society becomes more wholesome, more serene, and spiritually healthier, if it knows that its citizens have at the back of their consciousness the knowledge that not only themselves, but all their fellows, have access, when ill, to the best that medical skill can provide.
Bevan was clear that the “fellows” here was intended to include “foreign visitors”, emphasising that “medical treatment and care should be a communal responsibility that they should be made available to rich and poor alike in accordance with medical need and by no other criteria” (emphasis added), and that “it would be unwise as well as mean to withhold the free service from the visitor to Britain”.
As more and more healthcare providers and patients hit by the policies speak out, it is becoming increasingly apparent that the intrusion of the hostile environment into the NHS is undermining these principles, with devastating consequences. The charging regulations have destroyed that key founding principle of the NHS: free care for all based on need, not financial ability, not on who you are, or where you come from.
Barely weeks before Johnson made this speech, Kelemua Mulat died of advanced breast cancer, aged 39. She had been denied potentially life-saving cancer treatment for six weeks. Healthcare workers, migrant groups, and community organisations will gather together this Wednesday 23rd October to remember Kelemua, Nasar, Saloum, Elfreda, and all the other people - whose stories are so often invisible - who have suffered and died because of upfront charging and the hostile environment in the NHS. Actions are planned in London, Bristol, Birmingham, and Manchester. If you can’t make it to one of these events, here’s what else you can do:
- Join us in demanding the Department of Health and Social Care stop NHS charging.
- Use our toolkit to learn how to support people facing charging and how to start your own local campaign - www.PatientsNotPassports.co.uk
- Read about the impact of charging policy in this briefing Patients Not Passports: Challenging Healthcare Charging in the NHS
- Follow us on social media to stay in touch @DocsNotCops.