The NHS relies on migrants to work in the NHS, but implements hostile policies towards migrants seeking care, says Roghieh Dehghan Zaklaki

Last Friday, as the results of the 2019 general election were announced, I went to my clinic with a pit in my stomach, and it still is there. Boris Johnson’s win, with a large majority, will have real consequences for me and my patients.

It is a confusing time for me to practise as a GP in the UK. I am a Muslim immigrant from Iran and an EU citizen (I grew up and studied medicine in Austria). I have worked in the NHS for seventeen years, spanning a wide range of governments with varying political philosophies. But a sense of unease that started after the EU referendum has only become more intense with an election result that makes Brexit inevitable and gives a strong majority to a determined anti-immigrant government.  

My confusion, both personal and professional, comes from health policies which diminish the value of migrants in our society and restrict their access to healthcare. These policies clash with the high regard in which physicians are generally held. NHS charging regulations of 2015 and 2017 demand upfront payment for treatment of undocumented migrants. These are mandated by the government, but they are executed by doctors. Consultants withdraw dialysis and withhold cancer treatments from our patients. They inform us that their overseas management officers have contacted the Home Office and judged our patients “illegal.” Legal status casts off those patients from the circle of care and professional conscience. 

The current political climate has forged deeper bonds between me and my migrant patients. But the UK government sees them very differently. This conflict of values causes me to examine my own place in society as well as my willingness to speak up for my patients.

Every Friday, I receive a weekly email from the Royal College of General Practitioners (RCGP) with the latest relevant updates to general practice. It never fails to remind GPs of their vital role in the NHS, and it fills me with pride. 

Sadly, the sense of “I am indispensable to our NHS” is short lived. When I get home, a different reality hits me. There is a message from the Home Office in my inbox: “Thank you for your application for the EU Settlement Scheme,” it reads. “You will receive a decision shortly.” The boilerplate language is inadequate to capture the gravity of the moment. Because of Brexit, I have to wait for a decision on whether the UK can remain my home after so many years of working and building my life here. The whole process serves as a reminder that my dedication to treating British people is not enough to truly make me one of them. The underlying message is that I am indeed an outsider. 

My sense of heroism and inclusion quickly changes to guilt and exclusion. 

To transform the NHS into an inclusive system that works for all of us in equal measures is something the British Medical Association (BMA) is aspiring to. For us to achieve this worthy goal, we need participation from a wide range of perspectives and human experiences. However, participation requires belonging, and belonging calls for a sense of safety. Yet, safety eludes us in the face of dehumanising and discriminatory policies that run the NHS. 

The Department of Health (DOH) makes a distinction between two groups of migrants: those who are documented and therefore “deserving” of NHS care and those who are not. However, unlike what politics want us to believe, migrants do not come as isolated individuals. We are human beings. I straddle two separate worlds as a physician and as a migrant, and I know myself through my membership of different group identities. Identity is understood as having a “personal” and a “collective dimension.” The latter refers to our social identities, such as those related to race, gender, culture and religion. What is more, we tend to identify most with the vulnerable and subordinate aspect of our identity. As a GP, I inhabit a dominant group status. As an immigrant, I find myself in a subordinate group identity. In today’s UK, my self-perception is first and foremost as a migrant. Clearly, when the collective aspect of my identity is excluded from NHS care, when members of my ethnic, religious, or cultural community are denied rights that are taken as entitlements for others, when they are deemed unworthy. I too feel unworthy. I too feel disqualified as a member of society. 

Ironically, migrants are the engines of NHS. 35% of medical practitioners and 22% of nurses working in the UK in 2012 were born abroad, and the NHS has been actively recruiting health professionals from abroad since the 1990s. Boris Johnson is proposing to boost NHS by bringing in 50,000 more nurses and 6,000 more doctors. The paradox of hostile policies toward migrants and the dependence on migrant healthcare professionals to run the NHS is striking. The consequence of this chasm is a vulnerable and complacent migrant labour force in NHS that does not assert themselves nor confront the status quo. In short, true participation is not possible. This is not a relationship of equals; it is a manifestation of dominance. 

Boris Johnson’s government wants me to run its NHS, but it degrades and scapegoats my (migrant) community and warns me not to treat the UK as my home. How is an ordinary doctor or nurse supposed to dedicate themselves to a highly demanding and under resourced institution without being allowed to call it her own, without a sense of equal rights and entitlements? 

If we are to break away from discrimination in NHS—if equality truly matters—then we need to call out the divisive policies that impair the health and sense of belonging for migrants. 

As a GP, I know that policies which threaten the most vulnerable in society have no place in medicine. Ultimately, discriminatory policies threaten and disempower each one of us.

Roghieh Dehghan is a GP in London and works at the Institute for Global Health at UCL. 

Competing interests: None declared.