{"id":46320,"date":"2019-12-20T11:52:14","date_gmt":"2019-12-20T10:52:14","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=46320"},"modified":"2020-01-07T18:07:45","modified_gmt":"2020-01-07T17:07:45","slug":"roghieh-dehghan-zaklaki-run-the-nhs-but-do-not-call-the-uk-your-home","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2019\/12\/20\/roghieh-dehghan-zaklaki-run-the-nhs-but-do-not-call-the-uk-your-home\/","title":{"rendered":"Roghieh Dehghan Zaklaki: Run the NHS, but do not call the UK your home"},"content":{"rendered":"<p class=\"standfirst\">The NHS relies on migrants to work in the NHS, but implements hostile policies towards migrants seeking care, says Roghieh Dehghan Zaklaki<\/p>\n<p><!--more--><\/p>\n<p><span style=\"font-weight: 400\"><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2019\/12\/5bd88576e630259ebddefd6f_untitled-p-500.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-thumbnail wp-image-46326\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2019\/12\/5bd88576e630259ebddefd6f_untitled-p-500-150x150.png\" alt=\"\" width=\"150\" height=\"150\" srcset=\"https:\/\/blogs.bmj.com\/bmj\/files\/2019\/12\/5bd88576e630259ebddefd6f_untitled-p-500-150x150.png 150w, https:\/\/blogs.bmj.com\/bmj\/files\/2019\/12\/5bd88576e630259ebddefd6f_untitled-p-500-300x300.png 300w, https:\/\/blogs.bmj.com\/bmj\/files\/2019\/12\/5bd88576e630259ebddefd6f_untitled-p-500.png 500w\" sizes=\"auto, (max-width: 150px) 100vw, 150px\" \/><\/a>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&#8217;s win, with a large majority, will have<\/span><span style=\"font-weight: 400\"> real consequences for me and my patients. <\/span><\/p>\n<p><span style=\"font-weight: 400\">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.\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">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. <\/span><a href=\"https:\/\/www.gov.uk\/government\/publications\/overseas-nhs-visitors-implementing-the-charging-regulations\"><span style=\"font-weight: 400\">NHS charging regulations of 2015 and 2017<\/span><\/a><span style=\"font-weight: 400\"> 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 &#8220;illegal.&#8221; Legal status casts off those patients from the circle of care and professional conscience.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">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.<\/span><\/p>\n<p><span style=\"font-weight: 400\">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.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Sadly, the sense of \u201cI am indispensable to our NHS\u201d is short lived. When I get home, a different reality hits me. There is a message from the Home Office in my inbox: \u201cThank you for your application for the EU Settlement Scheme,\u201d it reads. \u201cYou will receive a decision shortly.\u201d 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.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">My sense of heroism and inclusion quickly changes to guilt and exclusion.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">To transform the NHS into an inclusive system that works for all of us in equal measures is something <\/span><a href=\"https:\/\/www.bma.org.uk\/about-us\/equality-diversity-and-inclusion\"><span style=\"font-weight: 400\">the British Medical Association (BMA)<\/span><\/a><span style=\"font-weight: 400\"> 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.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">The Department of Health (DOH) makes a distinction between two groups of migrants: those who are documented and therefore \u201cdeserving\u201d 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.<\/span><span style=\"font-weight: 400\"><a href=\"https:\/\/press.princeton.edu\/books\/paperback\/9780691130286\/the-ethics-of-identity\"> Identity is understood as having a &#8220;personal&#8221; and a &#8220;collective dimension<\/a>.&#8221;<\/span><span style=\"font-weight: 400\">\u00a0The latter refers to our<\/span><a href=\"https:\/\/global.oup.com\/academic\/product\/madness-and-the-demand-for-recognition-9780198786863?cc=gb&amp;lang=en&amp;\"><span style=\"font-weight: 400\"> social identities, such as those related to race, gender, culture and religion. What is more, we<\/span><\/a><span style=\"font-weight: 400\"> 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\u2019s 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 <\/span><span style=\"font-weight: 400\">ethnic, religious, or cultural<\/span><span style=\"font-weight: 400\"> community are denied rights that are taken as entitlements for others, when they are deemed unworthy. I too feel unworthy. I too feel <\/span><a href=\"https:\/\/global.oup.com\/academic\/product\/madness-and-the-demand-for-recognition-9780198786863?cc=gb&amp;lang=en&amp;\"><span style=\"font-weight: 400\">disqualified as a member of society<\/span><\/a><span style=\"font-weight: 400\">.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Ironically, migrants are the engines of NHS.<\/span><a href=\"https:\/\/www.who.int\/hrh\/migration\/14075_MigrationofHealth_Workers.pdf\"><span style=\"font-weight: 400\"> 35% of medical practitioners and 22% of nurses working in the UK in 2012 were born abroad,<\/span><\/a><span style=\"font-weight: 400\"> and the NHS has been actively recruiting health professionals from abroad since the 1990s. Boris Johnson is proposing to boost NHS by bringing in<\/span><a href=\"https:\/\/www.independent.co.uk\/infact\/boris-johnson-nhs-nurses-conservative-manifesto-recruitment-a9217406.html\"><span style=\"font-weight: 400\"> 50,000 more nurses and 6,000 more doctors.<\/span><\/a><span style=\"font-weight: 400\"> 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.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Boris Johnson\u2019s government wants me to run its NHS, but it degrades and scapegoats my (migrant) community and warns me <\/span><a href=\"https:\/\/www.businessinsider.com\/boris-johnson-says-he-will-stop-immigrants-treating-uk-as-their-own-2019-12?r=US&amp;IR=T\"><span style=\"font-weight: 400\">not to treat the UK as my home.<\/span><\/a><span style=\"font-weight: 400\"> 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?\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">If we are to break away from discrimination in NHS<i>\u2014<\/i>if equality truly matters<i>\u2014<\/i>then we need to call out the divisive policies that impair the health and sense of belonging for migrants.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">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.<\/span><\/p>\n<p><em><strong>Roghieh Dehghan<\/strong> is a GP in London and <a href=\"http:\/\/www.ighgc.org\/fellows\/dr-roghieh-dehghan-zaklaki\">works at the Institute for Global Health<\/a> at UCL.\u00a0<\/em><\/p>\n<p><em><strong>Competing interests:<\/strong> None declared.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>The NHS relies on migrants to work in the NHS, but implements hostile policies towards migrants seeking care, says Roghieh Dehghan Zaklaki [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2019\/12\/20\/roghieh-dehghan-zaklaki-run-the-nhs-but-do-not-call-the-uk-your-home\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":45642,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[14774,236],"tags":[],"class_list":["post-46320","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-brexit","category-nhs"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - 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