All political parties are talking more openly about immigration than a few years ago, responding to what they see as public disquiet at the numbers settling in Britain, and their effect on employment and public services. “I believe controlling immigration and bringing it down is of vital importance to the future of our country” is how the prime minister put it in a major speech in April.
And yet the politicians also know that, without immigration, the British economy and society would have developed very differently. And there is one institution in Britain where immigration has made a profound difference – the health service. In the same speech in which he called for stricter immigration controls, Mr Cameron added: “Go into any hospital and you’ll find people from Uganda, India and Pakistan who are caring for our sick and vulnerable.”
Immigration and health care in Britain have long been intertwined. Stephanie Snow of the University of Manchester, who has researched this area with her colleague Emma Jones, notes that even before the creation of the NHS Britain was recruiting from Ireland for its hospitals. Nurses and doctors also came from among the internationally displaced, such as Jewish refugees from Nazism.
Once the NHS was up and running in 1948, demand for health service labour increased rapidly, not only for basic care but also for new techniques and technologies such as radiology and blood labs. At a time of overall labour shortages in the British economy, health service workers from abroad were vital, with recruits from the Caribbean and the Indian subcontinent especially prominent.
Such recruitment was often presented as a temporary measure, yet demand proved far more long-lasting, particularly in the ‘unpopular areas’ of health care, such as geriatrics and mental health. Those coming from abroad, Dr Snow points out, “have had least choice” when developing their NHS careers, and have not always enjoyed the best training opportunities.
Some GP practices, for example, where British-born doctors were most reluctant to work – such as those in Welsh mining valleys – were often staffed by Indian or Pakistani recruits. Such recruits also compensated for the many British doctors and nurses who, after training in Britain, emigrated to North America or Australia. The NHS also faced the loss of thousands of trained staff who left for better-paid work in other sectors of the British economy.
The overall scale of recruitment from abroad is striking. By 1960, between 30 and 40 per cent of all junior doctors in the NHS were from India, Pakistan, Bangladesh and Sri Lanka. “The Health Service would have collapsed” said eminent doctor Lord Cohen of Birkenhead, if it had not been for this “enormous influx”.
In some periods of tightened restrictions on immigration, medical staff, especially doctors, were exempted. At other times government intervened to try and reduce their recruitment in favour of those born and trained in Britain. But this has often been followed by hurried new recruitment from abroad as those running the health service realised they had not adequately planned for future needs.
Around 30 per cent of doctors and 40 per cent of nurses in today’s NHS were born outside the UK. Those proportions may yet rise as an ageing population limits the potential supply of British-born staff while adding to increased demand for health care.
So the NHS, suggests Stephanie Snow, revered as a “symbol of national life” in Britain, has in fact been one of the great institutions of immigration and integration too. ‘International Health Service’ might be a more appropriate name. And the politicians have always had
to steer a difficult line – between addressing public angst about immigrants taking ‘British jobs’ and overburdening ‘British services’ while knowing that the most extensive
and valued of those services, the NHS, would have struggled without the work of those who have come from abroad.
Chris Bowlby is a presenter on BBC radio, specialising in history
This series is produced with History & Policy. You can find out more about them and read their papers at www.historyandpolicy.org