On Sunday, I was asked to speak at the Medsin national conference at Leeds University, in place of a friend from the NUS International Students committee who was unable to attend. I’m not an international student myself, so part of preparing for this talk was actually teaching myself about the current proposals. To be honest, I was shocked, and I really didn’t think much could shock me coming out of this government any more. I’d strongly urge you to read the bill, and the consultation document, which is available online.
Copied below is the speech I made to a workshop in the ‘NHS Stream’, alongside activists from Student Action for Refugees (STAR) who made an excellent presentation on the impact of the bill on refugees and asylum seekers in the UK as well.
I’m here today to talk to you about the recent Immigration Bill, and the changes that are going to be put in place with regards to access to the NHS and health services, including primary care (e.g. GPs). I believe that this bill marks an extension of the anti-immigration discourse which is already ingrained in the culture of the UK media, which has up until now made a case for ‘good’immigrants, and ‘bad immigrants’, the boundaries of which seem to be dependent on right wing ideological interests, rather than the realities of migration in and out of the UK (because, why let the facts get in the way, right?). The media, and successive governments, have convinced the public that migrant/illegal immigrant/refugee/asylum seeker are all interchangeable terms, and in that way it becomes easy to paint a further group as ‘bad’ simply due to the blurring of language. If you connect ‘illegal’ to ‘immigrant’ and then start referring to international students as ‘immigrants’, then there is already a negativity connected to them. In the foreword to the paper, a couple of examples stand out. It mentions “migrants and those who may be here unlawfully” – it groups them together, in spite of this being two entirely separate groups of people. It also mentions “migrants should come to the UK for the right reason” – instantly posing these ‘good migrants’ against some unidentified other, here for ‘the wrong reasons’. Someone mentioned to me a concept called ‘dog-whistle politics’ recently, which helps explain this phenomenon.
In July, the Department of Health and the Home Office published proposals to start charging migrants for healthcare in England and Wales. This includes anyone with ‘temporary residency’, as opposed to permanent leave to remain in the UK. This came from a UKBA/Home Office consultation, headed by Theresa May, which made the political and financial case for migrants to start paying for healthcare. The government claims that this is to combat ‘health tourism’, though 75% of those affected by these changes are international students studying in the UK, and in addition there are actually no statistics to show that health tourism is a big issue. ‘Unpaid treatment for foreigners’ (and yes, that’s the only stat we have – it certainly doesn’t seem to be limited to ‘health tourists’ alone) in the NHS costs £30-50m a year, which as a proportion of the NHS’s £104bn budget, is 0.15%.
I’m going to start by reading you some excerpts from Theresa May’s introduction to that paper, because I think it frames the debate and helps us to understand the impetus behind the government bringing this in.
1) “Uncontrolled immigration has caused a range of problems for the UK. Without proper controls on immigration, community confidence can be damaged, resources stretched, and the benefits that immigration can bring are lost or forgotten”. ‘Uncontrolled immigration’, a ‘range of problems’. It’s not really stated here what these problems are, how they are manifested, or how they weigh up against qualitative evidence, or statistics. In fact, what this appears to be doing is setting the tone for a paper which (unsurprisingly) assumes that immigration is a de facto bad thing, and later, that some migrants can become less of a ‘bad thing’ – less of a menace (less ‘illegal’?)– by being ‘economically useful’. In this case, paying for health. Note the phrase ‘resources stretched’. There is no mention of how much of our public resources are actually supported by migrant workers (Medsin activists told me at the workshop that in actual fact, one third of NHS staff are migrant workers!). Oh, and don’t ask me what ‘community confidence’ means, and how immigration can damage it.
2) “Our immigration system [functions] to control immigration for the benefit of the country. This includes taking action to protect public services and the benefits system from undue pressures that may be placed upon them by migrants and those who are here unlawfully.” ‘The benefit of the country’, ‘protect [from] undue pressures’. No statistics are given here or anywhere in this paper as to what these pressures are, or what makes them so impossible to sustain. It goes on to state that “Immigration controls will be built into our benefits system, the NHS, our housing system and the wider provision of services across government.’ – this is an extremely bold claim, and one which turns huge groups of people – GPs, private landlords, jobcentre staff, over to monitoring immigration, and creates what you might call ‘internal borders’ within a country’.
3) “These proposals respond to longstanding public concern that the current rules regulating migrant access to the NHS are too generous…we want to see tough action taken against those who have no right to be here or who abuse our services.” I think what this does is buy into a very populist, very hostile discourse around immigration, which should perhaps come as no surprise. It even says that the proposals are a result of ‘public concern’, rather than fact. But even then, constant use of terms like ‘too generous’ and ‘abuse of services’ do make their intentions quite clear.
So what do these proposals amount to?
The consultation offered two alternatives – mandatory private health insurance, or a levy paid with the visa fee, and non-payment of which would mean rejection of a visa application.
For students, this means £200 a year, payable as a whole sum (so £600 for a three year course) at the time of your visa application. As I understand it, this can’t actually be done under present law, and the government is trying to change it so they can bring this in. They will actually have to change the residency test in order to enact this policy. 75% of those affected are international students, and the levy is now the model they are going ahead with, and students will have to pay out these huge sums of money, in addition to their visa fees, international tuition fees, and the other high costs linked to studying abroad.
The thing is, the government barely even tries to suggest this is based on an economic argument – because there isn’t one. Their own statistics show that the cost of treating foreign nationals in the NHS amounts to £33m a year, and 63% of that is recovered back from those same people. So the cost of migrant access to the NHS actually amounts to around £12m a year – 0.01% of the NHS’s annual budget. In addition, the cost of administering this process will reduce this saving even further, and makes it pretty unlikely the saving will be achieved at all. As anyone who works in health or support services knows, early intervention is better, and cheaper, than emergency treatment. Putting financial barriers and immigration controls in the way of accessing primary care will lead to people simply not accessing them at all, and will only lead to more people accessing emergency services later on, at a much higher cost to the NHS.
So if not financial savings, then why?
As I’ve mentioned, the paper is quite clear on its motivations if you read between the lines. It talks a lot about ‘fairness to taxpayers’ and ‘not getting something for nothing’. I think this is a really important concept to unpick. I’m a socialist so, I believe that we shouldn’t have borders, or immigration controls at all – you might have heard the phrase ‘noone is illegal’. My ideology and my politics informs my view. But even if I were to buy into this idea – that no one should get something for nothing – it’s not even true in this case that that’s what’s happening. All students pay national insurance contributions through the fees structure. What’s even more jarring is that many, many international students are actually working for free for the government whilst studying – nursing, medical, teaching and social work students to name but a few. I think that they should be free of the costs of university fees anyway, but to add an annual levy for those who are actually working in the health service as free labour, really does add insult to injury, and debunk the suggestion that this is actually about contribution to the economy.
The Queen spoke on the bill, stating, “ “My government will bring forward a bill that further reforms Britain’s immigration system. The bill will ensure that this country attracts people who will contribute and deter those who will not.”
What the government is doing here is setting out an entirely new set of principles around healthcare. There’s an interesting phrase in this paper – “The government is committed to providing a health service that is generally free at the point of delivery” (my emphasis). Can you see an extra word there? This is a significant change in the way we talk about and perceive the NHS, and one of which we should take note.
A final point, and one for you to think about as the future doctors and health workers of this country. The suggestion here is that GPs will have to ask for proof of visa/payment of the levy before offering primary care. The Royal College of General Practitioners called this ‘a form of immigration control’.
The NUS International Students Campaign has launched the ‘Don’t Close the Door On International Students’ campaign which I’d encourage you to get involved with. I think student activists should be making clear demands for universal access to free healthcare, not dependent on ‘contribution to the economy’, and to link up with medical unions and bodies against these controls.
After my speech, we discussed the bill and the implications for international students in detail. Most of the students in the room are training to be doctors, and one said that she felt it completely compromised the doctor-patient relationship, and undermined the principle of care and medical ethics. Another student also felt that it conflicted with the Hippocratic oath (of confidentiality), if doctors were asked to report illegal immigrants or those who hadn’t paid the levy, and how doctors shouldn’t be doing the UKBA’s job for them.
There were also broader political questions raised about the ideology underpinning the proposals, that they were a reaction to the increased popularity of the UK Independence Party and the Conservative Party’s fear of losing seats to the right over immigration issues. Moreover, it was raised that the entire thing seems to be creating a culture of fear, which fuels racism and popularity for far right, xenophobic politics.
One attendee, a nursing activist, explained that just last Thursday, health workers in Unite have voted in favour of non-compliance with the immigration controls that they may be asked to carry out, which was a welcome piece of news and something I’m interested in finding out more about, and will be proposing that the NUS and Unite work closely over this. The same proposal will be put to Unison’s health conference in 2014.
We discussed some campaigning ideas above and beyond those recommended by NUS. One action point being taken back to Medsin centrally is the idea of a ‘pledge’ for Medsin activists to sign up to to say that when they are qualified, they will not take part in these controls – I hope that this is something the NUS can launch jointly. Students also suggested using the digi-screens in SUs around the country to promote the campaign, and getting involved in raising awareness online too.
Later on, the closing session of Medsin conference was a panel debate on privatisation/marketisation of the NHS, with speakers from Nuffield, the Conservative Party, the Labour Party, and the National Health Action Party. I raised a question based on the discussion in the workshop, “Earlier this year, the Home Office and Department of Health put forward proposals for temporary migrants to pay a levy of £200 a year before they can access NHS services, and that GPs will have to effectively act as border officials checking peoples’ visas. 75% of those affected will be international students. The government has claimed that this is for economic reasons, but this doesn’t add up. The cost of this group to the country is 0.01% of the NHS budget, and increased costs in immigration enforcement will likely cancel out any saving. A great number of these people are students actually providing free labour to the health service through placements. I have two questions. 1) If there is no financial benefit then why are we introducing barriers to healthcare? 2) I’ve had students here raising concerns about the doctor-patient relationship if GPs have to administer immigration controls – what do you think about that?”
Of the four speakers, three agreed with the first speaker from Nuffield who said, “Penalising international students seems very short-sighted” and went on to state that “Research from the University of York shows the opposite to the government research.” The Labour councillor called the proposals “Pure populism”, whilst the speaker from the National Health Action Party said, “the Tory Party are terrified of UKIP – they are pandering to right wing votes”. The Conservative councillor responded by saying that health tourism is a ‘serious problem’…to which I replied “there’s no evidence that health tourism exists”…he didn’t reply.
And there isn’t. Don’t let the government fool you into thinking that this is anything other than a concession to the UKIP/Tory swing voters. International students are an asset to our society, and are already paying disgusting, and prohibitive amounts to access education in the UK. I believe in free education and healthcare for everyone, and an end to the marketisation of education and health services.
Rosie Huzzard 