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There is, however, a less visible but equally devastating intention to this policy. This othering and dehumanisation of migrants is used to reinforce the idea that the NHS should only be available to those who ‘deserve’ access; that there are those who are undeserving of healthcare. In doing so, this policy legitimises the idea that it is acceptable – even desirable – that some people be forced to either pay for their care or go without treatment.
The idea of a ‘cash-strapped’ NHS is so entrenched in the public psyche that it now goes unchallenged as the default economic reality for the NHS. Too often patient-blaming narratives focusing on the apparent abuse of the system by migrants and so-called ‘health tourists’ (along with smokers, or people with a higher BMI) obscure analysis of the deliberate and ideological cuts to public provision, and the ways in which money is being extracted or wasted on processes associated with privatisation.
By fostering a sense of scarcity of NHS resources, the government creates a veiled threat to your well-being in order to encourage complicity in a system where your health is positioned as more important and more deserving than that of your neighbour. Prioritising one’s needs is of course made more urgent – and perhaps easier – by constant demonisation of migrants in the media. Combine this with the legacy of colonial superiority that remains pervasive in British consciousness, and you have the perfect excuse to start unpicking the universality of our universal healthcare system.
Racist policies rely on economic arguments to justify these decisions, pretending that they aren’t ideological, but simply economic common sense. Unsurprisingly, these arguments simply don’t add up. The government’s own figures put the cost of ‘health tourism’ at 0.3% of the NHS budget, a figure that pales in comparison to the billions wasted annually on PFI repayments and other effects of privatisation. At the same time, studies clearly show that it is actually cheaper to provide necessary healthcare for free than it is to withhold care and then pay for the emergency admissions that inevitably follow.
Ironically, people who are persuaded on the basis of imaginary self-serving economic necessity to be complicit in a system that targets and charges migrants, are supporting the creeping privatisation and the normalisation of upfront charging that will ultimately affect them as it will all of us.
The creation of the ‘undeserving patient’ must be seen as part of a continuing project by successive governments to move from a public healthcare system to a private one. A hugely unpopular project, it would never win at the ballot box – so it’s been made possible only by slow and stealthy privatisation, combined with a healthy dose of scapegoating marginalised groups. Competitive tendering (in the provision of domestic and catering services within the NHS) began under Margaret Thatcher, the privatisation of buildings and maintenance under ‘Private Finance Initiatives’ – where private companies build and operate NHS facilities and lease them back to NHS Trusts on long term contracts – under John Major, though adopted far more widely under Tony Blair.
Blair also introduced ‘Independent Sector Treatment Centres’ – private companies paid by the NHS to deliver healthcare free at the point of use. As a result, more than one-third of the UK’s hip and knee operations are now carried out by the private sector. Building on this and Thatcher’s ‘internal market’ the Coalition’s Health and Social Care Act 2012 created new ‘Clinical Commissioning Groups’, funding bodies forced to tender contracts on the open market. As a result private companies increasingly run whole NHS services – with private providers running 39% of community services contracts in 2016. Importantly, CCGs are also deciding which services will be available free at the point of need or ‘on the NHS’ – and hence which ones people will have to pay for privately. This decision-making process too is being privatised. In February 2015 private companies won portions of a £5 billion 4-year contract for “Commissioning Support Services”. The companies that now offer business intelligence and contracting advice to CCGs include Optum – the UK arm of US insurance company UnitedHealth, previous employer of NHS Chief Executive Simon Stevens.
By placing the NHS in a chokehold and allowing the service to collapse under financial strain, the Government is able to build support for a new system of delivering healthcare, or at least to reduce affection for the NHS. Privatised services are already in place and waiting to fill the void left as the NHS collapses. The legitimacy of this process is bolstered by the creation of a growing class of ‘undeserving’ patients – starting with migrants and expanding to include smokers or people with high BMI, it is becoming mandatory to ‘earn’ your right to health care.
It is critical that we resist upfront charging for care, that we fight the racism inherent in this current policy and that we fight the ongoing privatisation of the NHS as it enters its final phase. Docs Not Cops is building a national network of health workers and patients to resist immigration checks and charging for NHS care – join us, start or join your local Docs Not Cops group and demand that NHS trusts stand up for their patients and resist these policies.