Immigration + NHS: you can’t reduce one without reducing the other

Do you know who your doctor is? Do you care? Does the history of the medical practitioner you’re dealing with matter to you? Her education? Her culture? Her religious beliefs?

Like most people, I have my GP surgery I go to for serious things and niggles, then there’s the local A&E and the associated hospital’s clan of cleaners, nurses, orderlies, doctors, managers, admin staff, physios, technicians and consultants. These are things as a UK citizen I know and am grateful for the quality of care they provide. Every time I’ve been to hospital for operations, x-rays or cracked bones I’ve experienced great service from the whole tribe.

And when I’ve been at my most vulnerable in those times in A&E I’ve been moved by the staffs’ patience, dedication and skills. At no point have I ever questioned their ability based on their educational, cultural or religious history – I just want them to make me better as quickly as possible. I simply assume that if they work there, they are qualified for whatever role they are undertaking. This seems common sense and although the NHS has its problems, it is broadly respected by the people who use it and jostles with other rich countries’ health systems, last year ranking as the best of the top 11 wealthiest countries in the world. Therefore the service and its 1.4million workers are doing a good job overall to deal with over 1million patients every 36 hours.

But the ‘how’ is the key question. How is the NHS kept stocked with workers, from the consultants to the cleaners? Short answer: foreign workers topping up our own ‘UK produced’ labour market. Which effectively slams two of the biggest national conversations into one problem: NHS and immigration – a melting pot which few frontline politicians would have the stomach to stir. But stir they must, because to the backdrop of Theresa May’s speech to Conservative Conference last week the person who runs the NHS, Simon Stevens, also commented on immigration policy. This is the guy who politicians listen to. It was his declaration in October last year which changed the Tories’ and Lib Dems’ tune on just how much money the NHS needed. When he talks, politicians jump. And his views didn’t chime with the Home Secretary’s.

Now the general public is a different animal when it comes to rational discussion on important issues. Immigration is one of them. The latest briefing from Oxford University’s Migration Observatory has a thicket of data on the UK public’s attitudes to immigration, most notably that three quarters of people in Britain currently favour reducing immigration. This does chime with Theresa May’s speech, but then there are parts which show a more nuanced view. For example, in a 2010 survey by Transatlantic Trends it was found that 72% of the public support admitting more doctors and nurses from other countries to cope with increasing care demands, while 51% support admitting more care workers.

Hence there is an appetite for these skilled workers to be admitted, people appreciate the need for them and don’t necessarily care about their background as long as the NHS believes they’re fit enough to do the job. Yet, unless the rules are drafted very carefully, hordes of NHS foreign workers will have to be earning more than £35,000 to remain – with only nurses excluded from this today as a result of pressure on the Home Secretary – so what does this do for those lower down the income chain, perhaps without the value-added skills the public don’t mind being admitted? The cleaners and orderlies are equally important, with the NHS employing significant numbers to ensure the service runs as efficiently as possible. They don’t earn anything close to that amount and indeed the service couldn’t afford it. So unless higher, unaffordable salaries are brought in to the NHS to get round these rules, something more than just admitting foreign nurses has to give on immigration policy to ensure the NHS can continue its huge daily workload.

In conclusion, from these figures and attitudes, it is clear that there is a tightrope to be trod which encapsulates the needs of the NHS, public attitudes and those of politicians seeking election. However, it isn’t an easy one and it wouldn’t take much to knock the careful high-line act off course in a fit of political populism. Back to you Home Secretary.