The hostile environment has no place in the NHS

The NHS is quite deservedly a symbol of national unity. In sickness and in celebratory births, it protects us and our loved ones — universally, irrespective of our ability to pay. It stands to reason that ‘Protect the NHS’ has been a recurring mantra throughout the pandemic to remind us to unite and care for one another and this beloved institution.

But since the implementation of the Immigration Act 2014, the NHS has been unable to protect everyone. As a consequence of this legislation, migrants who access healthcare can be charged at up to 150% of the cost of their treatment and NHS providers can share their immigration status with the Home Office. So rather than protect and care, the NHS can expose. It has, as intended, become a ‘hostile environment’ for some of the most vulnerable people in our communities.

The hostile environment in healthcare is as old as Britain’s colonial past. Oppression of racialised minorities spanned across health education, care and research. Medical research in particular was a beneficiary of the transatlantic slave trade which supplied Black bodies for its advancement. In spite of this use of Black and brown bodies, Britain has a history of denying healthcare education, healthcare jobs and healthcare itself to people in the colonies, a legacy which persists today.

Despite being invited to plug staff shortages, migrant NHS workers are more likely to experience bullying and harassment from patients and colleagues alike. Regardless of their qualifications and experience they are often denied senior jobs. The absence of care is reflected in health outcomes for racialised minorities. As examples, Black and Asian women are more likely to die during childbirth than white women and Black and Asian people are more likely to die of coronavirus. This historical pattern continues with the hostile environment, designed to deny healthcare to migrant communities who have often fled unimaginable horrors in former British colonies.

As such, it’s no surprise that Public Health England and Independent Sage's analysis has shown that the poor Covid-related health outcomes observed for racially minoritised communities may be due to both historic and continuing racism within healthcare. Experiences of racism may have led to minoritised communities being less likely to seek care and staff feeling unable to speak up with concerns about risk, such as a lack of PPE.

These experiences have fuelled distrust and fear, which is leading to reduced uptake of vaccines amongst racially minoritised communities. To try to quell these fears, an exclusion of hostile environment legislation has been put in place for Covid-19. But the evidence suggests that people are still struggling with vaccine access because healthcare professionals are continuing to undertake immigration checks aligned with usual practice and the entrenched fear of the hostile environment remains.

This is why Medact, along with Migrants Organise and Doctors of the World, have coordinated a public call to the Department of Health and Social Care to ensure the vaccines programme works for everyone by ending the hostile environment. Nationwide, 330 organisations, including local authorities, health organisations, rights and faith groups, charities and trade unions, have signed up.

In Sheffield, local health professionals, rights groups, artists and poets are uniting behind the campaign, including Sheffield Doc/Fest, Migration Matters Festival, Opus Independents and City of Sanctuary.

Anna Nicholson-Lailey, a local NHS doctor, said: “Hostile environment immigration policies within the NHS create fear amongst migrant communities, which sadly prevents many from accessing healthcare [...] The only real solution is to end these harmful policies, which should have no place in our health service and are incompatible with public health.”

Alexi Dimond, City of Sanctuary Sheffield employee, said: “The hostile environment erects unnecessary barriers, and creates mistrust and real dangers for migrants who need to access healthcare. This has a devastating impact on peoples' health.”

It’s clear that for the vaccine programme to work, all parts of the NHS must be united with the aim to universally care and protect. Access to healthcare is a human right – not something to be denied along historically-marked colonial lines.