6 – Unlike the public, non-EU  doctors and nurses have to  pay for NHS services

After the crisis, many readers will understandably want there to be some significant, progressive changes to society.

In my recent series of posts, I have been arguing that progressive change is far from certain. It will not happen simply because inequalities and other matters have received publicity because of COVID-19. My main point is that if we want changes we have to mobilise arguments for them. Then we will need to win those arguments in the hearts and minds of a few million people.

Today I want to work through the process behind the policy by which Government makes non-EU migrant workers pay an annual surcharge for using the NHS. One consequence of this policy is heavily ironic. Frontline NHS staff that are migrants from non-EU countries must pay an annual surcharge to use the services that they provide.

During the recent election campaign the Conservative Party announced it was increasing this surcharge from £400 to £625 for all non-EU migrant workers. Their plan is to extend it to EU workers on Jan 1st 2021 – the date they have set for leaving the EU. The fee is payable for each member of the migrating family, so an individual, their partner and 2 children would have to pay the government £2500.

When this increase was announced both the RCN and the BMA rightly concentrated on the fact that nurses and doctors would have to pay. They called it pernicious.

After the election, when the new Government promised numbers of new nurses (many from abroad), it was pointed out that these charges would act as a strong disincentive for nurses and doctors to come and work in the NHS. Richard Murray, CEO of the Kings Fund, called it perverse to make people pay for a service they themselves are providing.

Nurses earn on average £23,137 a year. Donna Kinnear, CEO of the RCN, pointed out that a new nurse would have to work for 116 hours to pay off the charge for their family.

The Government’s response to this – through a spokesperson – was  “We are delivering on the people’s priorities by increasing the immigration heath surcharge for those coming to live in the UK and will be setting out our plans shortly” (Quoted in Guardian 28 December 2019)

This argument for a migrant surcharge feeds into the belief (wrong in fact, but powerful in emotion) that one of the problems with migration to the UK is that it puts a ‘strain on our public services’. This leads to a notion that the reason close relatives are waiting so long for hip replacements is because of the migrants in front of them in the NHS queue. This in turn helps support the argument for them paying a surcharge.

I set out both sides of the argument here because it is a clear example of where the side that I am on – those who don’t agree with the surcharge – feel they have a good case. The Government however believe the surcharge is one of the people’s priorities and are acting on that belief.

Let’s not forget that the last election was won (and with a big majority) by a set of powerful nationalist arguments. Voters gave their new Government the right to claim that the surcharge is one of the people’s priorities. And this is a Government that knows who won, and who lost the election.

These (winning) strong nationalist arguments have not gone away. The argument for British exceptionalism during the pandemic feeds into them. Stopping the surcharge will require the defeat of those argument.

The Covid crisis has made the difference between these arguments a lot starker. We now have a situation where nurses and doctors (heroines and heroes in the front line) are working every day in extremely dangerous conditions. Putting their lives at risk to protect you and me. If any of those paying the surcharge became ill – they would only receive NHS services because they had paid – while those they treat pay nothing.

I can’t really think of a more powerful moral argument. There is clearly something very wrong here. I think it may even move some people away from the nationalist argument. But to assume that even this powerful moral argument will win – would be to underestimate the power of the opposing argument.

The Secretary of State famously said, when arguing for this surcharge, that we do not have a. “International health service we have a national health service”. It doesn’t take someone with an ‘A’ level in rhetoric to point out that this important link between national and national health service, gives the nationalist argument a significant boost. Even people who are anxious about nationalist arguments but love the NHS can support this viewpoint.

The public are receiving a series of very powerful everyday experiences that confront this nationalist argument, so now is the time to talk to them about the relationship between nationalism and the NHS. Every day – in every news bulletin – there are stories of nurses and doctors from all over the world that are saving our lives. Sadly, nearly every day, there are also stories of nurses and doctors from all over the world losing their lives because they are saving ours.

So now is the time to point out the fact that if we did not have an internationalist health service, we wouldn’t have an NHS.

Now is the time to point out that the two nurses that the Prime Minister named as working by his bed in ICU – were from New Zealand and Portugal. Sounds to me like Guys and Tommy’s provide an international health service.

While this experience is strong in people’s hearts and minds is the time to begin the argument. We need to add to the moral argument the concrete experiences that the public are now having about this combination of international and NHS. I’m not going to suggest that everyone will be persuaded but I do think enough may be to remove the argument for the surcharge from the list of ‘people’s priorities’.

But it won’t just happen. It will need to be made to happen.