Remembering the migrant architects of the NHS: By Julian Simpson
The National Health Service is frequently referred to as a ‘typically British’ institution.
The former Conservative Chancellor Nigel Lawson famously said it is the closest thing the English have to a religion. The phrase ‘the architects of the NHS’ is used to invoke the Labour Health Minister Aneurin Bevan and the social reformer William Beveridge who contributed to the establishment of a system that aimed to provide free healthcare for all. What is often forgotten, or certainly insufficiently recognised, is that the NHS has from the outset been dependent on migrant workers, often from black and minority ethnic backgrounds, to deliver that vision. Take the BBC website’s page on the early history of the NHS – not one of the images featured shows a non-white person (http://www.bbc.co.uk/archive/nhs/index.shtml).
The contrast with the reality of lives in GP surgeries and hospitals across the UK could not be starker. And this has been the case since the NHS was set up in 1948. In the early 1950s, over 10% of doctors had qualified outside of the UK. Over time, the reliance on migrant doctors from Central Europe and the Republic of Ireland gave way to a dependency on medics trained in the Indian subcontinent -10,000 of them were working in the UK by the end of the 1970s. Today, around a third of NHS doctors are overseas-born. Of course, the migrant workforce is not limited to doctors: a survey conducted in a London hospital thirty years ago found that over 80% of caterers and cleaners were overseas-born. Thousands of nurses from the Caribbean came to work in the NHS in its early years– there were between 3-5,000 Jamaican nurses working in British hospitals by the mid-1960s. More recently, countries such as the Philippines and South Africa have made significant contributions to the nursing workforce.
As is often the case with migrants, these workers found themselves doing the jobs that local people did not want to do. This goes for cleaning for instance, but also involves working nightshifts, caring for the elderly or the mentally ill and being based in less affluent areas. A large number of migrant doctors became geriatricians or psychiatrists and by the early 1990s a third of GPs in Manchester and Sunderland had trained in the Indian subcontinent. In parts of Greater London like Barking and Havering, the figures were even higher.
If the NHS is indeed a national religion, many of those who kept the faith alive are to be found amongst the generations of migrants who worked for the organisation. The architects of the NHS are also those that through their work and initiatives contributed to its development and made it what it is today. They say be kind to your children, they will choose you nursing home. On the same basis, it might be worth starting a more positive dialogue about the role of migrants in the UK. They have historically played a huge part in the care of the most vulnerable sections of society and continue to do so today. Perhaps a monument to those who have contributed so much in the context of the National Health Service would help to reframe discussions about what it means to be British and who made the UK what it is today.
1. Jannett Creese on her ward on Christmas day 1960. (Copyright: migrant healthworkers.org.uk)
2. Dr Dipak Ray fronting an equal opportunities campaign with the then TUC general secretary Len Murray. (Copyright: migranthealthworkers.org.uk)
Julian Simpson has just completed a PhD on the role of South Asian doctors in the development of general practice in the NHS. He is a
research associate at the Centre for the History of Science, Technology and Medicine at the University of Manchester.
The views expressed here are his own.
More information on the roles of migrants in the NHS workforce can be