People, Politics & Law

How national is the NHS?

Updated Friday 30th June 2006

Parvati Raghuram traces the links between the NHS waiting lists and health care crises elsewhere

Valuable space - two nurses by an empty bed Copyrighted image Icon Copyrighted image Copyright: Production team

'Nil by mouth: The government recognises that it is unethical to poach nurses from sub-Saharan Africa. But kind words alone won't cure this problem' , The Guardian, 27 August, 2004
'WHO asks Britain to stop poaching doctors', The Independent, 7 April 2006

Faced with headline after headline on how doctors and nurses are leaving their countries and coming to work in the National Health Service (NHS), we are often quick to condemn the UK government, for not stopping the haemorrhaging that is having such drastic effects on the health of people in the developing world.

We are haunted by how reducing waiting lists for UK patients often involves not just longer waiting lists, but in fact a complete collapse of health service in some parts of Sub- Saharan Africa.

This is often played out as the story of two nations - one which benefits at the expense of the other. There is a great clamour to train more health professionals in the UK so that the dependence of one nation on another can be reduced, the parasitism of the NHS in the UK plugged.

And then we hear:
'Foreign medics told we don't need you now' Daily Mirror, 22 April 2006

At relatively short notice doctors in the UK have been told that because we have now expanded the number of medical graduates we train, we do not need you any more. So how exactly do we square the discomfort that we feel when we hear about the health of nation bought at the expense of the other, with that which we feel when faced with the compulsory return of medical professionals who have done so much to keep our nation healthy?

The NHS is held up as one of the finest outcomes of the welfare state. It provides a health provision system that is comprehensive, i.e. "from the cradle to the grave" as Aneurin Bevan famously said, and also free at the point of delivery.

Moreover, if the Chancellor of the Exchequer Gordon Brown is to be believed it is not simply a health provider but a very British institution. In his speech to the Fabian Society on January 14, 2006 'A modern view of Britishness founded on responsibility, liberty and fairness' he called the National Health Service 'one of the great British institutions.’

He went on to point out that the NHS was 'founded on the core value of fairness that all should have access to health care founded on need not ability to pay,' and noted that '90 per cent of British people think it portrays a positive symbol of the real Britain'

The NHS is not then just about health provision but also a plank for portraying 'good British values'. But is the national the best framework within which to think of the National Health Service? And if not, where else can we find this national being shaped?

When we look around us and see advertisements for the Health Service we are also faced with images of people whose Britishness is questioned at other turns, the African-Caribbean nurse, the Asian doctor.

More than 30% of doctors employed by the National Health Service in England are overseas qualified, marked as non-nationals by being assigned the term 'International Medical Graduates'.

Many of them are 'underpaid, overworked and over here'; the NHS employs them without fully recognising the qualifications or experiences they bring with them.

What are the spatialities that are brought into play when we walk down to our local doctor?

And then we may ask how it is that the doctors and nurses we see in NHS hospitals have migrated from the Caribbean, from India, Pakistan, from Ghana, Nigeria and Malawi. What is the narrative that binds these countries together, that encourages doctors from these countries to come to the UK to validate their training with the stamp of Royal Colleges in medical specialities?

What temporalities are involved in producing these trajectories, in shaping the very peculiar version of the international that is called upon in producing the workforce of the National Health Service.

Perhaps addressing these questions is one way of addressing the discomfort we feel when faced with the headlines quoted above. Perhaps we should not look for answers to the shape of the National Health Service in the nation alone.

Parvati Raghuram Lecturer in Geography at the Open University.

This article was used to support the OU / New Economics Foundation event - Interdependence Day - held in July 2006.

About this extract

This article is adapted from the study material from the Open University course Understanding Health & Social Care.

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