14 Apr 2020
They love our labour, but not our lives: The high price of public service
Written by: Uchechi Eke
On Friday 10th April, The Guardian reported that the first 10 doctors to die from the Coronavirus were from Black Asian and Minority Ethnic (BAME) backgrounds.
The head of the British Medical Association (BMA) has called on the government to urgently investigate if and why BAME people are more vulnerable to COVID-19. Those doctors have ancestry in regions including Asia, the Middle East and Africa. Even allowing for the over-representation of BAME staff in the NHS – the fact that they were all from ethnic minorities was “extremely disturbing and worrying”, the BMA chair said.
Thursday night, Sean Combs hosted a ‘state of emergency’ live stream, owing to the alarming rates of African Americans dying from the Coronavirus, in majority Black cities across the US – including Illinois, Milwaukee, New York, Michigan and Louisiana. Of the 16,000 deaths in the US, half are African Americans. 1 in 10 Americans are black. 1 in 2 Coronavirus fatalities are black. Alongside Van Jones, Angela Rye, Rev Al Sharpton, Killer Mike, Congresswomen Alexandria Ocasio-Cortez and Aylanna Pressley, the purpose of the broadcast was to discuss self-care solutions, and shed light on the underlying social, economic and environmental disparities many African Americans face, leading to a higher predisposition to the virus.
How can you observe social distancing if you are housed in a tower block? How can you practice hand-washing when your water supply has been cut off? How can you fight a virus when your immune system is already compromised due to asthma, high blood pressure, Lupus, hypertension and diabetes – all conditions prevalent in the Black community? How can you self-isolate if your job demands you go into work? Many African Americans endure not only job scarcity but job insecurity. This worrying trend is now being seen in the UK.
Just like the US, many immigrants in the UK irrespective of their profession, live-in high-density areas, populated by an over-representation of BAME communities – social stratification due to historic polices, have led minority groups to suffer harsher socio-economic penalties. Among the wider BAME population, the fact that many are in public servant roles, combined with their living arrangements, could be contributing to their disproportionate presence in intensive care units.
The Intensive Care National Audit and Research Centre found that 35% of almost 2,000 patients were non-white, nearly triple the 13% proportion in the UK population as a whole. Fourteen per cent of those with the most serious cases were Asian and the same proportion were black, according to the study, which has triggered calls for further research to understand why the virus appears to be having a disproportionate impact on non-white ethnic groups.
“You’ve got a high proportion of BAME people not able to stay at home, serving the nation, putting themselves at risk… “If you add that to overcrowded and multi-generational occupancies, the infections can be brought back home and spread to other members of the family.”
Could the lethal mix of structural racism, systemic oppression and the impact of Austerity lead more ethnic minorities to die? If COVID-19 is a non-discriminatory silent killer, why is the alarm bell ringing loudest in predominantly black communities?
In 2012, the Health & Social Care Act ushered in an unprecedented wave of reform and reorganisation, underscored by Public Private Partnerships (Private Finance Initiatives). An unholy marriage between high-ranking government officials and corporate cavillers. This union significantly changed the way the NHS was funded and services delivered.
PPI claimed to give patients more choice and access to better and more specialist treatment. Spending on non-NHS providers is not a new development. Both the Blair and Brown governments used private operators to increase choice and competition as part of their restructuring programme. However, the incoming Coalition government ramped it up to a new level. Data from 2018/19, reveals NHS commissioners spent £9.2 billion on services delivered by the private sector. Infrastructure from hospitals to equipment, and medicine to car parks were not only outsourced, but procured by stealth to the private sector. The wholesale theft of our beloved institution at the hands of major corporations and big pharma, created the breeding ground for COVID-19 to expose he inefficiencies of the health and social care system – costing lives, both within our wards and on our streets.
Founded by the then Labour Minister of Health Aneurin Bevan in 1948 to eliminate ‘freedom from fear’, the premise of the National Health Service was to ensure medical treatment was free at the point of entry – available to all based on need, not ability to pay. No one was ineligible. Universal healthcare was the bastion of our democracy. The gold standard and bedrock of British society, envied and later replicated by most western countries.
However, the NHS of yesteryear is unrecognisable. What we now see is a retrofitting and re-purposing of health care – from social good, to only good for some. Our assets have always been our highly trained medical staff. Now our assets are sold on the open market, to a cartel of consultancy firms and private healthcare providers, not to benefit sick people, but to profit shareholders. The raid on the NHS has been felt harshly by the most vulnerable and marginalised among us. 10 years of austerity has decimated services, with the devastating statistics clear to see.
Research from the Institute for Public Policy showed that 120,000 deaths could have been prevented if the pace of spending as seen between 1990 and 2012 had been kept. The consequences of the scale of cuts, is nothing short of criminal. A&E performance levels have been the worst on record, 4.6 million stuck on waiting lists, bed shortages have resulted in people lying in corridors, access to prescriptions a lottery, and cuts to social care and mental health services has severely impacted our senior citizens as well as our young people. The extent of the negligence is exhaustive, dire and shameful.
According to the Commons Library, around 153,000 out of 1.2 million NHS staff are immigrants. This is 13.3% of all staff for whom a nationality is known, or just over one in eight. Between them, these staff hold 200 different non-British nationalities. Contextually, of every 1,000 NHS staff in England: 869 are British; 44 are Asian; 21 are African and 11 are from somewhere else.
The Coalition Government planned to restrict immigration to the UK through capping non-EU immigrants and to introduce more stringent controls for highly skilled migrants. This move was seen as contradictory given the long history of recruitment of overseas health workers.
The majority of doctors entered Britain during or after World War II, suggesting that many of them would have been Jewish and Central European refugees from Nazi-dominated Europe. Later, migration from the Indian subcontinent became a key dimension of the recruitment of doctors in Britain. At the end of the 1970’s, the Royal Commission on the NHS estimated that between 18,000–20,000 registered doctors in the UK were born outside the UK, with half of these being from India or Pakistan. In the 1950’s and 1960’s, large numbers of Irish and Caribbean nurses were essential to the expansion of NHS services, a pattern that was replicated in the early 2000’s when nurses from Africa, India and the Philippines came to the UK (source: Mackintosh M, Raghuram P, Henry L. A perverse subsidy: African trained nurses and doctors in the NHS. Soundings 2006).
In November 2019 the Conservative Party issued a statement suggesting that international migrants – among other things – will make things worse. It said: ‘the last thing our NHS can afford is Labour’s plans for a four-day week and uncontrolled and unlimited immigration, which would could cripple our health service, leaving it understaffed and underfunded.’…But it’s already on its knees, its already understaffed (that’s why over 20,000 people have volunteered since the pandemic hit) and why a further £5 billion has been injected into the system.
Clinical staff have been very vocal about the lack of PPE supplies and ventilators, many being gagged for blowing the whistle. As many of us know, it is difficult for black people to speak up, we don’t have many safe spaces to voice our dissent, especially in our places of work. We are already stereotyped as being loud, abrasive and non-conforming. Add stress, pressure and a health crisis into the mix, and you begin to understand why we may choose to be silent – “BAME doctors often feel bullied and harassed at higher levels compared to their white counterparts,” Dr Chaand Nagpaul said. “They are twice as likely not to raise concerns because of fears of recrimination.”
Existing research tells us that migration is good for the NHS – but at what cost? in their 2018 report the Home Office’s own Migration Advisory Committee on EEA migration in the UK found ‘no doubt that EEA migrants contribute more to the health workforce than they consume in health care’.
The term ‘immigrant’ (a person who comes to live permanently from a foreign country) is highly controversial, and was the ugly underbelly, that propped up the Brexit propaganda rhetoric from 2016. Britain’s health system is heavily dependent on foreign doctors, many of whom are now on the front lines of the fight against the epidemic. Just like the hostile environment under Theresa May gave rise to the Windrush scandal, many people from the Caribbean’s were enticed to England, and encouraged to work in the public sector. Alongside bus and train drivers, many devoted their lives to the NHS, only to be deported or detained upon failing to produce documentation proving their citizenship. The truth is “Migrant doctors are the architects of the N.H.S. — they built it and held it together and worked in the most unpopular, most difficult areas, where white British doctors don’t want to go and work” – Dr. Aneez Esmail, a professor of general practice at the University of Manchester.
The NHS is the largest employer of BAME staff in the UK with 40.1 percent of medical workers from BAME backgrounds. The NHS needs more staff from overseas, not less. Staffing shortages in the NHS currently stand at around 100,000 – and could grow to 250,000 or more by 2030. The NHS will need to recruit an additional 5,000 international nurses a year until 2023/24 just to stay afloat. International recruitment is also needed in social care, where workforce shortages stand at around 122,000.
A move by the UK government to press ahead with its plan for a new post-Brexit points-based immigration system has been slammed by critics as “out of date” with the economic realities exposed by the coronavirus pandemic. under the plan, there will be no specific entry route into the country for so-called “low-skilled workers” – the likes of whom have been thrust to the front line of the outbreak in recent weeks as delivery drivers, farm and supermarket workers, home-care assistants, hospital porters and cleaners.
“It is becoming more and more apparent that the immigration system as it was designed and published weeks ago is just not fit for this economy,” said Sophia Wolpers, a Brexit and immigration policy specialist at the not-for-profit business advocacy group London First. “The coronavirus crisis has shown how many of the roles deemed to be lower-skilled are vitally important to the UK economy as a whole,” she added.
Citing the example of workers in the food processing and logistics industry, as well as the home-care sector, Wolpers said the deadly COVID-19 pandemic had put such positions’ value into the spotlight.
Foreign nationals currently make up about a sixpth of England’s 840,000-strong care sector workforce, while some 20 percent of workers in the UK’s agriculture sector come from overseas. “Right now they are the some of the ones working hardest to make sure we stay alive,” Wolpers said.
As of April 14th, 382,650 people have been tested of which 93.873 tested positive. As of 5 PM 13th April, of those hospitalised in the UK who tested positive for coronavirus, 12,107 have sadly died (source: Public Health England). These figures do no account for the number of deaths in nursing homes or in their own private residence. As many as 13 percent of the country’s nursing homes have had confirmed cases of he coronavirus.
How many of these individuals worked in the NHS? What we do know is 46 NHS staff have died to date. Ten of them, BAME male doctors – who arrived in Britain from different corners of its former empire (including India, Nigeria, Pakistan, Sri Lanka and Sudan), have become the first, and so far, only doctors publicly reported to have died in Britain after catching the coronavirus
“At face value, it seems hard to see how this can be random – to have the first 10 doctors of all being of BAME background,” Dr Chaand Nagpaul said. “Not only that, we also know that in terms of the BAME population, they make up about a third of those in intensive care. There’s a disproportionate percentage of BAME people getting ill… “We have heard the virus does not discriminate between individuals but there’s no doubt there appears to be a manifest disproportionate severity of infection in BAME people and doctors. This has to be addressed – the government must act now.”
Historians of immigration have since the end of the last century been arguing for an enhanced appreciation of how migrants have contributed to shaping European nation states – their role has been marginalised and sometimes denied through a process that Gérard Noiriel called ‘collective amnesia’.
Let our memories not betray us. The policies of successive governments have failed to protect the lives of patients and professionals. Pandering to political point scoring is a regressive and dangerous ambition. We need leaders who will fight for our workers, not send them into a burning house, tell them to ‘take it on the chin’, or allow the ‘virus to move through the population’. If we are in a war, then why are politicians bringing a knife to a gun fight? Our front-line workers need every weapon in the arsenal. They need to be protected, not only from the virus, but adequate time off, a living wage and access to mental health support.
In tribute to the enormous contributions (seen and unseen) undertaken by workers of the NHS, many of which have jumped through racist hoops to get here, who’s sacrifice has enriched our unseasoned culture and have made our society more diverse, let our praise of these gallant men and women not be disingenuous.
From carers and cleaners to retail workers and drivers, the current crisis is showing us how much we depend on immigrants at all skill levels. Let us not mask our thanks for their tireless efforts by clapping and sharing meaningless hashtags. The NHS has been sold to the highest bidders, and we all now rely upon a two-tiered depleted system. Wages have stagnated for years, with a depressing rise in staff using food banks to feed their families. By comparison, in light of the pandemic, hospital workers in Stockholm have received 220% of their usual pay – activated by the power of unions. Hospital workers in the UK receive a one-minute round of applause and possibly a shiny medal (backed by the Mirror Newspaper).
Now is the time to use our voices to hold our Politicians to account. We need Ministers who genuinely appreciate not only the institution of the NHS, the vision of its founding fathers, but the legacy of all its workers past, present and posthumous.
In addition to the 10 doctors, three out of seven nurses named as having died were BAME, as well as a hospital pharmacist and at least one healthcare assistant. To the families of the doctors who lives were tragically taken, to their families, friends and colleagues, and to all those who have fallen victim to the pandemic, I am truly sorry for your loss.
As Congresswoman Ayanna Pressley stated ‘Black people are resilient. But we are not invincible’. Black bodies are not sacrificial lambs. Our lives matter. Our labour matters. NHS staff look after us. We must also look after them. This article pays tribute to Dr. Amged el-Hawrani; Dr. Habib Zaidi; Dr Abdul Mabud Chowdhury; Nurse Areema Nasreen, Dr Adil El Tayar and Dr Alfa Sa’adu.
The NHS has launched a mental health hotline as part of a package of measures. Staff will be able to call or text a free number staffed by thousands of specially trained volunteers, to receive support and advice for the pressures they face every day during the global health emergency.
If you or a family member is a doctor, nurse, midwife, porter, pharmacist, carer, cleaner, or emergency worker, you can call 0300 131 7000 (7 AM – 11 PM daily) or text FRONTLINE to 85258 and access mental health services.
Take care everyone and #staysafe