It is not migrants who are causing the NHS crisis, but underfunding and privatisation. This is an argument we can win, and break up support for the far right, argues Lucy Nichols

The recent attacks on migrants, refugees and asylum seekers by the Labour government have encouraged a resurgence of far-right-organised mobilisations outside hotels housing homeless asylum seekers. Rather than defending these people against the huge level of racism being fired at them, the government is doubling down and scapegoating migrants for problems caused by their own ill-management of the system.

One often-repeated lie is that we need stricter migration policies to protect our public services. The NHS is then given as an example of the ways in which migrants are harming British society. The right is at least able to recognise some of the truth: our National Health Service is crumbling. 

Decades of underfunding and creeping privatisation welcomed by successive governments from various parties have led to the worst-ever public-satisfaction rates in the NHS, and waiting lists millions long. NHS dentistry, primary care, mental-health services, and many other crucial services are unable to meet the needs of a growing, sicker population. As many as 16,600 people are dying avoidable deaths each year because of delays in treatments. All this, while huge NHS job cuts are looming because of budget cuts being forced on Integrated Care Boards (which oversee NHS trusts).

These are all problems that the government promised to fix in its 2024 manifesto. Unsurprisingly, Labour has barely met any of its manifesto promises with regard to the NHS. The government has instead ushered in a new era of privatisation, outsourcing and cuts, all the while looking to place the blame for this debilitating crisis at the feet of whoever is the easiest target. Earlier this year, disabled people were to blame, then striking BMA members, and now migrants.

It is a lie that migrants and asylum seekers using the NHS means that others can’t access the NHS. This line of argument, backed by Labour, the Tories, Reform UK and Britain First, is flawed for a number of reasons.

Firstly, and as a slight sidenote, migrants actually use the NHS at a much lower rate than people born in the UK. Most people from abroad come to the UK to work or study. This invariably means that they are not children and are not elderly, the two age groups who use the NHS the most. Migrants use the NHS 40% less than people born in the UK. So, the idea that migrants cause any more of a strain on the NHS than anyone else is, as well as being grounded in racism, fundamentally flawed. There is also the fact that, if every migrant were to leave the UK, the NHS (like many other services) would immediately collapse. Huge numbers of NHS staff are from abroad, ranging from consultants and nurses to porters and cleaners. Furthermore, this is not at the expense of UK-born workers who are losing out on jobs to immigrants: if a UK-born worker cannot get a job in the NHS, it is probably because the government is outsourcing more and more NHS jobs, and even the official NHS jobs webpage is suggesting resident doctors go and find work in the private sector.

These are important facts that undermine the far-right caricature of a migrant who comes to the UK to steal jobs and resources. At the same time, we are not in the business of moralising about who does or doesn’t deserve access to the NHS, which should be freely available to all, regardless of why they come to the UK and whether they work in the NHS, or at all.

The NHS is under pressure, but not from migrants

Contrary to what the government tells us, we can have an NHS that offers good quality, comprehensive healthcare to all who need it, which is free at the point of need and publicly provided. Stricter immigration controls or ‘one in, one out’ asylum policies will not change this. This week, a government spokesperson told the Daily Mail that Labour is ‘fixing the chaotic asylum system … to ultimately relieve pressures on nationwide services.’ This quotation is from a Daily Mail ‘gotcha’ story claiming that ‘asylum seekers have been handed almost one million NHS “free passes” in the last five years.’ Former health secretary and Tory MP, Steve Barclay, said it is ‘completely wrong that asylum seekers are receiving beneficial access to health treatment compared to the taxpayers who fund it’.

The idea that migrants are somehow taking advantage of the NHS is incredibly problematic, although this ‘health-tourism’ lie is given as an excuse to place harsh limits on the services to which asylum seekers and migrants have access.

Importantly, all immigrants to the UK pay an NHS surcharge, including people who come here to work in the NHS. The surcharge was introduced by the coalition government in 2015 to stop this so-called ‘health tourism’. It has been raised from £200 to over £1000 a year for adults and just under £800 a year for children. Since it was introduced in 2015, the immigration health surcharge has raised £6.9billion for the NHS, of course, only a tiny fraction of the overall cost of the NHS, but a huge amount of money for the individual, and surely outweighs the money paid out to asylum seekers.

Undocumented migrants, however, are forced to pay extortionate fees if they use the NHS. This does not necessarily mean people who are in the UK ‘illegally’, but includes people who are waiting for their asylum application to be processed. For example, pregnant women who sought asylum but have not yet been granted it are often charged thousands for maternity care and can be reported to the Home Office if they can’t pay.

‘Free passes’ or basic healthcare?

The ‘free pass’ referred to by the Daily Mail is the NHS’s HC2 certificate, part of the NHS Low Income Scheme. This scheme helps people who would not otherwise be able to afford dental and eye care, as well as prescriptions, travel costs or wigs for alopecia or cancer patients. It isn’t just asylum seekers that are eligible for this support, but anyone with low or no income, and their families.

The services that the HC2 certificate helps pay for are very basic healthcare services that, of course, used to be free. Until 1951, NHS dentistry was entirely in-house: basically anyone, anywhere had access to good dental care. Opticians’ appointments were also entirely free until Thatcher introduced charges for the service in 1989. Now, competing private opticians spend thousands to advertise on TV, and the patient is turned into a consumer, forced to choose between Boots and Specsavers for care that should, and could, come from the NHS.

These services were not phased out because of overuse by migrants, but because successive governments decided that they weren’t worth paying for. Today, eight million people in England can’t get a dentist appointment, and nine in ten dentists won’t take new adult patients. Tooth decay, which disproportionately affects those in more deprived areas, is the leading cause for children between five and nine years old to be admitted to hospital, costing the NHS £50million a year. 

The Daily Mail would have us believe that the asylum seekers using the Low Income Scheme (which they are entirely entitled to) is more of a problem than the fact that such a scheme needs to exist in the first place. Instead of arguing that asylum seekers are barred from claiming financial support for NHS treatments, we ought to be arguing that the NHS is brought back to its original principle, of healthcare that is truly free at the point of use for all who need it, including dental care.

The NHS crisis is not going anywhere under the current government, despite initial promises. Labour is happy, however, to blame migrants for problems for which it is responsible. This makes it even easier for the far right to pull people onto their mobilisations, arguing that migrants are the reason they can’t get an appointment with their GP, or are having to wait months for surgery. 

If we can win the argument around the NHS – that we can have an NHS which is able to treat everyone, for free, regardless of immigration status or birthplace – we can also win other arguments, around housing, schools, social care and other public services. It is important to recognise that, while obviously grounded in racist ideas, many of the people joining the far-right mobilisations are not card-carrying fascists. They will have similar experiences to everyone else with housing, jobs, and healthcare, but incredibly misguided ideas about why they are having these experiences, fed to them by the right-wing media. In addition to mobilising, getting on the streets in support of refugees under attack, we also have to win arguments about the nature of the crises we are experiencing and how we should go about putting an end to them.