Writing migrants back into NHS history: addressing a ‘collective amnesia’ and its policy implications
Authors: Julian M Simpson, Aneez Esmail, Virinder S Kalra, Stephanie J Snow
Journal: Journal of the Royal Society of Medicine (2010)

The National Health Service (NHS) has used migrant workers from its inception. As early as 1957, the Willink Committee on medical manpower found that 12% of doctors in a random sample taken from the Medical Directories of 1953 and 1955 were mainly overseas-trained.2 The majority of these doctors had 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 1970s, 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.3 In the 1950s and 1960s, large numbers of Irish and Caribbean nurses were essential to the expansion of NHS services, a pattern that was replicated in the early 2000s when nurses from Africa, India and the Philippines came to the UK.4 A 2005 report found that in 2003, 29.4% of NHS doctors were foreign-born and that 43.5% of nurses recruited to the NHS after 1999 were born outside the UK.5

In spite of this long history of substantial migration into the NHS, little effort has been made to understand the ways in which it has influenced the development of healthcare in the UK. The popular perception of the NHS as a ‘typically British’ institution (in a restrictive white sense rather than in an inclusive sense) tends to prevail in public perceptions of the organization and in its self-image. Of the 19 photos used by the BBC's online archive to illustrate the development of the NHS up to the 1970s, not one shows a black or Asian person.6 The ‘historical timeline’ on the NHS website makes no reference to immigration.7 Political and organizational histories of the NHS pay scant attention to migrants. A word search for ‘immigration’ in Rivett's online National Health Service History yields little more than the occasional passing reference to overseas doctors.8 Nor can much be found in Webster's two tomes on the health services since the war.9

Where there is a focus on migrant health professionals in the NHS, the themes most widely covered are the experiences of individual groups of migrants and discrimination. This includes the dearth of opportunities for overseas doctors,10 the lack of recognition of the skills and experience of migrant nurses,11 exploration of how Irish nurses construct identity,12 reflections on the experiences of Black and Minority Ethnic NHS employees in the North West of England13 and a vast literature on racism grounded in empirical evidence14 as well as theoretical analysis.15

These studies have generated a wealth of useful data but three fundamental issues require further examination. First, there is a basic need to document and recognize the scale of the dependency of the NHS on immigration. Second, to what extent were migrants facilitators of development and/or agents of change within the NHS? Third, can a better understanding of this history inform policy?