Nurses, doctors and health workers have been arriving for many decades, often overcoming prejudice and discrimination to serve Britons in their hours of need, d
The historian and broadcaster Professor David Olusoga has made British history uncomfortable – and makes no apologies for it. Britons, he argues, are trapped in a make-believe past which has written out the contributions of a host of largely non-white people who have helped to shape the nation into what it is today.
He fears that because we are unaware or unable to recognise how our history has shaped our nation and its culture, we will struggle to reshape our institutions for the better. His latest target is arguably his riskiest yet, an institution central to the lives and dearest to the hearts of most – the National Health Service.
In his new BBC programme Our NHS: A Hidden History, Olusoga investigates how the health service has relied on immigration – one of the most divisive social and political issues of the age – for its survival. Nurses, doctors and health workers who have been arriving for many decades, often overcoming prejudice and discrimination to serve Britons in their hours of need, describe their experiences of “helping and healing with one hand while fending off the sharp end of discrimination and racism with the other”, as the broadcaster puts it.
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Britain ended the Second World War with an acute labour shortage and in dire need of an extra 1.3 million workers. At that moment, the Labour government set up the National Health Service, which went on to become the UK and Europe’s biggest employer.
The answer as to how to staff the NHS then – as now – to ensure that it could function was down to a key factor: immigration.
“I don’t think we could see how interconnected immigration and the NHS were until the pandemic,” says Olusoga. “The story of the National Health Service and the story of immigration are completely intertwined. You cannot have one without the other. One is a beloved institution that we see in entirely uncritical terms for most parts, and the other is arguably the most fraught political issue of the past half-century. I wanted to show how they are interconnected.”
It is not simply a tale of race and discrimination, although as recently as the late 70s classified advertisements seeking GPs to join existing practices routinely specified “British graduate required” – meaning, as one doctor says: “If you’re brown and from abroad don’t bother applying.”
“It’s also stories from people all over the world being intertwined by their connections, whether as patients or as doctors in this great thing called the NHS,” says Olusoga. “It’s also the story of people who have come to our country because they have heard about the NHS and almost could not believe what an amazing institution it is.
“The key point is that the story [of the NHS] doesn’t change. It has been short of doctors and nurses from its inception. It didn’t have – has never had – enough doctors and nurses. It has always been a service that has relied upon drawing in people all over the world.”
And that diverse workforce is both a strength and a weakness, the academic says, adding: “I’m not trying to make a judgement. This is a phenomenon. It is an international NHS. There are lots of positives and lots of negatives. It has made the NHS famous all over the world, and it has brought amazing people to Britain who have contributed.
“It has also taken fairly skilled, educated people from Africa, the Philippines, from the Caribbean, who could have done amazing things in their societies and brought them to Britain.
“Doctors and nurses took an enormous decision to come here. They faced difficulties, they faced racism but these were proactive people who made very brave decisions to leave their country to train in a new profession thousands of miles away.”
Olusoga, who is no stranger to controversy, shies away from commenting on the present-day NHS but acknowledges that there is some way to go before its senior management reflects the diversity of the workforce. “In terms of management [and diversity], I don’t think the NHS has a wonderful record,” he notes.
Today, about 170,000 out of 1.28 million NHS staff – almost one in seven – are non-British, comprising 200 nationalities. About 64,000 staff are Asian, accounting for 39 per cent of all doctors.
And the reliance on immigration has not changed, Olusoga says, only where the migrants are from. “The first people to come to fill the labour shortage in the NHS were the first people who came to fill Britain’s labour shortage in almost every sector, the Irish.
“Ireland has always poured labour into Britain, but that has changed as Britain’s relationships around the world evolved.”
Most recently, that has involved people from the European Union. More than 67,000 NHS staff in England – 5.5 per cent of the total – are from EU countries. One of the reasons why Britain has relied so heavily on overseas staff is also partly down to the number of doctors, nurses and other healthcare workers who emigrate – a fact which is often forgotten, Olusoga argues.
“Lots of doctors and nurses from Britain in the 1950s and 60s saw opportunities elsewhere and took their training and their skills and went to work in Australia, Canada or the US.
“So the labour shortage in the NHS is partly caused by the expansion of the NHS from 1948, but it is also the story of an organisation that struggled to find people because British people emigrate. For centuries, British people have been great emigrators and we often forget that.”
He is reticent about the NHS’s future, saying: “It is what we decide it to be. The borders of what it does or doesn’t do are political conversations. The NHS, since its inception, has been an enormously diverse and international organisation, and we didn’t really recognise that fully until the pandemic. Many more of us noticed that it was much more international than we presumed previously.”