“Docs Not Cops”

pic1
Photo: Emily Hatcher

by Sophie Lewis

Who works indirectly for the UK Border Agency? Volunteers help burn down migrant camps in Calais and elsewhere. In part due to cuts to its maritime services, bodies continue to wash up on EU shores. And as a result of recent policies, the government has made it clear that it would like the border control team to include landlords, neighbours, teachers, bank clerks, social workers, welfare administrators, and doctors. It is increasingly clear that the enforcement of the UK border is not limited to its ports of entry.

But the activists and medical trainees who go by “Docs Not Cops” are not going to comply.  In the context of the EU’s ongoing inadequate and even murderous response to migrants, I interviewed activists at DocsNotCops for Uneven Earth.* This group of medical workers and activists represent just one example – in Britain – of a struggle against border regimes that exclude and stigmatize migrants, to the detriment of everyone.

 

Why DocsNotCops?

The UK National Health Service (NHS), a system of socialized healthcare introduced in the aftermath of World War II, has been universally operative and “free at the point of use” since 1948. But advocates of privatizing public infrastructure (as pioneered by Margaret Thatcher) are gaining ground in their longstanding assault on the NHS.

In the years since, millions of people have taken to the streets to defend “Our NHS” against those who would tamper with it. The campaign of opposition to “our” NHS has been multi-pronged—involving de-funding, speculation, and propaganda—but the consensus is that it seeks to convert a public good currently organised along principles of universal welfare into a lucrative and stratified medical marketplace based on private care and insurance premiums, similar to that of  USA.

In 2015 and 2016, it is the NHS doctors on the “junior” contract, which Health Secretary Jeremy Hunt is threatening with reform, who have occupied the bulk of the spotlight within the wider social conflict over healthcare provision. In his attempt to impose the exploitative new terms, Hunt has come up against a tireless wave of resistance he visibly did not expect. Although public sentiment in support of a fully public health service was known to be high, the junior doctors surprised many by handing their union, the British Medical Association, an extraordinarily strong mandate for taking strike action against the government: the ballot showed that 98% of more than 37,000 in England had voted in favour of full strike action. Perhaps even more surprisingly, doctors on strike have consistently been found to enjoy full support from a vocal majoritarian cross-section of society.

Most of those involved with DocsNotCops are also heavily involved in the junior doctors’ struggle. One interviewee, who asked not to be named, explained the current state of affairs for the fightback against Hunt’s reform: “The vast majority of its members have said they’re willing to escalate things. Unfortunately the BMA (our trade union) has been dragging its heels and not wanting to appear too militant. We’re seeing many medical staff talking about simply quitting the National Health Service, or even quitting the profession altogether. They’re still a minority, those suggesting a mass exodus, but it’s catching on, and it’s a terrible argument for many reasons—most of all because it would play right into the hands of privatizers. At this point, any “emergency meetings” the government tries to have with our BMA reps will be stormed by activists so as to ensure that continuous, 48-hour plus, strike action is on the table.”

The [Immigration Act] enlists doctors themselves in a closing of the borders.

But, specifically, DocsNotCops came into being in response to the passing of the UK Immigration Act. Hotly contested and repeatedly blocked prior to its approval in 2014, the Immigration Act was justified by a series of xenophobic discourses in mainstream newspapers (from the Daily Mail to the Guardian). These ill-substantiated anti-migrant narratives, fuelled by soundbites from politicians across the party spectrum, connected widespread ill-feeling generated by austerity policies and slow post-crisis economic recovery with a supposed immigration and asylum-seeking crisis. According to them, an unsustainable influx of both “medical tourists” and refugees has “swamped” Britain’s capacities to provide care at taxpayers’ expense: supposedly “stretching” the NHS to its breaking point.

The bill enlists doctors themselves in a closing of the borders, inside institutions. It changes the fundamentally unpoliced nature of public medical provision by introducing unprecedented screening, designed to identify those the state deems (as above) “undesirables” at the point of healthcare provision, in order to charge them fees, exclude them, or else dissuade them from seeing a doctor in the first place. In other words, the bill – as they see it – essentially turns civil, medical and caring professionals into agents of harm: “cops”; border agents; spies and debt collectors.

The policy changes have already produced tragic effects. Reem Abu-Hayyeh (DocsNotCops) cites, for example, “the sad case of Dalton Messam (44), an undocumented migrant who died in 2013 in East Ham from an unknown illness, too afraid to seek medical treatment in case he was deported, is testament to the potentially fatal consequences of limiting or cutting off access to healthcare for migrants.”

The energetic ad-hoc network came together to prevent this kind of shameful occurrence from ever being repeated. In their own words, the aim is “a society in which people aren’t scared of illness.” One trainee doctor and DocsNotCops activist observed: “As we move on with this fight, we’ve all been obliged to re-think the question ‘What is cost, in the NHS?’ Because we’re constantly confronting the fact that it’s the capitalists themselves who are putting the numerical value on what happens to people’s bodies under this system.”

The activists frequently point out in their written materials that Aneurin Bevan, the minister who founded the NHS, understood this profoundly. Bevan famously affirmed: “Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalized, but a misfortune, the cost of which should be shared by the community”. For these reasons as much as epidemiological ones, as DocsNotCops maintain, if a health system isn’t for everyone, it just won’t work.

 

The Immigration Act: paving the way for more austerity and privatization

As one of their first initiatives, DocsNotCops devised a consciousness-raising survey: How will the Visitor & Migrant NHS Cost Recovery Programme affect you?  By responding to the survey’s prompts, anyone can easily learn that the government’s proposed measures include the introduction of charges attached to accessing A&E and general practice. There is also now a £200 surcharge on work visa applications, even though the majority of migrants already pay for the NHS in various ways: taxes, VAT, National Insurance, tuition fees.

Are hospitals simply complying? No. Unofficial protocols, for now, still operate in most places to simply go ahead and provide care to those with the wrong documents (or none).

So, it’s not universal charges for the time being, but rather, charges for some of us—those of us who don’t meet certain residency and citizenship conditions. Rhetorically, this is justified in the language of ‘sacrifice’ with reference to overcrowding and balancing the budget. Yet it requires that hospitals work with the UK Border Agency’s data to scrutinize people – everyone, not just some of us – for their legal status, rather than just their illness. They must, of course, acquire the computer and bureaucratic staff capability to do so. DocsNotCops sees the introduction of this kind of administrative functionality as the thin end of a wedge that is designed to kill off any collective sense of entitlement to “no questions asked” medical care.

Are hospitals simply complying? No. Unofficial protocols, for now, still operate in most places to simply go ahead and provide care to those with the wrong documents (or none). To combat this resistance, as Sophie Williams (DocsNotCops) notes: “The Act states that NHS Trusts will receive ‘financial incentives’ to recoup costs. This could mean pressuring staff to racially profile patients … those deemed eligible for free care, and those not.” The ‘Overseas’ debt-collection teams now being introduced in many hospitals look set to start transforming UK healthcare into something more like the world’s infamously chaotic, ineffective, and inhumane for-profit models.

On a case-by-case basis, pro bono UK legal workers have argued for waiving medical fees on behalf of denied asylum-seekers awaiting appeal, and various other vulnerable people such as undocumented and mentally ill homeless migrants. Enormous quantities of time, money and energy have had to be invested for every individual in court in order to prove the principle: “can’t pay, won’t pay”. In 2015 DocsNotCops found out via a Freedom of Information request that one hospital’s eight such full-time staff, dedicated exclusively to recouping costs from migrants, succeeded with just 10% of invoices.

Perversely, increases in pointless salaried administrative staff, who are hostile to patient care and an encumbrance to those delivering it, are completely typical of ‘cost-cutting’ privatization drives across institutions.

Perversely, such increases in pointless salaried administrative staff, who are hostile to patient care and an encumbrance to those delivering it, are completely typical of ‘cost-cutting’ privatization drives across institutions. Similarly, both of the recent attempts to trial the type of computer system that is required to terrorize newly convalescing people in this way (linking the Home Office and NHS records), and thus supposedly enable savings, incurred a cost of around £10 billion and ended in complete failure. On the other hand, NHS workers found that the government had “inflated six-fold” the NHS ‘cost’ of migrants. These precedents make clear that, even if the figure for the “savings” represented by denying migrants free care were true, introducing the requisite computer system would likely be a financial fiasco that completely buried that sum.

With the advent of DocsNotCops, theatrical “border controls” (“Checkpoint Care” stunts) have appeared outside hospitals. Asylum-seeking Virgin Marys—unable to pay the £5,000 fee for maternity care for non-resident migrants—were symbolically prevented from giving birth at Christmas, and videos circulated in which a white coat is peeled off to reveal a border guard’s badge. These protests expose the introduction of selective charging in the NHS as racist, a perversion of care, and detrimental to all. As the manifesto states: “Instituting this scheme will drive vulnerable migrants away from NHS services. … No doctors should have to police the people they treat. … Charging migrants for healthcare is the first step to normalising charging for everyone”.

NHS workers found that the government had “inflated six-fold” the NHS ‘cost’ of migrants.

It is important to stress that the punitive UK border already existed to an extent within the National Health Service, insofar as it permeates British society in the form of immigration controls, raids, checks, and xenophobia. A 2015 report  by Doctors of the World found that, contrary to xenophobic tabloid narratives, the majority of migrants have felt deterred from using the NHS. And that’s before the Immigration Act had even been announced.

At a Docs Not Cops rally in April 2015, one doctor (active with Tower Hamlets Keep Our NHS Public, or KONP) was contemptuous of these reforms, which she referred to as racist: “This is an NHS which entirely depends on foreign workers. [Yet] a real hatred of foreigners is being stirred up in the country and in the NHS. … Our borders exist for rich people only when it suits them. … And they have the cheek to say that … people who come in to work in the country in poorly paid jobs are not entitled to healthcare! … We have to say no to this. We need to have humane care, we need people to come and work in our health services, and we need to have borders that are open for people.”

 

CAoo_FGW4AASBcn
Photo: Mark Boothroyd on Twitter

 

“Making both arguments at once”: Connecting migrant justice and politics of care

Belief in the possibility of universal welcome and care for all is not utopian. For decades, among the ranks of public health-workers, it’s been practiced and substantiated – and that includes all sorts of workers, not only those who swear to do no harm. Pitted against their values and experience are the border regimes that gratuitously detain hundreds of thousands of people every day, in prisons and detention centres which – perversely – rely on doctors to function.

By strategically refusing to collaborate with the immigration police, DocsNotCops is innovative but not unique. While the experience of a defensive “rear-guard” campaign to defend a public good from buy-out is, at this point, an all too familiar one for the Left, in many ways it is when activists are on the ‘offensive’, making impossible-deeming demands and affirming a positive transformation, that they are most united worldwide.

DocsNotCops say they have been inspired by acts of resistance by doctors on the other side of the world. In February 2016, for example, amid migrant solidarity demonstrations, one hospital in Brisbane, Australia refused to discharge a baby whose parents are seeking asylum. And when staff at Melbourne Royal Children’s Hospital protested against Australian government policies in October 2015 of placing children in detention and denying sick asylum-seekers care “a thousand doctors, nurses and other workers [had] finally howled in protest”—as Dr. Ranjana Srivastava put it.

So, today, DocsNotCops and their allies (a vast network including Doctors of the World, SolFed, London Black Revs, London2Calais, Together Against Prevent, ACT UP, 999CallforNHS, and KONP),  have mounted a counter-offensive against migrant scapegoating and capitalist enclosure of common resources. As they make the case for no borders, their members are also taking part in the nationwide industrial dispute raging over the government’s attempts to squeeze more profits out of the national junior doctors’ contract.

While anti-migrant austerity narratives can be exposed on their own terms, the principle that ‘docs will not be cops’ also goes beyond the fiscal—gesturing toward logics of care outside of nationalism and capitalism. 

This double focus of their struggle requires DocsNotCops’ messaging to be more thoughtful than others when refuting their opponents’ arguments for surveillance and austerity. For instance, they often come up against false statistics which suggest that non-tax-paying migrants and ‘medical tourists’ greatly burden taxpayers, or that the NHS is ‘bust’ and requires private buy-out. While these frames can be exposed on their own terms, the principle that ‘docs will not be cops’ also goes beyond the fiscal—gesturing toward logics of care outside of nationalism and capitalism. As Sophie Williams (DocsNotCops) said to me, “it’s about making both arguments at once”. It is not enough to point out that non-British people in fact bring net income to the NHS – not to mention indispensable labour (although this is true). To stand in solidarity with migrants and asylum-seekers, and to centre them in NHS organising in the context of their persecution, cannot be conditional on their cost-effectiveness, usefulness or unobtrusiveness within the system.

The distinction breaks down anyway: diseases don’t make distinctions around visas or passports, and people who avoid health services, out of fear of questioning or deportation, won’t just die but will tend to spread them. Their suffering—from the viewpoint of the owners of capital—should represent false ‘savings’ that, as DocsNotCops activists have argued, lead to far more expensive outcomes for society.

But what they demand is an “expensive” imperative that is simultaneously ethical and medical: far more migrants in the UK should avail themselves of health services than currently do. DocsNotCops are unapologetic about the cost of both junior doctors and truly universal healthcare. To those who would turn health infrastructure and carers into a nationalist surveillance mechanism funneling the poor and marginalized onto deportation planes—or, who knows, highly profitable debtor’s prisons—demanding the very best of healthcare for literally everybody who needs it, literally everywhere, is the only conscionable response.

 

You can get in touch with DocsNotCops by visiting the website docsnotcops.co.uk, finding their Facebook page and events, joining the mailing-list docsnotcopsnhsgroup@googlegroups.com, or following them on Twitter @DocsNotCops.

 

*some DocsNotCops activists asked not to be named in this piece.

 

Sophie Lewis is researching the uneven geographies of reproductive technology and ‘outsourced gestation’ (aka surrogacy) at the University of Manchester. She pursues joy and feminist killjoyism in equal measure and enjoys dancing, writing (e.g. at Mute, The New Inquiry, Jacobin), mushrooms, and militancy. She tweets @reproutopia.

Degrowth in Detroit?

 

detroit future city 9

by Seth Schindler

Speculative lending practices and the securitization of sub-prime mortgages were largely to blame for the 2008 financial crisis. The crisis was particularly severe in cities where the lack of liquidity in the financial system made it difficult for municipal governments to respond to the wave of foreclosures and resultant shrinking tax bases. With the worst of the crisis seemingly behind us it is time to reflect on its long-term impact on American cities.

Perhaps the most extreme example of a city in crisis is Detroit. The city’s beleaguered finances proved to be no match for the global economic meltdown and in 2013 Detroit filed for bankruptcy. This part of the story is well known, but much less attention has been paid to the vision of Detroit’s future development around which a consensus among local elites coalesced in the year-and-a-half since its declaration of bankruptcy.

While this plan retains some elements of out-of-the-box urban development programs, it dispenses with a growth-based strategy geared toward rejuvenating the city’s manufacturing base. Instead, it recognizes the likelihood of further economic decline and its emphasis is on improving the quality of life of Detroit residents, economic diversification and environmental sustainability.

In order to understand the willingness of policy makers in Detroit to relinquish the dream of returning to a golden era of Fordist manufacturing it is necessary to put the 2008 crisis in context. Like many American cities, Detroit is a casualty of the prolonged economic crisis that began in the 1970s. Auto manufacturers relocated production facilities to southern states and then overseas in an attempt to outflank organized labour and to counter a falling rate of return. The collapse of Detroit’s manufacturing base left the city’s finances in tatters, and policy makers responded by embracing market-oriented solutions that were in fashion in the 1980s.

detroit future city 3

There was a broad shift in the United States during the 1980s, in which the primary function of municipal government went from managing day-to-day service delivery to fostering economic growth. To this end “growth coalitions” emerged in many cities. These coalitions practiced “growth machine politics” aimed to augment land value and attracted inward investment. Public bodies assumed risk for large-scale urban development projects while private firms reaped the financial rewards.

This led to a perception among investors that municipal bonds were safe investments that offered lucrative rewards, so when Detroit’s municipal government sought to make up for its shrinking tax base by issuing bonds there was no shortage of willing investors. By 2012 Detroit’s deficit stood at $326 million while its tax base and population continued to shrink.

pullquote1

The textbook response to crisis in many cities has been to intensify neoliberal policies. Thus, when growth coalitions failed to attract investment or augment land value, the response has oftentimes been to offer even more favourable terms to investors while cutting back on services. This has led many scholars and activists to despair that while neoliberalism is the cause of the current crisis it is also perversely embraced as its solution.

Many municipalities have indeed imposed fiscal austerity since the onset of the financial crisis as a means of attracting investment. Some of these cities may have fundamentally sound finances, and policy makers may view fiscal austerity as a short-term detour aimed at calming skittish investors. According to this reasoning the pain caused by austerity will be offset in the near future once the growth coalition is able to resume a cycle of development and growth.

In the case of Detroit this optimism would have most certainly be misplaced because even the most aggressive version of fiscal austerity would not have reversed the city’s decades-long decline. This begs an obvious question: Why should a city endure the pain of austerity if further decline is inevitable from the outset?

Detroit’s elites decided that, while austerity was in the best interest of extra-local creditors, it also promised to make life even more difficult for residents, and they decided to repudiate the city’s debt and take the historic step of declaring bankruptcy. By freeing the city of its debt burden, bankruptcy has allowed Detroit’s future to be re-envisioned.

detroit future city 8

A coalition among Detroit elites coalesced around this emergent vision, which is based on creative land-use, environmental sustainability and economic diversification. It is articulated in a 345-page document entitled Detroit Future City (DFC). It reads like a master plan and focuses on five “planning elements”: economic growth, land use, city systems, neighbourhoods, and land and buildings assets.

Unlike entrepreneurial urban policies whose time horizons are measured in quarters and election cycles, DFC aims to rejuvenate Detroit’s economy in the course of the next five decades. The first step is to make the city liveable in order to stem the tide of out-migration, and to this end the plan calls for investments in neighbourhoods. Residents in neighbourhoods characterized by high levels of abandonment are encouraged to relocate to neighbourhoods with high population densities. Fordist manufacturing is rejected in favour of economic diversity, the single-family detached home is rejected in favour of densely populated diverse neighbourhoods, and in a major shift for the Motor City the plan envisions an efficient public transportation network. Perhaps the most noteworthy aspect of the DFC is “the re-imagination and reuse of vacant land for productive uses or, where there is excess vacant land, returning it to an ecologically and environmentally sustainable state.” The emphasis on sustainable land use is a significant departure from growth machine politics aimed at augmenting land value.

pullquote2

It is too early to tell whether the vision articulated in the DFC will be realized or if it will indeed guide policy for the next fifty years. Nevertheless, it is important to note that bankruptcy gave Detroit the opportunity to chart a new path. I refer to this as degrowth machine politics because it takes the further shrinking of Detroit’s economy for granted, and rather than placate creditors policy makers are focused on improving the quality of life for city residents.

The concept “degrowth” is not new but it has historically been used primarily by activists and scholars because politicians do not win elections by campaigning for shrinking the economy. This is changing since the onset of the financial crisis because there are many places in which degrowth simply seems to be a reality that cannot be reversed by fiscal austerity.

For example, elements of degrowth are beginning to enter mainstream policy discourse in southern Europe. Voters in Greece recently rejected fiscal austerity, and the concept has begun to enter mainstream discourse elsewhere in southern Europe. In the United Kingdom the Scottish National Party has chided mainstream political parties – and most notably the Labour Party – for not repudiating austerity.

detroit future city 6

Thus, it is possible that we could see the emergence of other degrowth machine political coalitions, and this provides an answer for the pressing question: What comes after neoliberalism? The transition to degrowth is not a linear advancement to a new political system based on purportedly universal ideology. Instead it is a mixture of locally adapted policies whose coherence lies in their intended outcomes rather than ideological underpinnings. The objective is to simply do more with less and thereby improve the quality of life, and this will oftentimes (1) reduce the quantity of resources used and (2) put localities – and local elites who were hitherto part of multi-scaler growth coalitions with extra-local financiers – at odds with their creditors whose main priority is protecting their investment.

pullquote3

Detroit may provide lessons for degrowth coalitions elsewhere. First and foremost, Detroit demonstrates that the intensification of fiscal austerity is not the only response available to policy makers faced with an economic crisis. In spite of declaring bankruptcy Detroit was not punished by creditors. On the contrary, the repudiation of debt transformed Detroit into an attractive destination for investors. For example, Goldman Sachs launched an initiative to invest $20 million in Detroit’s small businesses. Quite simply, an institution that is unburdened by debt seems like a better investment than one that cannot hope to repay its debt without the support of a guarantor (in this case the State of Michigan).

The reason why Detroit is able to attract investment is because its degrowth machine politics has clearly articulated an innovative plan for the city’s future. Thus, the rejection of austerity for austerity’s sake must be accompanied by a clear set of policies aimed at managing decline in a way that makes cities more liveable. In other words, the repudiation of debt should not be understood as a strategy to attract capital from different investors, but to rework with relationship with all investors so that any inward capital is leveraged toward the realization of a sustainable and equitable future.

 

Seth Schindler is a lecturer in human geography at the University of Sheffield.