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.
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.”
“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 firstname.lastname@example.org, 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.