I have been to a fair few healthcare demonstrations over the last few years – supporting the causes that have aggrieved nurses, doctors and other healthcare professionals.
Often, the whole thing is friendly, and sometimes you have time to chat to other people as the march goes along. However what is always striking to me is the difference between the crowd of participants and the clinical environment in which I have worked: on the rallies and demonstrations I don't meet many nurses from abroad. I just don't. I have no obvious statistics at hand to back this up – studies on political participation (although there are some available) – and so what I say is wholly anecdotal. But the possible lack of engagement with foreign nurses concerns me somewhat. And as someone concerned by health care politics in general, things need to change.
Could my rather flimsy story be contradicted? Many marchers/protestors at recent events have union affiliation. The RCN, the biggest health union boasts about 432,000 members. However, how many of these are active, foreign nurses is quite hard to work out (although I have asked the RCN this and am awaiting their reply). The nursing union offers student nurses and retired nurses membership, as well as nurses already on the NMC register. UNISON has around half a million healthcare members but this includes professionals other than nurses. If we look at some statistics concerning overall trade union membership, the overall of proportion of members (for any trade union) aged over 50 has increased. “Those employees with ten or more years of service make up about 52.5% of all union members but only 30.5% of all employees,” says a study by the Department of Business, Energy and Industrial Strategy. So we can hazard that there are quite a few union members close to retirement, or already retired. To extrapolate, it is unlikely that many older foreign nurses would come from the UK looking for work when close to retirement. The profile of migrants to the UK within relatively recent times, is one of younger people looking for work. Thus by making some deductive leaps, (ones needing further substantiation), it is likely that many of those foreign nurses that come to the UK are not and remain outside unions.
But it is possible that we are looking at this from the wrong angle: just because a professional is not attached to a trade union it does not mean that they are not politically engaged. Besides – being a member of a trade union does not necessarily imply that you are active within it. However, when it comes to building a mass movement of healthcare staff to effect change the support of many foreign nurses would be useful, considering the changing demographics of the NHS. The figures behind the oncoming shortage of nurses caused by Brexit, poor working conditions and nurses retiring do not need restating here. If we want a better NHS then foreign nurses need to be part of that process. I enjoy the knockabout conversations on Twitter and other social media – healthcare politics is active and vibrant there – stimulated by tough work in desperate and dire conditions. But not only is social media an echo chamber of political activity, it is predominantly on such mediums, particularly Twitter, that the voices seem white and middle class.
So let us return to where we began – how to engage more foreign nurses with healthcare politics. I know from experience that settling in a foreign country makes you feel unable to upset the Status Quo. But beyond my own rather privileged experiences of migration - the implicit racism and xenophobia that has crept into mainstream political discourse can be quite frightening. It is important then to share an inclusive narrative of the NHS' history. In an article last Summer, Sasha Scambler highlighted migrants' legacy on the NHS.
The unexpected success of the NHS and the rise in demand in the first years after its launch led to recruitment campaigns in 1949 which saw thousands more migrant nurses arriving in Britain predominantly from the Caribbean […] by 1957 12% of NHS doctors were mainly overseas trained, with the majority being Jewish or central European refugees from WW2.
The success story of the NHS is one that could not exist without migration. The stories of many of these people need to be told, and receive public attention. Healthcare is an emotional business, and requires emotive story-telling that relates to present circumstances.
However, story-telling is not enough. Even if the present pressures on foreign nurses were eased – nursing will always be a hard job that requires a great deal of energy – both mental and physical. The working language of the NHS is English. But campaign groups need to be aware that for staff whose English is not native, continually operating in a non-native language is tiring. There is absolutely no reason that activists and campaigners cannot produce healthcare politics news in simple English (politics has jargon enough). Content could event be produced in other languages that reflect the diversity of staff. Politics is not just work, but also free-time and our life outside work. The content that is produced needs to be something picked up and read easily – on a smartphone on the train home or on a break at work. The accessibility of Nursing Notes content, for instance, is very good.
To change how our health service is run will involve nurses and healthcare assistants, who exist as the single biggest group of NHS employees. For too long healthcare politics has though well-meaning, not appreciated fully who its workforces consist of. Even if it fails in this specific task, by making healthcare politics more accessible and emotionally relevant, campaign groups can bring more people from all walks of life over to their side. A good healthcare service is open to everyone, and defending it requires solidarity with all its workers regardless of where they're from.