Smina Akhtar

Smina Akhtar

Citizenship for all NHS workers now

Reading Time: 6 minutes

Smina Akhtar looks at the history of UK immigration systems, and how they are designed to serve capital rather than society or human rights. She says it’s time to offer full citizenship for any NHS worker who wants it.

Full citizenship for NHS workers Within a week of lockdown the critical role that migrant workers play in Britain, and the National Health service in particular has come to media and public attention. As I watched TV news reports of the NHS doctors and nurses who one by one had lost their lives doing their jobs treating people in hospital with Covid-19, I noticed that the first 10 doctors and the first nurse to tragically die by contracting the virus themselves were all black or brown, moreover they were all black and brown Muslim. In fact, we now know that 70% of frontline NHS and care workers who have died so far from Covid-19 are black, Asian and minority ethnic (BAME).

With the exception of some reports discussing the critical role that migrants have played in building Britain’s NHS, most took a completely colour blind approach to this horrible and sad news. Within a week the narrative changed from colour blindness to ‘we love migrants’ which I argue is equally dangerous because it suggests that the presence of migrants is only tolerable on the basis of their worth to ‘us’ the genuine British people who, using this logic, are defined as essentially white. The black and brown NHS doctors and nurses therefore are to be valued because they are here to save lives, white lives.

Many of these NHS staff are British citizens, many are not, so it is vital that we demand that they all be granted immediate citizenship if they want it. It is a sickening display for the Home Office to extend visas so that NHS staff can remain working here, saving lives, for only the duration of the pandemic. If they are good enough to save us, they are good to stay here. And furthermore, have we not learned from this crisis the need for a fully and permanently staffed public health system, one resistant to global crises?

The implications of not granting citizenship are illustrated by a heart-breaking tweet by Mostofa Omran, a cardiology registrar working in a NHS hospital. In it he states that he has Covid-19 symptoms and fears that if he dies his family will be thrown out of Britain, reminding us that even highly skilled migrants have a precarious immigration status which I discuss below.


Higher wages equals greater value – this is the logic that post second world war immigration and asylum policy has been approximated on. This short article gives a brief history of immigration policy and argues that once primary immigration for black and brown people ended in the late 1960s and early 70s, the British state has encouraged the migration of these groups if they possess a skill that is needed by the state or capital.

That the ‘new’ immigration rules introduced by the Home Secretary Pritti Patel within the last few weeks are not a departure from what has happened in the past. Immigration policy is an example of state racism. Racism at the point of the territorial border changes its form from a hard bordering to softer bordering, but only for those deemed to be more deserving and only in response to the demands of the economy. Already racialised through slavery and colonisation, the 1948 Nationality Act famously gave the status of ‘British subject’ to people in the ex-colonies, resulting in about 500,000 coming to Britain between 1948 and 1962. Ministers quickly expressed shock at the numbers of black and Asian migrants, portraying their presence as a security risk by pointing to the racist attacks against them as they arrived. It is important to note that the types of justifications used by the state at that time to limit the migration of black and brown migrants have been used repeatedly to the present day to justify stricter bordering processes.

The government’s response was the 1962 Immigration Act which marked a watershed in the politics of racism in Britain, because whilst its wording did not signify race, it was worded in a way that would reduce the numbers of black and brown people coming to Britain. The Act did not remove British subjecthood but stipulated that only those who had a passport issued by Britain or Ireland, not an ex-colony, could enter Britain, in addition they had to be in possession of a work voucher. This combined with the Commonwealth Immigrants Act 1968 (which was passed within 3 days in response to the Kenyan refugee crisis) because after independence Kenyan passports were issued by Britain, which meant that entry to Kenyans was not restricted by the 1962 Act. The 1968 Act dealt with that anomaly by restricting entry to only those from the Commonwealth who had one or two generations of grandparents born in Britain, it was highly unlikely that black or brown people would have ancestral links to Britain.

Nadine El Enany in her book (B)ordering argues that “The effect of the 1968 Act was to create a group of citizens of the United Kingdom and Colonies who did not have an immediate right of entry into Britain despite that the only passports they held were British. Two hundred thousand East African Asian British passport holders were abandoned, made stateless” – a complete disregard for a group fleeing persecution.

The 1971 immigration Act introduced the partiality rule which again restricted primary immigration of black and brown people. At that time 98% of people born in Britain were white. The 1981 Citizenship Act like the immigration acts of 1962, 1968 and 1971 made no reference to race but was racist in its effect. It created the category of British citizen which could only be granted to those born in Britain if at least one of their parents was a citizen. It also included a requirement of ‘good character’, again it should be noted both of these criteria have been used to justify recent deportations of people who have lived in Britain since they were children.

Since primary immigration ended, the British state has created entry paths for migrants who are deemed to be deserving and useful, thus migrants are not just bordered but hierarchically ordered according to their perceived value to the economy. Skill shortages were met by introducing the Highly Skilled Migrant visa, which is a lucrative way of encouraging migration of only those who possess the skills that are needed in Britain, the criteria are determined by the Home Secretary. Britain has since the 1950’s recruited doctors and nurses from the continents of Africa and Asia to fill shortages within the NHS and continues to do so.

Thus, though we see that the needs of capital supersedes the need for certain forms of racism, racism doesn’t stop, it is done differently. It was reported in the Guardian that “20% of the more than 1.2 million staff employed by the health service were BAME, compared with 14% of the general population of England and Wales (based on the last census). The proportion increases to 44% when it comes to medical staff. The latest figures show that 43% of senior NHS doctors and 47% of junior doctors were BAME”.

Many of the migrant workers in the NHS are on such visas and it is ironic that those who are risking their lives for ‘us’ pay for that right in the form of visa fees yet do not have the same rights as British citizens, including no rights to unemployment related benefits. Moreover they are required to pay towards health insurance to use the NHS and if they die their families have no right to stay in Britain.

The need for low waged and ‘unskilled’ labour has in recent years been met by migrants from predominantly Eastern European states, Brexit was meant to put an end to that but the need for about 70,000 workers to pick fruit and vegetables during the Covid-19 pandemic, which has resulted in British workers being sick or in lockdown, has resulted in charter flights being organised from countries such as Romania, another example of the racist narratives around East European migrants being withdrawn by the Brexiteer groupings within the state because of looming economic decline – including farmers going out of business resulting in potential food shortages.

It is clear from the analysis of the history of immigration legislation that racism is used flexibly to include and exclude migrants based on the ‘value’ the state attaches to them. Migrants are thus defined and placed on a spectrum of deserving and undeserving. This is how the good immigrant and the bad immigrant is created, the good immigrants are now our doctors, nurses and carers; they are separated from the bad immigrant who is defined as the ‘bogus asylum seeker’.

The Home Secretary Pritti Patel has recently said that any NHS staff who are due to renew their visa’s this year will no longer be required to do so and can wait until next year. This is because the good immigrant is needed to save lives during the pandemic. As more and more NHS staff lose their lives as a result of the inadequate response of the government to the Covid-19 pandemic, it is absolutely imperative that we demand that all migrants working in the NHS are given permanent citizenship, should they want it, in order to clearly demonstrate that they are part of Britain and not good immigrants here just to serve ‘us’. It’s time to break the logic of racial immigration and citizenship policy.

Picture courtesy of byronv2

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