The future of the NHS depends on workers' freedom of movement

08 Oct 2016
There are 100,000 overseas doctors in Britain working for the NHS and the Tory drive towards a foreigner-free workforce of doctors would be a disaster, says Diane Abbott.
When Jeremy Hunt announced his stupid and anti-foreigner plan for Britain to become “self-sufficient” in doctors, he also included a reactionary new measure to be imposed on British-trained doctors. From now on, under the Hunt plan, doctors trained in this country will have to work in the NHS for four years. Otherwise, they will have to repay the cost of their training, which the British Medical Association estimates at over a quarter of a million pounds minimum.
This demonstrates a general law that the labour movement has understood for a long time: an injury to one is an injury on all. We must make clear that it is not immigrants that drive down wages. Predatory employers, insufficient workplace protection and weakened trade union rights do that. Regressive measures which are an attack on overseas workers always rebound and include regressive measures against domestic workers too. In a failed effort to restrict overseas workers the Tories are ordering restrictions on workers trained here too.
For the NHS, the drive towards a foreigner-free workforce of doctors would be a disaster. There are 100,000 overseas doctors in Britain. At the same time there is already a significant shortage of doctors. We should be training more doctors and other health professionals in this country, just as we should be training all sorts of skilled and highly skilled workers across a range of sectors. But the idea that that we could or should seek to eliminate overseas doctors from the NHS and become “self-sufficient” is a reactionary fantasy.
Even if all of Hunt’s additional new 1,500 British-trained doctors don’t drop out, and even if he successfully forces them all to work for four years, this still would not cover the retirement rate of existing doctors and the growing demand for them as the population grows and ages. We will need overseas doctors for generations to come.
This means that we should be offering guarantees for all overseas workers currently working here. It is a scandal that Theresa May and Liam Fox want to use their status as a “bargaining chip” in negotiations with EU countries. But these existing workers here will also need replacing, and we cannot force British-trained doctors to work here indefinitely. We need freedom of movement for doctors and other health professionals for the continued existence of the NHS.
The demagogic campaign against foreigners that was first championed by Ukip and is now mainstream Tory policy obscures a key point. Freedom of movement is a workers’ right. In all societies where there are significantly greater freedoms for business and for capital than for workers, then in practice workers’ rights are severely curtailed. Business is at a huge advantage. This reaches an extreme in the most authoritarian countries. So for example, the “pass laws” in apartheid South Africa made black workers non-residents without rights even as they were graciously allowed to suffer the most brutal exploitation in the mines and elsewhere.
Even in this country, the Poor Laws formerly restricted the movement of workers within Britain from one parish to another. They could not seek poor relief outside their own parish if they were unemployed and went looking for work. The Poor Laws were only effectively abolished by the Labour government in 1948.In all these cases, business was able to freely establish wherever it chose. The effect is that workers’ bargaining rights were severely curtailed, in some cases eliminated. They had to accept whatever jobs, and at whatever wages and terms the employers in their locality chose.
This is one of the key, overlooked issues in the current widespread assault on the freedom of movement.
Economists for Brexit, the only grouping which produced economic arguments in favour of Leave, argued that British manufacturing would be eliminated by the adoption of free trade and that inequality would widen dramatically as financial services would grow dramatically. This may be an exaggeration. A more sober analysis from the UK Treasury is that in a European Economic Area agreement, government finances for services like the NHS will be £20 billion lower after 15 years, while falling back on World Trade Organisation rules reduces government finances by £45bn. Public services would be decimated. This Tory government is scapegoating foreigners to distract from its own complete failures of policy. Living standards are falling because of them, not migrants. The labour movement cannot accept living standards being lowered by Brexit and the attack on freedom of movement, and must stand to defend both.

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