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Homunculus of the Empire

Saurabh Jha on how immigrants from the Indian subcontinent rescued Britain’s National Health Service a quarter of a century after it was born

Saurabh Jha Published 05.07.23, 06:24 AM

When my father first arrived on British shores to work in the National Health Service (NHS), he recalls limited culinary choices — he ate fish and chips for a month and that’s it. His colleagues were from Pakistan, Sri Lanka and Kenya. This debonair cosmopolitan was a mining town in Wales, where the only non-white people were doctors and their families.

Shortly after Independence, and the beginning of the decline of the Empire, Britain embarked on an ambitious social project in which it would provide its citizens healthcare free at the point of use. The chronological juxtaposition of these two events, superficially unrelated, isn’t coincidental. Twenty-five years after the birth of the NHS, doctors arrived in droves from the Indian subcontinent, to serve the NHS, and save it from being asphyxiated by penury.


Most of my father’s classmates from Patna Medical College and Hospital, moved to the UK. My father wanted the coveted imprimatur of British medical education — membership of the Royal College of Physicians. The Brits had left India but the allure of their institutions still remained in popular imagination. When my father became a member, fireworks exploded in his native village in Bihar in celebration. My father attempted relocating to Bihar, just as he had resolved. But the NHS had made him morally prickly. He was repelled at the thought of charging his patients for his services, and he returned to Britain promptly.

The NHS isn’t free. It’s paid by national insurance, a form of social insurance used in erstwhile mining towns, where its founder, Aneurin Bevan, was born. The NHS wasn’t so much a socialist project, as many believe, as much as an insurance project. Ironically, the NHS was born when war-torn Britain was at its economic nadir. Britain’s expansionism had contracted and it began introspecting. Socialism was on the march.

Britain resisted communism’s allure with its unique mutation of ideology — Fabian socialism, a popular if somewhat elitist movement that wanted the best of capitalism and the bestof socialism. The Fabians wanted free healthcare for economic reasons. No person, they felt, should be made bankruptby illness. The welfare statewas a sort of iron curtain, inoculating Britain from full blown communism.

Soon after the NHS’s birth it became apparent that the costs of running a free healthcare system had been underestimated. Since then, the NHS has grappled with costs partly by welcoming foreign-trained physicians. Noting the shortage of doctors in primary care in far flung places in Wales and Scotland, where British medical students didn’t wish to practice, Britain invited foreign medical graduates and many arrived from the former colonies. Indians and Pakistanis who never rubbed shoulders with each other after the Partition were now on the same side in British hospitals. The NHS, the last sigh of the empire, became a homunculus of the commonwealth.

The contribution of foreign doctors to the NHS extended beyond the first generation. Many of the children of physicians, the subsequent generations, became physicians and served the NHS. Bevan didn’t foresee that the NHS was possible only because of Britain’s colonialadventures, but with a twist —it was the colonised who became the colonialists; good colonialists, who served without expropriating.

History continues to mock Britain. Now many of its medical graduates flee to Australia and Canada for better opportunities, leaving the NHS, which is in dire straits, even more dependent on foreign doctors.

When my father first arrived, foreign doctors faced explicit racism, particularly in towns where doctors were most needed. Racial tensions were exacerbated by the mass migration of Asians expelled by Uganda’s ruler, Idi Amin. Conservative MP, Enoch Powell, made the incendiary “River of Blood” speech in which he warned against mass immigration.

Foreign doctors were needed but unwelcome. There was a cognitive dissonance, still unresolved, between the needs of the NHS and the prejudices of the population who used it. The NHS couldn’t deliver Bevan’s promise on staple of homegrown physicians and nurses. Immigration may not have been in the NHS’s DNA, but it was its lifeblood.

Britain has evolved. Subcontinent cuisine is now arguably tastier in London than in the subcontinent. My father’s generation abandoned ambitions of getting into coveted specialties such as cardiology and neurosurgery, which were reserved for British medical graduates. They were shunted to jobs and locations the Brits rejected. My father, an unapologetic Anglophile who feasts on British comedy, is still grateful to Britain for his professional opportunities and the educational opportunities it has given his children.

The next generation of British Asians don’t have to abandon their ambitions and are increasingly becoming cardiologists and neurosurgeons. They’re also increasingly intolerant of racism, even the implicit variety. Racism in the UK has been blighted but not extinguished. For instance, the physician regulatory body, the General Medical Council, disproportionately punishes doctors from ethnic minorities. The NHS is considered a national treasure, and rightly so. But few acknowledge that they enjoy such jewels only because of the immigrants.

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