One bitter absurdity now sits at the heart of British life. It centres on the NHS, our strained systems of social care and an ever-more toxic and hateful conversation about immigration. Without hundreds of thousands of people who have come to the UK from abroad, the most basic aspects of how we look after old, infirm and ill people would simply collapse. Politics, however, increasingly seems to demand that this truth has to be denied – and the result is a level of hypocrisy that is remarkable even by modern standards.
Three weeks before last Christmas, my dad – who turns 89 next month – fell down a flight of stairs, and broke his hip. After a terrifyingly long wait for an ambulance, he was admitted to hospital in Macclesfield, Cheshire, and operated on. In the midst of yet another awful NHS winter, the treatment he received felt faintly miraculous. And there was another aspect of his stay that seemed no less remarkable. Macclesfield is hardly the most diverse place in the world, but most of the doctors and nurses who so carefully looked after him were first-generation immigrants, mostly either from African countries, or India: people regularly overburdened and rushed off their feet, but who answered my endless questions and queries with an amazing grace and patience.
My dad was on the orthopaedic trauma ward for six long weeks. And from my first visit onwards, my mind began boggling at the scenes quietly playing out around us, which are surely similar all over the country. When I glanced at my phone, or heard a news bulletin blaring from another patient’s iPad, the headlines were often about the current political obsession with immigration and integration. Each morning, a trolley laden with newspapers would appear, and the most popular choices were the Mail and Express, whose pages were – as ever – regularly full of warnings about influxes of foreigners, and a country supposedly falling apart. In the most visceral way imaginable, what was happening in front of our eyes disproved just about all of it, but the contradiction simply sat there: one more howling British inconsistency, in a country brimming with them.
Midway through January, I began to get acquainted with another place: a care home in the outer Mancunian suburbs, to which my dad was transferred for physiotherapy and rehab. I have been there a lot lately. Just about all the clients and patients are of the ethnicity we classify as white British – while, once again, most of the staff are from abroad. My dad’s most regular care worker came to the UK from the Indian state of Kerala. The people in charge are mostly from the Philippines. They carry out duties that would leave most of us wondering where to start: lifting people out of bed and easing them into long and painful days; providing constant friendship and comfort; answering endless cries for help.
Twenty-eight per cent of NHS nurses are non-UK nationals; among doctors, the figure is 35%. In London, the relevant share of health-service personnel is 30%. The figure among English social care workers is reckoned to be as high as 32%. But as of March last year, migrants in that line of work have been subject to a cruel new rule, whereby they cannot bring any dependents to live with them: the result has been a sharp decline in both the number of approved health and care worker visas, and applications for them. You can join the dots from that development to another story. Around one in seven NHS beds is said to be occupied by someone well enough to be discharged, but waiting for social care. In the latter sector, the most recent estimates suggest that there are 130,000 job vacancies. The chief executive of Care England, Martin Green, says the dependents ban is “shortsighted and profoundly damaging”. This is the proof.
But the grim Westminster mood music continues; in fact, it is rapidly turning completely poisonous, across the political board. Last year, Kemi Badenoch was asked about her stance on immigration, and her answer reduced care work to a crass cartoon: “We need to make sure we are thinking about the next generation, not just who’s going to wipe bottoms for us today.” She now wants to force people from abroad to wait 15 years before they can apply for British citizenship, while also denying permanent residency to anyone who has claimed benefits or social housing. Clearly, this is what happens when conservatism is dragged constantly rightwards by Reform UK, a party that wants “net zero” immigration, and whose leader was recently heard telling farmers protesting about changes to inheritance tax that the government wants to acquire “lots of land because they’re planning for another 5 million people to come into the country”.
The Labour party is obviously feeling the same pull. The last couple of weeks have illustrated what Keir Starmer and his colleagues think is going to get them out of their current hole: pursuing his promise to “reduce immigration – legal and illegal”, charging the Tories with running what he rather mendaciously calls an “open borders” experiment, and making sure eyes are averted from the practical consequences of a tacit return to the so-called hostile environment. With the prospect of tightened public spending, the possibility of a more constructive agenda – reducing the political salience of immigration by building social housing, ending local austerity, or finally reforming and boosting a threadbare care sector so more British-born people take jobs in it – feels like it is falling away. Instead, the UK may be about to learn the same lesson awaiting large swathes of Europe, and the US: that particularly in ageing societies, effectively hanging up a sign that reads “migrants not wanted” is never the cleverest move.
When human beings are dependent on others for the most essential needs, the most moral response ought to be gratitude. But dependency also tends to trigger resentment and anger, which I think is part of the contemporary British condition. It is not that long since millions of us stood outside our houses and gave “key workers” a vast round of applause; now, our politicians seem set on telling a lot of them that they are either not wanted, or only allowed to be here on the basis of miserable and inhuman restrictions. Westminster, in fact, seems to be fixed on a future that Badenoch, Starmer and Nigel Farage may eventually be old and infirm enough to directly experience. I keep picturing a care home call button being frantically pushed, and no one coming to help.
John Harris is a Guardian columnist
