The NHS and Nationalism

Written by: Asher Conway

The NHS exists today Britain’s sole unifying institution. In the absence of any one national identity, ethnicity or shared set of ideals, the NHS has emerged as a central pillar of modern British identity. Whilst divisions in public opinion have emerged in recent years over ancient institutions such as parliament, the military and even the monarchy, the NHS remains sacred as a political concept. In 2018, a YouGov poll found that the NHS is the institution that Britons are second most proud of, far surpassing that of the monarchy and lagging behind only the uncontroversial fire brigade. However, this has meant that as the importance of the NHS in Britain’s own idea of itself has grown, so has its use as a conduit through which British nationalism can be expressed.

Because the stated purpose of the NHS is to provide healthcare ‘free at the point of use’ to all those in Britain who require it, the service has become for nationalists the single most effective means of inducing the British public to delineate who belongs to the British nation – and who is entitled to the benefits that come with it – and who doesn’t. Much of the immigration debate in Britain, the issue British nationalism is chiefly concerned with, revolves around the NHS – its capacity to provide for an increasing population; it’s neglect in favour of foreign aid and EU funding; and even the ethnographic makeup of its beneficiaries. Although NHS nationalism originally was the preserve of the UK’s far-right fringe, as the rhetoric has intensified in the last decade, it has gradually perforated into mainstream political discourse.

The deep irony underlying the far-rights’ invocation of the NHS as a tool of nationalist rhetoric is that the institution was established on firmly socialist principles. Spearheading the introduction of the welfare state when it was created by Attlee’s Labour Government in 1948, the NHS was intended to provide fair and equal healthcare access to a nation emerging from the ruins of the Second World War. Part of why the service came to be so central to British identity is that its introduction was accompanied by the disintegration of the British Empire in the immediate post war years. In this transformational period, the ambiguous strands of British identity that coalesced around the empire project began to unravel – being subsequently supplanted by the promise of the welfare state and its implied social contract. British identity now awarded the citizen with tangible rights and benefits through access to social provisions. Thus, the NHS naturally became the political football over which questions of British identity were argued.

Even as much of the welfare state was subsequently dismantled by the Conservative Governments of the 1980’s and 1990’s, the NHS remained sacred and protected. Margaret Thatcher’s famous 1982 promise that the NHS is ‘safe in our hands’ reflected the fact that, for all their reformist ambitions, the British Governments of that era recognised the sanctity of the health service in British life, security and identity. When the next wave of public-sector cutbacks came in form of austerity in the Coalition Government of 2010-2015, the NHS was once again spared, for fear of alienating large swathes of the electorate. Nevertheless, one concomitant effect of this ‘age of austerity’ was that immigrants, and their alleged exploitation of the NHS’s generosity, became the focal point of the wider political debate about immigration.

The attention of British nationalist parties turned towards the NHS in the politically tumultuous years following the 2008 financial crash. With much of government policy hinging on a perceived lack of funds, nationalist figures began to question the capacity of the country, and more specifically the NHS, to withstand more immigration. In 2009, the fascist British National Party, then in its brief ascendancy, caused controversy when it distributed millions of leaflets displaying a quote from a supposedly anonymous doctor about how immigration is destroying the NHS, prompting a stern response in the medical journal The Lancet. This was accompanied by an increase in coverage of cases of ‘health tourism’ in the years of austerity by right-leaning tabloid papers such as the Daily Mail and the Daily Express, with one headline reading ‘Foreigners using NHS cost Britain up to £2 BILLION a year’. The effect of such rhetoric relating continued problems existing within the NHS to immigration figures was substantial. Despite the fact a significant proportion of NHS workers are themselves foreign born, one 2015 poll found that two thirds of Britons believe migration has a negative effect on the NHS.

The BNP’s 2009 Poster

By repeatedly denigrating the effects of immigration on the ability of the NHS to function fairly and effectively, nationalist figures within British politics have been able to force debates about identity through the prism of ‘protecting’ one of Britain’s most beloved institutions. This narrative has then been picked up by aspects of the press, who are all too keen to portray the NHS as being exploited by, and under attack from, external forces. This was most pertinently expressed by then UKIP leader Nigel Farage, who in a 2015 election debate, after highlighting the problems of health tourism for HIV treatment, declared “we have to put our own people first”.

The use of such rhetoric has two interrelated consequences: by constantly referencing the NHS in seemingly separate policy discussions, the NHS is solidified as being one of the core elements of British identity; but by then pushing for a public debate about whom should be entitled to such benefits, nationalists force the public sphere to consider who are “our own people”, and who are not. The discussion elevates the significance of the NHS far beyond what it actually is – merely a healthcare service – and construes it as a more abstract representation of British identity, and the rights it confers onto those who possess it Eventually, much of political discourse surrounding identity in Britain inevitably turns towards the future of the NHS, and who should be granted the privilege of access to it.  This was most ominously displayed in the run-up to the 2016 Brexit referendum.

Boris Johnson’s infamous red bus during the 2016 Vote Leave Campaign

When Boris Johnson travelled the country in the now infamous red bus emblazoned with the message “We send the EU £350 million a week, let’s fund our NHS instead”, it represented the co-opting of nationalist rhetoric about the NHS by mainstream British politics. Despite the inaccuracy of the claim, it was one of the few campaign messages to really resonate with the public consciousness. It ensured that what had been a peripheral debate about the convoluted process of EU funding was now seen in relation to only one thing – the NHS. Soon after that, Michael Gove, Johnson’s ally in the Vote Leave campaign, said in a speech that EU immigration, specifically six million people emigrating from Turkey, would make the NHS “unsustainable by 2030”. Campaign slogans about external threats to the NHS were no longer exclusively deployed by the right-wing nationalist fringe, they had become the principal message of some of the UK’s most prominent political figures. Whether these two figures – who previously had been seen as relatively liberal Conservatives – actually believe in the rhetoric they’ve adopted is largely irrelevant, because as Johnson’s 2019 landslide electoral victory demonstrates, it’s certainly proven to have been effective.

The Coronavirus Pandemic of 2020 has increased the importance of the NHS in the lives of the British public more than ever before. Collective rituals usually reserved for remembrance of the victims of war have been adopted as a means of thanking workers in the NHS. Public messaging campaigns urge social distancing for the purpose of ‘saving the NHS’, once again showcasing the centrality of the NHS to British political life and identity. In this time of intensified danger, where global migration has almost shuddered to a halt, NHS nationalism has mostly subsided with it. But in post-pandemic Britain, where the economic effects of the recent recession and Brexit are slowly borne out, the strong link between nationalist rhetoric and healthcare can be expected to make a resurgence.

Editor: Victor Wascher