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As we emerge from a global pandemic that has turned our world upside down, David Olusoga explores the hidden history of the nurses, doctors and health workers who, for more than 70 years, have been coming to Britain from overseas to serve in the NHS. Without them the NHS would have been in danger of collapse - not least during the current COVID crisis - but from the very start the story of this beloved British institution has been intertwined with one of the most divisive social and political issue of the age, immigration. The people who came to this country to work in the NHS have found themselves fighting battles they neither sought nor expected.
Today, more than 13 per cent of the 1.2 million people who work for the NHS are from overseas, representing 200 different nationalities, and in England and Wales more than 40 per cent can claim minority ethnic heritage, making the NHS the most diverse of all British institutions. The programme gives voice to the moving and often raw experiences of nurses from the Irish Republic, the Caribbean and the Philippines, GPs and surgeons from India, Pakistan and Sri Lanka and paramedics from Central Europe, as well as to the British-born children and grandchildren of immigrants who have found themselves helping and healing with one hand while fending off the sharp end of discrimination and racism with the other. Ultimately, their stories say as much about perseverance, dedication and the overcoming of obstacles as they do about discrimination and prejudice.
Today, more than 13 per cent of the 1.2 million people who work for the NHS are from overseas, representing 200 different nationalities, and in England and Wales more than 40 per cent can claim minority ethnic heritage, making the NHS the most diverse of all British institutions. The programme gives voice to the moving and often raw experiences of nurses from the Irish Republic, the Caribbean and the Philippines, GPs and surgeons from India, Pakistan and Sri Lanka and paramedics from Central Europe, as well as to the British-born children and grandchildren of immigrants who have found themselves helping and healing with one hand while fending off the sharp end of discrimination and racism with the other. Ultimately, their stories say as much about perseverance, dedication and the overcoming of obstacles as they do about discrimination and prejudice.
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00:03In the middle of a global pandemic that's turned our lives upside down, we made time
00:09to show how we feel about the National Health Service.
00:16It was a spontaneous display of affection for a unique and uniquely British institution
00:24that promises to be there for us from cradle to grave.
00:29The NHS first opened its doors on the 5th of July, 1948, and within a month, 97% of the
00:37British public had received these, their new NHS medical cards, simple little documents
00:43that represented an enormous transformation in people's lives.
00:49On July 5th, the new National Health Service starts, providing hospital and specialist
00:55services, medicines, drugs and appliances, care of the teeth and eyes, maternity services.
01:02Are you sure I don't have to pay anything for all this?
01:05Nothing.
01:06Among the people we applauded were tens of thousands of health workers who have sometimes
01:11been overlooked in histories of the NHS, but whose contributions have made the service
01:17what it is today.
01:19Morning, everybody.
01:20Morning, everybody.
01:33Morning, everybody.
02:07This is the last one to go on.
02:20In this film, I want to understand the experiences of people who migrated to this country to serve in the
02:28NHS, and those of the children and grandchildren of immigrants who followed in their footsteps.
02:36I'll be exploring their struggles.
02:39I was invisible. I'm not seen. I never want anybody to have that experience.
02:45It was very hard to deal with, and I remember one of the ways I dealt with mild trauma was,
02:52go to the dance hall.
02:54And marking their achievements.
02:56Well, that's the operation now. We'll clean up and put a dress in.
03:00When you've done a good transplant, and you know when you see it's functioning, you realise you're starting a new
03:09life for them.
03:10I'm going to open up government archives to discover how they were seen by a system that needed them, but
03:17didn't always want them.
03:18West Yorkshire graduate of British University required. Meaning that if you're brown and if I'm abroad, don't bother applying.
03:29If these women were used in parts of the hospital which brought them into direct or indirect contact with patients,
03:36there might be serious complaint.
03:40Serious complaint?
03:43From the very start, the NHS was only able to deliver on its promises by drawing into its ranks nurses,
03:51doctors, auxiliaries from other countries.
03:54And what that means is that the history of our most beloved national institution is intimately connected with another history.
04:02That of the most divisive political issue of the past 70 years. Immigration.
04:10From the Beveridge Report to the Covid pandemic, the story of the NHS has given us much to celebrate.
04:17But it's also the story of the many difficult questions that the NHS raises about the country we are and
04:24the country that we aspire to be.
04:44In January 2011, Yvette Phillips was admitted to the Royal Free Hospital in London for a life-saving kidney transplant
04:53operation.
04:55It was called a freeway swap. My husband had wanted to give me one of his kidneys, but it wasn't
05:01a good match, so we went into the freeway swap.
05:04You have three donors, three recipients, so therefore on that one day, six operations are done together.
05:12The lead surgeon for Yvette's transplant was Bimby Fernando.
05:16I think that's the miracle of it, the fact that something that's fantastic becomes routine. And I think, you know,
05:23the NHS is absolutely brilliant at achieving that.
05:26All on the NHS, every little bit of it. I'm worth a lot of money on the NHS.
05:33Yvette's operation was made even more special by a unique personal connection that straddled continents and stretched back more than
05:4230 years.
05:44I asked for Bimby to do it because his dad done my first one in 1977.
05:50It's the evening of January the 18th and Ozzy Fernando arrives at the Royal Free Hospital in Hampstead.
05:56With him, he carries a very important package. It contains two human kidneys.
06:02My name is Oswald Nihal Fernando. I was born in Sri Lanka. And I came to this country in 1963.
06:15And I worked in the NHS ever since I came here.
06:21Mr. Fernando is a surgeon. And in the very ordinary way in which real dramas happen, his job this evening
06:28is a matter of life and death.
06:33Gosh, where did you find that phone? That's amazing. I got black hair.
06:45Ozzy Fernando and his wife Talu came from Sri Lanka with their two sons, Chris and Rohan.
06:57Bimby Fernando was born here four years later and would follow in his father's footsteps to become a transplant surgeon
07:05at the Royal Free Hospital.
07:06So you came initially for what, four years?
07:10It was going to be just two years. Just two years.
07:13Just to get the exams, have a holiday and go back.
07:17That time didn't pan out. It didn't pan out.
07:20The Fernandos came to Britain seeing it as the best place to fulfil Ozzy's long-standing ambition to train and
07:28qualify as a surgeon.
07:30A year earlier, new laws intended to reduce what was called coloured immigration from Commonwealth countries had been introduced.
07:39But, as Ozzy discovered, when he went to arrange his visa, some Commonwealth immigrants were more welcome than others.
07:47Well, the chap at the desk said, you're going to England and we're very short of doctors.
07:55Why don't I get you a work permit which will allow you to work, not just do your course and
08:02get the exam?
08:04And I told him, you know, we are sailing in ten days' time.
08:09And he said, leave it with me.
08:12Ozzy and his family settled in Britain and in 1968, now qualified as a surgeon, Ozzy got his big break,
08:20joining a new kidney transplant team at the Royal Free Hospital.
08:25I was happy to be there. I was there right when it started.
08:33For Ozzy's patients, a transplant meant release from life-saving but debilitating dialysis treatment.
08:41At that time, they'd only just started dialysing children. Many of us were guinea pigs.
08:46For a ten-year-old, to sit for four hours is not fun.
08:52Just, dialysis just never agreed with me. It just didn't.
08:57And their growth is gone, they miss their schooling, their appetite's gone, and it's only a transplant that will help
09:08them to return to normality.
09:12We were dialysing one day and this consultant came round.
09:17And I didn't know at the time, it was Ozzy, Ozzy Fernando.
09:21And then he said, I understand we need to get you a kidney in quite quickly.
09:26It was Friday the 13th of May, 1977, so it's good luck day for me.
09:31My mum answered the phone and I just heard her scream, they've got a kidney for you.
09:39I'm trying to be up now.
09:44Is everything perfectly straightforward and successful so far?
09:48So far? I'm quite pleased.
09:51A good healthy kidney?
09:53Yes, looks nice.
09:57Right.
10:00Well that's the operation, now we'll clean up and put a dressing.
10:04When you've done a good transplant and you know when you see it's functioning, you realise you're starting a new
10:13life for them.
10:16It was just, it was life changing, completely life changing.
10:22I never thought I'd get married.
10:25I never thought I'd pass my driving test, I never thought I'd have a job.
10:29I never thought that I would certainly have a daughter.
10:35We called her Kayleigh and her middle name is Fern.
10:39And the Fern is after Mr Ozzy Fernando.
10:43When you look after people, when you care for people and when you support people,
10:49you know, you form these lasting bonds that never go away.
10:54Also, it's just absolutely wonderful to be part of her life and see what happens to her.
11:02It became necessary for her to have another transplant.
11:06At the time when I had it done, they gave it five years.
11:09It lasted 34 and a half years.
11:13And it only failed because of wear and tear.
11:15I'd worn it out, I think.
11:18And she then contacted me and said, I'd like you to do it.
11:22And I said, look, I'm retired now.
11:26And then he said, well, in which case I'll want the other Fernando to do the operation.
11:32Bimby.
11:33Bimby Fernando.
11:34I was adamant it was Bimby.
11:36Hello.
11:37Hi, Bimby.
11:38So, Yvette, how are you doing?
11:40You keeping well?
11:42I'm all right.
11:43Yeah?
11:43Not bad.
11:44Yes.
11:44And this is the first time I've spent quite a long time with my dad as well.
11:49So, you know, just seeing him.
11:50This is one of those stories that helps to explain why we feel the way that we do about the
11:56NHS.
11:57The transformation of one individual's life by the delivery of free universal healthcare.
12:03But this story of Yvette, Ozzie and Bimby, it contains a transplant of a very different sort.
12:11The migration of one family from Sri Lanka to Britain 60 years ago.
12:16And that migrant family, the Fernandos, they have been contributing to the nation's health and wellbeing ever since.
12:24And that contribution is far from unique because migration has always been part of the story of the NHS.
12:32From even before it was officially launched.
12:39To find out more about the international roots of the NHS, I've come here to Plumstead High Street, close to
12:47London's docks.
12:49In 1926, a young Parsi doctor, Feridun Bumla, arrived here from Bombay to set up as a GP.
12:59His two sons, Ruintan and Darius, would take over the practice after the Second World War and play active roles
13:07in the creation and establishment of a national health service.
13:12Today, Ruintan's children, Saraya and Cambys, work as NHS GPs just across the river in Tower Hamlets.
13:21And the surgery on Plumstead High Street is a place of family pilgrimage.
13:31So the NHS, I mean, the story of healthcare in this country is kind of a family history for you
13:36guys.
13:36It's very much a family history.
13:38Over three generations.
13:40Three generations.
13:41And now my daughter is training, is almost at the end of training to be a GP now.
13:45So a fourth generation.
13:46She will be the fourth generation.
13:48And it began here.
13:50It began here.
13:52And why, why this part of London?
13:56Our grandfather had quite a posh practice in Bombay, but he found that the unequal rate of exchange meant that
14:06he couldn't buy as affluent as a practice as he'd been hoping to.
14:10And you got this.
14:11These were the practices that no one else wanted to work in.
14:14The practices where you couldn't make a lot of money and you...
14:18Because they weren't rich patients.
14:20Because they weren't rich patients.
14:21Most, this was pre-NHS when people would have to pay for their, for their care.
14:29Our granny would say how people would come and put a chicken on the doorstep.
14:32Because they couldn't afford the medical bill.
14:34Because they couldn't afford the medical bill.
14:35So things changed so much after when the NHS came in.
14:38Yeah.
14:39It's a big, big change in point.
14:41Have you chosen your family doctor?
14:43If not, ask your doctor now if he'll look after you under the new scheme.
14:49Now don't forget.
14:50Choose your doctor now.
14:54Your father is a, was a GP.
14:57And that of course is how most people access the new NHS.
15:01I mean the GP surgery is at the centre of this, this revolution in healthcare.
15:04GPs are the sort of gatekeepers of the NHS.
15:08Determining how best to channel patients, who needs to go to hospital, who doesn't.
15:14But, just at the point when the cash-strapped NHS in those early years
15:20was trying to establish and establish general practice as the, as the bedrock of the NHS.
15:30There weren't the doctors to go into these sorts of areas.
15:33So without the contribution of Asian doctors, it would never have got off the ground.
15:41As the result of much intensive study into questions of social security,
15:45Sir William Beveridge is the recognised authority on present day and post-war problems.
15:51Staff shortages were built into the foundations of the NHS,
15:55starting with the Beveridge Report itself, published in December 1942
16:01and offering a first draft of a post-war welfare state,
16:05with a cradle-to-grave health service at its heart.
16:10The report proposes an all-in scheme of medical treatment of all kinds for all citizens.
16:21The Beveridge Report was the blueprint for a new and better post-war Britain.
16:28And key to building that brave new world were women.
16:32Because at the heart of the Beveridge Report was an assumption,
16:36one that was made by its author, William Beveridge, and by many people at the time.
16:41And that was that the vast majority of women who, during the war,
16:45had worked on the land, in industry, in clinics and hospitals,
16:49would, once the war was over, want to leave work, get married,
16:54become housewives and have children.
16:58Never has having a baby been more popular.
17:01Sometimes they come in twos.
17:05Sometimes in threes.
17:07In the next 30 years, Beveridge said,
17:11housewives, as mothers, have vital work to do
17:15in ensuring the adequate continuance of the British race
17:19and of British ideals in the world.
17:23And if they didn't, Beveridge warned, the British race cannot continue.
17:29But if British women were having British babies
17:32or taking on less demanding work in factories, shops and offices,
17:37who would look after the British race when it fell sick?
17:40Nurse! Nurse, I want you!
17:44Yes, our nurses are busy and overworked because there aren't enough of them.
17:49Many hospitals have closed wards because of that.
17:53Who will help?
17:55To make up for the inevitable shortfall, nurses were recruited from overseas,
18:01starting with the place that had supplied labour to Britain so often in the past, Ireland.
18:09This is a file of documents produced by the Ministry of Labour in 1944,
18:15so before the NHS had been created.
18:19And this one lists the types of roles within the existing British healthcare system
18:25that women from Ireland were expected to fill.
18:28And it says that there is a serious shortage of nurses,
18:32especially in mental hospitals, sanatoria, fever hospitals and public assistance institutions.
18:40And that there is considerable scope for recruitment of experienced nurses
18:45and of new recruits to the nursing profession from among women in Ireland.
18:50These roles, working in sanatoria and fever hospitals,
18:55these are just about the most undesirable jobs in healthcare in the years after the Second World War.
19:02And that's because it was in those institutions that people were treated
19:06for one of the most feared and dreaded contagious diseases of the age.
19:11TB, tuberculosis.
19:16Back in the 1940s and 50s, that disease was killing around 400 people a week in England and Wales.
19:27I'm meeting up with Moira Duckett, who, as Moira Mellott,
19:32first came to Britain from Ireland aged 18.
19:36I was brought up in a place called Connemara,
19:38and the first language there was Gaelic.
19:42I was the oldest of ten.
19:45So I had to be a very good girl and be a good example to everybody.
19:51But I also had this bee in my bonnet.
19:54I always wanted to be a nurse.
19:57And so I started nursing maybe 1956, maybe the end of 55.
20:05This was a period when a lot of girls were coming from Ireland.
20:09Can you tell me about the nurses that you trained with and where they came from?
20:12Well, most of the nurses I trained with were from Ireland.
20:15I think there was only one English girl in my school.
20:19But I thought, oh, probably the English students don't want to do it.
20:22It's hard work and it's badly paid and it's, you know, I just thought they don't want to do it.
20:29And the TB wards were one of the places where nurses from Ireland were often sent to work.
20:34Were there lots of Irish nurses on the TB wards?
20:36Well, everybody had to have their stint in TB as well as all the other wards.
20:40And sometimes you'd go back to it if they were short of staff.
20:45They were always short of staff.
20:47What were conditions like on the TB wards?
20:50There were 28 patients very near each other.
20:53Windows open all the time, of course.
20:55But we had masks.
20:57You'd have to make sure they were washed.
21:01You'd, um, kept their spittoons every, quite often.
21:08Your face still grimaces at the idea of the spittoons.
21:12It was very, it was not nice.
21:14But we had to do that.
21:16They couldn't help it.
21:19They would be spitting, coughing.
21:23They might start coughing up blood.
21:26They would be in hospital maybe for months and maybe years.
21:30And it was a big trauma and having to deal with going home and thinking somebody's very sick.
21:35And it was very hard to deal with.
21:38And I remember one of the ways I dealt with my trauma was to go to the dance hall.
21:46Listening to music, that was my therapy.
21:49You know.
21:52I'd sit somewhere where nobody could see me hardly in a corner.
21:56The way I went to every Bloomin' dance hall in London.
22:02The other thing that I recall, thinking back to my time, there was one girl from Jamaica.
22:10I don't know what her first name was because we always used surnames.
22:14And she was Rochester.
22:16And she was from Kingston.
22:18And I wish I could meet her now.
22:20She was wonderful.
22:21This is the Jamaican nurse?
22:23Nurse Rochester?
22:24Yeah.
22:25Nurse Rochester.
22:26If you watch this, I'm saying hello and I enjoyed your company.
22:34You're welcome.
22:35In the 1950s and 60s, the Caribbean islands were proving to be more fertile ground for NHS
22:41recruiters, particularly for nurses who came to Britain in their thousands.
22:48Carol Baxter made the journey from Jamaica.
22:52I saw a newspaper one day from a nurse who came back on holidays to Jamaica in the 60s.
23:01She left it on a bus and I picked it up.
23:04This was a British newspaper?
23:05A British newspaper.
23:06But it was talking about the NHS.
23:08And I got absorbed in that.
23:09And what I realised was that there's this service free of the point of contact from the cradle to the
23:15grave.
23:16And I think that's still a very, very noble thing to aspire to.
23:20And that's what brought me here.
23:22That's what brought me to the UK.
23:27From government archives, we've dug out a file that deals with something referred to as the Barbados Experiment.
23:34Launched in 1949, it was one of the first official schemes designed to recruit women from the Caribbean to come
23:41and work for the NHS.
23:44This advert appeared in the Barbados Advocate newspaper in 1949 for the employment of women as hospital auxiliaries, brackets, domestic
23:53workers in the United Kingdom.
23:56How would this advertisement have been interpreted by young women and their families in the Caribbean?
24:00It's a scheme to get people to come and do the serving jobs.
24:04The non-medical jobs?
24:05Non-medical, non-professional jobs.
24:07So that would be one understanding of it.
24:10But two, someone in the Caribbean, people knew the NHS was, you know, an important institution.
24:16They would probably see it as far more high status than it was.
24:19So they may well have seen this as a foot in the door?
24:23Yes, definitely. Definitely it was the talk.
24:26Who so-and-so's daughter has gone off to England to become a nurse?
24:29So nursing was kind of used as a bait.
24:33And the bait worked.
24:35There has been a terrific response, although it has been stressed all along, that only 33 girls are needed.
24:43We've had 531 applicants from which a choice is to be made.
24:47So 33 places, 531 applications?
24:52Hmm. Very competitive, yeah. So they, you know, they creamed off the best.
24:59As we work our way through the file, individuals start to emerge, as seen through the eyes of the officials
25:06who had brought them here.
25:08I would mention, however, that the girl, oh, there's a name here, Gwynny Violet Innes, is a secondary school girl
25:16of the middle classes.
25:18You may wish to note that Innes holds her school certificate and is therefore eligible for regrading as a student
25:26nurse.
25:26She may ask to do this at a later date?
25:29Yeah.
25:30So these are young women who are not going to see domestic service in the NHS as the limit of
25:37their ambitions?
25:39Exactly. So, yes.
25:40So this is a page from the Royal College of Nursing's Register of Nurses, and if you look under I,
25:48there is our Gwynny Violet Innes.
25:5227th of the 7th, 1953, at North Middlesex Hospital, London. So she's qualified.
25:59Wow. So that's a fantastic achievement. She came as a domestic within four years. The training itself took three. She
26:08proved herself.
26:09And she's registered as a nurse. What does that mean?
26:13There are two levels of nursing. There was the state registered nurse, which is the registration you get after doing
26:20a three-year training,
26:22and you had professional status, and you were, obviously, you were better paid, and you had a chance to progress
26:29to senior levels in nursing.
26:33There was another level in those days, which was called state enrolled nursing.
26:38You did a shorter course. I think it was two years. It wasn't as demanding. And you were there to
26:45deliver basic care and to be an assistant to a state registered nurse.
26:52But the majority of black nurses I met started out that way as state enrolled nurses.
26:58They didn't have that, those two levels in the Caribbean. You just, you're a nurse, you're a nurse. So you
27:04just applied for training as a nurse.
27:07People are a nurse. People are a bit more astute now in not being tricked in that way.
27:11I mean, is it fair to say that they were tricked?
27:13That's how it was seen by the women I met. A lot of the women were resentful and very, um,
27:18very upset and very distressed.
27:19So, Nurse Ennis in 1953 has been very lucky. Well, she beat the system, didn't she?
27:26But even with the higher state registered qualification, the system could still be stacked against black nurses.
27:35Many were channeled towards the unpopular so-called Cinderella specialisms, where opportunities for training and promotion were believed to be
27:44greater.
27:45I've come to Nottingham to meet Tryphena Anderson. She came to Britain from Jamaica in 1952 and took on one
27:54of the most challenging specialisms of all.
27:56Mental nursing, as it was then called. Working here at the Coppice Hospital, built in the 19th century as a
28:04so-called lunatic asylum.
28:07Never wanted to be a psychiatric nurse. I was channeled in that direction.
28:13Um, I wanted to be a health visitor. But being black, I knew I wasn't going to get it that
28:21easy.
28:22So, when I got the chance to come here, I knew I had to strengthen up my backbone. But it
28:31was the making of me, too.
28:34Morning, everybody. Good morning. And I'm very sorry I'm late.
28:38Louise Garvey, who arrived from Jamaica in 1957, also saw psychiatric nursing as a stepping stone towards the realisation of
28:48her real ambition.
28:49I wanted to be a ward sister. And I knew that I needed to have two certificates. And I got
28:58into the psychiatric nurse first.
29:01Um, if you have a determination and you knew what you wanted, you work out what needed, you need to
29:08do to get what you want. And of course, that's what I did.
29:14In an era before modern psychotropic drug treatments, working on the wards was emotionally demanding and physically dangerous.
29:22My sister and another nurse were on the spot before she could hurt me. It was over almost as quick
29:27as it started.
29:29Things become physical. And you could get beaten up. People would thump you for no reason at all.
29:36And of course, we have things in place. Like if you think someone is ill and might be physical, we
29:43had medication that you would have to sedate the person.
29:49Some of it was really heart rending, because it meant that you would have to have several staff physically holding
29:59someone down to give them the injection.
30:02A lot of it was heart rending, you know.
30:06But other challenges came from the hostility of some colleagues, particularly when black nurses began to win promotions.
30:14The white peep nurses used to get frustrated and says they don't know this and they don't know that.
30:22And they're always late, which isn't true.
30:28And if you should do anything wrong, it would be, you know, like a death sentence.
30:37They would sort of plan and come up with a lot of devious acts to try to get you this
30:44sack.
30:45You did reports, you wanted to sort out the client's notes and things, and they're supposed to be in the
30:52file.
30:53But when you come to go and get that to do your write up, suddenly they're not where they're supposed
30:58to be.
30:59And this was because they didn't feel comfortable working alongside black people, or they didn't want black people in senior
31:04positions?
31:05They didn't want black people in senior positions. They really hated it.
31:10They did say that.
31:22Sir Carter, we're going to come in.
31:24Certainly, nurse.
31:25Excuse the dustpan, I'm just clearing up the mess in the sitting room.
31:29As a black nurse, when you knock on the door, you'd be told in the earlier days...
31:37Um, I'm, nothing's wrong with me, I don't want you, and you get the door shut in your face.
31:43They would physically also hit you and hit your hand and say, I don't want you to touch me, your
31:51black, your dirty blackness will rub off.
31:54Well, they're not used to having black people coming into their homes, are they?
31:59Next week I will come back, I'll knock on the door, and I will say, well, I'm only here to
32:07make sure you're all right.
32:08Are you all right? Yes, the door is closed, I go away.
32:12When I rang my mother and said I couldn't stand this place, and people were so racist and rude and
32:17horrible,
32:18and she said, if they're racist to you, that is their problem, not yours.
32:23You know, so get over it.
32:26And when I'm coming back the next week, I may come back with a couple of buns in my hand
32:30or something like that,
32:32or a couple of sprigs of flowers, something.
32:35Oh, well, you better come in then.
32:37I stood up in the ward, and I just said, I am so fed up of this, you people.
32:43I said, I know that I am black. I have been black for 21 years.
32:49So tell me something I don't know.
32:53And there was silence.
32:55I was always called Smiler.
32:59That was my name by my patient, Smiler.
33:02I always enter their door with a smile.
33:12What is it about the NHS that not only attracts minority ethnic people, but has all loyalty, regardless of how
33:21badly we're treated?
33:22When I first moved up to Manchester as a nurse, I was invisible.
33:27You'd bleep the doctor, because he wanted some support, they wouldn't come.
33:33It wasn't every single one, but it was enough to be a problem.
33:39So I ended up asking a white colleague, I'd say, I feel this we need to get the doctor up,
33:47but please would you mind ringing?
33:49But I couldn't say why.
33:51I think I still didn't want to say it was my colour.
33:55I didn't want to say it.
33:57So they would trust other white nurses more than they would trust me.
34:05So for me, you can take it as negative and make it be negative, or you can take it as
34:12a positive and actually run with it.
34:13And you start stepping into areas that have interest for you.
34:17I just thought, well, I need to work where I'm not beholden to anyone, where my work, where whatever I
34:25do, is the patients have the say.
34:30So that's when I particularly wanted to go into the community, working for people with learning disabilities.
34:36My role was to move them out of the long-stay hospitals so that they were in a position where
34:42they could be abused and overlooked.
34:45I was invisible. I'm not seen. I never want anybody to have that experience.
34:55Staff shortages didn't just affect the supply of nurses, but also of doctors.
35:01The so-called brain drain of British trained doctors leaving to work overseas had been a problem since the founding
35:08of the NHS.
35:09But it received new prominence in the 1960s as the service approached its 20th anniversary.
35:17I'll tell you what's wrong with the National Health Service.
35:19First of all, there's an inept, ignorant, slow, tardy central administration.
35:28What do you feel is the basic attraction for doctors to emigrate, especially to the States?
35:34I think probably the freedom of movement and choice and the increase in the amount of work they're able to
35:43do.
35:44And here are the bosses of the government, and they're paid direct by the government.
35:53The gaps were plugged by the overseas doctor, tempted to come to Britain and work for the NHS by the
36:00prospect of training in the specialisms of their choice.
36:03I've come to do my fellowship in ENT surgery. It should take me about three years to do this.
36:10And whether I settle down or not depends on the circumstances prevailing at that time after I finish my graduation.
36:17Most were from India and Pakistan, where medical schools set up in the days of the British Raj still taught
36:25from standard British textbooks.
36:28Before long, the NHS was dependent on overseas doctors, and any threat to the supply was enough to trigger alarms
36:36in the Ministry of Health.
36:41In the summer of 1965, a border war broke out between India and Pakistan.
36:47In the archives, we've discovered a file that reveals how officials at the Ministry of Health fretted about the consequences
36:54for the NHS
36:55if doctors were called home to do their bit.
36:59This is a note drawn up by an official at that ministry.
37:03And in it, he warns of reports that the war between India and Pakistan might result in the recall to
37:12India and Pakistan of doctors from British hospitals.
37:16And if that were to happen, the NHS was in danger of collapsing, possibly within the next few months.
37:25Officials carried out a rapid survey.
37:28Their findings, particularly for smaller hospitals outside the main urban areas, were alarming.
37:35Of the 128 junior doctors in the area around Nottingham, 55 were from India or Pakistan.
37:43And in the areas around Sheffield and West Riding, there were 175 junior doctors, of whom 80 were from India
37:51or Pakistan.
37:52And in Lincoln, the area around Scunthorpe, Grimsby, Grantham, there were 66 junior doctors and 55 of them.
38:00So five out of six were also from India or Pakistan.
38:04Now, if large numbers of these doctors decided that they had a duty to return home, then in effect, the
38:12NHS in these parts of the country would grind to a halt.
38:16Officials at the Ministry of Health were left to hope, as this note says, to hope that the war, for
38:24everybody's sake, will be stopped.
38:33This was the last gunfire of the brief war between India and Pakistan, putting an end to the conflict that
38:39has cost 5,000 lives.
38:42The war ended after just two weeks, and with it, fears of an imminent NHS collapse.
38:49But the dependence on overseas doctors was far from over.
38:54Untested and unfamiliar with the ways of British medicine, the overseas doctor travels to his first National Health Service attachment.
39:02I'm meeting one of those overseas doctors, Kailash Chand, who came to Britain in the late 1970s, eager to discover
39:10more about the workings of the NHS.
39:14I was fascinated by the whole concept of NHS, right from my younger days.
39:20I grew up in India. I have seen the misery of people who can't access healthcare.
39:27And I think from that date onwards, I always said that healthcare is a fundamental human right.
39:35Kailash would serve in the NHS for more than 40 years, with many achievements to his name.
39:40But his path wasn't always straightforward.
39:43So I said, sir, I'm interested in paediatrics. So if you can help me, I would very much like to
39:50work in Alderay Children's Hospital.
39:53And the shocking thing to me was, and he was a very senior consultant, he said, Kailash, that's not going
39:59to be possible.
40:01People coming from Southeast Asia or from any international medical graduates, they have the lowest preference getting a job in
40:09a teaching hospital.
40:10He did help me. He did help me. He said, fine, if you want to work somewhere else, then I'll
40:16recommend you, I'll give you my reference.
40:18But when your consultant told you that you couldn't realistically have a career in paediatrics,
40:25and that there was parts of the NHS where it was deemed appropriate that an Indian doctor could work in
40:30parts that were deemed inappropriate, were you shocked?
40:34Yes, I was disappointed rather than shocked. At that stage, my need was to find a job so that I
40:39have a financial security and I get my wife join me.
40:43So for that, for me, it didn't matter what job I get, as long as the job is in NHS.
40:49That's what it is. And I got that job in NHS working in A&E in Manchester and Coors Hospital.
40:55My name's Neil Singh. I'm a doctor, GP working in Brighton, and I'm proud to work in the NHS and
41:03have a family that has three generations involved in healthcare.
41:10My father came to this country with an idea of learning in some of the best institutions in the country,
41:18but he was never given a position in one of the major teaching hospitals.
41:23We've got nine applicants. I've had a very quick look through them. Everyone, without exception, is somebody who's qualified overseas.
41:31We've got a lot of people in English. Obviously, there are many reasons why that might be, but, you know,
41:36for many people in his generation, it was clear that there was discrimination.
41:43Yes, this one's from India.
41:45I can't...
41:46Pick Nahar or something. I've never heard of that.
41:49I can't even read it.
41:51First job went to the English candidate. Second job was always go to Scottish. Third go to Welsh.
42:01And then the fourth will always go to the Irish champ. And then after that, the fifth job was for
42:09me.
42:10Worcestershire, graduate of British University required with obstetric experience.
42:15Whitehaven, Cumbria, graduate of British University wanted as fourth edition.
42:20Young male graduate of English or Scottish University required as assistant.
42:24West Yorkshire, graduate of British University required.
42:28Sussex Coast, young graduate of a British University required.
42:32Meaning that if you're brown and if I'm abroad, don't bother applying.
42:36You are not required where they can get a white or a local graduate. Simple as that.
42:43So the only ones who would take you are those practices where they couldn't find a graduate of British University
42:51to come through, which are often rather poor, deprived parts of the country.
42:58How are you, Mrs Thompson? I'm very well, thank you, sir. Good.
43:03As with the overseas nurses, many overseas doctors were drafted into the so-called Cinderella services, like geriatric medicine.
43:12Some consultants now refer whimsically to geriatric hospitals as part of not the National Health Service, but the Commonwealth Health
43:19Service.
43:21I remember, as a medical student being taken out of the geriatric ward for the first time, it would have
43:26been about 1978.
43:29And I remember it so clearly. And I said to myself, I never want to grow old in this country.
43:33It was so disheartening. It was awful.
43:36But the overseas doctors, yeah, they were the people who didn't just think, oh, well, too bad I'm going to
43:41be a geriatrician.
43:42They said, you know what, the service is really terrible and we are going to transform it.
43:47Okay. I think you are improving, aren't you?
43:52And same in general practice. It is one of the specialties of general practice, where probably about 40%, so think
44:00about that, 40% of the doctors are ethnic minorities.
44:05And why is that important? Because you look at the areas which were the most deprived areas.
44:09And who staffed that service? It was ethnic minorities.
44:17I had some difficult times.
44:20There was an occasion when I arrived for surgery in the morning and I saw my staff and some of
44:27the patients in the neighbourhood washing down the front of the surgery door.
44:34So as I approached, I said, what's the matter? So they said someone had covered the front door with feces.
44:40I mean, it was frightening because you never know if they would turn violent.
44:46They delivered the foundation of the NHS, which is to provide care for everyone at the time of need, from
44:52birth to death.
44:53You know, that to me was what the NHS promised.
44:56And I think that this generation of doctors really put their all into it and transformed it.
45:03But you just did your job and got on with it.
45:07And over the years, it got better.
45:17Transforming the NHS for patients was a major achievement.
45:22Transforming it for those who worked there was just as challenging.
45:27There came a point when I'd been to six consultant interviews and I found I wasn't even shortlisted.
45:33And this really brought me up.
45:35And I phoned the regional medical officer and his reaction was really stunning.
45:43He said, how dare you question what we are doing?
45:46Who do you think you are? He said.
45:49He said, how dare you like that.
45:50In 1985, microbiologist Dr Melilla Noon, originally from Sri Lanka, brought industrial tribunal cases against the NHS.
45:59Proving she'd been passed over for consultant posts.
46:03Jobs for which she was eminently qualified.
46:07And it was then I realised that if I was white, he wouldn't have spoken to me like that.
46:13And in fact, if I was white, I would have got a job by then.
46:17When I first heard about what had happened in the appointments committee, of course it came as a big shock
46:24to me.
46:25It was like a kick in the teeth.
46:29Around the same time, another tribunal concluded that racist comments had been made about Indian-born psychiatrist Dr. Sashi Sashidharan,
46:39following an interview for a consultant's post.
46:42Things could be said about the candidates behind closed doors, and the candidates would never hear about it.
46:49A BBC documentary made at the time brought the two whistleblowers together.
46:55Forty years later, I'm sitting down with Melilla and Sashi to watch it again.
47:00I felt that by bringing these cases, I'd be forcing people to discuss the issue.
47:06What's it like watching that film all these years later?
47:09Yes. I hadn't realised just how angry and upset I was when I realised that there was racism.
47:19People don't realise how difficult it is to actually accept it.
47:25It was unexpected. I thought I was quite welcome here.
47:29When I spoke to people senior to me, who were my mentors, about what was happening, there was an implicit
47:38assumption that I will not talk about it.
47:40And then you are subtly coerced into silencing yourself as a result of that.
47:50One could be seduced into thinking that because there are so many black faces around in the National Health Service,
47:56there is no racial discrimination.
47:59But if you look harder, you can see that most of the black people are in the lowest paid jobs,
48:04at the bottom of the pile.
48:07In the documentary, what was critical is that you didn't see yourself in isolation.
48:13You not only found each other, but you looked at other areas and other sectors within their natures.
48:19These are the auxiliary workers who clean, cook and carry, and without them, the National Health Service would grind to
48:27a halt.
48:28What I discovered was that we are in this struggle together.
48:34It doesn't really protect you, the fact that you're a doctor.
48:39What ultimately mattered, certainly at that time, was your skin colour.
48:45You're not white, you're black.
48:49In the NHS and beyond, other forms of discrimination continue to come to light.
48:56Only this year, the General Medical Council acknowledged that doctors from ethnic minorities are twice as likely as white doctors
49:04to be referred to its disciplinary committee.
49:07All these things are all part of a systemic problem, really.
49:11And I think it comes from a failure to acknowledge the impact that race has.
49:15And this is how racism operates, of course.
49:17And I think that there was a failure to recognise that this could be a problem.
49:20Three of the influx of Filipino nurses arrived to begin work on their wards.
49:24They've been recruited to try to solve a shortage of 70 nurses at the Medway Maritime Hospital.
49:34As demands on the NHS increase, staff shortages continue to be met by regular recruitment drives in all parts of
49:43the world, from the Far East to mainland Europe.
49:46Today, more than 13 per cent of the 1.2 million people who work for the NHS are from overseas.
49:53And in England and Wales, more than 40 per cent can claim minority ethnic heritage, making the NHS, by a
50:01long margin, the most diverse of all British institutions.
50:05So what was the question was, was my name, my role, my hospital?
50:11I'm Edna Flores-Penumbo.
50:13I'm one of the matrons at the Accident and Emergency Department of the Royal Liverpool University Hospitals.
50:22My name is Padal Klim, I'm a paramedic and clinical operations manager, working for East Midlands Ambulance Service.
50:31My name is Sarah Itam and I'm a consultant urological surgeon in the NHS.
50:37My name is Samina Ishaq. I was born in Pakistan. I work as a consultant anaesthetist at a North London
50:48hospital.
50:49So I was trained back home in the Philippines.
50:51I was born in Brina, in Czech Republic.
50:55So my parents and grandparents lived in the UK virtually all their lives. However, originally they were from the Caribbean
51:01and West Africa.
51:03Everyone will tell you that there have been huge improvements in the international NHS, but daily challenges remain.
51:11Being one of a handful of black female surgeons, you come to accept that you may experience more challenges and
51:18hurdles than your counterparts.
51:20So you have to have a lot of determination and a lot of perseverance.
51:24I've worked in emergency departments where I've had to treat patients that I know have been out Paki bashing.
51:32I have met one person during my training who was an English 17-year-old lad, telling me I'm stealing
51:42their jobs.
51:43I want to correct them and tell them, you mustn't do that. Do you know that you are now being
51:48treated by a Paki doctor?
51:49I said, no, I'm not. That's why I'm here. It's because they haven't had enough paramedics.
51:56You welcomed me here and I'm now here to help you.
52:00My mum used to say to me, never allow anyone to define who you are or what you can be.
52:06You must define yourself.
52:07I've been here 20 years and obviously I won't be here if I don't love the place.
52:14So this is my second home. And my third home is the NHS.
52:21Please welcome Mike Oldfield and the staff of the United Kingdom National Health Service.
52:29At the opening of the London Olympic Games in 2012, 900 million people around the world were let in on
52:36a national secret.
52:37The unique place the NHS holds in our hearts. It came as a bit of a surprise, even to ourselves.
52:47Watching it back, it was just like, wow, that was amazing. And it's like, oh yeah, I was in that.
52:55Nurse Pat Brown, a daughter of the Windrush generation, was in the London Stadium that night, doing what she does
53:02every working day, being a small but vital part of the NHS.
53:07Nurse Pat Brown, a daughter of the NHS.
53:08I was in the NHS.
53:10I was in the NHS section at the bottom of the NHS, it wasn't till that night, that we realised
53:18how special it was going to be, it's difficult not to almost like do the dance moves.
53:29You were so well-practiced.
53:34To me, it seemed like a lot of people, almost everybody valued the NHS,
53:38but that night, people were able to go,
53:41actually, no, we love this.
53:42Yeah.
53:43This really matters.
53:45Yeah. And that's what it felt like.
53:47It felt like we were suddenly really, really loved
53:49because I think morale within the NHS was quite low.
53:55And then we presented this to the world
53:58and it was just like, we've got this amazing service.
54:02When I look at it and watch it again,
54:05it makes me think that that was a moment
54:08rather like the moment we're going through now,
54:11for very different reasons,
54:12when we've actually had one of those reckonings,
54:16those moments of realisation of what the NHS is.
54:19Yeah.
54:20I think...
54:23So, it's hard because...
54:27Sorry.
54:29I'm going to cry.
54:35It's...
54:36It's hard.
54:37I wasn't on the front line, so to speak,
54:40but I've seen the effects that it's had on my colleagues.
54:43I'm very aware of what's...
54:46happening to lots of people.
54:49And, um...
54:52As a nurse, you go into this.
54:55You want to care for somebody.
54:56You want to heal them.
54:58And, um, you want them to go home well after being sick.
55:02Um...
55:04But this...
55:07It...
55:08It...
55:09It was just something else.
55:35It's just something else.
55:41This is our NHS.
55:43This is our NHS.
55:44It's the people's health service.
55:45And all the people are all different colours,
55:48different ages, different sizes, different heights.
55:51And therefore, they all have an equal investment
55:55in this organisation.
55:57I think we cannot do without our international staff
56:01by any means of the imagination.
56:04They are our NHS.
56:07I was once paying a home visit to a couple,
56:11and...
56:13You know, it's not the only time, um,
56:15but...
56:15that I...
56:16that I end up seeing somebody who's reading
56:18a paper with a...
56:21xenophobic front page and headline.
56:24Um, so he put his paper away,
56:27saying, um,
56:29you know, this country's going to shit
56:30because of immigration.
56:32In that moment, I did, um,
56:34decide to remind him that I come from a family of immigrants.
56:38You know, he...
56:39he looked at me as if...
56:40he'd seen me for the first time.
56:43And said,
56:45no, not you, Doctor.
56:47You're one of us.
56:50It's taken something as terrible
56:53as a global pandemic
56:55that's claimed thousands and thousands of lives
56:58for us to truly appreciate two things.
57:02the first is just how much the NHS really matters
57:07to the people of this country.
57:10The second is that the NHS relies,
57:13and has always relied,
57:15on people who've come here from all over the world,
57:19and that our National Health Service
57:21is, in that sense, international.
57:24The National Health Service
57:34Inspired by patients and staff of the NHS,
57:37a film poem from 2018,
57:39with a stellar cast.
57:41The NHS to provide all people.
57:44Streaming now on BBC iPlayer.
57:46,
57:52the Singingifiques
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