Politics of Care in the NHS: Navigating Immigration Enforcement at the Clinical Frontline
Author
Dyhr, Tiana Octavia Natasha
Term
4. semester
Education
Publication year
2025
Submitted on
2025-10-15
Pages
66
Abstract
As part of the UK government’s 'hostile environment' agenda, people who are not considered 'ordinarily resident' face charges and data sharing when they access secondary healthcare—that is, hospital and specialist services. These policies sparked backlash and led to activist groups such as Patients Not Passports and Docs Not Cops, which challenge their ethical legitimacy. This thesis draws on semi-structured interviews with NHS doctors and participant observation at Patients Not Passports meetings to examine how clinicians navigate these rules in everyday practice. It explores the ethical dilemmas at the intersection of healthcare and immigration enforcement. The analysis uses the lens of street-level bureaucracy—how frontline staff exercise discretion—to understand how policy is negotiated in practice. Findings show that discretion is often used as quiet resistance: doctors reject or work around certain directives on moral grounds. Clinicians reported that the rules clash with their ethical commitments and the founding principles of the NHS, placing them in profound moral dilemmas. Many prioritised care and equity over strict compliance, revealing a sustained tension between institutional expectations and professional ethics.
Som led i den britiske regerings 'hostile environment'-tilgang bliver personer, der ikke anses for 'sædvanligt bosiddende', mødt med brugerbetaling og deling af personoplysninger, når de søger sekundær sundhedshjælp (hospitaler og specialbehandling). Disse tiltag udløste modstand og gav anledning til aktivistgrupper som Patients Not Passports og Docs Not Cops, der udfordrer reglernes etiske grundlag. Specialet bygger på semistrukturerede interviews med NHS-læger og deltagerobservation ved møder i Patients Not Passports. Det undersøger, hvordan klinikere håndterer reglerne i hverdagen, og hvilke etiske dilemmaer der opstår i krydsfeltet mellem sundhedsvæsen og udlændingekontrol. Analysen er forankret i teorien om street-level bureaucracy (frontlinjebureaukrati), hvor de ansattes skøn bruges som nøgle til at forstå, hvordan politik omsættes i praksis. Fundene viser, at skøn ofte bruges som stille modstand: Læger afviser eller omgår visse instrukser af moralske grunde. De oplever, at reglerne strider mod deres faglige etik og NHS’ grundlæggende principper, hvilket sætter dem i dybe moralske dilemmaer. Mange vægter omsorg og retfærdighed over streng efterlevelse, hvilket synliggør en vedvarende spænding mellem institutionelle krav og professionel etik.
[This apstract has been rewritten with the help of AI based on the project's original abstract]