Politics of Care in the NHS: Navigating Immigration Enforcement at the Clinical Frontline
Author
Term
4. semester
Education
Publication year
2025
Submitted on
2025-10-15
Pages
66
Abstract
As part of the UK’s “hostile environment” agenda, individuals who are not deemed “ordinarily resident” within the state are subject to fee-charging and data-sharing practices when accessing secondary healthcare. The introduction of these policies sparked significant backlash, leading to the emergence of activist organisations such as Patients Not Passports and Docs Not Cops. Formed in direct response to the legislation, these groups challenge the ethical legitimacy of the policies, arguing that they infringe upon core clinical principles and compromise the integrity of care. This thesis draws on semi-structured interviews with NHS doctors and participant observations of Patients Not Passports meetings to explore how clinicians navigate hostile environment policies in their everyday practice. It delves into the ethical dilemmas that arise at the intersection of healthcare and immigration enforcement, examining how doctors deploy discretion to reconcile professional obligations with the demands of these policies. The analysis is framed through the lens of street-level bureaucracy, using discretionary practices as a conceptual tool to understand how policy is negotiated in practice. Findings reveal that discretion is frequently exercised as a form of quiet resistance, rejecting or circumventing policy directives on moral grounds. Clinicians consistently expressed that these policies conflicted with their ethical commitments and the founding principles of the NHS, placing them in profound moral dilemmas. Many aligned their personal values with the ethos of the NHS, prioritising care and equity over compliance. Their responses reflect a deep tension between institutional expectations and professional ethics.
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