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60 2 Empire, migration and the NHS The establishment and development of the NHS in the post-​war period coincided with the dismantling of the British Empire. Colonial-​era language or parallels have been used at times to describe the relationship between the NHS and the migrant labour it has relied on.1 However, the development of the British healthcare system and the impact and legacy of the Empire are two closely linked phenomena that historians have rarely considered together.2 The same can be said of the history of post-​war migration to the UK and the

in Migrant architects of the NHS

93 3 The empire of the mind and medical migration It is important, in order to understand how the NHS and British general practice were able to draw on the labour of South Asian doctors, to appreciate, as was shown in the previous chapter, how British immigration and medical registration policies remained defined by imperial legacies for much of this period. It is also crucial to appreciate that these legacies continued to shape medicine in the Indian subcontinent and the thought processes of doctors—​as is apparent in their oral history interviews and in

in Migrant architects of the NHS
South Asian doctors and the reinvention of British general practice (1940s– 1980s)

The NHS is traditionally viewed as a typically British institution; a symbol of national identity. It has however always been dependent on a migrant workforce whose role has until recently received little attention from historians. Migrant Architects draws on 45 oral history interviews (40 with South Asian GPs who worked through this period) and extensive archival research to offer a radical reappraisal of how the National Health Service was made.

This book is the first history of the first generation of South Asian doctors who became GPs in the National Health Service. Their story is key to understanding the post-war history of British general practice and therefore the development of a British healthcare system where GPs play essential roles in controlling access to hospitals and providing care in community settings.

Imperial legacies, professional discrimination and an exodus of British-trained doctors combined to direct a large proportion of migrant doctors towards work as GPs in industrial areas. In some parts of Britain they made up more than half of the GP workforce. This book documents the structural dependency of British general practice on South Asian doctors. It also focuses on the agency of migrant practitioners and their transformative roles in British society and medicine.

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Quarantine, immigration and the making of a Port Sanitary zone

The English System is a history of port health and immigration at a critical moment of transformation at the end of the nineteenth and beginning of the twentieth century. It challenges generally held assumptions that quarantine policies delineated intransigent national borders, and argues instead that the British geo-body was defined as a more fluid construction. A combination of port sanitation and sanitary surveillance, known to contemporaries as the ‘English System,’ was gradually introduced as an alternative to obstructive quarantines at a time of growing international commerce. Yet at the same time escalating anti-alien anxieties sought to restrict the movement of migrants and transmigrants who arrived from the Continent in increasing numbers. With the abolition of quarantine in 1896 the importance of disease categories based on place, which had formed its foundation and which had been adapted for the new ‘English system,’ lessened. However, these categories had not collapsed but were merely transferred. This book examines this crucial transition showing how the classification of ‘foreign’ and ‘domestic’ disease was translated, after the abolition of quarantine and during the period of mass migration, to ’foreign’ and ‘domestic’ bodies – or the immigrant and the native population.

intangible elements of medical relationships. Put simply, if a surgeon could not gain the trust of those in his care, he did not have authority. If he did not have authority, it was more difficult to perform the experiments and procedures that brought recognition. Through threads such as these, Australian voyages bind together the histories of medicine, social power, colonialism, and migration across national borders and geographical space. Notes 1 John Hood, Australia and the East (London: John Murray

in Health, medicine, and the sea
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Historicising a ‘revolution’

held against them. I also share his view that such episodes enlighten us as to the nature of scholars’ gaze and should encourage a critical reflection around their priorities. It is helpful to bear his critique in mind when thinking about how historians engage with the contemporary history of migration. When it comes to the role of migration in post-​war Britain, much research so far has missed the fundamental impact of population movement on everyday life. This is not to prescribe one way of doing history over another or to deny legitimacy to studies dedicated to

in Migrant architects of the NHS
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Writing the history of the ‘International’ Health Service

1 Introduction: writing the history of the ‘International’ Health Service The histories of the National Health Service (NHS) and of British general practice are profoundly intertwined with the history of the imperial legacy and of medical migration. This book shows that the NHS, which was established in 1948, would not have been what it had become by the 1980s without being able to draw on the labour of migrant South Asian1 doctors. When it comes to the history of the NHS, the migration of South Asian doctors cannot be treated as a side issue. An appreciation

in Migrant architects of the NHS

31 1 The making of a cornerstone Before exploring in detail the way in which migrant South Asian doctors shaped general practice and the NHS, I first want to situate their story within the broader context of the history of British healthcare, empire and of post-​war migration to the UK. The role of migrant doctors in the NHS is not confined to general practice. They were disproportionately represented in junior positions, less prestigious types of medicine and in geographical areas that were unpopular with local medical graduates. I will say more about the

in Migrant architects of the NHS
The role of country of origin

a clinical team comprising myself, medical doctors undergoing postgraduate training in psychiatry, psychiatric nurses, a clinical psychologist, a social worker, an occupational therapist and undergraduate medical students doing electives in psychiatry. The findings from our studies form the basis for this chapter and largely shape the discussion and conclusions presented, in the context of the broader literature on this topic. Migration and mental disorder Migration is associated with altered patterns of psychological distress, mental disorder and access to

in Ethical and legal debates in Irish healthcare
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the lifeblood not just of Australia, but of colonies in general. Ships were sources of labour, news, goods and food, ideas and government orders, but they also induced great anxiety. Most importantly, voyages were not separate from the social, political, cultural, and environmental contexts through which they began, passed, and ended. Through the experiences of people who travelled, I see voyages as assemblages: medical concerns, military priorities, social hierarchy, penal reform, mass migration, colonial politics, and

in Health, medicine, and the sea