A line often used by opponents of Ukip's policy on managed migration is that without immigrants the NHS would collapse, often welcomed with rapturous cheer from left-leaning audiences during debates.
This was repeated by the MP for Bolsover, Dennis Skinner, when Mark Reckless was sworn into office last week after an incredible by-election victory. My instinct was to cry foul, to be angry at his insults but I found myself laughing instead. In a chamber overwhelmingly male, an island of career stability in a sea of uncertainty for millions, a tired old socialist who has not worked outside politics for decades berated someone who has been re-elected by his constituents.
Has Dennis ever wondered how the nation can fully house parliament without immigration of any kind? Every MP has British citizenship and enjoys a host of expenses, a luxurious pension and the trimmings of office. Sadly probably not, he lives in another world. It's not Ukip who live in the 1950s, its class warriors like Dennis who are still fighting the last war, the days of final salary pensions, job security and a balance of workers and work are long gone for anyone outside Westminster.
What was on display was a rather pejorative view of healthcare workers. The NHS is more about good news for Labour than good healthcare and a toxic attitude to the professions drips from its politicians. If people genuinely believe the NHS would collapse without immigration is there not one honest person on the left that asks why? This is never said of firefighters, or solicitors or of police officers; in fact until 2001 no one could be a policeman without British citizenship.
Immigration like many things is good in moderation but the spasmodic recruitment of nurses from overseas is anything but. Instead we have a decades old culture of binge immigration, mass recruitment from the third world to make up for self-imposed shortfalls at home. The Labour years saw a boom in immigration, up to 12,000 a year, but this stemmed from a cut in training places by the Major government and increasing care needs, and recruitment fell as training places rose again. The coalition is again cutting training places, the lessons sadly have not been learned.
What is almost never discussed is the number of British nurses who leave the UK, and they leave in their thousands. The supply of nurses in developing countries is vast, and can be relied upon to manage down the expectations of nurses here. Better wages? Better training? No. You take what you're given or you go to Australia or the Middle East. A health service run on targets needs a compliant workforce: nothing makes you complaint quite like student debt and job insecurity and this threatens to undermine the professionalism we all rely on as potential patients.
The NHS is unique in Western Europe not so for having foreign nurses but for recruiting so many from poorer countries, a sort of negative foreign aid. Where Switzerland has 22% of its nurses from overseas, 85% of these are from other developed countries; in England the figure is 16% but 80% of these are from third world countries. Finland, with so few non-native Finnish speakers to choose from, yet with a similar living standard to Britain, has less than 2% of its nurses from overseas. It is similar for doctors too: 15% of Sweden's doctors are from abroad, in Finland 7%, and in the UK its closer to 50%, again most immigrant doctors are from the third world.
Whether one sees immigration as universally wonderful, sensible in moderation and quality or as something harmful the facts are undeniable: a European country can rely on foreign workers to man its health service as much or as little as it wishes to. No one seems to want to discuss the impacts of emigration on healthcare, both the loss of UK-trained nurses or the asset stripping of poorer countries as happened under Labour, leaving fewer healthcare workers in countries with greatest need.
Ukip are not anti-immigration but we are abolitionists. We want to abolish asset stripping of the third world to man our public services. We want to abolish the idea that the NHS is to be seen as a Cinderella service, important of course to the country but too often viewed as a necessary evil to be manned as cheaply as possible, to be managed like a good news plantation.
This image of a plantation owner really brings me right back to politicians like Dennis Skinner and commentators like Owen Jones. They do not see the NHS as a system that could be manned by a home grown workforce, one we could retain through better conditions, free of targets and putting the patient first. They do not preach equality of opportunity or aspiration of any kind; they sermonise Mudsill Theory, that 19th Century idea that without slaves there'd be no sugar, without those at the bottom of the public sector pay scale, in the mud, there'd be no great successes for those higher up, people like them.
I do not believe that nurses, pharmacists, and midwives have had their working conditions fatally fixed. We can end binge immigration once we start to plan our workforce on the assets we have in this country, with its high youth unemployment and rising health needs we can start to the serious question of why so many of these key workers are leaving. We need to raise expectations of what we can offer NHS workers, not manage it downwards. As another abolitionist once said, "you may choose to look the other way but you can never say again that you did not know."