Arfeen Zakia, Nash Eleanor, Rashid Mohammed Ahmed
UCL Medical School, Faculty of Medical Sciences, University College London, London, United Kingdom.
London School of Hygiene and Tropical Medicine, London, United Kingdom.
PLOS Glob Public Health. 2025 Sep 5;5(9):e0005141. doi: 10.1371/journal.pgph.0005141. eCollection 2025.
The UK National Health Service (NHS) has relied on Migrant Healthcare workers (M-HCWs) since its inception. These M-HCWs have typically come from Low and Middle-Income countries (LMICs) and particularly, countries that were previously under British colonial rule. Despite this, medical workforce shortages persist in the NHS and there has been a lack of policy consensus about how best to ameliorate it. In June 2021, Baroness Dido Harding made an ultimately unsuccessful pitch to lead the NHS. During this period she made a statement where she expressed an ambition to reduce reliance on M-HCWs that was met with controversy in the general and medical press. This Critical Discourse Analysis (CDA) examines the responses published in newspaper, media and journal articles in the month following Baroness Harding's statement. The dataset includes a variety of opinions about medical migration and M-HCWs and explores how language is connected to power and knowledge constructed and the effects of these discourses. It draws on theoretical approaches derived from the philosopher Michel Foucault and the postcolonial analyst Edward Said. A total of 48 articles were included in the final dataset which highlighted two main strands of discourse. The first strand is dominant and dissents against Baroness Dido Harding herself, her position, and her statement, predominantly on the grounds that it undermines historic and ongoing contributions of M-HCWs to the NHS. The second strand, which is notable in its relative absence, supports the implications of reducing reliance on M-HCWs. We identified a dominant discourse of support for M-HCWs based on their valuable contributions to the NHS. However, the relative absence of the second strand suggests a marginalisation of debate about the reliance on migration pathways which were often founded on colonial roots, the exacerbation of brain-drain from the Global South, and the inequities that this perpetuates.
自成立以来，英国国民医疗服务体系（NHS）一直依赖移民医护人员（M-HCWs）。这些移民医护人员通常来自低收入和中等收入国家（LMICs），特别是那些曾受英国殖民统治的国家。尽管如此，NHS的医疗劳动力短缺问题依然存在，而且对于如何最好地缓解这一问题，一直缺乏政策共识。2021年6月，迪多·哈丁女男爵试图领导NHS，但最终未能成功。在此期间，她发表了一份声明，表达了减少对移民医护人员依赖的愿望，这在大众媒体和医学媒体上引发了争议。本批评性话语分析（CDA）研究了哈丁女男爵发表声明后的一个月内，报纸、媒体和期刊文章中发表的回应。该数据集包含了关于医疗移民和移民医护人员的各种观点，并探讨了语言如何与所构建的权力和知识相联系，以及这些话语的影响。它借鉴了哲学家米歇尔·福柯和后殖民分析师爱德华·赛义德的理论方法。最终的数据集中共包含48篇文章，突出了两条主要的话语脉络。第一条脉络占主导地位，反对迪多·哈丁女男爵本人、她的立场和她的声明，主要理由是这一立场削弱了移民医护人员对NHS过去和持续做出的贡献。第二条脉络相对较少出现，它支持减少对移民医护人员依赖所带来的影响。我们发现了一种基于移民医护人员对NHS的宝贵贡献而支持他们的主导性话语。然而，第二条脉络相对较少出现，这表明关于依赖往往基于殖民根源的移民途径、全球南方人才流失的加剧以及这种情况长期存在的不公平性方面的辩论被边缘化了。
