Interview with Sophie from Docs Not Cops

The Sideways Times Podcast is back! After quite a long absence we’re back with a great interview with Sophie from Docs Not Cops, who campaign against the British government’s ‘hostile environment’ policy in the National Health Service (NHS). In this podcast we talk about how Docs Not Cops organise, the history of charging, and the hostile environment within the NHS. We also touch on the wider context of racism within the British healthcare system. Sophie is a doctor who’s been involved with Docs Not Cops since its beginning in 2014. The interview was conducted before the British general election in December 2019.

Lani: Hi Sophie, I’m really excited to have you on the podcast today talking about Docs Not Cops and working against the hostile environment in general, and I think we’re gonna have a bit of a discussion around that, hopefully enough information about what Docs Not Cops do, and things like that, but also a little bit deeper into organising and things. So I’m really excited, and do you want to start off by talking about how you got involved?

Sophie: Yeah, thanks Lani. So thank you for having me, and yeah, so I got involved in Docs Not Cops back in, would be 2014 now. And I went along to a public meeting that was held at Unite headquarters, organised by Act Up London, actually, and a number of activists from Act Up London, trade unionists, some doctors, and other healthcare workers involved in Unison, and also Medact there. And kind of answering the call really to be part of an organisation that would fight against charging – against charging for NHS services. And against immigration controls in the healthcare system. And at the time I was in my first year of medical school, and a big part of why I’d decided to train as a doctor was to fight inequality, and I felt like this was the kind of struggle that I wanted to be involved in. And, partly for political reasons, but also because I didn’t want to be a doctor who had to choose who I would treat, and choose who would pay and who wouldn’t, and I felt that went against the principles of the NHS, that I agree with. So yeah, that’s how I got involved, all those years ago.

Lani: You said originally you went to an Act Up meeting, organised by Act Up. Can you tell me a bit more about how Docs Not Cops started? Cause that was right at the beginning, right?

Sophie: Yeah, right at the beginning. So Act Up, as a group, so it’s an international organisation, and there are kind of chapters and branches in different cities across the world. So there’s an Act Up London, and they had really spearheaded the campaign, recognising that the proposed Immigration Act, as it was in 2014, would threaten access to HIV medications, to anti-retrovirals. And at the time the debate was about – I think Nigel Farage was actually responsible for putting it out there, that access – free access to HIV medications would drive immigration to this country. And so Act Up, along with the HIV Trust and Terence Higgins Trust, did a lot of work lobbying around ensuring that HIV medications would remain free in the proposed Immigration Act and the charging frameworks that were yet to be implemented. But, you know, their kind of pre-empting of what has happened, of up-front charging, you know, really spearheaded this campaign, and at the time it was – Act Up London had seen that it would be an issue for HIV-positive people, but called this meeting recognising that it needed to be a much – you know, a broad campaign that would fight all forms of charging and immigration control in the NHS. 

But I think it’s a really interesting trajectory, like the history of Docs Not Cops, to have come out of what, you know, has been one of the most successful grassroots campaigns globally, against the pharmaceutical industries, for access to treatments, you know – a group of people who were seen as really marginalised by HIV in the 80s and early 90s, who took that power onto the streets and really changed, you know, the course of people’s lives, millions of people’s lives. And I think that trajectory of being part of a history from that grass-roots organising story really impacts the kind of work that we do now. You know, focusing on direct action, and focusing on lots of social media, and kind of like public-facing work, so.

Lani: So you talked about sort of how Docs Not Cops came about, Maybe we can talk a bit more about what you actually do, and why… what the aims of the campaign are?

Sophie: Yeah, I mean talking from my kind of experience of being in the campaign and what I’ve seen, you know, to – how it works, I’m sure that other people will have different opinions, but, you know, we’re not a group that has like a set, you know, kind of a manifesto that we all adhere to, but anyway I’ll try and do my best to give an idea of what the organisation’s like. So I mean as a group, you know, we fight to defend free healthcare for all, to stop immigration policing in the NHS, and to stop all forms of charging for NHS treatment. So that includes the Visa surcharge, and it includes up-front and retrospective charging as well. And the reasons that we do that are, you know, we think that it’s a human right to have access to healthcare. We also think that, beyond human rights, it’s about solidarity with people, and the harm that charging causes, that we have a responsibility to stand up and say, you know, this is beyond the limits that we’re willing to comply and work with, and that we need to fight to change it. 

And also, you know, we have a key aim to educate and inform people. As well as agitate around it, but educate and inform people of both the implications of the charging, like the harm it causes, but also their own – like their own responsibility actually, particularly for healthcare workers, to know and tool up about how the Immigration Act affects their patients. And, you know, what ultimately they are also complicit in, without knowing, you know, if they don’t understand. So I think those are the like main aims of what we do, and… and why do we do it? I suppose the organisation – so Docs Not Cops, it’s kind of made up of, yes, doctors, but actually probably the minority of the group, almost, is doctors, I’d say. There’s, you know, a group of people who are, so medical students, and nurses, people who work in journalism, people who are, you know, teachers or lecturers. There’s actually a huge range of people who are involved in the organisation, but, you know, the main message is that, yes, some of us are doctors, but also we’re all patients. And there – the NHS isn’t just an organisation that’s run by doctors and nurses, it’s actually an organisation that is used by everyone, and used by patients. And so that’s a really key part of our work, is that everyone can contribute to this campaign.

Lani: So yeah, so you talked about wanting to kind of stop charging, and healthcare being a kind of right for everybody, and the fact that everybody uses the NHS, or should be able to anyway. But these – there’s charges, but particularly the sort of borders within the NHS are not a new phenomenon really.

Sophie: No, not at all. It’s interesting, that said the NHS in its inception, so Nye Bevan, going back, what’s it, 71, 72 years ago now, talking about the fact that the NHS being a universal service that was free for everyone at the point of need, was the option to practice what he called civilised medicine. And that was in answer to the Conservatives at the time claiming that this was, you know, opening up the doors that, you know, by treating everyone – you know, the same immigration arguments that we have now, actually right at the core of when the NHS was set up. You know, so it’s really interesting that actually that – the creation statement of the NHS makes it free and open and accessible to all. And part of that – you know, yes there’s a financial argument of is it more expensive to monitor and to exclude people than it is to just treat them. But actually there’s a much bigger point, which is what Nye Bevan made, which is, you know, what type of society do we want to live in? Do we want to live and work in one that kind of blames and scapegoats and charges and excludes, or do we want to live in somewhere that’s – that actually we recognise the need and the right to healthcare. And obviously, like from that founding statement of the NHS, things changed. I mean, it’s not all free, as we know! Like, you know, dental work, and optometry, and you know, all of that stuff did change even quite early on in the NHS. 

But activists, in terms of kind of charging for services, you know, the kind of – the first legal framework that made kind of charging possible actually came round in 1977, NHS Act then, and it basically talked about the way that people could be charged if thought necessary. And that same wording was then repeated in the 2006 NHS Act that was brought in under Labour. And, you know, during that time, I think there was the possibility of being able to charge people, it was something that existed, there was a – if somebody had insurance, if they offered to pay, maybe somebody would have followed it up. But actually it wasn’t seen as something that was routinely done, or exploited as a source of income. But from 2006, kind of onwards, there was a feeling that actually, with the internal market in the NHS, and departments kind of being ranked in terms of the financial spending against each other, hospitals being ranked against each other, that actually there was a bit more financial pressure around in general. And the way that that internal market worked, in some ways for the good, in other ways for the bad, just turned the light on for thinking actually how do we start charging people and what’s the mechanism we could do that? 

And, you know, there wasn’t anything structural that was put in place to change that 2006 legislation, but then of course we come round to the 2014 Immigration Act. And in that, it then draws on the kind of charging language that was used both in 2006 and 1977, to say actually, we should be seeking out people who are not eligible for care and we should be charging them. And so that’s the kind of trajectory, so we go from the founding principles of the NHS, that said there should be free at the point of need for everyone. Then actually going through some permutations of that being changed in wording, but not necessarily in practice, to then actually changing in practice in 2014. And with the Immigration Act in 2014, it made it a requirement for trusts to try to identify patients who might not be eligible for free care. And that, at the time, covered specialist services like outpatient clinics, and it covered elective or non-urgent surgery. And it also introduced the visa surcharge for people who were applying for visas from outside the European Economic Area. And, you know, a bit of a grey area at the time around people who didn’t have insurance who were in Europe. 

And then actually what we’ve seen is that the 2014 Immigration Act, it was only the beginning of a series of phases of implementation of ever-stringent requirements on immigration status to be checked in the NHS, so we then – so yes, we had the surcharge. There became – you know, like there was then an increase in the surcharge. And then from October 2017, it then introduced up-front charging, for people who were deemed ineligible, they could not receive outpatient care, or non-urgent hospital treatment, without being able to prove that they had the money to pay for it. And that same framework said, and the things that are free at the moment, like emergency care and GP care, might not be free in the future. You know, so it’s really like laid the groundwork for saying OK, actually every single aspect of the NHS will be chargeable for individuals who are thought not eligible. And yes, that is an issue for these – you know, for people who are frightened, you know, frightened by the fact that they are – they’ll have to pay. It doesn’t act as a deterrent, cause if you’re unwell, actually you still end up having to go to hospital, but just when you’re more ill, and actually when the situation’s got much worse. 

But also, like the issue around the fact that if people then don’t pay, it means that they’re also tied into this – then their immigration status is completely tied to the fact that they’ve not paid this bill. And that makes people even more frightened about seeking care. So the fact that trusts – you know, they’re now required by law to seek out this money, you know, that is a huge transition in the way that the NHS, and the access to care, as from when it was first founded to now, how that is completely changed. And it’s not just about the people who this affects right now, you know, you have to think about look, this is an entire system change, and it doesn’t take that much more imagination to think actually this is a way of, you know, introducing charging for everyone. You know, and I think a more insurance-based system in general. Because now trusts have a statutory obligation to charge. You know, what more could – to check immigration status and to charge. You know, how long will it be before they’re actually checking whether or not you have insurance? 

So you know, that’s one of the concerning features of this, the piecemeal change across the 2014 Immigration Act and its various successions following that. And how different services have been brought into that, to basically encapture the entirety of the service. So that’s the really broad like overview of how charging has kind of been introduced into the NHS. And along that, obviously there’s all the harm. You know, there’s the stories that we hear of people who – like who have just been at the real – like blunt end of the way that this state can treat people. And that’s part of, yes, the hostile environment, but also just how, you now, people who are working class are really despised, I think.

Lani: Yeah, and it made me think about the context of kind of privatisation in general, and how that, perhaps I was away when you were talking, anyway the way it sort of connects with the hostile environment in a very concrete way, kind of opening doors to the privatisation. Some of that is difficult to comprehend, somehow.

Sophie: Yeah, I completely agree, and the fact that actually the hostile environment really uses private systems, or systems of privatisation, to do the state’s work. So for instance, you look at housing policy, and you look at the fact that it’s private landlords who are then responsible for checking immigration status of their tenants, you look at schools and it’s about checking, you know, the postcode and the allocate – you know, it’s all about entitlement, and whether or not these people are deemed entitled to that particular service, rather than thinking about, you know, what was the welfare state? And who should have been benefiting from it? It’s actually the way it’s been pulled apart, those same mechanisms are being used to implement the kind of the immigration policing. And it’s the same across all of the different aspects of the hostile environment – you know, education, housing, policing and, you know, and bailiffs, and the whole network as well as health.

Lani: So how does the hostile environment actually work in the NHS?

Sophie: I think the NHS has been a hostile environment for some time. I don’t think this is new. You know, I think actually people talk about being proud of the NHS, the fact that it’s kind of this national gem, but I think back to actually the people who really built the NHS were people who were invited to come and work in the UK from the – from, you know, the colonies. I mean like from this like very colonial relationship of Britain to the Commonwealth. And people were offered citizenship from the British Nationality Act, from 48, but kind of only in words, I mean, and that’s – when we think about the Windrush scandal, you know, these are the people who were only ever shown institutional racism, and were not given the same rights alongside their British colleagues. And were not welcomed. And there’s this piece of footage from the 1960s, a kind of recruitment film called The Nurse, that shows young women of colour working in the NHS, you know, gratefully. But doesn’t show any of the hardships that they faced, any of the racism, any of the difficulties, you know, with promotion and pay and equal rights. And at the same time, the state not even being able to get together the paperwork, to make sure that they can prove the legitimacy to be here, and that being the issue with people – a huge number of people finding themselves ineligible for free care now, despite having worked for the NHS. You know, in some cases people being deported, while having actually contributed, you know, or having worked for the NHS, and the hypocrisy of that, I think, is part of this institutional racism that people have faced. 

Anyway, in terms of the actual like, you know, the way that it works today, the kind of definition of the hostile environment is, you know, making it difficult for people to live in the UK without proper immigration status, and like those kind of difficulty things that, you know, it’s – if you want to access care, being asked to prove your eligibility. You know, like being able to prove your residency is very – is actually very hard. It’s not a clear-cut equation. People are asked, you know, have you lived abroad in the past 12 months, and that is then a gateway question to either, you know, being asked to bring in their passport, or a visa, or you know, documentation of the bills that you’ve paid, or – there’s a huge amount of evidence that then people are often asked to rely on to show their eligibility. And that’s either bringing it in themselves, or actually, you know, often the Home Office actually enquiring of people, being – there’s some evidence to suggest that GP practices and hospitals are being asked to provide information on patients directly to the Home Office. 

Now there’s been some evidence, you know, the information sharing, there was a memorandum of understanding between NHS Digital, which holds a lot of personal information about people, and the Home Office. And that information – there was information being shared kind of unequivocally without any scrutiny at all. And that has stopped for the moment, kind of pending investigation – pending review, but still the Home Office inquires about patients, and GPs are no longer – they don’t have to give that information over, like it happened before, but you know, they still are, because they don’t realise what their rights are. And so the people who are now checking eligibility to care and being part of the border controls, kind of on arrival for people, but actually also people who have been in this country, have been living here, have contributed to a community, you know, to their family, to their friends, to the places they’ve worked, and they’re now, you know, being asked just the simplest questions at the GP practice, or, you know, ‘are you somebody who’s entitled to care?’ You know, ‘have you got your passport?’, and just the humiliation of being asked those questions, you know, it’s – and the fear of being charged. And that is the way that the hostile environment is working in healthcare. It’s trying to deter people from using services, often in the majority of cases that they are able to access, and they’re being questioned erroneously, but we have to ask the bigger question, like what do we mean – who deserves these treatments and who doesn’t? And, you know, part of what Docs Not Cops’ work is about is to try and say no, actually everybody should be eligible for free care when they need it.

Lani: Yeah, and that’s one of the things that we were thinking about, in terms of this deserving and undeserving, right, so it’s how it sort of twists up with ableism and racism, how it kind of all connects together, is this sort of discourse of who is deserving.

Sophie: Mm, and that discourse of deserving meaning, you know, you’re somebody who’s paid your taxes. You’re somebody who’s paid your national insurance. Or is deserving somebody who’s working and paying taxes, or is deserving somebody who happens to have, you know, been unfortunate enough to need help, and who hasn’t accessed it? Or is this somebody whose mental health is stable enough that they can work – you know, there’s a lot of arguments here that draw in disability, and mental health, and that – the physical health aspect of it, I think, is a big problem across the spectrum when people talk about deserving and undeserving migrants, as well. This huge issue of vulnerability. And that we’re – there is this, kind of almost very top-surface show, you know, that ‘oh, of course we’ll help people who are vulnerable, but not people who aren’t’. And so that deserve – and then it switches. You know, we’re allowed to be vulnerable, but not allowed to be powerful and organised, but also have mental health issues or physical health issues. 

And I think it’s the fact that that – that mess, at the moment, like you were saying, of the ‘undeserving’ basically becoming the scapegoat for the crisis in the NHS, for the fact that the services aren’t functioning. And it’s very easy to say it’s because these people needed, you know, they’ve used it all up, it’s all gone. The people who didn’t pay the taxes, the people who weren’t working, the people whose mental health and physical health wasn’t good enough, it’s – let’s blame them. Let’s not blame the financial crisis, let’s not blame the funding decisions and cuts by the government. And that – articulating that is really important to make it clear that we cannot scapegoat. We have to go to the core of these issues that there is an ideology that drives the hostile environment, you know, that tries to break apart communities, encourage policing of border controls amongst communities, because divided we’re weaker. And I think that’s a – you know, a really strong message to remember when we’re campaigning, and being part of a movement.

Lani: So yeah, a good little segue, I think, into thinking about and starting a conversation around how it is that you organise, and how does it – where things are at, what’s going well, what’s not so good about it? Anything you want to say about how it all works.

Sophie: [laughs] I’ve finished chewing my nice bit of carrot cake! Like as an organisation, I think I – you know, I have my own perspective on how I think Docs Not Cops works, and like I said earlier I’m sure that, you know, other people will think differently, but the actual structure of the organisation has really changed over the time that I’ve been involved in it. So, kind of we’ve gone from having quite a lot of support from, you know, like from Act Up, or from trade unions, to then being quite small, and at that time mostly kind of medical students and focusing on trade union organising within the BMA, or at university level, and doing direct action, and then from kind of – from picking up different members who had a much more varied, and much more experienced in organising, particularly from Climate Camp, and brought a whole new perspective on how the group could organise, and having much stronger emphasis on social media, on links now with bigger kind of like NGO and migrant rights groups. You know, that’s a huge trajectory in what, like we’re talking is it 5 years really, since the organisation, 5 or 6 years since we started. So it’s been through a whole number of permutations, I think some have worked better than others. 

And, I mean at the moment, the ways that we organise now, I think I’ll try to maybe explain by looking at some of the different actions that we’ve done. And, you know, thinking about the different forms of action, both online and on the streets, that we’ve participated in, and both where we’ve maybe been the kind of spearhead of that particular action, or event, and actually then when we’ve stood back and we’ve been part of an event with other organisations, and so like what’s been the strategy for each of those as well. 

So the kind of the most recent action that we did was the vigil and marches represent – to kind of reflect on the two-year mark for up-front charging. And for that, you know, that’s building on knowing various groups at different hospitals, so that – they were organising in conjunction with Keep Our NHS Public in particular, and Medact. And the ways that those actions were planned are kind of in serial monthly meetings, that were happening up until the action. So I think the plan for that action was made kind of June, July. 

There’s then… we’ve had monthly meetings now for about two years. And in that kind of identifying that this action was something that we wanted to do, identifying a smaller working group of people who were keen to get that off the ground. And also identifying people who have particular local contacts, and who felt like there was something that they could build out of at their particular hospital, and then going forward, making sure that there was a Google doc for people to be able to put their ideas on, and also make it have – having a kind of contact list for people who we could either approach from other organisations to be present, to speak, to kind of hold banners, to be present at the demonstrations as well. And then, towards the actual day itself actually having a social media strategy as well, so there’s a different – we actually have different Whatsapp threads for different parts of the organising. And we’ve tried lots of different things actually, that we had a Slack group for a while, we then had one big Whatsapp group for a while, that then was dissolved because people found it completely unwieldy and unmanageable. And so now there’s some smaller Whatsapp groups, for like specific tasks, and so there being an action-specific Whatsapp feed and a social media-specific Whatsapp feed. 

And kind of then, in the days leading up to the action – you know, I think probably about two weeks in advance, people making sure that there are – there was a press release, or a kind of a statement that goes out, that there’s media contacts have been arranged. There was a lot of work that went into the aesthetics of the action as well, you know, people being outside the Department of Health, you know, in scrubs with their hands tied, like really strong powerful images that people then engaged with. So across that week we had like over 100,000 engagements on Twitter, which is, you know, a huge input – a huge output for a relatively small organisation. So I think in terms of like the way that that was organised, like it demonstrates the fact that there’s a very democratic structure, that we bring people together and that it’s discussed what kind of actions people want to do. There’s an ongoing kind of commitment of people who are not like full-time working on this, and that it has to – the timelines often have to reflect that as well. And that then it was centred in places where we felt we had a community, or other organisation support to make it as big as possible, and then making sure that we’ve got like media contacts as well. 

So that was kind of like how one, like one particular set of events on that day were organised. We’re actually probably quite a small organisation, in terms of like it’d be – like there’s probably about 5 to 10 people who will be at every meeting, or try to be at every meeting, who do the majority of the online, and emailing, and doing the speaking at events. But the way that that kind of is made slightly more manageable is I think people tend to try and take it in turns to share out some of the workload, and like at some points people have to step back, and have to give themselves some space from it. It can be really intense when people are trying to coordinate all these different things, and there’s a lot of responsibility on them in some ways. But then people tend to come back in, and so there’s this kind of tag team aspect of like making sure that people look after themselves. And I think the things that have really helped Docs Not Cops, like in the past like two years in particular, is each year we’ve kind of had like a kind of a sit down day of working out what the priorities are for the organisation, and that being like an open meeting where people are invited, and that we have a structure about how we approach different arguments that, you know, whether the legislation is changed, a kind of a bit of tooling up in terms of the actual arguments that we need to try and convince people of our position around charging. But also about what is the strategy for Docs Not Cops, and often that’s around things like communication channels. So is the Whatsapp working, is Slack gonna be better, who does the emails, what’s our email address, what’s happening on the website? But also strategy in terms of how we work with other organisations, and, you know, over the past two years we’ve had a really important emphasis on actually collaborating with other organisations. 

And I don’t know if you’ve seen similar things in other groups, who are fighting against hostile environment and other parts of the movement at the moment, but, you know, we’ve found it really important to collaborate with organisations that can offer something different to what we do, and actually bringing together our core strengths, so like specifically I’m talking about the Patients not Passports campaign, and that’s run together with Migrants Organise, which is a migrants’ rights charity, and Medact, which is a – kind of a charity, a more like non-governmental organisation that collects together ‘lefty’ doctors and healthcare workers, and runs a number of different campaigns from climate change campaigns, to the refugee relief, to working on the hostile environment. And I think the ways that our organisations kind of complement each other is, you know, those organisations have more money that we do. So that always helps, but also Migrants Organise provide like that community grounding, to make sure that whatever strategies we have in a hospital, or at a GP practice, or in a university, are then mirrored with the strengths of the communities facing the impacts of charging, you know, and that might be a particular case, of a particular individual, or a family who are facing charging, and as an organisation then being much more close to the ground, to be able to know what we can do to support, who are the other organisations that can help, and mass this sense of as political power around this. 

So that’s – you know, that’s brilliant, and then Medact often actually provide a bit of the kind of… I don’t know, like institutional clout, in some ways. So there’s been a lot of work around like lobbying, talking to the professional bodies, particularly for doctors, so the Royal Colleges, Royal College GPs or the Royal College of Physicians, and as a direct action group – like Docs Not Cops just don’t get in the room. I think having that professional aspect, with a bit of money and grounding behind it, has helped, but of course then, when Medact are in those discussions, because Docs Not Cops – you know, we’re kind of the branding, we’re a bit of the glue that makes this work, we’ve got the online presence, we’ve got the name, and we’ve been quite clear in the messaging. And actually we draw in people who run the workshops, do a lot of the… kind of the face work of the campaign, that actually it then means that our messaging is then going to those larger organisations. And so I think we’re drawing in some of the radicalness, that neither of those organisations would necessarily be able to do on their own. 

So I think that’s also then a big part of our strategy, which is to actually like bring the strengths from these two diff – with three different groups, and try and draw on all of them. And I think the Patients not Passports campaign has been able to really demonstrate that, like there is a national strategy, which for an organisation with 5 to 10 key people who are always there cannot have [laughs] they can not have a clear national strategy that has – that’s gonna work. And I think, you know, we’re in – it does draw up – you know, it does bring up some issues of like who makes decisions, that are abiding to these organisations, and who leads on some of these issues when all three organisations are involved. But it means, you know, it’s not often easy, but it does mean that there’s – despite there being tensions, it doesn’t mean that it’s not productive. So I think that’s kind of one of the new things that we’ve been doing, that I think it is really working at the moment. But yeah, I don’t know if there are other examples in the – like in the movement that kind of work similarly?

Lani: I guess that that kind of cross… cross-tactic organising, I suppose, is – was a useful thing to make links with other organisations that can do different aspects of what you’re doing. And thinking about that in terms of building coalition and solidarity, and what your positions are – your position as an organisation, but also – and also as people within those organisations, of what are your primary positions, I think. Yeah, so I was thinking about that in terms of that kind of cross coalition solidarity. And is there anything around that, sort of for you personally, how that is – how Docs Not Cops and how your involvement is around solidarity and around like using your particular positionality, I guess, your particular positions?

Sophie: And I think – like as a doctor, you know, like you have a huge amount of privilege, and like in recognising that there is like a class privilege, and like medicine is incredibly hierarchical, and the – recognising that like being able to make a statement as a doctor is something that is like listened to. I don’t know, you can get in a – you can get a letter written in a newspaper, you can get in a hospital, the body of doctors has more power in it for like class and institutional reasons, that actually I disagree with, but that’s the system as it is at the moment, and being able to come out and say like ‘I disagree with this’, with the charging, and it’s against the Hippocratic Oath, it’s against what I went into medicine to do, I think has a – you know, that is a statement of solidarity. 

But it also has to recognise that like – I don’t want to work in that kind of institution, and I think about, you know, the fact that I’m not the person who’s gonna be charged, but I don’t want to be complicit in a system that does charge, and so kind of calling out on people to feel like they should have responsibility to know what they are complicit in. So the kind of act of it is a statement of solidarity, being in Docs Not Cops, talking about – you know, I want to stand in solidarity with people who face charging. But also about recognising that I am gonna use the institutional power that I have to try and bring this down. And there are, like, there is an issue around like actions of individuals versus the action of the group or the campaign. And there have been individuals who’ve faced like kind of serious consequences for taking action around individual cases in their hospitals, of kind of resisting charging. And I think we can’t support people to take individual actions that might bring about kind of consequences for whether or not they’re gonna lose their job, or – it’s really hard to say to people that they should put themselves on the line like that when as an organisation we don’t have any money to be able to defend them legally, we don’t have any employment lawyers that would be able to advise them. You know, all of our work is kind of on the political level of union support, you know, trade union support, and workplace support. But also, shaming. Shaming the trusts, using that campaigning model I was talking about and the kind of media around this to shame trusts who charge individuals who are – who would never be able to repay these fines, and never – and their immigration status having, you know, being threatened and the consequence of it. 

Yeah, there’s the issue around, we were talking a bit about what does it mean for me personally, and like we were talking a bit about racism in the NHS, and you know, I’m a white, cis woman who – I don’t face racism, but I will stand up against racism, and I will defend my colleagues and my patients. And there is an element of recognising that are you somebody who’s gonna be quiet and complicit, or are you somebody who’s gonna recognise the racism and the inequality that’s persisting. As a doctor I’m gonna use that position to try and make that, you know, to make myself heard. And I can do that, and I can commit myself to it, and I can ask other people to do that, and I think that’s – that’s a starting place. While also reflecting on the fact that other people’s experiences of racism, you know, you have to be heard from them. They have to speak for themselves, and you have to champion their voices at the front of whatever campaign work that you do.

And that’s why our work with Migrants Organise and Medact is so important, because it actually helps us promote some of those voices that aren’t in our group itself. We don’t do casework, you know. We do have people who have been affected by charging, but we need to make sure that their stories are handled in a way that isn’t gonna jeopardise immigration status or their access to healthcare, and I think that’s best done by working together with the different organisations who have the skill-set. But yeah, so like you know, making sure that we champion the people at the front of the campaign, but that we do that really sensitively. And I think that’s kind of – yeah, my approach to how I deal with some of the issues of like identity, and personal identity in a campaign.

Lani: Yeah, that’s brilliant. So, we’re coming up towards the end now, but I was just thinking about what is it that you – if you had success, if you were like ‘Alright, we’ve done this job, I’m gonna do something else with my time now’ [laughs]

Sophie: What, like we won?

Lani: We won! [laughs] Yes! Or what would it look like? For Docs Not Cops, not – probably not for like overturning, you know –

Sophie: [laughs] Capitalism!

Lani: capitalism [laughs]

Sophie: We’ll leave that for another podcast! [laughs] Yeah, I think like… what I like about this campaign – maybe I’m just an optimist and I think this will happen to all the campaigns that I’m involved in, but I think we could win. You know, like there is the attitude towards the hostile environment is changing, and the fact that the Labour party, at their annual conference this year, voted against – you know, voted against the hostile environment as it exists now. I mean in words, and that there are some, obviously some disagreements with the – amongst the Labour party and against – and among activists as to what commitment they’ve actually drawn themselves into, but it’s a start. And it’s a – what that success would mean for us is that – I think it would be gradual, and I can’t imagine us stopping charging immediately, but, you know, I can imagine maybe one hospital trust, maybe a couple of hospital trusts at the same time saying ‘This is not financially viable, the harm is disproportionate, and we will not charge any more’, despite it being against the law. 

I think what we saw with Right to Rent, is that it took – you know, that was through a legal battle, it wasn’t – it wasn’t kind of pressure on an individual – on a kind of housing or council basis, that was won through the courts, but it was found that it was dispropo – it was racist and discriminatory. You know, there has to be a point at which hospital trusts think ‘We cannot continue to discriminate people at this extent, it goes against’ – you now, it is not legally viable. In the same way that fracking has stopped. You know, the government has created its own threshold for what it will consider the boundary for fracking, and it said actually these – the companies can’t meet our thresholds, therefore it stops. I mean, obviously it’s still in words, it hasn’t necessary – you know, it doesn’t mean it will stop for ever. But actually there was a threshold that they’re not willing to go beyond any more, and I think what I can see happening is some – is hospital trusts across the country being forced to say ‘The harm is too great, we will not do this any more’. And once there are a couple of trusts doing – who have to stand up and say that, you know, I think actually that puts the government in a really difficult position to continue to do it. And all the evidence at the moment points towards it being harm, disproportionate harm. That the wrong people are being charged, that when people are being charged the money is not being recouped, and actually the spiral of charging and debt, and bailiffs, and immigration status, is one that is pushing people into poverty, into extreme forms of poverty, that actually people are going to have to hold up their hands and say look, we can’t – we can’t do this any more, that the – that the coming together of the cases that we work on, the organising with Patients not Passports, the shame that that puts on trusts and the fact – you know, getting them to say ‘we won’t charge any more’ would be a huge win. And I think that could be the – one of the wedges with which the hostile environment will be broken. And yeah, so I think – yeah, I think it will happen.

Lani: Brilliant, thank you for your time and that interview. 

Sophie: And thank you very much for having me. It’s been a delight!

Lani: I hope you enjoyed this podcast. I would like to say thank you to Marlon Nyirenda of Dis Art You Know for the music on this production. If you’d like to get in touch with us, please do so on Twitter at @SidewaysTimes, or by email at sidewaystimespodcast Let me know what you think of the podcast, and also if there’s anybody you think we should be talking to in particular. love to hear your thoughts. Look forward to it!

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