All human life is in Homerton hospital’s car park. Or at least, passing through Homerton hospital car park on the way to A&E or outpatients or maternity. A Bangladeshi woman in a wheelchair. A Hasidic Jewish schoolboy with ringlets and a limp. A bearded hipster with a newborn baby in a plastic carrycot. Inside there are nurses from the Philippines, from Spain, from Italy, from Gambia, from the Caribbean. There are doctors from India, and radiographers from Germany, and anaesthetists from Pakistan, and cleaners from Ghana, and midwives from Nigeria. To cut to the chase: there is everyone from everywhere. And of course they’re not alone in this. With more than half of all doctors coming from abroad – as they have since at least the late 60s – Homerton hospital in the East End of London is like every NHS hospital in every city in Britain.

On the morning of Friday, 24 June, this was a fact that struck Junaid Masood, a Pakistani-born, British consultant urologist when he came to work at Homerton – and it struck him in particular as he looked around the theatre where he was about to operate. “It was the morning after Brexit,” he says. “Everyone was shocked and depressed and I just had this moment of clarity because I looked around and thought, ‘Oh my God, every single person in this operating room today is from the European Union. So, at the end of surgery, I got everyone to hold up a placard saying where they were from and put it up on Facebook. And then it just went nuts.”

It really feels like a loss of innocence to have a symbol of British tolerance dragged through the mud in this way Roberta Bivins, Warwick University

The picture of his team, smiling in their blue surgical scrubs, featured an Irish radiographer, a German consultant anaesthetist, a Greek urology registrar, three Spanish nurses and himself. It immediately went viral. The Facebook post was shared 19,000 times, tweeted hundreds of thousands of times, spawned copycat photos from NHS hospitals up and down Britain and ended up on the pages of newspapers across the world.

Their smiles, however, look almost innocent now. Last week, the rhetoric of anti-immigration became wrapped up in the survival of the NHS, an institution that has been built upon the hard work of immigrants for almost its entire history. The health secretary, Jeremy Hunt, announced to the Conservative party conference that the NHS needed to become “self-sufficient in doctors” by 2025. It needed to end its reliance on foreign doctors, and it would do this by training an extra 1,500 medical students a year.

This was news to everyone, not least those working in the NHS, or heading up our medical schools or the British Medical Association, because apart from anything else, the numbers simply don’t stack up. “It’s completely unrealistic,” Deborah Gill, the head of UCL medical school, tells me. “It’s a drop in the ocean. An extra 1,500 students is going to make no difference whatsoever.”

Facebook Twitter Pinterest Medical staff at Royal London hospital, east London. Photograph: @ShafiAhmed5 via twitter

But that doesn’t make it any easier to hear. Leonidas Karamountzos, the Greek registrar in Masood’s photo, looks uncomfortable when I ask him about it. “It can make you feel… look, I’m not going to say unwanted. Everyone is so polite. But if you keep hearing, ‘we don’t want any more immigrants, we don’t want foreign doctors’, it does make you feel unwanted in a way. I’ve been here six years, and of course I’m gaining from the NHS, I’m gaining experience, I’m getting paid, but it doesn’t feel fair that after six years you have people saying, ‘You know what? We don’t need you any more. We think we can do without you now, OK?’

“Because I don’t think you can do without us. That’s the thing. But then you get up and you go to work and you try to help British people get better.”

Masood and Karamountzos are telling me this in the tiny gap between their morning clinics and their afternoon surgeries. “It’s absolutely chaos this morning, I have to be honest,” says Masood when he greets me. “The clinic is massively overbooked. But this is what always happens. And you spend 10 minutes more with one patient and there’s a massive knock-on effect and this happens every week, unfortunately, and I’ve got to rush upstairs because I’ve got four patients that need surgery this afternoon.”

Hunt promises to end NHS reliance on overseas doctors after Britain leaves EU Read more

This is a familiar story to everyone who’s ever used the NHS. But what’s new is the toxic language of immigration coming up against the day-to-day reality of the NHS. This does feel new and ugly and unwelcome – and, for the 101,000 doctors born overseas who work in Britain, and the 140,000 nurses, and the 64 million of us who depend upon them, it’s a depressing new departure.

Until now, the NHS has been a place apart from what happens politically. It is an institution, something so fundamental to our sense of Britishness that it has somehow managed to resist the xenophobic tide that has become such a feature of British public life. It is something that survey after survey tells us we hold precious; that touches every person in the country, in the most personal, intimate way. And the whole fabric of its continued existence relies on immigration.

Roberta Bivins, a professor at Warwick University who is undertaking a major project to map the cultural history of the NHS, tells me that although the NHS has been leveraged as capital and ammunition by politicians since its very inception, there is something new at work. “We expect the NHS to be above all that. It really does feel like a loss of innocence to have something that is a symbol of British tolerance and cosmopolitanism and egalitarianism dragged through the mud in this way. It is truly shocking.”

The NHS is one of the unique things that unites us as a nation, she says. “It’s a fundamental part of British identity. It’s been something that has represented how much we believe in equality. What I’ve found is that the NHS is constantly framed as the space that proves that Britain is a tolerant nation. Where racial and class and ethnic barriers are overturned. Where you can go and expect Britain to be at its best. Your doctor may have come from anywhere, and you will be treated the same as anyone else.”

And that is still true. “I don’t see people and think, ‘You’re British. You’re Afro-Caribbean. You’re whatever,’” Karamountzos tells me. “For me, a patient is a patient. It doesn’t make any difference to me. Patients are patients and doctors are doctors. This is what counts.”

Facebook Twitter Pinterest Medical staff at the University Hospital of South Manchester. Photograph: @uhsmnews via twitter

And for at least 40 years it’s been where the differences between us have been erased. “The NHS would never have survived the pent-up demand from the interwar years had it not been able to import staff from Africa and the former colonies,” says Bivins. “That has always been the price of universal access, and it has been enormously benefiting to British society.

“Even by 1968, 46% of all doctors below consultant came from abroad, and 30% of all nurses.”

What’s more, for much of the UK, she says, it was the first place where middle Britain came across multiculturalism. Part of Bivins’s project is a “people’s history of the NHS”, and as such she’s been gathering stories, “talking to lots and lots of people, and for many, especially older people, they’ll say it was the first time they met a black man or so on. It was where middle Britain met migrant Britain, and in a totally non-negotiable way. It’s the one place where you’d be mixing with people who are not like you, whether in terms of class or ethnicity – and who you’ll be dependent on during some of the most intimate and important moments in your life.”

It was the opening ceremony of the 2012 Olympic games, she says, Danny Boyle’s great visual poem to the NHS, that made them start thinking about the central role the NHS plays in Britain’s cultural life. “And what is astonishing is how much the attitudes and rhetoric have shifted since then. It’s been quite amazing – and depressing – how that has happened in just four years.”

Boris Johnson says NHS will get substantial extra funds after Brexit Read more

Boyle’s co-writer for the ceremony was Frank Cottrell Boyce, who tells me that the section on the NHS was “Danny’s passion”. He wanted the ceremony to be emotional. “The NHS is where British people are born and where they die… It’s a huge unifying force in British social life and the point of entry for thousands of migrants.” Boyle “really put himself on the line for it – threatening to leave when they suggested cutting it”.

By “they” he means the government, and it turns out there’s a thread here. The culture secretary at the time? Jeremy Hunt.

The BMA – which represents 170,000 doctors – knew nothing of the proposals before Hunt’s party conference speech was made. They were not consulted. The head of the Royal College of Physicians, Jane Dacre, points out to me that 40% of new consultant posts are already not being filled. At UCL, Deborah Gill says that while they welcome lifting the cap on the number of medical students they’re allowed to admit, they’ve no idea how it will be funded, if there will be enough foundation placements, or why it has anything to do with foreign doctors “coming over here, as they do, curing our patients and paying their taxes”.

Nicola Strickland, head of the Royal College of Radiologists, tells me she believes the situation to be desperate and that Hunt’s proposals cannot possibly solve it – in fact, that they are likely to make things worse. To put it into perspective, she points out that only a tiny number of the extra 1,500 students will choose to go on and qualify as radiologists, and they won’t come through the system until 2030, or 2032 for clinical oncologists who the college also represent. “And by that time,” she says, “we’ll be lucky if we have a health service for them to work in.”

Every specialism perhaps believes that its own is most crucial. But Strickland makes a convincing case for how the crisis in radiology recruitment will break the entire system. “It underlies almost every single diagnosis these days, and demand is going up exponentially. It’s increased by 29% in the past three years. But there is simply not the staff. We have hard solid data that shows that we need 260 extra trainees a year for the next five years even to catch up with the rest of Europe. We know this for an absolute fact. We are currently tied third bottom with Turkey. Imaging underlies every part of the health system and without it the entire health system will fall apart. I am desperate to get this message out there, and nobody is listening to us.”

Facebook Twitter Pinterest Medical staff at Broomfield hospital in Chelmsford, Essex. Photograph: @shevyuk via twitter

A third of radiologists already come from abroad and they are trying to recruit more, but already one in 10 consultant positions is vacant, unable to be filled. “If you believe passionately, as we all do, in free healthcare at the point of need and you see that being destroyed… well, it’s very depressing and demoralising,” says Strickland. “Already 230,000 people are having to wait a month to get the results of their scans and that’s just not right. It causes stress and anxiety, and delays life-saving treatment. We are trying to tell everyone we can. We could train people but the money is not being made available and it’s going to break the health service. I really mean that.”

It’s hard as an outsider to understand quite how big a crisis the NHS is in – if it really is as bad as Strickland says, or if it has always gone through these sorts of episodic cycles. But Anthea Mowat from the BMA tells me that it is real and that the collapse in morale is like nothing they’ve ever seen. “We’ve just done a survey, doctors 10 years post-graduation, and 42% of them say it’s much worse than they expected, and approximately the same number plan to go to work overseas because they don’t feel valued in the NHS.

“We’ve got to the point that our own UK-trained doctors don’t feel valued. And now we don’t value our overseas doctors either.”

In fact, Masood tells me that his department, for the first time, has a vacancy for a registrar and no applicants. “This has never happened to us before. We haven’t had a single applicant.” And a university hospital in London is a more attractive proposition than many posts, such as a GP in Stoke-on-Trent, for example, where 65% of GPs are already from outside the EU. Chandra Kanneganti, head of the British Indian Doctors’ Association, who runs three practices in the city, tells me there are currently 34 vacancies. Most of them have been empty for a year.

But then, he says, because of visa changes it’s almost impossible for Indian doctors like himself (he’s originally from Hyderabad) to come and work in Britain. “Instead they go to the US, to Australia and Canada. In the 1960s, general practice in Britain was on its knees and it was my colleagues who came in droves to work in the inner cities and places no one else wanted to go. They saved the NHS, and the government needs to recognise this and not make this kind of politically motivated attack on us.”

I try to end the interview with Kanneganti, but he won’t let me go. “I am so proud of the NHS, and I love this country. I love it for the way it recognises talent and hard work. And we do work hard and we pay taxes and we do not take benefits and all we are saying is, please recognise this.”

It’s madness that someone as accomplished and hard working as Kanneganti feels the need to justify his position. Or Nancy Ifill, a sister in the emergency department of Whipps Cross hospital in East London. I catch up with her at 11pm, just after she’s arrived home in Colchester, Essex, having left the house at 6.30 that morning. She’s originally from Barbados, came here in 1989 and is now a British citizen. So does that mean she doesn’t feel the insecurity that many non-UK NHS staff feel? That they might not be able to stay.

“I would never say I feel totally secure. You just don’t know. With Brexit, it feels like if they want you to go back, they could. I don’t know if this is being fuelled by Nigel Farage and his ideologies. It’s a similar thing with Trump and Hispanics, but it makes you feel like you really don’t belong. Like you’re a lodger. And when we’ve had enough of you we’ll put you out.”

Does it upset you? “Of course it does. At the end of the day you come here, you contribute to the system. You’re not mooching off the state. And it’s a significant contribution. A society cannot function without a healthcare system. If you don’t have a healthcare system, you don’t have a society. And for people to think that you don’t matter… well, it’s a bit tragic.”

Her colleagues at Whipps Cross are from everywhere. In her team, “I can probably count the number of ‘home-grown’ nurses on one hand. ‘Home grown’! It’s such an insulting, derogatory term.

“Who is this organisation made up of? It’s foreign people. Whether they are nurses, cleaners, doctors, the great majority of people working in the largest organisation in the world are foreign people. If you remove them, you won’t have a system. This institution is at the heart of British life and it’s made up of foreigners.”

It is, and it’s where the ideology of Brexit strikes against the idea of ourselves as a people in the most intimate way possible. Because the NHS is where we are literally at our most naked and vulnerable. It’s at the heart of what we believe it is to be British. We are – as every staff room in every hospital in every British city shows – a country that depends upon the hard work and contribution of people who have come from elsewhere. Who are there when we’re born. And there for us when we die.

We hope.

Facebook Twitter Pinterest Junaid Masood

Junaid Masood, consultant urologist, Homerton hospital, London; British, born in Pakistan

“I came to Britain at a young age because my father came to work here as a doctor. The comments by the health secretary last week were almost like an anti-recruitment message. Jeremy Hunt sort of yelling to the world, ‘Don’t come to Britain because we don’t want you.’

“We’re going to really struggle massively to get skilled staff now. I’ll give you one small example. We have a vacancy for a registrar. This is a good job in a good hospital and we have not had a single application. I don’t know if that is a coincidence, but this has never happened before.”

Facebook Twitter Pinterest Leonidas Karamountzos

Leonidas Karamountzos, urology registrar, Homerton hospital; Greek

“It’s made the future very uncertain. I’m not sure what I’ll do now. I’ve had so many colleagues in Greece say to me, ‘Oh, you made a mistake. You went there. Now you’re going to be kicked out.’ It’s certainly going to put other people off coming.”