From the point of view of many readers, growing up at Hailsham has a negative effect on Kathy and many of her peers. For example, they all live in fear of their keepers and of the environment in which they are held. School lore suggests that children in the past who were disobedient were mutilated, and this emphasis on their physical bodies is deliberate. The children are all subjected to frequent and thorough medical examinations, and though this rigid attention to health suggests concern, the care is somehow impersonal and therefore confusing.

A childhood at Hailsham is characterized by confusion, which has a negatively disorienting effect on the children. No one seems to understand much of anything, which is destabilizing. The dramatic irony of the novel can become almost painful for the reader, as the reader learns, before many of the young people at Hailsham, that their whole existence is designed for the survival of others. The children at Hailsham are valued only for what they can provide, not for who they are, after all.

Never Let Me Go is often categorized as a work of dystopian literature, and this sad treatment of innocent children is one of the more terrifying elements of the novel. Not only are the children being nurtured as clones in order to donate their organs, but they are also kept in the dark about their role, which only leads to confusion.

Hailsham is a temporary juvenile detention center with the superficial trappings of a school. Its function is to house the cloned beings until they reach adulthood. Because the children are allowed out on the estate's grounds and lack a frame of reference for normal childhood practices, they do not realize that they are incarcerated. The adults who staff the institution are wholly committed to deceiving the children. When they are grown, the cloned beings are taught that they are not humans and that their fate was predetermined: to provide organs to transplant into other humans until the clones have no remaining useful parts.

The most lasting negative effect is their death. Leading up to this and apparently making it inevitable, the children are indoctrinated into believing that they have no choice in determining the course of their lives. The concept of free will is never presented to them.

Kazuo Ishiguro includes a few details that suggest possible cracks in the totalitarian regime. As young adults, the cloned beings are sent to live in cottages and allowed to communicate with one another. The authorities cannot completely control the spread of information or gossip, so the children develop misguided, hopeful ideas of possible alternatives to their certain doom. As of the novel's end, none of them has yet rebelled.

At first, Hailsham seems like an idyllic environment in which to grow up and get an education. Later, though, as the truth is revealed, the characters realize they were always living a lie.

Hailsham seems to be a school where students express their creativity and idolize their teachers while forming strong bonds with their classmates. When Kathy recalls her childhood at Hailsham, she seems nostalgic for the innocence of that time. Once the children "graduate" from Hailsham, they go off to other cabins where they live with other "graduates" before starting their roles as either "carers" or "donors." At this point, the young people learn that their destiny is basically to house donor organs for "real humans." The Hailsham students, it turns out, are clones. This explains why they have no memories and seem unconcerned about their parents. The donors give organ donations in one to three separate surgeries; when they "complete," they have nothing more to give, meaning they die. The carers are responsible for nursing the donors until the carers become donors themselves.

The Hailsham cohort have no real control over their "lives," and when they learn the truth they are, understandably, devastated. They look for ways around their fates. For example, Kathy and Tommy think that if they are in love, they can be spared; they even go to the home of a school founder only to be told that was always an unfounded rumor.

The Hailsham students are harmed by their time at the school because they are lied to—or at least not told the truth—about their purpose. On the other hand, how does one tell a child this is his or her fate? It seems unethical, but it is also an impossible situation. Never Let Me Go highlights these ethical conundrums that can result from advancing technology and medical progress. The novel asks whether we should pursue such a route even if it is possible, as it has dire consequences for some of the players involved.