Reflections on the UK Health System

I have talked to several Americans who've had really horrible experiences with the UK's National Health Service. Others have been full of praise and thoroughly surprised by the level of attentive care they were given. Here are my general reflections about how you might find the care over here, especially as it differs from the American system. I realize being totally unbiased is not possible, but I'll do the best I can.

The fundamental thing to remember about the NHS is that because they are a branch of the government, they do not function like the American private practice system. In short, their primary aim is not to please you. Health care workers have little incentive to make concessions, do things your way or bend over backwards for you. This is because their livelihood does not depend on your satisfaction with their work--they are paid by the government, not by you. This is not to say, of course, that health care professionals in the UK are heartless and lazy. I cringe just typing that sentence. I have had some wonderful doctors here who have worked hard on my behalf and shown a great deal of care about me and my family. I have also had some who nearly put me in tears because of their calloused, unconcerned and unmotivated air. The funny thing is, I could say the same thing about doctors I've had in the US. The difference is, in the US, you have the choice to leave and go find a doctor you like better. Your options here are much more limited, often non-existent.

As a result of this foundational difference, here are some things you might face (based on my experience and that of friends):

Negatives:

1. Dead ends: You may feel that your doctor in the UK will not try as hard you think he/she could to find solutions to your health concerns, particularly if the problem is complicated. For instance, a friend in his 30's, after snapping the arch in his foot, was told by his UK doctor that he would never walk again. He was offered no further assistance. He flew back to the US to see his doctor at home and was walking again within a week.

2. Rigid Compliance to Rules: You may feel your health care provider cares more about the rules or the system than about your needs. We recently had a friend whose NHS prenatal classes were completely canceled. When she asked her midwife how to proceed, i.e., how/where to get the replacement classes, she was told she'd just have to go without because the other classes were full. Another friend was forced to leave her doctor's appointment after 10 minutes because her time was up. They didn't care that she had more questions and concerns to discuss.

3. Limited Options: As I said above, your choice of a health care provider will likely be somewhat limited. If you don't like the practice you're at, changing practices will not necessarily be a sinch if it's possible at all. In my experience, you are only permitted to register at the practice that is nearest where you live. The exception is if there is a practice that generally accomodates the University students, though these practices often have heavy burdens placed on their resources and you may find better care at the one closer to home.

Positive:

Remember, it's free. Whenever I face something unpleasant, I remind myself that the care I'm getting is 100% free. I was talking to a friend in the US last week who's about to have a baby. Adding herself and the new baby to her husband's insurance plan is going to cost them $700/month. Having the baby, even with insurance, will cost them several thousand dollars. Sometimes I can hardly believe we don't have to think about those enormous expenses!

Having a Baby in the UK: What to Expect for Delivery and Recovery

I already posted on what you might be able to expect from the antenatal (prenatal) maternity care in the UK. Here are some thoughts on the delivery side of things.

1. The NHS midwives generally give you the option to have your baby in the hospital or in your own home under their care. Some areas also have birthing centres.

2. Your antenatal midwife will almost certainly not be the one to deliver your baby. Antenatal midwives and birthing midwives typically have distinct and separate jobs here.

3. If you choose to have your baby in the hospital, you will be given a private room for delivery. After delivery you will be transferred to a recovery room. Recovery rooms are typically shared with up to three other postnatal women and their babies.

4. Your baby will typically be left with you after delivery and throughout recovery, not taken to a nursery.

5. I think it's fair to say that the midwives treat delivery in a less medical way than it is often treated in the States. It will not be normal for you to be strapped down with IV's and other tubes connected to you. You should be a be able to move about freely during labor if you want to.

6. In my experience, your husband will not be allowed to stay at the hospital with you overnight.

Things you might not have expected to have to take to the hospital, but probably should:

1. A gown or something you don't mind giving birth in. That's right, the hospital does not typically provide you with a hospital gown to wear.

2. Nappies/Diapers. The hospital staff will expect you to have brought your own supply. They may send your husband to the store to buy some if you haven't.

3. Flip flops. Without going into too much detail, just remember you may be sharing a shower with up to three other post-natal women.

Afraid of Flying? Try this

Well, I'm a little embarrassed to admit this but since having a baby I have developed an annoying fear of flying. Annoying because I live in the UK and that means that plane travel is an inevitability of my life right now. In fact, since this fear developed less than eight months ago, I have taken six flights and am about to make another trip in a few days. I probably would have just assumed that I was kind of crazy and tried to deal with it on my own had it not been for two things: 1.)I've now spoken with two other students/student spouses here who have developed a fear of flying (okay, so at least there are three of us!) and 2.) I found this course online designed just for people like me. Apparently there are thousands of us closet airplane-fearers out there!

My fears haven't extended into the realm of hyperventilating or having a panic attack or anything like that--I've just come to dread the whole experience--the lack of control, the unexpected noises, landings, take-offs, turbulence--it all makes me a little jittery. I've apparently done a good job of keeping it to myself, though. In fact, I mentioned it to my generally observant husband the other night and he looked at me surprised and said, "You're afraid of flying?" I was grateful at least that I hadn't appeared to be a nervous wreck!

It was in my desire actually to enjoy this next flight and not be gripping the armrests half the time, that I decided to see what help I could find online and that's how I found the course. It's called Fear of Flying Help Course and it's a free online course designed to help travelers overcome their fear of flying. Pretty straightforward. The course consists of reading through five lessons and watching short embedded video clips (also available on youtube) along the way. It took me an hour or two to complete. It was designed by an airline pilot and walks you through what all those noises are that you hear on a plane, what's really happening during turbulence, the construction of an airplane, maintenance requirements, etc.

I admit, parts of it were a bit corny and it would no doubt be silly to those who don't understand the fear in the first place, but I still recommend it to any other flying-fearers out there. It really is free, though at the end he gives you the option of donating if you want to. And, best of all, I can honestly say that after completing the course I'm not worried at all about my upcoming flight. It was definitely effective!

Money Saving Tip #4: Don't Pay for Housing

One of the best ways to save money is to reduce your major monthly expenses, and one of the expenses at the top of the list is definitely housing. Just think of the money you'd save if you could eliminate that expense! Not to put too fine a point on it, but it would be somewhere between £5,400 (£450/month) and £9,600 (£800/month) per year depending on the housing prices in your area. And that's to say nothing of utility costs which might be around £1000/year.

The trick to eliminating this expense is to find a live-in position that offers free accommodation as either your entire compensation or part of your compensation. In my experience of looking, these jobs are actually in plentiful supply, you just have to know where to look. I recommend Gumtree, Craigslist and caretaker.org as good places to start. To give you an idea, below are three different positions that I was offered when we moved to Edinburgh. All were willing to accommodate both my husband and me, though two out of the three weren't willing to house a baby too.

Nanny: I was offered free accommodation and utilities along with £200/week payment and plentiful holidays. The work expected was 5 days a week, light housework and minding children who spent most of their day at school. The accommodation was an entire flat in the basement of the home, including our own bath and kitchen.

B&B Caretaker: Free accommodation and utilities with very limited additional pay (probably enough to buy groceries). Accommodation consisted of a double bedroom with shared bathroom and kitchen area. Work was helping prepare breakfast, cleaning rooms and looking after the front desk when the owners were away.

Homeless B&B Caretaker: Free accommodation and utilities plus £200/week. Work required serving breakfast to select homeless people staying in the B&B, light cleaning and locking up at night. Accommodation consisted of spacious flat with own kitchen, but shared bathroom.

As you can see, there are a variety of different options. Others that could be explored are caring for an elderly or disabled person in their home, doing gardening/landscaping on an estate or helping as a farmhand on a nearby farm. These are all opportunities that I have seen available in exchange for housing. Often the position will include a car. Sometimes it will be outside the city center and you'll have to evaluate whether the commute would be worth it. The point is to get you thinking outside the box for solutions to one of the biggest regular drains on your bank account. Happy house hunting!

Getting a National Health Service (NHS) Number

Remember, as an American studying in the UK for more than six months, you have access to the UK's National Health Service (NHS). This means that you do not need seperate health insurance like you would in the US because the NHS is government operated and functions without the involvement of private insurance companies.

Obtaining your NHS number is pretty simple. All you have to do is register with a GP. (GP means General Practitioner, or doctor.) After your successful registration you will receive, by post, a yellow mailing from the NHS--hopefully within a week or two. This mailing will contain your NHS number in the upper right hand corner. It will also contain your surgery (a.k.a. doctor's office) details and Community Health Index (CHI) Number. Make sure you keep it in a safe place.

Unfortunately, since you need to register at the GP in order to get your NHS number, you cannot apply for it long distance. You must already be residing in the UK.