Behind Closed Doors: The NHS

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I’m writing this as a BCD piece because my husband and I are not ready to talk openly about our plans to have kids but this still needs to be said: the NHS is a wonder that should not – must not – be taken for granted.
Having lived in the UK all my life (apart from stints spent travelling), my husband and I rashly abandoned our jobs after we got married last year and set off to try to establish a new life for ourselves abroad for a few years. We’ve done pretty well on the whole and now both have jobs in a far-flung developing country: pretty much what we were hoping for.
His job is with a European-based organisation; they give him sensible amounts of leave, pay him reasonably well and give him decent health cover that would bring him back to the UK if he got really sick. My job on the other hand is with an American-based organisation. On paper it sounds amazing, I work for an NGO in an exciting country doing good environmental/human rights work but – and this is a big but – the benefits are terrible. My pay, annual leave and maternity leave provisions are all laughable but the one that’s getting to me the most at the moment is the health insurance I get. My employers are proud to offer health insurance with a reputable international company and the staff (mostly local and American) are massively grateful to receive it; several of them have gone out of their way to tell me how great it is, leading me to think healthcare by other US employers must be pretty rubbish.
I knew having health cover where we’re working is a good thing but didn’t think too hard about what would be covered – I think I naively assumed having health insurance would mean I could access NHS-like services as and when I want. Turns out that’s not the case. As we’re wanting to have kids pretty soon, maternity health cover is an issue for me; after a week of negotiating health insurance options with my employers (a horrible experience – I found having to even engage with my new boss on health issues felt really invasive) I’ve ended up having no choice but to be signed up for health insurance that absolutely will not cover me for anything pregnancy/birth related. My only option to get that cover would have been to openly tell my new boss I’m planning to have children soon: not a conversation I was willing to have.
If I am able to get additional insurance cover that would cover me for maternity-related health, cover would likely not start immediately and (having looked at the options) might mean I have to wait 10 months after taking out insurance to even get pregnant. I’d naturally tend towards the ‘happy accident’ school of pregnancy planning and hate this world of horrendously mundane, utterly unromantic, insurance-related planning of when to have kids I suddenly find myself in.
Other things I won’t have any cover for are things like any medical equipment I might need (bring your own wheelchair), immunisations, eye tests and preventative screenings like smear tests – suddenly something you put off and dread ‘having’ to have in the UK becomes something you don’t have and you miss. Am I any less likely to develop cervical or breast cancer because I live elsewhere? I think not. If we struggle to conceive and need fertility treatment we’re completely on our own and dental treatment is not covered at all; I didn’t think to ask in the interview process as I assumed teeth are part of health so health cover would include teeth. Nope.
I feel like being brought up in the safe arms of the NHS has made me utterly naive about the big wide world of healthcare costs; I guess I should have realised that this would be the reality of moving abroad but in between getting married, job hunting, moving abroad and grieving for a lost parent last year, healthcare didn’t take up much of my attention. I hate the feeling that my employer suddenly has a right to a say in very personal decisions about when we have children.
Feeling that my healthcare is dependant on my job (which they can sack me from without notice) makes me feel very very vulnerable. I know I’m luckier than some in knowing that I can always come back to the UK (where I will be paying any tax I should with my pitiful salary) and the wonders of the NHS if I end up in a difficult position with no healthcare and do need treatment but man how I WISH the rest of the world had something like the NHS. I try to explain it to foreign colleagues and they just Do. Not. Get. that you never have to discuss money with a doctor, that everyone gets treatment however ill they are and for however long they need it. I know the NHS isn’t perfect but it’s something the UK should be truly proud of. True to cliche, I didn’t know what I had ’til it was gone.
Categories: Behind Closed Doors, Health
17 interesting thoughts on this


  1. SB
    Posted April 24, 2013 at 7:27 am | Permalink

    Yes! Yes! and thrice Yes!

    The NHS isn’t perfect and unfortunately everbody knows somebody who has had to wait for treatment/ referrals/ etc but treatment that is free at the point of access is a massive luxury that we take for granted.

    My family have always received excellent treatment and I count several YOUNG members of them who under a medical insurance system would have had their treatment stopped and would, therefore, no longer be with us. A cousin of mine has spent the last 9 months having cancer treatment and recently has had his immune system ‘rebooted’ to make sure every last bit of the disease is gone. If he had had to pay for that, I’m sure he would have had to refuse it. With the NHS we can look forward to him getting stronger every day and hope that he enjoys good health for many years to come.

    SB x

  2. Lexie
    Posted April 24, 2013 at 7:50 am | Permalink

    I’m another whose family are really appreciative of the NHS without whom my sister wouldn’t be here today. It’s certainly not perfect, but it’s pretty damn good. Which is why all the meddling going on at the moment is worrying. The House of Lords votes on the NHS regulations today.
    There’s an interesting article in the New Statesman about exactly what the government are trying to push through.
    A x

  3. Posted April 24, 2013 at 7:59 am | Permalink

    Very true words, as someone who works for the NHS I have my fair share of complaints on how it’s run, what is happening to us nurses etc. However the fact remains that we are damn lucky to have it, to have the ability to receive treatment for nearly any condition without charges is not something that we should ever take lightly.

  4. Posted April 24, 2013 at 8:32 am | Permalink

    Yes, healthcare should be universal. It is outrageous that in many places it is not, and we should fight for it, so thanks for talking about this
    In The Netherlands the system is half subsidized by the government (coming from taxes) and half private, meaning you have to pay every month, but you can choose your coverage and it is mandatory, so everyone gets access to it. Even if you are unemployed / or your income is under a certain threshold you still get covered, in those cases the government covers it until you are able to do so yourself.
    I am so grateful that there is such a system in place, health is so delicate and fragile, everyone should be able to get care, no matter what.
    It is actually one of the reasons we are for the moment not considering moving abroad, regardless of the fact that I am unemployed and would probably have much better chances in other countries, and living abroad is something my husband has always wanted. As we are having trouble to conceive we are blessed and so infinitely grateful to have access to treatment (which would not be the case in other countries)

  5. Katy W
    Posted April 24, 2013 at 9:07 am | Permalink

    This is timely – has anyone been watching the NHS in a day programmes? There was one on last night – the breadth and range of work they do every day is just astonishing (this from someone who is friends with GPs and surgeons but really has only spent time in hospital visiting relatives, not as a patient, luckily – so I think I just didn’t know what sort of things went on). Of course everyone knows someone who’s had a long wait for treatment but in a system so huge, that treats so many people (1.5m people a day, according to the programme – which is mind boggling) we are so lucky to have it.

    This might make it sound like I relate everything to TV, but if anyone has watched Breaking Bad, it shows how destructive a paid healthcare system is for normal people with longterm illnesses. It’s a concept (high school chemistry teacher gets cancer, starts making crystal meth to pay for treatment and provide for his family) that just wouldn’t happen here and we are the better for it.

    Excellent post anon, and all the best with your future plans – and good luck!

    K x

  6. Cheri
    Posted April 24, 2013 at 9:07 am | Permalink

    I may be wrong so dont take my word as the truth, but I’m sure I read where a british journalist who had been living in America for X number of years had to pay for her healthcare when she came back to the UK on holiday and needed an emergency operation, as she hadnt paid tax/NI her for so long. You may want to check where you stand with that, if and when you come back.

    On the flip side, I think we all need to realise in the UK how lucky we are!

  7. AJS
    Posted April 24, 2013 at 9:36 am | Permalink

    Another massive supporter of the NHS here. Both my parents spent their entire careers working for the NHS and have always made sure I’ve been appreciative of just how lucky we are here in the UK. Now that we’re embarking on our first round of IVF, on the NHS, and having already had many months of tests/examinations/procedures to have gotten to this point, it really has brought it home to me how fortunate we are to have such a system in place.

  8. Posted April 24, 2013 at 10:19 am | Permalink

    As I’ve talked about on these pages before, I owe the my local hospital and the NHS a debt that I could never repay. I continue to be completely overwhelmed with gratitude with the service I have received, more so with every passing month of the last year.

    What a lovely piece xx

  9. Gemma N
    Posted April 24, 2013 at 10:30 am | Permalink

    Argh, just wrote long comment and then had iPhone malfunction! Grr

    Will try and be briefer this time! Yes the NHS is amazing. But I do worry about what state it will be in if this government hangs around much longer.

    My husband and I have sometimes talked about moving abroad (in a very general ‘wouldn’t it be cool to live in New York’ kind of way) but the lack of healthcare and welfare state in general really bothers me. We would probably be ok personally cos the kind of job he would get would cover us both, but it’s more the feeling of privilege, and that so many other people wouldn’t have access to what I consider to be basic needs, that would make me uncomfortable.

    Think I’m just too much of a socialist to live in America! Although I still think it would be cool to live in NY. Maybe just for a year?!

  10. Posted April 24, 2013 at 1:20 pm | Permalink

    I completely love this, I’ve always been a huge supporter of the NHS, we are so lucky to have it and too many people don’t appreciate what we have, and take it for granted. Huge thank you for writing such a positive piece.

    On a more depressing note, I truly believe that one of the worst legacies this current government will leave behind is what they’ve done to our NHS, and we should fight for it at every available opportunity.

    K x

  11. Anon (author)
    Posted April 24, 2013 at 2:39 pm | Permalink

    Thank you for such a positive reception to the piece – I wrote the piece as a bit of a rant and have since been worried no-one would be in the slightest bit interested in my health insurance woes!

    I completely agree with the commenters that have said this government is doing terrifying lasting damage to the NHS. When I lived in the UK I was as apathetic as the next person and totally took the NHS for granted but I think this might become a bit of a soap-box subject for me. If I were in the country now I’d be out there on the streets and writing to my MP incessantly (if it’s not too late for this round of reforms). As it is I’m just signing online petitions…

  12. Fran M
    Posted April 24, 2013 at 2:52 pm | Permalink

    I hang my head in shame, because I’m not too hot on what’s happening to the NHS exactly (or what the government is trying to do to it). I have a vague notion that they are trying to privatise chunks of it / to outsource services.. yes?! Lexie, I shall read that article you linked to when I get a minute later.

    A society that lets the young, ill and weak perish just doesn’t seem like a proper society to me. So awful to think that your first thoughts upon being told that you have terminal cancer might be “how is my family going to pay for this?”

    I was going to say that I’m lucky that I’ve not had to rely on the NHS much personally – however even the run of the mill things (smear tests, pill prescriptions, dental check ups, doctor’s appointments) are HUGE. Who knows where I might be now without the state making it so easy for me to access those crucial health checks/prescriptions? Really appreciating the NHS right now and those who work for it.

  13. Posted April 24, 2013 at 5:32 pm | Permalink

    As a Brit living in the US, good health insurance was essential to us moving and we’re really lucky to have amazing insurance that covers everything for very little cost (my husband works for a hospital that is part of a state university system, the holy grail of insurance.)

    I still miss the NHS terribly. I got very ill and ended up in the ER, and despite my insurance was still treated in a corridor. The staff were amazing so I didn’t mind, but the idea that private always means better is nonsense! Since then I’ve been on medication that isn’t available on the NHS but I’ve had to jump through innumerable hoops to get it, including a huge amount of work by my doctor. I really miss the simplicity of the NHS, I felt safer knowing that it was in control, not someone concerned with profits.

    The NHS is the single greatest achievement in the UK, and worth fighting for

  14. Anita
    Posted April 25, 2013 at 9:23 am | Permalink

    Am so sorry I missed this yesterday but I was too busy at, yes, you guessed it, work…. Or to be precise slogging my heart and soul out as an NHS GP.

    I love and am so proud of our NHS. Every time I read a Daily Wail piece slagging it off a little bit of me dies. It is an amazing resource and the people within it (mostly) work so hard for so little (I earn a decent wage but certainly not a brilliant one and cannot compete with my friends who are city bankers -no big end of year bonus for me!) but I do it for the love of the job. Katielase is so right that the NHS we know and love is fast disappearing (thanks, Tories) because it’s no longer about what’s best for the patients, it’s about getting the quickest returns with the least financial outlay.

    Anyway, enough of me and my soapbox. Thanks for your great post Anon, and I really hope things work out for you.

  15. Christie
    Posted April 25, 2013 at 9:32 am | Permalink

    Sorry for the late reply on this, just catching up! I too am a big fan of the NHS, my job involves setting up policies like you have for companies and it always baffles me how little companies take the maternity issue into consideration.

    They range from being uninterested in how a family would cope without the cover to not giving it a second thought until someone ends up pregnant and then there’s all out panic about the cost! The policies can vary so much between insurer that you really need a company (or a good broker!) that’s taking all the potential issues into consideration, often with companies, and especially US owned firms, that’s not the case.

    Whatever happens, I hope it all works out well for you!

  16. Posted May 4, 2013 at 8:29 pm | Permalink

    So glad someone write something like this. It infuriates me to hear all the moans about the costs, waiting lists etc people here rely don’t appreciate what we have with the NHS. It’s amazing and something we should fight tooth and nail to keep.

  17. Caroline
    Posted May 6, 2013 at 7:05 am | Permalink

    I got to say, you really are lucky. As an American, health insurance is challenging to say the least. My fiancé doesn’t have health insurance. Hasn’t been to a doctor in 15 years. He’s been to the dentist 2-3 times in as many years. (Even private dental coverage is not really a thing here.) If he ever even broke his arm, we would owe thousands of dollars we don’t have. Neither of us have ever worked for a company that provided insurance (which you still have to pay for but it’s
    more affordable.) and can’t afford $200 a month for insurance for him. (I only have insurance because Obama’s healthcare reforms mean I can stay on my parents insurance a few more years. Thank you. Of course, those same reforms mean next year we start paying fines for his lack of health insurance, although we haven’t yet seen the promised reductions in cost.)
    Yes, your NHS is a huge blessing, flawed as it may be.

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