In the month since the twins’ birth the debate about healthcare has been raging on both sides of the pond. In the US the Supreme Court has upheld Obamacare (again), while here in the UK the Health Minister Jeremy Hunt has announced significant changes to NHS doctors’ contracts, prompting the #ImInWorkJeremy social media campaign.
When I lived in America I was lucky to have good health insurance, but having lived in the UK for the last 14 years I can honestly say that nothing beats the NHS.
It is a national pastime in Britain to bemoan the lack of resources the NHS receives (leading to outrageous waiting times and postcode lotteries) while simultaneously worrying about how expensive it is (leading to higher taxes, and calls to cap immigration). But the principle of healthcare that’s free at the point of use is not in doubt.
As we have watched the other pillars of the welfare state fall (I’m thinking particularly here of Housing) the NHS staggers along under increasing pressure. The general election in May saw all parties vying with one another to promise additional spending for the NHS, alongside systemic reform to ‘improve’ what is already an incredibly efficient system (seriously, look it up, it’s a world-leading model of healthcare efficiency and efficacy).
By contrast, in the United States it took Obamacare to provide even a semblance of a universal coverage (which was first dreamt up by Roosevelt in the 30s), and in some Republican-controlled states the local government would rather lose Federal funding for Medicare than accept the constraints of Obamacare.
Having experienced treatment on both sides of the pond I thought I’d share a little of what I loved (and didn’t) about having a baby on the NHS.
IVF – for free.
When I tell my American friends that we had five years of fertility treatment and didn’t pay for any of it, they don’t believe me. This is thousands of dollars of treatment that we couldn’t really afford. It also felt like a real recognition that this was a genuine problem and not some vanity project.
Having said that, there is a post-code lottery: not all trusts provide the NICE-recommended 3 rounds of IVF, and not all patients get a choice about where or how they are treated.
I spent 4 years of unsuccessful fertility treatment at UCLH, which has some of the best success rates in the country. Haringey refused to pay for my IVF there, so I was sent to the Homerton for IVF, which has some of the lowest success rates nationwide. But we got lucky despite the longer odds: the standard of care was fantastic, and our IVF was successful on the first round. It just goes to show that statistics are irrelevant when you’re dealing with a data-set of one.
It’s worth noting that this kind of provision is under threat from budget cuts. I highly recommend the IVF-Yes campaign website for information on the issues surrounding continued funding for IVF and other fertility treatments on the NHS. www.ivfyes.org
Good quality antenatal care.
For the pregnancy itself we returned to UCLH, because of its proximity to my work, and because they have a specialist twins unit. When we decided to have two embryos implanted instead of one, it was partly because we thought it wouldn’t work. At all. So the news that we were expecting twins came as a bit of a shock. All of a sudden I was having a ‘high-risk’ multiple pregnancy: on the plus side, instant family! On the negative side, there are so many ways a twin-pregnancy can go wrong, and some of them don’t really bear thinking about.
One unlooked-for bonus of a high risk pregnancy is that you get additional scans. I’ve read about IVF patients who struggled with the lack of medical attention during the pregnancy itself. Having been used to going for scans at least every week, it must come as quite a shock to suddenly have to go months between appointments.
Because of / despite all the extra attention I was healthy throughout the pregnancy, as were the twins. Until the last two weeks, that is, when I was diagnosed with hypertension, and had to spend several days in hospital under what felt like house arrest. At every stage the doctors, nurses, midwives were compassionate and professional; though it was incredibly frustrating, I knew it was the best place for me to be.
C-Section and beyond.
I will admit to feeling relieved when I found out I was having twins, as it meant I could have an elective C-section. My number-one priority was ensuring that the babies arrived safe and well. But avoiding having to go through the ordeal of natural childbirth wasn’t far down that list of priorities. Similarly my husband, who has never been great at seeing other people in pain, wasn’t looking forward to holding my hand through what could have been several hours (or days?) of labour.
After the scare with my blood pressure, everything seemed to have calmed down and was proceeding as normal. In fact it started to get a little comical.
As we were sitting in the waiting room we ran into a friend from NCT whose wife had given birth the night before. I then saw a former colleague whose wife was in labour, who told me that a (totally unrelated) current colleague was also in the same hospital having their baby (I hadn’t even known they were expecting). Finally, some new grandparents turned up to see yet another of our friends who had been due a week before. London may be a city of 9 million people, but there are times when it feels positively tiny.
Then after a couple of hours of waiting around things started to move very quickly. I had been too blasé about the epidural, which took ages to site. At one point the pain was so much that they had to stop as I was crying so hard I couldn’t keep still (so much for my husband being spared seeing me in pain). Mercifully once the drugs kicked in everything went without a hitch and within minutes I could hear Margot spluttering and taking her first breaths, followed a couple of minutes later by Isaac.
Then my blood pressure went through the roof, spiking at about 200 / 125. For the non-medical among you this is not a good thing. I was transferred to the ‘Close Observation Bay’ for just over 24 hours and pumped full of all the drugs they could throw at me.
The doctors, nurses, and midwives were incredible. I don’t remember much about the first couple of days; it even took me a week to realise that the twins must have spent their first night in the NICU, but we’re all here to tell the tale.
Next, I was released onto the post-natal ward, and for the first time I began to get a sense that the NHS is fraying at the edges.
Though the staff were fantastic, it was clear that they were all under tremendous pressure and as a result things (like blood-tests, or weight-checks) were being missed. Because of this we probably spent an extra 10 hours in hospital, which may not sound like a lot, but by the time we left we were desperate to be discharged. Ironically, if they’d released me earlier it might have eased up some of the backlog further down the line.
Throughout all of this, midwives and nurses (including one from my previous stay a couple of weeks before) kept returning to check in on me and the twins even though I was no longer officially in their care. To me this is a mark of people who genuinely care about the quality of the work they’re doing, and who see their patients as human beings.
The Future of the NHS
This blog isn’t meant to be political, but it’s unclear to me how the latest wave of reforms will improve the NHS. I understand the theory behind using patient choice and market pressures to drive up standards and efficiency. But the theory doesn’t line up with experience: the American model shows that market-based medicine doesn’t actually create value for money or improved patient outcomes.
It’s not just the Department of Health that is threatening the NHS. The Home Office, with its ridiculous reforms to immigration policy (which, had they been in place fifteen years ago, would have prevented me from moving to the UK) is also putting the NHS at risk. Nurses and midwives (to say nothing of health care assistants, phlebotomists, porters etc.) will struggle to meet the new 35k threshold for continued residency, and as a result the NHS will face a catastrophic staffing shortage.
The NHS needs immigrants. And we all need (and love and cherish) the NHS. You don’t need to be a genius to join the dots, kids: if you really care about the NHS you can’t be anti-immigration. There are some jobs which are vital to society, but which don’t pay as well as being a stock broker. And if saying so makes me a pinko-commie socialist, I’m fine with that.