To try and get my Dad back to the UK so he can die here

[Ataloss23]

I am looking for a bit of support with this, as I don't really know where to start!

My Dad lives in the USA, born in Scotland but moved over in 2019 when he married his wife who he met whilst traveling over there.

18 months ago he was diagnosed with stage 4 pancreatic cancer. He tolerated treatment well, and we have been lucky to get more time with him.

He decided he wanted to move back to Scotland, so he could live out his days here. He sought advice from lawyers and they began the immigration process for his wife, which has been long winded. She has paid all of her fees, including NHS fees and had her embassy interview 9 weeks ago. We have been told it takes up to 12 weeks to get a response.

His treatment over the past few months hasn't gone as well as it has been, and he has taken a real decline this week. I've ended up flying over to America to be with him as we don't know how much time he has left. We are discussing hospice options, and he has said that he would much rather find a way to get back to Scotland, because he still wants to die back home. So I am trying to do everything I can to get him home, but would really appreciate some guidance.

His Dr here has said that he may be able to discharge him for flying, if he feels he would be able to manage the whole flight and we can manage his pain. My concern is how quickly could we access services in the UK? We live quite rurally, so not the same issues for getting access to GP as people in larger populated areas experience. I'm more concerned about how we would access District Nurses, pain relief, stuff like that rather than home support/hospice/care home, as we will be providing his care at home and should manage it all between us.

And regarding the Immigration process - his wife is unable to travel to the UK while immigration clearance is ongoing. Is there a way to expedite this to get him home this week does anyone think? As much as he wants to be here to die, he doesn't want to be here without her. I have plans to phone Immigration in the morning from over here to see what we can do, as I feel this is the biggest challenge we are going to face.

I know this isn't a very common situation, but does anyone have anything similar that they could share with me, or have any professional insight regarding accessing District Nurses or Immigration?

I'm also trying to suss out what services we will need to get him home - private ambulance from the hospital to my house, a hospital bed (can I even get one of these in the house if I don't have access to OTs? Pain management in the community etc. Is there anything else I haven' considered that I need to look into?

I know we are probably chasing something that isn't possible, but I want to make sure I'm doing everything I can to meet his wishes.

Any thoughts or advice would be great please!

I'm sorry that others have had bad experiences. But my late husband's care was exemplary, and his pain managed very well with a syringe driver. He died very peacefully at home, in the way he wanted to.

I just want to balance this thread somewhat, as it could be quite terrifying for any posters that are beginning this journey with a family member.

The blunt question here is how close to dying is he. Someone in the UK would only get transferred to a hospice when they are expected to die in the next few days - 2 weeks roughly. I've no idea if that's similar in the USA. In the UK hospice & community hospital beds are in very, very short supply. If his prognosis is only a few weeks I'd really question if the stress of the journey and the uncertainty around practicalities at home are worth it. Realistically you'd need to nurse him in your own home - I'm sure the GP & community team will be supportive but getting a bed in a hospice or community hospital is very difficult. A nursing home will be around £1400 + a week.

It is fantastic that you are able to make this happen for people. It is fantastic that you are working somewhere that the system works well and great care is available.
It is utterly tone deaf for you to keep stating it as a hard and fast fact in a way that seems to be suggesting that people who have experience the miserable alternative are wrong. They lived a miserable experience, they are damaged by it, they are warning that too often the system fails.
You telling them repeatedly that some patients have a wonderful experience, exactly the one they would have wanted for their own loved ones, is just kind of mean.

No it is not. Its balancing the usual MN hysterical scaremongering that everything NHS related is just awful.

But this man would be arriving at an airport to be transferred to rural Scotland - what if he needs an ambulance and ends up in hospital? My experience with my dad (rural Scotland) was that once he was in hospital, we had to wait for things to be signed off.

@Blushingm Its like you were there with us.

His consultant knew more than you.

Stop gaslighting me I was there.

I thought us citizens could come for 6 months on a tourist visa

But op needs to be prepared for the worst case scenario, and not look at this with rose-tinted glasses. I get that you saying that NHS support and treatment can be brilliant, and it can be, but sometimes the dots don’t join up, meaning that delays and problems can occur.

@Blushingm was that person in the system already though?

No it is not. Its balancing the usual MN hysterical scaremongering that everything NHS related is just awful.

And in doing so you told a woman who clearly DID have a really bad experience that she is being irresponsible and daft (and now scaremongering) to talk about it. If she is irresponsible and daft to assume that her experience might mean others have the same - then surely that applies to you too?

The issue here to me isn't the NHS anyway. It is getting this poor man across the atlantic - at the very least a 10 hour gruelling journey door to door (if he is on the US east coast). NHS provision for a new patient newly arrived in the country with no local medical notes, diagnosis or history will be the least of the OP's problems.

No - unknown to us til this morning

I’m just saying that it’s incorrect what you say about the drugs in a SPD - there’s no max and a nurse couldn’t set it up off her own back

im not gaslighting anyone.

You’re determined to convince us that the NHS operates exactly as it should, @Blushingm
You can see why some may be somewhat sceptical…

If he is as poorly as you suggest, I would be surprised if an airline would allow him on a standard flight:

Or that any doctor would pronounce him fit to fly.

This.

Find out if he can move then set the care in place, see if it’s manageable/any good, then decide. What plans have you made if he lasts longer than expected?

Would insurance cover as well? I know he wants to come back to Scotland but is that a viable reason for insurance to cover when potential costs could be huge

Wow that’s impressive. Took local GP service a week to add my DM to my NHS App and a further week to process a prescription, since the pharmacies no longer accept paper prescriptions.

How do you get everything through the system if you don’t have their records?

if he is retired I assume he is on Medicare (Medicaid is for the poor). It does not cover international travel. You need travel insurance for that, and I don't know who would cover in this scenario.

damn it I hit the gif thing by mistake and can't delete it on edit. Please ignore!

My ml was diagnosed and given 3 months, gps, nurses,care teams were all great. Sorted all bed etc to be brought to the house within 24hrs..Sadly she only made it 2 weeks from diagnosis but she died happy as she wanted with her family...Was quite amazed it all got into our tiny living room plus all the gear but clearly the teams know what there doing..Wishing you all the best during this hard time.

This is a really shitty thing to say to someone who had a bad experience.

Travel (or any other insurance) is for insuring against the risk that something might happen. You can never insure something that will definitely happen as the insurer knows they will be definitely paying out - so if they were to offer insurance the premium would have to be more than the cost you are insuring against.

You're right of course, though there's no actual knowing that he'd become critically ill during the journey and require all the things which would cost so much

There's obviously a very high chance however, and that alone would cause many insurers to refuse cover; after all one of the many questions is whether you have a terminal iagnosis and OP can hardly say no

There is also a big question of whether returning to the uk like this would count as being ordinarily resident within the uk. You are not entitled to free nhs care just because you are a British citizen, you must be ordinarily resident here.

I said that and was told I was “ spouting nonsense” In Scotland it is a different story, apparently!