What are our healthcare options?

[Brocante]

We are an Australian couple who are relocating to London in a few weeks and we have just found out we are pregnant for our first time. We're elated but now also very worried about our maternity healthcare options and need your advice.

Our Australian private healthcare will only cover us if mum-to-be stays in Aust to have baby, but Dad2B must go to London to start new job, so this solution is not ideal. Dad2B's new job in UK provides Bupa private health but it does not cover maternity or birth. Our Aust Insurance cannot be transferred to UK. UK insurance companies won't cover us because we are already pregnant and won't clear the waiting periods.

Mum2B is afraid to use NHS and is very set on gping private. Cost seems extremely high. Online research indicates it could cost us £20k+.

What are our options? Any advice is appreciated.

Use the nhs. Research and choose your hospital carefully. I had totally faultless care from the nhs.

Use the NHS if you are entitled to it. As a non UK resident you may not be entitled.

Your option then would be to pay.

The NHS is good enough for us Brits. Why would it not be good enough for you?

I am other way round, from uk and just had first bub in Aussie private system. What are your concerns about NHs and maybe I can answer them. I just wanted to say that the uk is completely different to Oz, the private maternity sector is tiny, used by very few other than celebrities And the very rich. And not covered by insurance as you've discovered. The very large majority use the NHS without even thinking.

Any questions about the NHS system, just ask and I'll try and help and I'm sure others will too. Like I said, I've just had a baby in Oz and I remember how confusing it was trying to figure out the system, so I kinda have an idea about these things.

Congrats and good luck with everything

wellieboots is right, tell us more about why your wife wants to go private. Then we can help more. This isn't a judgment (I had a private birth myself) but knowing more about your circumstances would help us to help you.

Private maternity in the UK is available for ante-natal and delivery (for hospital births, the latter only in London and surrounds, as far as I know). You can have consultant obstetrician care or an independent midwife. You can mix and match and dip into private maternity as you wish - if you have the funds. The £20K you mention would be for fully private consultant antenatal care and a c-section delivery at the Portland in London. That is the top of the range. At the other end of the scale your wife could have a homebirth with an independent midwife for about £3K.

You're right in that UK insurance generally won't cover ante-natal care (there are some exceptions, but normal care isn't covered). Insurance companies will contribute to the cost of a c-section, for which you have to have a medical reason (not to do so is sex discrimination). Have you looked at the Bupa International policy? They do cover private antenatal and vaginal and c-section deliveries. I'm not sure though if that has an exclusion for the already-pregnant.

If private maternity is a deal-breaker, you will need to pay for it yourself (and there are ways to bring the costs down, such as having private delivery but NHS ante-natal care) or ask your company to pay for it as part of your relocation package. Can you phrase it as a loss of benefits which you need to be made up to receive the equivalent?

full independant MW care is about 3K, but you can pick and choose and use bits of NHS and bits of independant, so you can get just antenatal or postnatal IMs for less, or full package of 3kish

the DOH website has some info about NHS eligibility but it isn't clear about whether this includes maternity services, You are eligible AFAIK for free GP services so that would include antenatal/postnatal MW and health visitor, but not sure about inpatient care for a forseen event

oh and you would get free NHS services for any emergency/unforseen event so if things go wrong you're covered, its just the forseen inpatient ward based stuff you may be charged for

Ahem - just a little tidbit: consultants are actually the most senior doctors and
normally no longer use the Dr title. They are call Mr and Ms (without the Dr.).
This one caught me and caused a lot of trouble (I thought he was awfully competent to be in training :) )...

Glimmer, that's not quite true. Consultants are the most senior , yes, but the Dr vs Mr/Ms divide is actually a medical vs surgical thing, not a seniority thing.

Consultant obstetricians are, I believe, also surgeons, hence Mr/Ms, but all surgeons are Mr/Ms, so more junior general, orthopaedic, plastic surgeons etc are also Mr/Ms.

Conultants in general medicine, paediatrics, care of the elderly, emergency medicine etc are all still use the Dr title.

This is because in days of yore, when surgery was still in it's infancy, medical doctors felt it was a barbaric practice and objected to surgeons calling themselves doctors (even though most practicing surgeons were already docs). The two groups had a falling out and surgeons were not allowed to call themselves doctors. All these years later, it has now become a point of pride among surgeons - they don't want the Dr title back.

Sorry for the mini history lesson (and also the thread hijack, OP!), but I hear the "consultants are Mr not Dr" misunderstanding all the time and it's one of my pet peeves.

As you were.

(Sorry OP, no advice to give you beyond what others have already said, but good luck!)

your options are to pay for private care, or to use the NHS. You need to find out if you are entitled to do the latter for anything other than emergency care.

Thanks all.

@Wellieboots @ghislaine thanks for the detailed advice. The concerns about the NHS are primarily due to us having paid (a lot) for private health insurance for 5 years for the explicit purpose of having a baby, and it irks us that this was all for nought. But that's the gamble with insurance really. Secondarily, as Aussies we have heard a lot of bad things about the NHS, mostly from Brits who have moved to Oz. Thirdly, we know that the Australian public health system, while trustworthy, is a churn-and-burn system. Get 'em in, get 'em out, quick. And we don't want to enter into that kind of system in a foreign country, especially for our first child, and especially when it has taken a long time and a lot of trouble to get pregnant.

My contract/visa does allow us to use the NHS. And Bupa will cover any emergency complications. A very good Brit friend who has moved to Oz has given us some advice. He says the NHS is great and to choose the right hospital. He recommends Chelsea Westminster and Portland. Thoughts?

Also, how do we get in? Do we need to book now? Do we need a referral from a UK GP? Also, advice on obstetricians would be much appreciated. And can we find an obstetrician we like and have him/her take us through the NHS, or must we use whatever Dr is available if we use NHS? If so, what would that be like?

We don't mind paying the extra £6k for our own obstetrician if we can go through the NHS with him/her.

Under the NHS you don't necessarily have an obstetricion unless you're high risk, then your MW refers you. If you don't like them you can ask to be referred to someone else, but you don't choose your ob, and you don't see one unless there's a reason why you can't stay just under MW care. If you choose a clinical hospital birth there will be obstetricians on hand in case of complication

under the NHS theres:

MLUs (midwives only, if you run into complications you get transfered to a CLU, which has doctors etc, it may be in the same building or may be an ambulance ride away. They can refuse you if you are high risk, you can get risks overwritten if you go through the supervisor of midwives. Usually only pain relief there is birth pools, pethedine, tens, gas and air

CLUs, basically hospital births, you have a MW with you but there are doctors about and full range of pain relief and operating theatres. Water births and space to pace etc are not always available at CLUs

Home birth, everyone is entitled to one, they're not supposed to refuse to attend to you if you insist on staying home even if you're high risk. You get two midwives, same pain relief options as MLU and transfer to CLU if there's complications

and you book in via the GP surgery you are going to use, your community midwife is based there

HTH

It doesn't quite work that way. If you want an obstetrician for ante-natal care you will have to pay AND you will see that person privately. You can't pay the NHS hospital to ensure an obstetrician takes over your wife's care. On the NHS you will only see an obstetrician if she or the baby have health concerns that warrant specialist attention.

As to hospitals, in London you don't get free reign as to where you want to go on the NHS. You are restricted to hospitals in your catchment, and that will depend where you live (same for GPs). For example, at one point I wanted to get referred to Queen Charlotte's which is in the W12 postcode but I couldn't as I lived in WC1. So you will either need to move to the area that services the hospital you want or ask for recommendations for hospitals in the area that you are committed to moving to. You can change hospitals if you move, and in some cases London hospitals will take out of catchment referrals but I think these are quite unusual these days because of the pressure on maternity services here. I then moved again and had my antenatal care at an out-of-catchment hospital but because I was having the delivery privately, this wasn't a problem.

You should be able to find plenty of threads on London hospitals if you look in the Childbirth section. Lots of these hospitals have private maternity wings for delivery and post-natal care (this costs, of course).

One other thing - the Portland is not an NHS hospital. It's a fully private maternity hospital.

you can have your baby privately at Kingston Hospital by Mr Carl Chow! his fees are £7500. Hospital fees about £1600! Good luck

Thanks SweetTea :)

I have long wanted to understand the surgeon Ms/Mr thing.

you mentioned Chelsea and westminster. This is one of the best NHS hospital. If you want NHS care then this will be good choice. Obviously you won't be able to get the midwife or consultant of your choice but the general level of care is good. i think You will need GP referral to book for antenatal care.

There are many Obstetrician in Chelsea and generally they are all good. From my personal experience; my friend has delivered in Chelsea couple of months ago and she was under care of Mr Raza. She had a very good experience and delivered normally. I then visited him for a gynaecological problem. He was thorough and excellent, took his time to explain everything. was really pleased.

Good luck

You will a big advantage of the UK system is no obstetrician and no fees means much greater chance of nob medicalised birth. The NHS is fab, midwives are fab. Drop your prejudices and be grateful you are entitled to free health care having only just arrived! Best of luck.

Not not nob! Awesome autocorrect.

I imagine the OP is a father by now!

Wonder how they managed....

"Consultant obstetricians are, I believe, also surgeons, hence Mr/Ms, but all surgeons are Mr/Ms, so more junior general, orthopaedic, plastic surgeons etc are also Mr/Ms."

Weirdly (and I don't know why) consultant obstetricians in Scotland call themselves Dr X rather than Mr/Miss X like they would in England.