Hesitant to move back from US to UK because of terrible state of NHS

[Star555]

I'm a long-term expat (in my 30s) living in the US. My parents and I moved to the US many years ago when I was in school, and although I have always thought about moving back home as an adult (I love history and culture and easy access to Europe, which the US woefully lacks), my parents are settled in the US and don't want to move back because they think the UK is in a bad state (failing NHS, high taxes, older infrastructure, etc.) One parent had a major operation recently and is under ongoing treatment at a top hospital here in America, and they think they would not have had received timely care like this in the UK given the current state of the NHS.

I have been on the fence about whether moving back home would be a good choice or not, and am thinking about it more seriously now given the US government situation, although my parents are against the idea. I don't mind the lower salaries in the UK so much (I have a STEM postgraduate degree and would likely have a job at a company in/near London), but I am mainly concerned about the state of healthcare. I have heard so many horror stories about overflowing A&Es and huge waits for life-saving treatments in the UK. I am currently single and don't have any close family or friends in the UK that I could count on for support if I were to need major medical treatment (touch wood). I would be willing to pay (or my employer would pay) for private insurance, but am not sure how much it would truly help.

Has anyone else decided against moving back to the UK, or decided to move out of the UK, primarily because of the sorry state of the NHS? Is access to timely medical care really that bad in London and the South in general? On one hand, I want to return to my homeland and raise (future) children there because of the culture, etc. but on the other hand I want reliable, high-quality medical care for myself and any kids I might have.

I’ve had a heart attack and had to wait over a year for a cardiology appointment following it.

This is the thing -- thankfully I am healthy and do not anticipate needing a lot of healthcare at this age, but if I moved back it would be with an eye to settling down and spending the rest of life in the UK. My own parents were very healthy too but once they hit their late 50s they suddenly started having lots of issues (including operations and prolonged treatment for cancer and other less scary but still urgent things). So who knows what I might need when I am my parents' age?

The US system tends to over treat, the UK often undertreats. One can bankrupt you, the other can drive you mad with its slowness and inefficiency. However, the quality of care once you’ve jumped through the hoops and are in front of the medical professional is fairly similar. There are risks either way, it’s just which one you’re more comfortable with.

Personally, and I speak as an American who has lived in the UK for a long time, I’d move to a well-funded borough of London so you’re quids in with the postcode lottery, get the best private insurance you can afford, and make sure you have the confidence and skills to advocate for yourself when you do have to access NHS care.

I've had quite a bit of recent NHS experience, I got and continue to receive excellent cardiology care after finding out I had a heart condition. I also broke my foot I was into a and e, triaged x rayed, given a boot, a number to call to book physio, and crutches in under an hour.
My mum just had a knee replacement at a private hospital under right to choose. Her first consultant appointment was late June and she's had the op already, it could've been earlier but due to another unrelated personal issue she couldn't do the August date offered.
Or you can choose private health insurance like you do in the US.

The 'postcode lottery' only applies for GP appointments, right? If major treatment is needed at a hospital / from a specialist, can the GP not refer the patient to a hospital/specialist farther away? E.g. if one lives in Southampton and sees a GP there, but wants to be treated at a London hospital, will it be a longer wait than for someone who lives in London? (Obviously if it's a life-threatening emergency, it'll have to be the nearest local hospital!)

I’ve lived in both countries. I moved back to UK 5 years ago and it’s the best decision I ever made. It’s a very personal thing though. I’ve found the NHS to be absolutely fine when I have needed it and the same for my family. Admittedly, I do have private health care through my employer but I haven’t needed it so far. I can’t find an nhs dentist though - have had to go private for that

Why is there two threads on the same topic?

Because I posted here (Living Overseas) first, then realised that my question was more appropriate perhaps from people currently living in the UK who may have previously lived in the US. That's what I wrote at the top of the newer thread...if MN had a way to merge two threads, that would be great.

Ahh fair enough. I thought I was going mad as it looked so familiar 😂

Yeah exactly.

I've always had good experiences though there is no doubt some people haven't.

If you can pay for private for chronic things I really wouldn't worry about it - or I suppose I mean I would be more worried about the US than the UK (I have a few cousins born and raised there who have UK passports and have moved here now)

Yes, you generally have the right to choose where you want to see a specialist, and no you don't get penalised on the waiting list because you aren't a local.

We can all only post about our own experience and that of our loved ones. My family and I have only ever had excellent care on the NHS. And yes, DH and I have both lived abroad and experienced several different health care systems.

There has been chronic under investment which has led to long waiting lists for some non-urgent care, but hopefully they're starting to come down now.

Firstly as an expat myself I would never base this decision on healthcare when both countries have first world health care. One is very expensive and the other is free and both have their pros and cons.

If you are young and relatively healthy it shouldn’t really be an issue.

There are so many many many considerations for moving ‘back’ - job, politics, economy, housing, coat of living, culture, work life balance (a year of maternity be weeks), holiday (four weeks a year be two), travel, opportunities, etc etc.

Look at the whole picture and really think about where you see yourself.

I’ve had good and bad. I’m sick of ringing my GP 100s of times to get at best a phone call (though tbf they will see you if they deem it necessary), at worst, “sorry we have no appointments left” when you have been dialling on repeat for 25 minutes!).

I have been waiting nearly 4 years for a neurology review and only have a date now because I got my GP to refer me again as my symptoms are much worse.

I’m also under gastroenterology and waited 3 years for review. I have an amazing on-the-ball consultant who has to overbook her clinics so she can get everyone fitted in.

I had a x-ray (don’t remember why now) in our local hospital 10/15 minutes away, a couple of years ago. I came straight home to my GP ringing me. The radiologist had seen something concerning on my x-ray, called my GP and I was through the system in weeks. I had a tumour on my adrenal gland. I had surgery to remove it and TG it was benign.

It’s a mixed bag I think but you have more options going private if you need to,

Interesting thread. I think private health insurance is needed now.

Step had to wait two years for a knee replacement which was done in the summer. MIL was put off and put off for cataracts - they were visible for three years and her quality of life was affected. In the end DH paod.

Mother however was diagnosed with severe stenosis of a heart valve that had to be replaced and it was done within six months at a specialist unit in London, 80 miles from her home. The op cost about £15k on the NHS - it woukd have been £50k privately due to the equipment and number of people required. That was brilliant but the admin was horrendous, it was cancelled once with little apology, and when mother couldn't bopk a blood test digitally, phlebotomy were unpeakably rude. She stayed in overnight and saw one nurse lie down on an empty bed for a couole of hours and the ward was mixed, large and extremely busy with a couple of people who frankly shpukd have been sedated or with a 1:1 MH carer.

The care might be ok when you get it but the generalised poor standards and lack of respect and courtesy are reprehensible.

The NHS treats everyone the same. Like sh1t.

If I were choosing on the basis of health care I wouldn't choose eiher tbh, some days I regret that we didn't apply to Canada as we would have qualified for visas at the time! (Although getting a family doctor in Canada can be difficult.)

It's a terrible postcode lottery and not just for GP services, though that's the worst as GPs control all non-emergency access to everything else. I will say that the maternity care I had in the US was far superior to what I had in the UK and Tony Blair was PM when I had my first.

It's true though that you can't make comparisons using aggregate statistics. There's significant variation in the UK as well: even with more equal healthcare access, other social determinants of health matter a lot.

I don't know if I'd make the decision based on healthcare unless I had a specific scenario. For example we ruled out moving back to the UK because 2 of my 3 are autistic and the quality of medical and education services really are better where we live in the US.

I'd hesitate to move to the US for all sorts of reasons, not the least the healthcare situation. Surely in any event you are used to paying for medical insurance? Just get private medical cover as a back up.

Your opening post sounds like you have been watching Fox news.

I'm currently on the 'two week pathway', before this I had a positive FIT test so I had a colonoscopy, that was clear but I was sent to 'the vague clinic'.

This morning I have a CT booked, last week I had an endoscopy, a chest X-ray and an ultrasound.

I have no idea how quickly you would get those tests in the USA.

My GP has recently gone to an online booking system. You fill in a form online and send it, a Dr triages on the basis of the form.

This might not be a GP appointment, it will be the most appropriate person.

So I suspected I had a UTI, the triage Dr asked me to bring a sample in, I then got a text message saying I had a UTI and a prescription for antibiotics was sent to my chosen pharmacy.

So did I get an appointment with a Dr? no, but I did get health care? yes.

Another thing to note is that the US and the UK have different systems of health care.

I mentioned a FIT test. In the UK over 50s get sent a package with the test in, you do the test in your own bathroom and post it off. It is only if the test is positive that you get a colonoscopy.

I believe in the US it is common to have an annual colonoscopy when you are over 50.

Obviously the FIT test is cheaper than a colonoscopy, but it also doesn't have any risks and no time off work, no sedation etc.

I'm not saying one is better than the other, just that they are different.

No, colonoscopy is every 10 years. We do have the option of the faecal test if you're not at elevated risk, but it's not as accurate and you can wind up being called in for a colonoscopy anyway, so people sometimes choose to just go with the colonoscopy (I did).

Wait times in the US depend on so many factors; you'll see people bragging that they were seen instantly and others complaining about months for a specialist.

No, my parents have also been given FIT tests to do at home in the US. Only if that is positive does a colonoscopy happen. Not sure where you got the idea that the US thrusts annual colonoscopies upon seniors by default! (I think the guideline is one colonoscopy every 10 years for at-risk individuals only.)

Glad to hear you got quick bookings though, and hoping that the CT scan is negative!

It really varies

I filled in a form (econsult) for a GP appoitnent for a lump in Breast.
Appointment with GP 2 days later
Referred on a 2 week cancer wait
Hospital rang me within half an hour to go in the next week
All tests completed same day

Cant fault that at all

How much per year are you paying for your healthcare coverage? The question then becomes what would you pay in the UK (which is zero if you have zero income, or a small proportion income tax+NI if you are earning). Unfortunately in the UK we have the healthcare system we are collectively willing to pay for. Combined with inefficiency and wastage, much of which is created in a confused 'internal' market generated by muddled political attempts to make the NHS profitable in the same way US healthcare is, you'll end up with a very different healthcare experience. In the UK sick people are patients, in the US they are customers (with the right coverage or cash).

The UK is a very different country and culture. I don't think healthcare would be what makes or breaks a move for me, but worry about that may be shorthand for worry about jumping back into the UK life in general

@Star555 one of the main differences between the systems is emergency care. You cannot buy it in the UK - you can get referrals post care for private treatment, but initially everyone goes through the same funnel. It’s an issue - particularly if you have an emergency on a Saturday night etc when the waiting room is like the wild west. In general though, when the NHS works, it works well. It just isn’t consistent everywhere. And that’s an issue no one has been able to resolve. my own experience of GP appointments is positive- my nhs surgery uses tech well and in general I’ve never not been able to get a same-day appointment. I also have PMI so I appreciate I’m in a fortunate position in having choice if I need a follow up.

However, what struck me about your post is that you plan to move to the UK and have children where you have no support network. Don’t underestimate how much support you need having children, and how lonely/exhausting it can be - especially if you get ill yourself. Yes, you can buy in help but it’s unlikely to be 24hr. In your position, if it’s an option I’d ask for a secondment to the UK with your job and see if the UK is how you remember it or if it’s something that you would want for yourself moving forward before committing to moving back. I’d also check the rules surrounding what nhs care you are entitled to access as you’ve been out of the country for a length of time - being British by birth doesn’t mean an automatic right to care which is free at the point of access. You’re likely have to pay to access the services, and as we know it isn’t consistent everywhere. I wish you luck in making your decision.

But that’s because of the lack of care in the US for poor or unemployed people. And it must vary from state to state.
In a wealthy part of the US the health care is the best in the world I would think, I lived there 10 years ago. Here in the U.K. it’s very hit and miss ime.

No, they die because they get shoddy care. 65% maternity units are unsafe in the UK. If the OP is planning to have children, I recommend she avoids the UK.