The good, the bad, and the ugly of England's universal health-care system
The fire alarm in our hospital room is blaring. Despite our attempts to stifle the sound with a towel, it is deafening. My husband sits on one side of our room in a stiff vinyl chair cradling our newborn baby boy in his lap, cupping his tiny ears to protect them from the noise, which has been unrelenting for 10 minutes now. He is weary. I am weary. This is our sixth day in a London hospital, and the third consecutive day of fire alarm "testing" on the postnatal ward to which we've been assigned. Babies are screaming. Haggard, sleep-deprived new parents like us are losing their minds. But in the hall, the medical staff march on, unfazed. They smile at one another, make small talk, and generally ignore their patients' complaints. To them, this living hell is normal. It's just another day in a National Health Service hospital.
The National Health Service, or NHS, is the United Kingdom's public universal health system. It was established in 1948 after World War II, and has since grown to become a massive operation: The NHS sees a million patients every day. It employs 1.7 million people, which makes it the fifth biggest employer in the entire world. And of course, it is free at the point of use for U.K. residents. If you walk into an NHS hospital with a broken arm, you'll walk out with a cast, a few x-rays, and zero bills to pay. That's because people who live in the U.K., myself included, contribute to the NHS through taxes and national insurance payments (the U.K.'s version of Social Security).
While the NHS has long been the subject of some scorn in America, it is also often heralded elsewhere as a shining example of how universal health care can succeed. British citizens are fiercely protective of it. One survey found that Brits list the NHS as the number one reason they are proud to be British. And there's good reason for this: The NHS is great. Having grown up in the States and become accustomed to the complicated web of insurance claims, co-pays, deductibles, and enormously confusing bills that plague the American health-care system, I found the idea that I could receive top-tier treatment for free here in London mind-blowing. After I got pregnant last year, the maternity care I received leading up to and during the birth of my son was outstanding.
But this system is far from perfect. It is plagued by funding problems and staff shortages. We encountered the NHS's dark underbelly after postnatal complications landed us in the hospital. The NHS gave me a healthy baby, yes. But the NHS also gave me nightmares that still wake me from a dead sleep, even nine months on.
My son was born promptly on his due date after a pretty textbook labor and delivery at a birth center connected to a hospital. Our medical team was exemplary: The midwives read and respected my birth preferences, even down to my weird request to remove the clock from the wall so I could really, truly slip into labor land without feeling the weight of time passing. After the birth, the nurses brought me tea and toast, and even broke the rules to sneak my husband a meal, too. They were gentle and caring, and they left us to bask in the glow of our newborn child. For about 24 hours we stayed in our bubble and cooed over our son's precious face and tiny features. It felt like heaven.
But then, during a routine examination, a doctor noticed a problem with our son's breathing. What had been a quiet, tranquil room was suddenly buzzing with machinery and medical staff. Within minutes, they'd fitted him with an oxygen mask and a pediatrician was at our bedside explaining that they were taking him to the neonatal intensive care unit for observation and a round of antibiotics for what they thought was an infection.
The postnatal ward to which we were assigned was just a short elevator ride from the birth center, but it may as well have been on a different planet. It was made up of dozens of "rooms" — tiny cubicles with four curtains for walls. Privacy was non-existent. We could hear everything going on around us — patients' cell phone conversations, private consultations, coughing, laughing, eating, snoring, and of course, crying newborns. The worst, though, were the sounds of grief and agony coming from the new mothers who, it seemed to me, had been left alone to suffer through the night. One woman across the room was in great pain from her c-section, and I remember waking to hear her vomiting and crying. I kept waiting for a midwife or a doctor to arrive to comfort her, but no one ever did.
Many recent surveys have found the NHS to be drastically understaffed, and doctors in particular are desperately needed. Last year, the British Medical Association called the NHS's doctor shortage "chronic" and warned that if something wasn't done to stem the problem, "patient care will suffer." For us, it already was: Our son was out of the NICU, but the medical team still didn't know if he had an infection, and face-to-face consultations with the pediatricians treating him were rare. When we did get a moment with a doctor, it was brief and hurried. As a result, we still didn't really understand what was wrong with our son, or if he was getting better. And we had no idea when we'd be home.
Sleep was hard to come by on the ward. Occasionally I'd be jabbed by an elbow belonging to the patient in the next bed over. My 6-foot-2 husband tossed and turned in his chair, which barely reclined. I thought about inviting him into the bed with me, but the disciplinarian midwives were incredibly strict about the beds being for moms only. If you were caught sharing, or even just letting your partner catch a few hours of sleep while you rocked the baby in the chair, you were reprimanded.
Eventually, we were given our own room, which felt like a small miracle. But our new quarters seemed like they hadn't been cleaned in days; the bathroom smelled of sewage and the floor was littered with trash. And then there was the fire alarm — sure to start blaring right when the baby had fallen asleep or when one of us had finally managed to drift off. It was torture.
We looked to the midwives for comfort, but found little. This is not a particularly satisfied bunch. The Royal College of Midwives found that for every 30 midwives who join the profession, 29 leave. Many say they are leaving because they feel they can't provide the best care to their patients given their overwhelming workload, and we certainly felt this. Our midwives seemed desensitized to the environment on the ward, and multiple times we were stunned by an overall lack of bedside manner or sense of compassion. My son's feeding tube, which had been essential while he was in the NICU but was no longer necessary once he was back with me and learning to breastfeed, was dangling from his nose, barely held to his face by an old piece of medical tape. It seemed the doctors had simply forgotten about it. I practically begged a midwife to remove it, which she did, with a yank and an eye roll.
In the wee hours of one dreadful night, when my son was struggling to nurse and I was near delirium from sleep deprivation, my husband asked the midwives at the front desk if they could come give me some breastfeeding advice. Instead, they told him my four-day-old son was just crying for attention. I don't think I've ever felt more hopeless and alone than I did in that moment. We felt abandoned, forgotten. And the longer we stayed, the more invisible we became: Multiple times I went long stretches without a meal, only to find out that dinner was hours ago and the staff had accidentally neglected to bring me any.
On the fifth day, we became so desperate, we hatched an escape plan. Our son was improving and there were no more signs of infection, but the medical team seemed inclined to keep him on antibiotics for another few days "just in case." Meanwhile, our mental and emotional wellbeing was taking a horrendous beating. We decided that unless the medical team could give us a very good reason to stay, we were leaving. Luckily, it didn't come to that. Six days after my son was born, we got permission to go home.
Perhaps the most dehumanizing part of this entire experience was how powerless we felt. There was no one I could complain to, no manager I could shake my fist at. We were just another disgruntled, weary family clutching our newborns and waiting to be released. That's the thing: When you take the money out of medicine, when you're no longer a paying customer with alternative options, you lose your leverage. You are at the mercy of the system.
This is not to say there weren't instances of deep and moving compassion during our stay. When my son was first taken from us, for example, my husband went with him into the NICU and I was left alone in the birth center. Of course I wept. A kind midwife sat with me on the bed and, as I sobbed into her scrubs, she held me to her chest and told me everything would be okay. There was the NICU nurse who told us she'd been whispering words of encouragement to our son through the night while he slept in his incubator. There was the kind pediatrician who, on our last day, spoke to us at length about our son's condition. He looked us in the eyes and acknowledged our frustrations. It's amazing how far a small gesture of compassion goes to make up for a multitude of sins and misgivings.
I don't want to seem ungrateful. After all, it's very possible the NHS saved my son's life. And my husband and I often talk about how different things would be if he'd been born in the U.S.: No doubt we'd be dealing not only with a new baby, but insurance claims and possibly crippling debt. I walked out of that hospital with a healthy child and not a penny owed. I am very thankful.
But I'm also traumatized. I often wake in terror from nightmares in which we're still stuck in the hospital. The smell of a medical setting sends my heart racing. The sound of a fire alarm makes me want to throw up. My experience isn't unique: My husband overheard one woman on the ward asking a midwife who she could speak to about the poor treatment she'd received. Nearly all the women in my new moms group recalled harrowing experiences in NHS postnatal care. Complaints to the NHS are on the rise, with more than 500 made every day. This is a problem that needs addressing.
It's also an incredibly complex problem that experts across the country are struggling to solve. Politics plays a large role, as does an aging population. Some people call for more funding. Others insist on shifting the focus to preventive care. Still others say technological innovations could hoist the NHS out of the past and propel it into the digital age. Probably what's needed is some combination of all of these improvements. Recently, the U.K.'s finance minister announced the NHS would receive an additional £27.6 billion (about $35 billion) a year by 2023, which is surely a step in the right direction.
I don't know how to fix Britain's universal health-care system, just like I don't know how to lower the costs of America's privatized system. But I do know that, while the price of good health care shouldn't be astronomical medical bills, it shouldn't be emotional trauma, either.