Experiencing the NHS as an immigrant through a Public Health lens

I woke up in the middle of one night, with horrible pain on my lower left abdomen. 

My husband and I are both new immigrants to the UK with no other family here. For months earlier, I could feel the pain getting worse. I would see my GP once a month, who told me that my test results came back normal and that this was just “hard to diagnose”. I was confused as to why I wasn’t being referred to a specialist and then I realised how long the waiting times are to see one. 

That night, through the mind-numbing haze of pain, I don’t remember how we got to an A&E. I was overwhelmed and anxious because I didn’t know what to expect. For most immigrants, navigating the NHS can be a daunting task when we don’t know what our rights as patients are, how the system works, excruciatingly long waiting times and we’re not sure of what the experience of care would be. 

As I was waiting to be seen, I saw a teenage boy curled in pain on the floor for about 5 hours before he was attended to. When I was finally seen in 6 hours, it took another 4 hours of waiting for various tests and results. Even though I was exhausted, I was relieved that I didn’t have to go to another wing of the hospital for tests and the results.  

So then, there I was being wheeled into the General Surgery in-patient ward. As a current public health professional and former healthcare practitioner, I was amazed to see that I was prescribed dihydrocodeine, an opioid painkiller. It is all but impossible to obtain opioid medication, even for cancer patients in India. The doctors and nurses were wonderful. They were extremely respectful and talked through their approach of why they hadn’t been able to diagnose me and why I needed to get an ultrasound scan. There was not a hint of the authoritative tone I had come to expect from my experience with healthcare staff in India. Even after 3 more days of being hospitalised, I was told that the waiting period could be indefinite and since the pain had reduced and I was sent back home. A week later, I got an appointment for a scan in 2 weeks’ time. 

This had me baffled. Why would it take more than 3 weeks for me to get a scan that takes less than 10 minutes to be done? The concept of waiting for weeks and months for a healthcare appointment is the norm here in Scotland. The days and months I spent feeling pain, fatigue, a host of digestive issues and allergic reactions has made me wonder how many others are in such a situation, where private care is unaffordable but public care means inability to function day-to-day for months and even years. The idea that this is the only way for the system to continue and for healthcare to be equitable needs to change! Prolonged waiting times can lead to worsening of diseases and conditions, especially in vulnerable and underserved populations. The result is increasing inequality and an increased cost burden on the NHS. IPPR report on Healthy people, Prosperous Lives (April 2023) mentions that long-term illness causing economic inactivity was twice as prevalent in Scotland as in the Southeast of UK. 

Before moving to the Scotland, I had worked on healthcare recruitment strategies in India, which is a Low- and Middle-Income Country (LMIC). And to me, the idea of waiting times in months feels absurd. The way to reducing waiting times is to have resources and people that meet the needs of patients. Every LMIC has had to grapple with a growing and ageing population, multiple pandemic or climate related crises, and/or low resources in their healthcare system. This has led to unique and context specific approaches to recruit and retain health staff. Apart from pay, there is no arguing the fact the working environments, access to support services and work-life balance make a huge part of any job satisfaction. The path to recruitment is relatively simple but the retention of staff is a far more complex issue. It is a mix of both problems that appears to exist in Scotland.

NHS staff in Scotland were phenomenal during the pandemic. So much so that we were encouraged to meet at our front doors and clap for them every week at 8pm. But as has been said repeatedly by workers and worker representatives; claps don’t pay bills. The growing discontent across the NHS due to pay and conditions is having dire consequences for those who stay in this precious system and those who ever consider working in it. Failing to treat workers with good pay and respect, will only make waiting times longer and create more economic problems, with a domino effect across sectors. 

The NHS has been hailed as one of the leading health services in the world, but for that title to remain, change is needed. Often wealthy, developed nations feel it is beneath them to look to the so called “developing nations” for answers, but there is much for NHS Scotland to learn from LMICs in creating a more cost-effective model that isn’t exclusionary. Listening to people experiencing the NHS and engaging with minorities especially, can help reduce healthcare inequality and as a consequence, improve economic outcomes.

As a migrant, I am often viewed as the problem, as some further burden, forgetting of course, that there are a disproportionate number of us working in health and social care. But rather than seeing us and our home countries as problems, maybe, we too can be part of the answer. I know, I am ready to be.