Public healthcare - Spain & UK

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Miro
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Public healthcare - Spain & UK

Postby Miro » Fri Aug 04, 2017 3:22 pm

There was recently a thread on another (less intelligent) forum about the Spanish Health Service v the NHS. It descended rather rapidly into a typical silly bickering contest, and was largely populated by comments about immigration in the UK & Brexit, which bordered on xenophobic, so I hope I'm not starting something similar here.
I believe there are positives & negatives in both countries, which is normal, and things can be a bit of a "postcode lottery" wherever you are, so fully accept that people will have very varying experiences, all valid, and hope that this will be a sensible and balanced discussion. I only offer up this since on another thread some members have expressed their interest in my experience moving back to the UK after 20 years in Spain, so hope that it will be interesting & perhaps useful for others. I know that health care, especially as we get older, can be a big priority in our decision making.
Over the years in Spain (and on forums) I have noticed a tendency among expats to slag off the UK NHS - I'm not sure whether based on personal experience, or purely on sensationalist journalism in the UK tabloids - but it always seemed to me that if more Brits read the Spanish press, they'd probably find all the same things (cutbacks, under-staffing, waiting times etc.) being reported there about the Spanish health services as they read about the NHS. Ignorance is bliss, as they say!
In general, I have never had any cause to complain about the health service in Spain (apart bureaucratic nightmares that I've documented previously on A.com), and don't doubt for one minute that the level of medical training, expertise and care is (usually) as good as it gets. But I am going to (briefly, if I can!) describe two recent situations, and then hope others will add to the discussion.

Late last year an elderly (80s) British expat friend fell ill (breathing difficulties) at home and called me. He didn't call a doctor or ambulance because he didn't speak Spanish and lived alone. When I arrived, he appeared gravely ill (coughing up blood) and I made the decision to call an ambulance immediately. The ambulance arrived within 20 minutes. The three man crew were wonderful - professional, attentive, friendly. He was whisked to Málaga A&E and we followed by car. By the time we arrived, he had been admitted and the ambulance crew had departed for their next assignment. We found him sitting in a wheelchair against a wall at the back of a huge, noisy waiting room full of what I estimated to be a couple of hundred people. he had an oxygen mask on, connected to a bottle on his wheelchair. He had been given some medication, including a diuretic, although we didn't know exactly what else if anything. He started needing the loo every 15 minutes or so, and Mrs.M had to take him, to the only toilet serving this huge room, which was filthy. At one point, an orderly came to change the oxygen bottle, and managed to drop it on Mrs.M's leg. She still has the scar. At no pint over the next eight or nine hours did any staff come to see us, and we had to constantly go to one desk or another (each passed the buck to another) to try and get any update on his situation. Another friend (who also spoke no Spanish) arrived eventually to relieve us. Soon after, he was taken away by staff to be seen by doctors. The friend was told he would be transferred later to the CHIP hospital (which we had never heard of, but is a private clinic not far from Carlos Haya). We went next day to CHIP, to find our friend in a bed in a room of two (the other patient was a semi-conscious Spaniard, constantly crying in pain) on a third floor. The nearest nurse station was on the second floor. Our friend could not reach the buzzer to summon assistance, so had to wait for someone to come by. He had an empty meal tray, which had been on his bed for 2 hours. We saw the food on another day, and it was truly awful. We asked to see a doctor to find out what his situation was. We waited two hours. When the doctor came, she asked what relation we were; when we said, just friends, she asked where his family was and who he lived with. When we said, in the UK, and alone, she asked simply, what's he doing here, then?
She told us (reluctantly) that he had pneumonia, and expected him to be in for about 10 days, but said when they discharge him, he couldn't go home alone so arrangements would have to be made.
Sadly, he passed away 6 days later.

Within days of settling into our new home in Southport, we had registered with a GP, had a basic medical check with a nurse (including blood tests etc.) and seen the GP for an initial consultation and medical history discussion. He sent us both for further blood tests for certain things, and on the follow up consultation a few days later I was referred for a urology appointment (which I've mentioned elsewhere so wan't elaborate on here). We drove to Ormskirk hospital (about half an hour away) yesterday morning for this appointment. I had not slept well, having some tightness in the chest and difficulty breathing, but shrugged this off as I'm prone to, but while waiting for my appointment, I started to feel very unwell. Mrs.M spoke to a nurse, who directed us to the walk in clinic (no A&E here). I was seen by a nurse immediately, who performed an ECG. A GP came to see me within 5 minutes to discuss teh ECG. Some irregularities concerned him, and an ambulance was called. 10 minutes later the ambulance crew were there performing their own checks, and based on these, they decided to blue light me to Southport A&E. Mrs.M does not drive, so the car stayed where it was and she came with me. At Southport I was seen immediately in A&E; more ECGs, blood tests, a chest x-ray...the doctor was concerned I may be having a heart attack, and consulted with her colleagues at Liverpool heart & chest hospital (Broadgreen, to the locals). Not long after, I was being blue lighted to Liverpool. We were greeted there by a large team of staff, and I was whisked away for an angiogram (which apparently trumps all other tests) One of Mrs.M's nieces happens to work as a cardiac technician at Broadgreen. Although not on my team, she had been notified and relieved of her duties in order to come and sit with Mrs.M while I was in theatre. The good news is, no blockages or semi-blockages showed up, & I was given the full all clear on a heart problem. The Southport ambulance crew waited the whole time, and then took us back to Southport A&E (took a bit longer this time!) A&E was busier now - people waiting in the corridor on stretchers and wheelchairs. The ambulance crew waited with us the whole time (maybe an hour) until I was handed over to the staff on duty. During this time, despite feeling much better by now, I suddenly and unexpectedly fainted. The ambulance crew were right there and attended to me. My blood pressure had dropped dramatically causing the faint. I was kept in an observation bay for perhaps a further three hours, with regular ECGs, blood pressure checks etc. & visits from the doctor in charge. One of the ambulance crew brought me a sandwich and a cup of coffee before leaving. He popped back in a couple of hours later to see how I was doing. Eventaully it was determined that some inflammation of the heart lining, possibly due to an infection, had caused the breathing difficulties. No further treatment necessary, just R&R! By the time they decided I could be discharged, another of Mrs.M's nieces and her husband had arrived, and collected my car from Ormskirk before taking us home.
All's well that ends well.

As I said earlier, in general I have found the Spanish health service to be excellent. But two things stood out for me when mulling over these two (very different) situations: the care and attention from all staff during my awful day was unbelievable - very personal, I was made to feel like I was the only patient they had. This contrasted with the sad case of my friend in Spain, who seemed to be treated as a number rather than an individual with feelings and needs. Even this I can accept, because I think it must be necessary in such a demanding job to be able to become emotionally detached, and I also believe these amazing people work under extremely stressful and difficult conditions - it's more important to me that they do their job efficient and effectively, rather than be nice - but a friendly disposition goes an awful long way when you're not at your best. Secondly, although we had many good and close friends in Spain - there's nothing quite like family in times of need.

As I also said earlier, everyone will have their own experiences (and opinions). All welcome.

Have a happy & healthy day, all :wave:

P.S. I have just received in the post a new appointment for urology next Tuesday, because I missed yesterday's! :thumbup:
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Re: Public healthcare - Spain & UK

Postby Free at Last » Fri Aug 04, 2017 3:51 pm

I've had very little experience of the state healthcare system in Spain - I only visit my doctor to get repeat prescriptions of what has been prescribed for me by my cardiologist in the private system. The appointments are very brief and there is no chat whatsoever, which doesn't bother me, but I do find it a bit strange that he never asks any questions about my health and there are certainly never any routine tests offered (although I do get letters from the breast cancer screening service inviting me to have mammograms). I'm sure if I asked for them there wouldn't be a problem, but it does seem that here it is up to the patient to adopt a proactive approach.

This morning, my OH heard from his sister in the UK that the results of some hospital tests undergone by his brother-in-law in February had arrived last week. He needs to have an angiogram, but has been told there is a six-month waiting list (this is in Lincolnshire). I'm sure it is very much a postcode lottery with the speed and quality of the services dependent on where you live..

I'm glad your experience of emergency treatment was so good, I tend to think that for urgent, potentially life-threatening situations both countries do a good job.

Your elderly acquaintance's experience of a private hospital in Málaga was quite different to mine, although I was in a different hospital (Parque San Antonio) for elective surgery. I had a private room (with balcony overlooking the sea), the nursing staff were very pleasant and friendly and prior to my operation someone from their Customer Relations Office came to visit me (she'd been told by the nurses that I spoke Spanish but wanted to run through the procedure with me and answer any questions I might have). She visited me again the next day after the surgery. It was about 7pm when the operation ended and the surgeon went to visit my husband in my room whilst I was in recovery, to let him know everything had gone well.

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Re: Public healthcare - Spain & UK

Postby chrissiehope » Fri Aug 04, 2017 11:04 pm

Twelve years ago I broke my ankle while in Spain. I was taken to Antequera hospital where it took three hours to pick out all the bits of shattered bone & fit a plate & seven screws to hold the bone together. I was there for two days, in a single room. The food was like any hospital food - unpleasant, and of course catering for Spanish tastes. Back then I hardly spoke any Spanish, and after the shift change at 8 pm that night, no-one there spoke English. Despite that, the staff were friendly & we got by with hand signals & a bit of French ! On arrival back in UK, I saw various medical people, & the almost unanimous reaction to the repair work done was "Oh, it's quite good"

I have had several stays in hospital in UK, & the experiences largely depended on which nurses were on duty - some were lovely, & some not so lovely. What was clear was they were very busy/understaffed, & it would often take a while before a buzzer was answered.
So all in all, my experiences in both UK & Spain had their good parts, and some not so good !
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Re: Public healthcare - Spain & UK

Postby Wicksey » Sat Aug 05, 2017 11:02 am

I know in Kent my inlaws have not had good experiences over the years. Some years back when my father in law had a bicycle accident, breaking his hip, it was a terrible ordeal for my inlaws and the inpatient care was horrendous. They have recently registered with a different GP who has certainly given a much better service than they've ever had, even making follow-up phone calls to see how they are. I think it very much depends on where you are and perhaps when you may need the services of A&E. Just out of interest we did ask at the surgery local to the house we own in the UK, just in case we needed to see a Dr whilst staying there when we first bought it, but the wait was 3 weeks for a routine appointment.

Glad to hear that you are OK Miro!

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Re: Public healthcare - Spain & UK

Postby El Cid » Sat Aug 05, 2017 11:54 am

There was a doctor in the UK on Radio 4 the other morning who said that in some areas they will not do a cataract op until you are almost blind or a hip replacement until the painkillers stop working.

I know which system I would prefer to use and as for getting a doctors appointment there have been many reports of three week delays in the UK. That is bound to get worse as they are running out of GPs fast and no one wants to train to be one. We can usually get an appointment next day.

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Re: Public healthcare - Spain & UK

Postby Wicksey » Sat Aug 05, 2017 12:07 pm

I forgot to say that here we have got appointments the same day or the next at the latest. The Saludresponde phone app is excellent for making appointments easily.

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Re: Public healthcare - Spain & UK

Postby El Cid » Sat Aug 05, 2017 12:31 pm

I was sitting waiting outside the surgery at 9am for my 9.08 appointment and wondered what the next available appointment would be. I checked with the app and it was at 12.30 same day!

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Re: Public healthcare - Spain & UK

Postby Paulinmalaga » Sat Aug 05, 2017 12:45 pm

IMO There will incidents of excellence and chaos in both systems. So to cherry pick in my mind is a bit unfair to both. A huge amount depends on location and time in both countries. A bit like our British Tabloids...if they are seeking a disaster story regarding the NHS they'll find one like wise a story of excellence.

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Re: Public healthcare - Spain & UK

Postby elusive » Sat Aug 05, 2017 5:30 pm

I think with things such as the NHS in both countries opinions can be made after very little experiences with it.if someone has a bad experience then that sticks and you certainly cant blame people for feeling negative towards one or the other then those who have a good experience go to the other extreme.No where is utopia.and theres prob rose tinted glasses used on both sides. One important note is if you are lucky enough to have the right to healthcare in spain (regardless of the law) something that to me is morally wrong in any country.1st or 3rd

I would think both services are excellent in emergencies because thats what you are trained for but then theres the issue of waiting lists sitting on trollies etc.i never had a problem with getting an apointment in the uk within a day or two and was seen quickly in spain when i had the right to see a dr.same for family members they got a MRI scan appointment quickly in spain when they were refused one in the U.K.and the spanish drs werent impressed when told about not getting standard screening in the U.K .Family experiences have been very bad in the UK resulting in permanant damage and negligence cover ups so im not the greatest fan on the NHS interms of a preceived arrogance of "god like" dr's who no one wants to say boo to or question.To me to many people in the uk are thankful for anything because they think the NHS is "free"

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Re: Public healthcare - Spain & UK

Postby Miro » Tue Aug 08, 2017 11:08 pm

Thank you everyone for your thoughts and comments, all very interesting. Naturally, we can all only draw on our own personal experiences, and chance factors may skew our resulting opinions one way or the other, but that doesn't make them any less valid, so please keep them coming!

I was back at the hospital today (outpatients thankfully, not A&E!) for the missed urology appointment that had been quickly rescheduled. I was seen on time, all very efficient and friendly, and more notably, a very calm and quiet, stress-free environment. This contrasts quite strongly with my experience over the years at places like Málaga Clínico & the Barbarella clinic, where there were invariably scenes more akin to a Mexican border post, with mothers and their feral children scrambling all over the place screaming, mobile phones blaring, and general pandemonium. I've never had any cause to complain about the actual medical treatment in these places, but I've always come out feeling pretty stressed and needing to decompress in the nearest cafe. Not a decent cafe within about a thousand miles today - but I also didn't feel in desperate need of one!
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Re: Public healthcare - Spain & UK

Postby IreneD » Tue Aug 08, 2017 11:33 pm

I had quite a funny experience last week at Hospital Comercal in Velez Malaga. I had to attend Ecografia Salon 1 for an ultrasound scan. OH and I got there in plenty of time and there were lots of people milling around, a queue of sorts, Spanish style. Further down the corridor there were chairs but they were all taken and the stretch by Ecografia 1 didn't have chairs. (Hence the milling, or queuing) Two nurses were waiting outside, with a tiny baby in a mobile cot, so I went up to them and asked what I should do. Just then the door opened and the radiographer came out and ushered in the nurses with the baby. One of the nurses told me to give my appointment paper to the radiographer, which I did.

As there were so many people waiting, I was expecting to have to wait hours. The nurses with the baby were in there ages but when they came out, much to my amazement, my name was called! My OH told me that while I was being seen, another nurse came out and collected lots of appointment papers.

What made me laugh though, was when I was PMing a friend on facebook about it. This was her reply "ha ha - you are beginning to behave like a local! Jump the queue asking a preguntita! Nice work. I bet the other Spanish in the room were impressed - she comes from Barcelona - they were muttering!" Lol!

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Re: Public healthcare - Spain & UK

Postby Miro » Tue Aug 08, 2017 11:56 pm

"Milling"...mmmm.....pushing, shoving, jostling, hustling, shouting, yelling - Spanish style milling, or queuing if you will, can indeed be quite amusing, entertaining even - in the local butcher's shop. I can put up with it, and compete with the best, in any outpatient situation, but in more serious or urgent circumstances, I think I'd prefer the kind of hushed orderliness I witnessed over the last few days in the various NHS hospitals and departments I've visited. Again, I stress, just my personal experiences, and maybe not concurrent with those of others.

Mrs.M was diagnosed many years ago with a heart condition (leaky valves), which has remained stable, and had annual check-ups with a cardiologist in Málaga until about 3 years ago, when the appointment didn't come as usual. On enquiring, we were told that her cardiologist, along with two others, had retired and not been replaced - cutbacks. She was told that she would be assigned to another, and told to wait...and wait, and wait. After nearly three years and several more enquiries, she did finally get to see a new one. Fortunately nothing untoward happened in the meantime, so in the scheme of things it didn't really matter - but it does irritate me to hear expats denigrate the NHS, happily repeating the stuff they've seen/heard in the UK press about the NHS being at breaking point, when they are not bothering to follow the Spanish press and reports of the same kind of problems in Spain.
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Re: Public healthcare - Spain & UK

Postby IreneD » Wed Aug 09, 2017 12:21 am

Oh, I agree, Miro. I didn't enjoy the 'milling' and was very apprehensive and stressed about the possible long wait, what order I might be seen in etc etc. i suppose it was the relief of being seen so quickly plus my friend's reaction that amused me.

I'm actually only halfway through (maybe not even that) re. a decision about what to do about my gallbladder problems. It has been pretty much a shambles, to date. I won't go into details but I'll just say it isn't straightforward.

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Re: Public healthcare - Spain & UK

Postby Terry Tibbs » Fri Aug 11, 2017 11:48 am

Interesting to read the comments and experiences in this thread. In general I believe that the vast majority of people who work in the health service in Spain and the UK are striving to do the best they can for their patients, regardless of any cutbacks, etc. That's certainly been my experience anyway in both countries, and in the others that I have lived in.

Late on on Monday night this week I was getting chest pains and as I have a minor heart condition I went to the Urgencias at my local hospital, CHARE in Benalmádena. I've been having digestive problems and moderately high blood pressure for quite some time and the investigations are ongoing, but as the pain was now in my chest too I decided to get it checked out as a precaution. Within 3 minutes of walking into Urgencias, I'd been booked in, tagged and was lying down with an ECG attached to my chest. Consultations, blood tests and an x-ray quickly followed, the conclusion of which was that the old ticker was fine. Just over an hour after arriving I was on my way home. I really couldn't have asked for any better attention - everything was done efficiently, with the number on my wrist tag used on the screen in the waiting room to tell me when to go to a consultation room. Despite there being a fair number of patients in, everything was calm and all the staff were kind and helpful throughout.

Coincidentally the next day I had an outpatient appointment at the 'Digestivo' department at CHARE. Long story short, but it looks like my problems are due to a food intolerance. I've been avoiding gluten and lactose since Tuesday and my blood pressure is now normal again for the first time in many months, plus I'm feeling a lot better. In a couple of weeks they are going to do a lactose intolerance test, followed if necessary by gluten testing. If one of these turns out to be the cause of the problem it will be a great relief to me as this is something that has been a problem, on and off, for several years and the doctors where I previously lived in Asia hadn't been able to pinpoint the cause. So to say I am happy is an understatement.

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Re: Public healthcare - Spain & UK

Postby Miro » Fri Aug 11, 2017 1:34 pm

Glad to hear you're chest pains turned out not to be a heart problem. After my own experience last week, I know how frightening it can be. Also good to hear of your positive experience. I'm not familiar with CHARE, but a friend back in Torremolinos was sent to Xanit recently for tests, on the Social, and only had good things to say about it. I don't know if the new hospital in the Guadalhorce valley is up and running yet, but when it is, maybe it will relieve some of the pressure on the Málaga Clinico and that may improve too.
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Re: Public healthcare - Spain & UK

Postby Terry Tibbs » Fri Aug 11, 2017 2:05 pm

Thanks Miro; I hope all is going well for you too and that you are trying to follow the 'R&R' recommendation that you were given. I have been told that I need to think more about having a quieter life myself instead of "running around helping other people" - not that I do that all the time, but having a less stressful routine is obviously a good thing as the years go by.

I believe the new hospital near Cartama is open, at least the Urgenicias part anyway. Not sure what impact that has had on Urgencias at the Clinico, as (thankfully) I haven't had to go there. But I did take a friend to an outpatient appointment at Clinico a few weeks ago and it was as hectic as I'd ever seen it. The 'milling about' that you eloquently described, and the crowding around any member of staff who appeared, was much in evidence. They don't seem to have a ticket system (the one at CHARE works very well), or if they do, they don't use it. I think the staff must have the patience of Job to work there. Despite the 'organised chaos' my friend was seen fairly quickly (only about 15 mins after his scheduled appointment time) and was happy with the attention he received. But my impression was that the Clinico is still overloaded - there has been talk for a long time about building a third big hospital for Malaga city, to ease the burden on El Clinico and Carlos Haya due to the ever increasing population. Let's hope that the talking will eventually stop and something will actually get built.

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Re: Public healthcare - Spain & UK

Postby Unicorn » Fri Aug 11, 2017 10:28 pm

For us down here in Estepona the exciting news is that our hospital is being built, it started in June. Although we have Cenyt and Hospiten, both private, work has started on the new state hospital just to the west of Estepona. Should be finished in 2 years. Good news for us as Costa del Sol, although excellent, is a bit of a hike!

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Re: Public healthcare - Spain & UK

Postby Miro » Tue Aug 15, 2017 3:18 pm

A good friend of mine back in Torremolinos has just told me of another sad case. He's been looking after a British chap, who speaks no Spanish, lives alone and has no family, for some time now. My friend arrived a couple of days ago to find this chap had suffered a stroke in the night. He couldn't talk or move his right arm. He is currently in Hospital Clínico in Málaga, where it sounds pretty much like a repeat of how my elderly friend was treated (as described in my opening post on this thread). He's attended to very occasionally by a young clueless nurse, but my friend is having to feed him etc. He hung around for 5 hours yesterday hoping to speak to a doctor, but saw nobody. His (Spanish) partner went to the hospital in the afternoon, and said it was even worse than in the morning. It sounds almost as if they're just leaving him to die. At best, he will recover to the extent that he'll be discharged to a social security nursing home, where God only knows what he'll face. I can't help feeling he is another sorry case of someone who should have returned to the UK while he still could. :(

My ongoing experience / learning curve with the NHS took a slight blow yesterday. After my hospital episode the week before last, I wanted to see my GP to follow up, as I seem to have a chest infection now and wonder if it's all related. I was dismayed to find that the earliest online appointment available was three weeks hence. :shock: But they had told me when registering that it's possible to see a doctor the same day if you come in the morning, so I went along at 9:00, only to discover that they open at 8:00 and all yesterday's appointments had already been taken. Wiser, I got there at 7:50 this morning, and got an appointment for 10:30 :thumbup:

Cut a long story short, yet more tests ordered (and some antibiotics meanwhile). One unexpected upshot, however, was that I found out because of my hypothyroidism, my prescriptions will be free for life. So the year's supply that I accumulated before leaving Spain wasn't necessary after all! :D
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Re: Public healthcare - Spain & UK

Postby Free at Last » Tue Aug 15, 2017 4:50 pm

Sadly, I don't think vulnerable people who have no family to visit them are ever in a very good situation when they are inpatients in hospital. I once had a short stay in an NHS hospital and was in the next bed to an extremely old lady, obviously very confused, who never had any visitors. At every mealtime, food was brought for her, left on her tray and then removed, untouched, when everyone else's trays were collected. No member of staff ever showed any concern that she hadn't eaten anything, she was never given any assistance to eat, the poor thing probably didn't even know the food was there.

My father was an inpatient in a different hospital for six months before he died, after having a stroke and then developing diabetes-related complications during his hospitalisation (and their slow and bungling response eventually led to 3 amputation operations and his premature death, but that's another story). He was having great difficulty in eating and after a few days of arriving during visiting time to find him wearing what appeared to be most of his meal down the front of his pyjamas, I asked for a meeting with their "modern matron". Oh, we have foam handled cutlery which should help him, I was told. Well, why did it take me having to intervene before he was given it, then, rather than a nurse or HCA noticing that he was obviously struggling? What do they do to help people who don't have families to speak up on their behalf?

Likewise, his speech was affected by the stroke and he was having trouble responding to routine questions. When visiting, I overheard an HCA who was bringing round drinks say to him very rudely, after she'd asked what he wanted to drink, "I can't understand what you're saying" and just turning her back on him and walking away. I raised hell about that and made an official complaint. After that I made him a set of flash cards with responses to the most common questions he was asked, such as what did he want to drink, did he want a newspaper, etc. Oh, what a good idea, said the nurses and the speech therapist (who stopped visiting him after he was transferred from the stroke unit to a medical ward because of the diabetes-related complications because apparently he "got lost in the system"). So how come it took someone who isn't a health care professional to think of it?
Last edited by Free at Last on Tue Aug 15, 2017 5:03 pm, edited 2 times in total.

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Re: Public healthcare - Spain & UK

Postby Free at Last » Tue Aug 15, 2017 5:00 pm

sorry, I messed up an edit


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