Dark side of sunny Spain for Britain's elderly expatriates
Jackie Stevens in Denia, Costa Blanca
The Observer, Sunday 9 July 2006
It is a familiar sight in any British hospital. Older women in blue sashes staffing a makeshift charity stall in a busy corridor. But here in Denia hospital on Spain's Costa Blanca, the volunteers have no time to serve tea. The expat-run charity Help is indispensable, providing interpreting and sometimes nursing and aftercare for the growing number of British patients that pass through here.
Tens of thousands of British settlers pursuing a dream retirement in the sun have doubled the population in this area in the past two years - and put a growing strain on a creaking Spanish health service.
Now Spanish authorities say they are placing an unbearable burden on scant medical resources and are demanding that the UK pays for their care. And in a move likely to send a chill through the expat community, Spanish doctors - even those who speak English - are now refusing to treat anyone who cannot speak Spanish without an interpreter present.
Dr Diego Vargas, a spokesman for the Spanish Society of General Medicine, says the language barrier is a medical risk. 'It makes diagnosis difficult - even doubling consultation time - and can give rise to serious misunderstandings and errors, for which the doctor will be held responsible
Research by the society shows a large increase in expats presenting with serious conditions at hospitals throughout the Spanish costas, but fewer than 10 per cent can communicate with staff, with almost a third relying on hand gestures and phrase books.
Jill Porter Smith, 75, who retired here from Cambridge 25 years ago, volunteers at Denia Hospital five days a week. 'Most of our clinics now have a sign over the door saying, "Non-Spanish speakers will not be seen without an interpreter," but with only a handful speaking fluent Spanish in a community of over 40,000, our volunteers are stretched to the limit. It's not unusual to deal with British people who have lived here over 20 years and complain about medical staff not speaking English. Because waiters and barmen speak English, they expect doctors to.
The society is now calling for extra resources to deal with the rising costs. Regional health authorities complain that providing drugs, health and social care for more than a million ageing Brits - and to a lesser extent, German and Dutch - is crippling, prompting the Spanish Health Minister, Elena Salgado, to demand an annual £40m from the UK government.
She says expats abuse the system by using health facilities without registering as residents. 'Many are relocating to Spain and receiving medical treatment for serious conditions more quickly and of a high standard unavailable to them on their own NHS but, as many of these are 'invisible' residents and have no appropriate medical cover, Spain is recouping only a fraction of the costs of treating them,' she told fellow ministers.
The UK transfers a monthly sum of €175 to Spain for every UK pensioner legally resident but three quarters of Brits, according to research by Spain's Health Ministry, have not applied for a residence card - out of ignorance, fear of taxation or a reluctance to sever ties with Britain.
So authorities on the Costas are cracking down, ordering doctors to ask for documentation before treatment Gutierez, an MEP for Murcia on the Costa Blanca, said: 'There is a huge cost to Spain because they have not been contributing to our health service. British officials think everything is fine because their citizens are getting everything free, but it's not.'
A spate of newpaper headlines have branded expats 'medical tourists' and a recent TV news show featured one elderly British couple revealing a list of operations they had had during their six-month stay each year in Spain. But David Burrage, 68, a former police officer and co-founder of the British Expats Association said ever-changing Spanish bureaucracy was confusing. 'Many newcomers get so tied up in red tape trying to apply as residents or NHS patients that they find themselves in limbo, not eligible for the Spanish NHS - nor the UK system because they are no longer resident there. Many only find this out when they get ill.'
Candy Wright, 48, who belongs to one of the first British families to settle here 34 years ago, campaigns for expats to register - even the 'swallows' who spend half of the year in the UK.
'We cover places like Calpe where the official population has almost doubled to 26,000 and the British out-number the Spanish. But the real population is closer to 50,000, and as most funding for public services is population-based, there's not enough doctors, fire engines, police, etc.'
People can have everything from their plumbing to their hairdressing done by Brits: they can watch British TV, they can live without having any contact with the state. Russell Thomson, a former British Consul, said this created a false sense of security. 'In the event of an emergency, these individuals can find themselves helpless. They don't know the language, they don't know the system, and only too late they find they have no medical cover.'
Eunice and Barry Worthington left Stoke-on-Trent for the Costa Blanca five years ago, intending to learn Spanish. 'But we've never got far beyond ordering food and drink, and as nearly all the occupants in our new 60-villa urbanisation turned out to be retired Brits too, we could get by without it.'
When Eunice, 66, suffered a suspected stroke last year, they had to drive for miles to find a British doctor, who referred her to a private hospital. She was diagnosed with a brain tumour - but they couldn't afford the operation. 'Our first thought was to go back to the UK, and get it done there, but as we were now Spanish residents, we were no longer eligible for treatment in the UK. This didn't mean we'd automatically be eligible for the Spanish NHS.' With the help of an English solicitor, she finally had the operation on the Spanish NHS when she turned 65. 'Apart from a couple of staff who got annoyed when I couldn't speak Spanish, it went really well - the hospital was like a five-star hotel, but I would advise anyone moving out here to plan carefully and learn the language.'Pauline Tolley, 62, was not so lucky. Her husband, John, 68, became ill with cancer and spent the last weeks of his life in a hospital in Murcia. As is the custom in most Spanish hospitals, she did the nursing. 'The Spanish have large families so they can rotate shifts but most British people here have only one family member with them.' She lived in his ward, sleeping in an armchair, changing his bedpan and feeding him until he died last month.
'It was a harrowing ordeal and as few members of staff speak English, I was on my own. The nearest hospital is an hour-and-a-half away. We're fighting tooth and nail to get something for the Brits because we have put an awful lot of money into this area and we don't take anything out of it.'
The president of Age Concern in Spain, Angela Keay, said they had 12,000 calls last year from elderly Brits. 'Most retire out here when they are fit and active and don't think beyond finding the best restaurants and the nearest golf course. Too late they discover the Spanish have few care homes and little social services or day-care for the elderly. We frequently have to arrange for individuals in an isolated, destitute state to move back to the UK and into residential care. This is happening on a huge scale and, with the numbers of people flooding in, the situation is going to get worse.'