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A Foot in Two Campos

Thoughts from a brand new home-owner in the Axarquía region of Málaga. I hope there might be some information and experiences of use to other new purchasers, plus the occasional line to provoke thought or discussion.

70 - Goodbye to the NHS
Thursday, August 29, 2013 @ 3:10 PM

A flying visit to the UK, just a week, mostly to see friends but also to sort the documents I need to begin the process of registering as resident in Spain.  Doing battle with British bureaucracy in order to minimise any hassle with Spanish bureaucracy.

So I've been researching residency for some months, and I've learned quite a few things:-

1.   I've learned that if you accidentally call it "residencia" on some expat forums, you might as well have invited the entire Spanish Armada to open fire on you.  "How could you possibly be so ignorant?" ask the vehemently-correct willy-wavers with too much time on their hands.  How could you possibly not have understood that "residencia" as it was, changed a few years ago and is now a matter of signing on the EU Register of Foreign Nationals (in order to declare that you are, well "resident" in Spain)?

2.   I've learned that the people in the UK's Overseas Health section are almost all incredibly nice and patient and do their best for you, despite the fact they spend their days talking to people who are moving abroad (usually to somewhere sunnier than the UK).

3.   I've learned that I should ideally have stopped work in December and moved to Spain in January, as this somehow triggers the maximum contribution the NHS makes to the Spanish health system to cover my health care.  Then I possibly MIGHT have got two and a bit years of healthcare in Spain paid by the UK government.  By retiring at the end of March (which I thought kept things tidy for tax etc) and being unable to be clear about an exact moving date, I have reduced my entitlement to one and a half years.

4.   I've learned that I should always check the maths myself.  When my final National Insurance bill didn't arrive I rang up as I wanted to pay it promptly, so my contributions would show as up-to-date, in order for me to get the S1 health form to give to the Spanish health system.  The nice lady in the Self-Employed Contributions section worked it out for me, to get me paid up to the end of March when I retired.  I did an online transfer straight away, and a week later phoned the Overseas Health section who informed me I still didn't have the full contributions.  The nice lady had done it in her head and had missed 10p off.  The next day I received a demand from HMRC National Insurance section, sent first class, for the missing 10p.  At the bottom of the demand was the standard statement that if I had difficulties paying, I could arrange to pay in instalments.  It was tempting ..... !

So once I had paid the missing 10p, Overseas Health finally confirmed my 2012/13 contributions were fully paid-up (along with the two preceding years), and yesterday with a deep breath I allowed the nice lady in Newcastle to press the button that would issue my S1.  A pause - a moment of fear.  It's odd, I have complete faith in Spain's health service, and English and Spanish friends mostly report excellent service.  But there's something about having been brought up with the British NHS that makes you feel quite abandoned when it's no longer there for you.  This is nothing to do with any misgivings about the Spanish system - it is simply that the mantra "from cradle to grave" is instilled so deeply within us, and I have many times given thanks to Nye Bevan for creating the NHS in 1948 free at the point of use, for everyone according to their needs.  Yet now, once the cogs of the Spanish and British bureaucracies grind their way through the paperwork, the Spanish system will eventually inform the British system that I am registered with them and then ...... and then ..... gulp .....  I will be removed from the caring arms of the NHS.

And that feels like the biggest step of all.  Tax - fine.  Pension - sorted.  Signing on the EU Register of Citizens - I'm ready.  I already have my NIE number, I'm registered on the Padrón at the ayuntamiento, my bank account seems to work fine, everything is going smoothly.  Oh and I speak the language.

But there are a number of assumptions that you hold without knowing it, if the accident of geography and parentage happens to make you British.  One is all that stuff about those bits of the world that used to be coloured pink ("Rule Britannia, Britannia rules the waves!").  Another is that the English language will probably see you right pretty much anywhere, even beyond those bits that used to be pink.  The third ..... and as it turns out, the only one of these three that I do actually hold dear ..... is that "from cradle to grave" the NHS will take care of us.

And now, for me, it won't.

 

© Tamara Essex 2013

 

THIS WEEK’S LANGUAGE POINT:

Staying on the health theme, it has always interested me that in Spanish we refer to the parts of our bodies not as MY head or MY fingers, but THE head and THE fingers.  So that the English "My head hurts" becomes "Me duele la cabeza" (the head is hurting me).  My intercambio partner looked puzzled when I asked why this is, and pointed out that it was unlikely that anyone else's head would be hurting me, so to say "my" head was both unnecessary and (to Spanish ears) rather ego-centric.  And this is the main reason for mentioning it here - it's one of the things they laugh at us for!  We sound very self-obsessed when we say "Me duele mi cabeza" so it's worth trying to get this one right.

 



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19 Comments


jane b said:
Saturday, August 31, 2013 @ 8:15 AM

Welcome to the world of the Spanish Health Service, Tamara. If our experience of the last 12 years is anything to go by, you will have no cause for regret.
However if you have not already done so, you need to change your bank account to a resident rather than non-resident one. I don't know what the difference is, techically, but I do know that 8 or so years ago a number of residents had their accounts frozen because they had not converted them.


lifeinvejer said:
Saturday, August 31, 2013 @ 8:36 AM

Good luck with the system. Spain has an even more unaffordable health care system so am afraid that I don't share you faith in the health care system in Spain at the primary care level. My experience of so called GPs in the local centro de salud is at best poor. Not for nothing do loads of Spanish use the private system in Spain. And before everyone tells me how awful the NHS is I am not doing comparisons but reflecting on Spain's efforts only. It's not a comparison view point.


jane b said:
Saturday, August 31, 2013 @ 8:39 AM

I guess it must depend on where you are then, lifeinvejer. I acknowledge that the system is in debt and this may present problems going forward but my experience of both private and public in Spain is that if you are prepared to do a lot of hanging around the public is better at the sharp end.


mountain-lass said:
Saturday, August 31, 2013 @ 10:12 AM

Interesting Blog. As someone about to retire early from the NHS, and about to move to Spain. You are lucky to have timed it right, there is talk in the UK of no longer offering the S1 to early retirees after next July, . We always knew that we would end up with Private cover for a while, but still!

ML
x


fyfin said:
Saturday, August 31, 2013 @ 10:16 AM

Tamara, I can relate to most of that - keeping it tidy re tax etc as I did exactly the same although not being self employed I have simply done my UK tax return up to 05.04.2013 and so I am tax resident in Spain from that date. We moved here in Nov 2012 but I still have UK pension income (although 3 yrs to go still for UK State pension).
Of course you are automatically tax resident if you spend more than 183 days in a year here and we are here permanent so that's it, but, I believe you can sort of chose the date you "decided" to be permanent inside that parameter.
The "residencia" issue - yes the forums are helpful but we mustn't call it that must we lol even though most of the Spanish officials do.
Everything else went well for us, NIE, Padron, S1 forms, and sorting out all the Ayuntamiento bills but the only thing that caused us some grief was this "residencia" issue. We sorted out all the forms and copies of everything but in our case we had to prove we could support ourselves and not be a burden on the Spanish State which is fair enough.
BUT, it's what they will accept as evidence that is the problem, basically anything in English is a no no , bank statements, P60s , letters from banks , all no use so it took 2 more trips to the Oficina de Extranjeros with a letter and P60 translated by a a Traductor Jurado (official translater who stamps the document).
However, after a few more email exchanges to chase them up we were able to call back at the office and collect our little green cards which state "Certificado de Registro de Cuidadano de la Union"
We are also learning Spanish but wonder if we'll ever get to the stage where we can have a meaningful conversation in Andaluz but we're not giving up, Free lessons by the Town Hall so we'll just keep going.
My S1 runs out in Jan 2014 and it looks like the only option then is private health care, until I hit the 65 mark although we haven't registered with our local Health Centre yet. There's a bit of trepidation because of the language issue but that's the final thing to do officially. Maybe I'll put it on my "to do" list for next week!



jane b said:
Saturday, August 31, 2013 @ 10:50 AM

fyfin: Private healthcare can be very expensive for the over 60s. If you can find a local buisness who is willing to put you on their books on a limited hours contract, and you pay them their part of the SS contribution as well as your own, (plus of course you pay any tax owed on income you don't actually receive!) you can get into the system. We know it works because we did it for a while! However I think it is now possible in some areas to make vountary social security payments which may still be cheaper than private.

I would not want to have a serious, urgent medical problem and have to rely on the private sector here because in my experience and that of friends, it does not compare with the public system at that level.


fyfin said:
Saturday, August 31, 2013 @ 11:07 AM

Interesting idea and worth looking into. Thanks for the comment, I now have another avenue to pursue and 2014 is a lot closer than I thought.


bigbrenda said:
Saturday, August 31, 2013 @ 12:03 PM

Tamara - I can soooooo identify with this. My concept of the NHS was also "cradle to grave" and leaving it is a big wrench.

The amount of time you can transfer is very weird isn't it? I think it's all to do with doing the transfer straight away. We split our time between the UK and Spain for several years so by the time we tried to transfer we had already used up our 2.5 years so got zilch. Hey Ho had to go private in the end as they won't accept us at all now.


DonLochnagar said:
Saturday, August 31, 2013 @ 12:07 PM

My experience with the Spanish Health Service so far is excellent. I had an appointment with Santa Lucia hospital in Cartagena. I was taken exactly on time and was out 10 minutes later. I had intense pain yesterday in my side and stomach and I got in to see my doctor within 30 minute of arriving at a busy health centre. He was able to do tests and I have kidney stones. An injection sorted out the pain and I was given a prescription which I got prescribed at the chemist right away and I am now waiting on the stones passing away!


fyfin said:
Saturday, August 31, 2013 @ 12:22 PM

Of course if you had "residencia" before April 2012 it seems you are entitled to healthcare in the Spanish system anyway. Unfortunately we came here too late! lol


jane b said:
Saturday, August 31, 2013 @ 12:25 PM

That depends on where you live. In Andalucia you only got it once you hit UK retirement age, but I understand that in Valencia Region you could get it anyway.


fyfin said:
Saturday, August 31, 2013 @ 12:58 PM

I'm not sure that's right and we have some friends who are about to test the system, I have also heard of success stories in various forums. Also, our Tax Advisor informed me that if we had registered before April 2012 we would have had no problem getting onto the system.


tamaraessex said:
Saturday, August 31, 2013 @ 2:57 PM

Thanks for all the comments, folks. And of course it's all going to change again if you read the UK government's consultation document which would give us all back our unrestricted rights to the NHS in the UK as long as we've paid 7 years of NI contributions. That would come in from April 2015 if approved, if I've understood it correctly. And my S1 would run out in January 2015 so not too much of a gap!


Scooby2 said:
Saturday, August 31, 2013 @ 6:30 PM

Just to advise everyone, foreign residents are not necessarily entitled to emergency treatment here. We are waiting for the necessary documentation from the UK to get onto the Spanish system - must admit, we've been lax about it - and previously, getting antibiotics from the local GP after having an abscess was no problem, so we were lulled into a false sense of security. However last month I was out walking and suffered 5 wasp stings. Whilst I didn't react to adversely to the venom, my arm was about twice its normal size two days later. The skin was so stretched it was shiny! So I went to our local farmacia hoping to get something to help reduce the swelling. The pharmacist told me to get straight to the medico, as he reckoned I urgently needed an anti-inflammatory jab. As the medical centre was open for emergencies I went straight there. There was a nurse there (she was the only person there, and I also mean that there were no other patients there either!) but she told me she could not treat me as I am foreign and I do not have a numero de Seguridad Social. She sent me away without so much as looking at my arm, never mind offering advice. I ended up taking 600mg of Ibuprofen 4 times a day, using an antihistamine cream and putting ice on my arm for the next three days.

This happened soon after another medical incident for which I thought I would be covered by my (Spanish) medical insurance. However we cancelled this when we discovered that the participating hospitals were all hundreds of km away, and there were none at all in the province where we live. This was not in the small print - it only came to light when we tried to claim.

Under new agreements reached this year Spain is supposed to give residents under retirement age access to emergency treatment. The DWP (+44 191 208 1999) will issue a letter in Spanish stating (if it's the case!) that you are not entitled to medical assistance in the UK and this, together with proof that your income is less than €100,000 pa (from memory I think that's the figure) from the Inland Revenue (translated by a Traductor Jurado, an official translator) OR your latest Spanish Tax return, this is supposed to be all you need to get on the system at the local INSS office. We tried to take our Spanish Tax returns but as they are 2 years old we were told that they are not acceptable and we need the translated letters from HM Revenue and Customs instead. This does not agree with the info we have, but hey, this is Spain and we are the foreigners.

So at the moment we're in limbo. We think that in the event of a car accident we will be covered by our fully comprehensive car insurance, which is something.

If this helps anyone, great.


Rob said:
Saturday, August 31, 2013 @ 8:07 PM

I second that about changes to the Spanish healthcare, our health cards expired so we popped in to get them renewed and found out that they wouldn't renew mine as my NIE had expired (wife is German me is CDN). Also they wouldn't put a car in my name again for the same reason.

WeI too had (Due to las crisis we are back in Germany) private healthcare and it's pretty much a must if you want timely treatment or a second opinion, but honestly the biggest issue is the lack of English, you can always find a doctor who will speak English but good luck on the support staff, if you don't speak Spanish you will be in for a very rough time!!!


jane b said:
Saturday, August 31, 2013 @ 8:16 PM

Our health cards do not seem to have an expiry date. Is that because we are UK pensioners and got our cards based on what used to be the E121?
I agree that it is not easy in the Spanish health service but they can hardly be expected to deal with all the languages spoken in every northern European country. Although the English probably outnumber the rest there is a good representation from pretty well everywhere in our area. If you don't speak Spanish you need to take an interpreter. It is something that they ought to consider for non English speaking people in UK instead (as I understand it) finding one for you!


DonLochnagar said:
Sunday, September 1, 2013 @ 12:55 AM

Rob, I am afraid you are mistaken, your NIE does not expire. Your padron may have expired or possibly even your residencia. As for the lack of English, this is SPAIN, hire a translator or learn the language.


Riorita said:
Tuesday, September 3, 2013 @ 6:51 PM

Why is the Brits expect English to be spoken everywhere? Pay for the services of a translator until you learn the language. Get to know the locals armed with a dictionary. You will make good friends and will soon pick up the language and have a few laughs along the way.


DonLochnagar said:
Tuesday, September 3, 2013 @ 7:02 PM

I saw a comment on facebook from a person who was in cleaning a rental villa. She asked the people if they had enjoyed it. "Yes, I suppose so", they said, "but everyone speaks Spanish"!


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