Health Emergencies Abroad

Your child injures their foot on the beach, you or your partner fall ill - they need to see a doctor but neither you nor anyone else in the family speaks the local language. So what do you do if you have a health problem while abroad?

Start by calling your insurance company's 24-hour medical emergency number for advice, including help with language problems.

You need to do this first, in any case, because otherwise you may not be able to reclaim the cost of any treatment.

Your insurer may even arrange to pay directly for treatment, rather than reimburse you later.

Don't forget to keep the receipts for anything you have to pay for, so you can claim the money back.

If you have an E111 form for the person requiring treatment, you'll get free or reduced-cost treatment. The E111 is valid in most countries in Europe but covers only what residents of that country receive in emergency care, not necessarily what you would receive under the NHS - so you may have to pay for ambulances, for example. The form would not pay for the patient to be flown home, either. An air ambulance could cost thousands of pounds, which is why travel insurance is essential.

Source: Travel feature in Good Housekeeping, August 2005

Reducing Prisoner Numbers the Dutch Way

In the Netherlands, 19 prisons have been closed in the past few years, with more  expected to close next year (2017), at a time when the UK and much of the world struggle with overcrowded prisons. How does this work?

The Dutch way is to look at the individual and try to remove the reason for the crime. If someone has a drug problem, they treat the addiction, if they are aggressive they provide anger management help, and debt counselling is given to those with money problems. Inmates must be willing to change but over the last ten years, the strategy has increasingly been effective.

Some persistent offenders (known as 'revolving-door criminals') are eventually given two-year sentences and tailor-made rehabilitation programmes. Fewer than 10% then return to prison after their release. (In England and Wales, and the US, roughly half those serving short sentences re-offend within two years; the figure is often higher for young adults).

In high-security prisons, offenders are helped to adapt to normal life on completion of their sentence. Large exercise yards include trees, picnic tables and volleyball nets; fresh air reduces stress levels for both inmates and staff. Inmates are allowed to walk unaccompanied to the library, clinic and canteen and they can learn to cook in the prison kitchen.

Dutch judges often use alternatives to prison such as community service orders, fines and electronic tagging of offenders, believing that it is better for people to stay in their jobs and with their families. Jail is increasingly used for those who are too dangerous to release or for vulnerable offenders who need the help available inside.

Some critics argue that the drop in recorded crime (25% over the past eight years) results from the closure of police stations, as a result of budget cuts, which makes crime harder to report, and low detection rates.

Some closed prisons have been converted into asylum reception centres, providing work for some former prison guards, while the desire to protect prison service jobs has resulted in some foreign inmates from Norway and Belgium serving their sentences in the Netherlands.

Source: The Dutch prison crisis: a shortage of prisoners, by Lucy Ash. BBC News item, 10 Nov. 2016

Source: Updated report. Why there are so few prisoners in the Netherlands, in the Guardian, 11 Dec. 2019

Iodine

With more people buying dairy-free products, there is a risk of missing out on a crucial mineral: iodine.

Milk and dairy products are a major source of this mineral, whereas plant-based substitutes such as soya, almond, coconut, oat, rice and hazelnut milks contain much less.

Iodine is:

• needed to make thyroid hormones, which help keep cells and our metabolic rate healthy
• important during pregnancy as it is essential for normal foetal brain development
• low levels can lead to a lower metabolic rate and weight gain
• in pregnant women is linked to their children (up to nine years of age) having lower IQs.

If you can't have - or don't want - dairy milk, you can get iodine from white fish or a multivitamin with the daily requirement of 150 micrograms.

Source: Health tip in Good Housekeeping, June 2018.

The NHS Needs a Reliable Source of Income

The NHS needs a reliable source of income. Here’s where to find it.

Our NHS is nearly 70 years old and hasn’t changed its model for delivering services sufficiently to meet the changes in demography, complex disease profiles and user expectations. Even more efficient working and collaboration with adult social care would not resolve the problem that a tax-funded, pooled-risk healthcare system such as the NHS that is free at the point of clinical need requires a more generous funding system than we currently provide or are contemplating.

Yes, we need to use more technology, integrate health and social care with more provision in the community, and train and employ more doctors and nurses. We also need to tackle the huge variation in cost and quality of care around the country.

But this all takes time and requires both capital and revenue investment. The predicted unrelenting increase in demand that the health and care system will face over the next two decades would require in the region of a 3-4% annual real-terms increase in funding. (More than the 1.5% increase since 2010 and the 10 to 15% reduction in adult social care spend over the same period.)

Future funding of the gap needs to be from continuous sources. The top 10% of earners pay 59% of total income tax receipts, the top 1% some 27% - this source is unlikely to release the funds needed. Sourcing new revenue should be based on the following principles. A new tax base for the gig economy, the older population should pay a fairer share of the costs, lifestyles costly to the NHS and care system should exact a premium and tax-reduction schemes should be tackled.

A) A 10% revenue tax on UK sales for Amazon, Google, eBay and Apple (who pay very little tax) would yield £2.4bn minimally, with tax rising in parallel with their growth.

B) Three hundred thousand retired people receiving a pension are higher rate taxpayers, so relatively well-off. If they did not receive basic state pension or winter fuel allowance, £1.95bn a year would be generated annually, which would also be index linked.

C) Overseas companies own £55 billion of UK property. A 5% tax on land registry value would gain £2.75 billion and could be inflation proofed. A higher tax on sugary drinks (20%), minimum alcohol pricing, and higher rate VAT for unhealthy food (definitions exist) could raise a further £1-2bn a year.

Collectively the suggestions would deliver £8.5bn a year recurrently.

Other revenue sources could include revamping inheritance tax, which is likely to bias revenue from wealthier people and those who have been higher users of the care system.

What happens if we do nothing? Winter pressures become all-year pressures. Access to care deteriorates. Premature death rates rise among both young and old. We slide down the international league tables in terms of healthcare performance. More staff leave the NHS and young people stop going into the UK healthcare professions because the pressures, working conditions and pay get increasingly worse. EU health professionals stop working in the UK after Brexit, and the so-called Brexit financial dividend proves a mirage.

We need a serious national conversation about how we realistically fund the NHS and social care, which has to be led by our politicians across the political parties.

Lord Warner served as a Labour health minister from 2003-07 and now sits on the cross benches and Sir John Oldham is the adjunct professor for global health at Imperial College, and is the former chair of the Independent Commission on Whole Person Care.

Read in Full: The NHS needs a reliable source of income: here's where to find it: by Norman Warner and John Oldham, The Guardian, 15 March 2018

Recycling Plastic Bottles in Norway

Maybe the UK could adopt the Norway bottle recycling system

Norway claims to have the most cost-efficient way of tackling plastic litter, with an industry-led scheme that recycles 97% of bottles. (Similar schemes are in operation in other Nordic nations, Germany, and some states in the US and Canada.) In the UK, figures show that only around half of all plastic bottles get recycled.

In Norway there is a tax on every bottle that's not recycled. How the scheme works is down to business. The consumer pays a deposit on every bottle - the equivalent of 10p to 25p depending on size. They return it empty and post it into a machine which reads the barcode and produces a coupon for the deposit. If liquid is left in the bottle, the machine accepts it anyway - but the deposit goes to the shopkeeper who'll need to empty the bottle.

The deposit-return machine accepts only two types of plastic bottle, with approved labels and  approved glue to fix the labels. This allows the labels to be stripped easily, and simplifies recycling.

In the UK, roadside collections of plastic bottles are contaminated by rogue rubbish being put in the recycling container.

Homeless people also collect discarded bottles to get the deposit back. To avoid them rummaging in waste bins in public places, racks are provided for discarded plastic bottles.

Scotland has already committed to a deposit return scheme, but Westminster has  been more cautious due to lobbying by drinks manufacturers and fears from small shops about the administrative burden. Norway's small shopkeepers are said to generally favour the deposit return system, being paid a small fee for each bottle, and benefiting from increased footfall from people returning bottles.

But even in Norway, not everyone complies; the worst offenders are youngsters drinking energy drinks on the way to school. So some schools have now installed bottle collecting racks at the school gates to avoid plastic bottles going into general rubbish bins.

A municipal recycling scheme, ROAF, collects the bins from 70,000 homes on the outskirts of Oslo. Plastic bottles are isolated from other waste by infrared recognition, but because they have been mixed with other waste during collection they can't be used again for food grade packaging but get down-graded into plastic furniture instead.

But even Norway's ultra-efficient recycling system can't compete with new plastic on cost, as the ingredients of plastic are just too cheap. The cost of each bottle is subsidised by a few pence by the manufacturer, and then passed to the consumer.

An advantage of deposit return schemes is that it obliges each part of the plastic chain to change their behaviour - from product concept to design; to manufacture; transport; use; and finally disposal.

Source: BBC news item 7 Feb 2018: http://www.bbc.co.uk/news/science-environment-42953038