We all create our own geographies. At home, my route to the shops ensures I go past whichever trees are at their flowering best, or in Autumn, past the ones with the most firey colours. In The NL, the streets in cities, towns and villages are almost all lined with Lime Trees, so at the moment walking anywhere is an olfactory bonanza.
There are so many visual landmarks here, that every journey is a delight.
Even in cities, quite ordinary buildings are adorned to make them reflect the owner’s taste and enhance the environment.
In Wales, my route to the top of Anelog is so ingrained that I recognise the rocks and differently shaped gorse bushes along the way. In other places, there are buildings with pleasing features or routes which remind me of especially happy or poignant events. There’s a soundscape too. As a child I liked to be next to any clock tower at the moment the bell chimed. On summer evenings, unable to sleep, I could hear the clocks of Leeds chime, one after the other and felt an almost physical connection to their various sites- the University, the Grammar School, Leeds Town Hall.
It’s disappointing when my internal geography lets me down, because a tree has been felled, a house altered or, as was the case in Groningen recently, the waterside bar, the ‘Peter Pan’ had been up-vamped into the ‘Harbour Cafe’. The ‘Peter Pan’ was a family favourite, partly because on our first ever evening in Groningen, they let us use their phone (pre-mobile days for us) to contact the owner of where we were staying. He’d got his dates mixed up.
Anyway, I can now tell you where the food shops are in several Dutch towns. Helpfully, they are usually within 10 minutes walk of where we are moored, but unhelpfully, they are often in disguise. Rather than the massive, illuminated nameplates on the buildings, as in the UK, one Aldi was actually concealed behind a plain set of doors, Albert Hein in Leeuwarden masquerades as a tiny shop on a normal street and even Jumbo only gives itself away by a few discreet flags, bearing its name and strapline -Beste supermarkt van Fryslan.
I can also tell you where the hospital is, in Sneek. An accident with the brake handle on the drop keel of our boat, meant that it slammed into my wrist, which became rainbow coloured and an odd shape.
Unfortunately, this happened when we were about to set off from a mooring on the Sneekamer, to avoid the forecasted deluge of rain. We didn’t succeed in that – the deluge started before we got going and continued to do its thing, throughout the whole journey – Dave in full waterproofs at the helm and me in the cabin, shouting out the navigational details and keeping my arm in the air. The persistence shown by this rain would have been laudable in many other circumstances, like tunneling out of a POW camp, trying to get through to HMRC on the phone or continuing to believe that the UK will one day come to its senses and re-elect a Labour Government, but I wished it had been a bit less committed when it poured on me as I walked from one building to another, trying to find someone with the authority to refer me to the A&E Department.
At the fourth attempt, raining all the while, these directions :Go out of these doors, pass between these two buildings, through a gate, walk along the path through the park, turn left, walk around the building and go in the entrance on your right’, got me there and I was told to take a seat; they could see me in half an hour. I had to complete a form, of course. It was in Dutch, but surprising how much of it I could tick or cross, as appropriate. When I got to the section asking what my hobbies were, I began to be suspicious and looking at the top of the paper, realised I was in a Chiropracter’s office. No worries, I thought. Maybe that’s how they do it here.
The Chiropracter got off on the wrong foot, or rather the wrong hand with me, by grabbing hold of my wrist! Once I’d made him understand that the wrist was the problem, he prodded and twisted it and informed me I had a twisted fracture of my radius; he could manipulate it back, although I should have an anaesthetic for this as it would be very painful; but he wasn’t qualified to do anaesthesia, so what did I want to do?
We eventually agreed that I should have an X ray and also that I was in the wrong place. He explained that in The NL you can’t self-refer to A&E, you have to see your own doctor first. I doubt this applies to urgencies, but anyway…he wrote his diagnosis on a card, signed it and off I went, back to where I’d started an hour earlier. Different receptionist, horrified that I’d been sent to the Chiropracter. She said it’s true you can’t usually self-refer, but she’d have expected the previous receptionist to use her common sense, as I was obviously not a Dutch National. Things then moved much faster. They photocopied my passport and E111, a triage nurse apologised profusely for the mix-up, Doctor Dave came in, shook me by the left hand, for which I was very grateful, prodded and twisted my right wrist and said he didn’t think it was broken, but only an X ray would confirm this. They X rayed, it wasn’t and the other good news was that the E111 worked and I didn’t have to pay.
It got even better when the receptionist ordered me a taxi and made me a cup of tea. The whole process took two hours, door to door and apart from my land- mark-less wandering around the hospital site, was very efficient and almost pleasant. Apart from the pain, of course.
In a 2016 survey of patient satisfaction with health services, The NL came first out of 35 countries and the UK was fourteenth.The only criticism about The NL was that waiting times were sometimes too long, but accessibility increased after they opened 160 new Primary Care Centres, open 24 hours a day and 7 days a week.
How do they afford this?
Everyone in The NL over the age of 18 (children are covered by their parents’ contributions) has to have Health Insurance, to cover basic medical needs, at an average annual cost of 1,200 euros, plus an extra 700 euros to cover dental costs and prescriptions. (works out at 158 euros per month). If you have a low income, less than 28,000 euros for a single person or 35,000 euros for a couple, you get help with these payments, on a sliding scale. G.P.s, obstetrics and post-natal care are all free of charge, but for some other treatments, you might have to pay the first 385 euros before your insurance kicks in. The government pays for long-term nursing care, but social care, delivered in your home is provided by your local council, after they’ve assessed whether it’s feasible for your family to provide any of this. Note their definition of a ‘low income’ – much higher than the UK one. And wages in The NL are higher than the UK (and, not to rub it in, they work fewer hours).
If you’re employed, both you and your employer pay towards the basic care and long-term nursing, with the employer making the greater contribution.
The insurance companies aren’t allowed to refuse your application, or to charge you more for a pre-existing condition and in a way I don’t understand, if one insurance company pays out more than another, it’s equalised for them by putting all the costs into a ‘risk pool’.
Now while I’m a fan of the principle on which the UK healthcare system was founded by Aneurin Bevan: healthcare for everyone free at the point of need: I know that the reality isn’t like that any more. We increasingly pay for parts of our health service; at the point of delivery: prescription charges and at the dentist and optician’s. Things like physiotherapy aren’t free unless your need is urgent or you can wait for a long time. So, although we think we have a free service, in fact, we don’t. Our healthcare service doesn’t compare well with The NL system and the organisation of services such as support in the home and the methods of assessing how much you pay, are patchy and inefficient. Maybe, we need to re-organise ourselves to properly ensure that we have a health service which is fit for purpose and there are provisions for the contributions people make (a) to be adjusted according to their means and (b) all the monies raised to go towards running the service. All employed people already pay NI contributions, as do their employers, but because we pretend that everything else ought to be free, we haven’t sorted out an equitable way to fund the things we already pay for. And it’s worth bearing in mind that the UK spends much less of its GDP on healthcare than other European countries – in fact we’re fifteenth. So it seems that what you spend is very closely related to how well you score on patient satisfaction.
If the UK spending just kept pace with the economy generally, we’d be spending £16 billion more by 2020 than the government is planning to. And ideas about adopting an insurance based system here actually mean that the easier and more profitable parts of the NHS are sold of: for profit, obviously. And this is wrong. I think because we’re so worried about having to pay for our health service, we forget that we already paying and that too much of the money is leached off as profit for private companies. Whereas in The NL, each person’s contributions go towards running the service.
I conclude, as others do, that we are low spenders on health. If we don’t do anything about it, the people wandering around outside hospitals won’t be looking for the department they want, like I was, but hoping that against all the odds they’ll be admitted and treated. Do we want it to be like this?