Information Pack for British Nationals hospitalised in Italy Author British Embassy, Rome British Consulate-General, Milan Date October 2015 1 Contents Introduction The assistance we can offer Our contact details The Italian Health System EU Charter of Patients‟ Rights EHIC Insurance Medical reports Fit to fly certificate Repatriation Complaints procedure Annex A - Provisional replacement certificate request Annex B - Some useful vocabulary Annex C - EU Charter of Patients‟ Rights full text 2 3 3 4 5 6 6 7 8 8 8 9 10 12 16 Introduction Although the quality of the Italian health care system has been ranked among the top 10 countries in the world by the World Health Organisation, hospitalisation in Italy can feel like a „foreign experience‟ for some British Nationals. Care provided in Italy within hospitals is generally advanced and compassionate. Some people however find the language barrier can cause them distress as Italian doctors and nurses are not always fluent in English. This information pack aims to help you understand how the national health system works in Italy and to give you information about the assistance we can offer during your hospitalisation. The assistance we can offer The Foreign and Commonwealth Office (FCO) is represented overseas by its Embassies and Consulates. Consular officers provide help and advice to any British National who gets into difficulty in a foreign country. If you are hospitalised in Italy we aim to contact you as soon as possible after being told that you have been admitted to hospital to assess how we can help you. We aim to provide assistance according to your individual needs. This may include visiting you if you are particularly at risk. Before deciding whether a visit is of help to you, we will take into account factors such as your medical condition, whether you have relatives or friends with you, whether you have a tour company representative or a shipping agent assisting you and whether you have medical staff who can communicate to you in English. If we believe a visit by a Consular official would provide you with valuable support, we will aim to visit you as soon as possible. We also have a network of Honorary Consuls, who work mainly on a voluntary basis and who can offer assistance and visit you in hospital. We can contact your family or friends in the UK to tell them that you are in hospital and we can help you consult your insurance company or a medical evacuation 3 company, should you require it. We may also be able to help you communicate with hospital staff in certain situations if they do not speak English. We do not usually contact or visit people who have travelled specifically for medical treatment. In Italy as well as in the European Economic Area or Switzerland you should carry a European Health Insurance Card (EHIC) which will entitle you to medical treatment. If you normally live in the UK, you can apply for the EHIC at any point, even after medical treatment has become necessary or has begun here in Italy (see www.ehic.org.uk). We cannot pay your medical bills nor offer translations of medical reports or diagnoses. We can provide you with a list of translators. We are not medically trained to evaluate any treatment you have been given. Our contact details British Embassy, Rome: British Consulate-General, Milan: British Embassy Rome Via XX Settembre 80/a 00187 Roma Italy Tel: (+39) 06 4220 0001 Fax: (+39) 06 4220 2334 https://www.gov.uk/government/world/org anisations/british-embassy-rome Our working hours are from 9.00 to 17.00 Monday to Friday (Italian time) British Consulate-General, Milan Via San Paolo 7 20121 Milano Italy Tel: (+39) 02 72 30 01 Fax: (+39) 02 86465081 https://www.gov.uk/government/world/org anisations/british-consulate-generalmilan#our-services Our working hours are from 9.00 to 17.00 Monday to Friday (Italian time) 4 The Italian Health System Italian legislation recognises the right to health as a fundamental human right. In Italy therefore the health care system (Servizio Sanitario Nazionale (SSN)) provides free emergency care (Pronto soccorso) for everyone, including non residents, and universal coverage to all Italian residents almost free of charge: patients are charged a nominal fee called a “ticket” (which varies in each region). Should you require emergency treatment in Italy this will be given to you free of charge as an EU citizen. You will need to provide your European Health Insurance Card (EHIC). Long term care may entail charges. SSN is under the central responsibility of the Ministry of Health. It operates at three different levels: National level: The Ministry of Health formulates a healthcare plan every three years called the PSN (Piano Sanitario Nazionale) which establishes general healthcare policies. Regional level: each one of the 21 Italian regions is responsible for the implementation of the PSN with its own resources and adjusts it to local needs or policies. Local level: local health authorities covering specific urban areas within a region are called ASL (Azienda Sanitaria Locale) and they provide health care services – e.g. primary medical services, specialist care, and coordination of all non-emergency admissions to public hospitals. As with most countries you may find inconsistency in the quality of health care facilities and services provided. This is mainly evident in hospital facilities and management rather than in the quality of medical treatment. Italian medical staff are extremely well trained. En-suite bedrooms are rare in Italian hospital. In-patient wards consist of three to six beds or more. Should you wish for a single room within the hospital you may need to pay for it or consider a private hospital. Request for a single room will be subject to hospital availability. As a patient you will need to bring everything you need with you, including towels, toiletries, etc. This can be a surprise to some British patients. 5 Meals are provided free of charge and are often served during visiting hours, when members of the family can help those who are not able to feed themselves. Please note that nursing staff do not usually help with feeding. There are social workers in almost every hospital who are able to help you. They can assist patients and families with non medical needs. When a non medical service is needed (an interpreter) the social worker will find the best available service in the area (charities or private) and alert them. Social workers can be contacted at the URP ( Ufficio Relazione con il Pubblico- Customer Services Office) based within the hospital. The EU Charter of Patients’ Rights All patients have the right to the hospital booklet (carta dei servizi) containing details such as meal schedules, visiting hours, floor plans, doctors‟ names, hospital rules, and the location of telephones and toilets. The information included may only be in Italian and you may need to ask for it. It usually includes the fundamental rights of the patients according to the EU Charter of Patients‟ Rights: http://www.cittadinanzattiva.it/files/corporate/europa/carta/European_Charter_of_Pati ents_Rights_england.pdf The European Charter of Patient‟s Rights was drafted in 2002 by Active Citizenship Network in collaboration with 12 citizens' organizations from different EU countries . The Charter embodies 14 fundamental rights with regards to information, consent, confidentiality and privacy, care and treatment. EHIC UK residents travelling in Italy should always carry their EHIC (European Health Insurance Card). The card is personal and covers you for emergency health care in public hospitals. If you are at a private hospital (clinica) your EHIC may not be accepted, unless the private hospital has a special agreement with the ASL (local health authority). Please note that EHIC is not a replacement for travel insurance, as it does not cover all the other expenses linked to your hospitalisation. An EHIC for example does not cover the cost of medical repatriation, should that be necessary. 6 It is important to have both an EHIC and a valid private travel insurance policy. Some insurers now insist you hold an EHIC, and many will waive the excess if you have one. Each member of a travel party must have their own EHIC. Parents and guardians can apply for those aged under 16. EHIC is easy to obtain and it is free. Please note that most UK residents are eligible for an EHIC, but residents of the Channel Islands and the Isle of Man are not. Please find a link to the NHS website where you will find information on how to apply for it: http://www.nhs.uk/NHSEngland/Healthcareabroad/EHIC/Pages/about-the-ehic.aspx If you require an EHIC during hospitalisation in Italy, and you don‟t have one, you can make enquiries with the Overseas Healthcare Team. Please find details below: Overseas Healthcare Team Room MO601, Durham House Washington Tyne & Wear NE38 7SF Tel. 0044 (0) 191 218 1999 Fax. 00 44 (0) 191 225 2131 If you do not have your card with you or if your card has expired, you can apply for a provisional replacement certificate. Please ask the hospital where you are to fill in the relevant form (Annex A to this information pack) and fax it to the Overseas Healthcare Team (fax number on Annex A). Insurance By taking out travel insurance and getting a free European Health Insurance Card (EHIC), you can avoid expensive medical bills if you have an emergency during your trip. The EHIC is not an alternative to travel insurance. It will not cover any private medical healthcare or the cost of things such as mountain rescue in ski resorts, repatriation to the UK or lost or stolen property. If you have purchased travel insurance and you have an emergency, you should contact your insurance immediately. It is important to get your insuarance company 7 involved at an early stage. Make sure your insurance is in direct contact with doctors. We can help you liaise between the insurers and Italian doctors but it is vital they are cooperating from the earliest opportunity. You may also want to contact your UK GP as insurers are likely to speak to them as well. When you purchase travel insurance inform them promptly of any pre-existing condition. Many claims are not validated because of undisclosed previous conditions. Medical reports Once you are discharged you will receive a letter briefly outlining your diagnosis and required medication. This will be in Italian. We cannot translate it for you but we can provide a list of translators. If you wish to obtain a full medical report (which includes blood test results, CDs of scans and so on) you will need to make an official request with the hospital – the hospital staff should be able to tell you how to do this. Please make sure you have requested it before leaving the hospital and made arrangements for it to be couriered to you. Fit to fly certificate If you are to be discharged and you are planning to travel home, you should check with your air company if they require a fit to fly certificate. This can be issued by the hospital stating that you can fly with a charter flight or indicating any specific need (portable oxygen for example). Please note that if you are pregnant you may also need to request this certificate from your doctor prior to departure, to cover your outward and inbound flights – check with your airline in good time to find out what is required. Repatriation If you wish to return to the UK and you are not fit to fly on a charter flight you will have to contact a private repatriation company. We can provide you with a list of companies but be aware they can cost up to €20,000. Your insurance company might be able to organise the repatriation for you (via air ambulance for example). However, you may have to pay for it if they haven‟t 8 validated your claim. If your claim is validated the insurance company should organise door to door repatriation. Complaints procedures If you are not happy with the care you are receiving and you wish to complain with regards to medical treatment, you can do this with the Ufficio Relazione con il Pubblico (URP - Customer Services Office) of the hospital. Usually a complaint can be filed in person, on the phone or in writing either by letter, email or fax. The main hospitals also upload templates on their website. If you want a second opinion on your health condition you can consider visiting a different hospital or consulting another doctor. For more serious complaints , it is advisable to seek legal advice and we can provide a list of English-speaking lawyers based in Italy. 9 Annex A Richiesta di duplicato temporaneo di tessera sanitaria Provisional Replacement Certificate request Fax To Organisation Overseas Health Care Team Pension, Disability and Carers Service, M0135, Durham House, Washington, NE38 7SF Fax number From Hospital contact details Date Pages 00 44 191 225 2131 Name of local Hospital A chi di competenza Chiediamo gentilmente il rilascio di un certificate temporaneo al paziente indicato nella pagina successiva e che il certificato venga inviato alla persona e al numero di fax indicato qui in alto To whom it may concern, Please issue a Provisional Replacement Certificate for the patient named on the following page, and forward the certificate to the fax number and contact name indicated above. Many thanks 10 DATI DEL PAZIENTE PATIENT DETAILS Nome (i) Name(s) Cognome (i) Surname(s) Data di nascita D.O.B. Numero di Previdenza Sociale National Insurance Number Indirizzo nel Regno Unito UK address Nazionalita‟ Nationality Data di inizio del trattamento medico Dates of treatment 11 Annex B Some useful vocabulary For the Patient (Per il Paziente) I feel unwell Non mi sento bene I feel ill Mi sento male I have a headache Ho mal di testa I have a stomach ache Ho mal di stomaco Can you give me something for the pain? Puo’ darmi qualcosa per il dolore ? I have a temperature Ho la febbre I feel dizzy Ho le vertigini I have been sick Ho vomitato I have been stung by a bee/wasp Sono stato punto da un’ape/una vespa He/She is allergic to... Lui/Lei e’ allergico a... His thumb is swollen Il suo dito e’ gonfio I have toothache Ho mal di denti It is not serious Non e ‘ grave TELLING THE DOCTOR WHAT THE DOCTOR SAYS What’s the matter? Here is a prescription for some tablets Take one, x times a day, after each meal Che cosa succede? Qui c’e’ una ricetta per alcune compresse Ne prenda una, x volte al giorno, dopo ogni pasto E’ la prima volta che Le succede questo? Le consiglio di andare in ospedale La farmacia apre alle... Is this the first time this has happened ? I advise you go to hospital The chemist’s opens at... AT THE CHEMIST’S I would like some plasters, please Do you have anything for a cold? I need a sterile dressing Can you recommend an insect repellant ? I have sunburn Per favore, avrei bisogno di cerotti Ha qualcosa per il raffreddore ? Avrei bisogno di garze Mi puo’ consigliare un repellente per gli insetti? Ho una scottatura solare 12 AT THE HOSPITAL How do you feel? What’s wrong? Where does it hurt ? Since when ? How often? How long does it last ? What makes it better? What makes it worse? Has it happened before? Did you lose consciousness? I need to take a blood sample Come ti senti? / Come si sente? Qual e’ il suo problema? Dove Le fa male ? Da quando ? Quanto spesso ? Quanto tempo dura? Cosa lo fa migliorare? Cosa lo fa peggiorare? Le e’ successo in precedenza? Ha perso coscenza? Dovrei farle un prelievo del sangue MEDICAL HISTORY Have you ever had an operation? Are you taking any medicines ? Are you allergic to any medicines? Do you smoke? How long have you been smoking? Do you drink? Have you ever used drugs? Ha mai avuto un’ operazione? Sta prendendo qualche medicina? E’ allergico a qualche farmaco? Fuma? Da quanto tempo fuma? Beve alcolici? Hai mai fatto uso di stupefacenti? DIGESTIVE SYSTEM diarrhoea indigestion jaundice gallstones stomach ache heartburn ulcers vomiting constipation hemorrhoids hepatitis diarrea indigestione itterizia calcoli biliari mal di stomacco bruciore di stomaco ulcere vomito stitichezza emorroidi epatite RESPIRATORY SYSTEM cold difficulty breathing flu raffreddore difficolta’ a respirare influenza 13 dry cough chesty cough phlegm sore throat asthma pneumonia emphysema tosse secca tosse grassa muco mal di gola asma polmonite enfisema CARDIOVASCULAR SYSTEM chest pain palpitations heart attack shortness of breath hypertension stroke heart rate heart murmur dolore al petto palpitazioni attacco di cuore / infarto respiro corto pressione alta ictus frequenza cardiaca soffio al cuore / soffio cardiaco NEUROLOGICAL SYSTEM convulsion numbness tremors epilepsy fainting spell paralysis blurred vision convulsione intorpidimento tremori epilessia svenimento paralisi visione appannata (visione obnulata) GYNECOLOGIST How many times have you been pregnant? When did you last have a baby ? Have you ever had a ceasarean section? Did you have an anaesthetic for the delivery ? When was your last period ? Is your period regular? Do you have a heavy or light flow? When did the pains start? Have you lost any blood? miscarriage voluntary abortion labor pains / contractions condom the morning-after pill Quante gravidanze ha avuto ? Quando ha avuto l’ultimo bambino? Ha mai avuto un parto cesareo? Ha avuto un’ anestesia per il parto? Quando e’ stata l’ultima mestruazione? Le mestruazioni sono regolari? Ha un flusso abbondante o leggero? Quando sono iniziati i dolori? Ha perso del sangue? aborto spontaneo aborto contrazioni preservativo pillola del giorno dopo (contraccezione postcoitale) 14 TREATMENT medication prescription dressing plaster plaster cast terapia ricetta medicazione cerotto gesso 15 Annex C European Charter of Patient’s rights 1-Right to Preventive Measures Every individual has the right to a proper service in order to prevent illness. 2-Right of Access Every individual has the right of access to the health services that his or her health needs require. The health services must guarantee equal access to everyone, without discriminating on the basis of financial resources, place of residence, kind of illness or time of access to services. 3-Right to Information Every individual has the right to access to all kind of information regarding their state of health, the health services and how to use them, and all that scientific research and technological innovation makes available. 4-Right to Consent Every individual has the right of access to all information that might enable him or her to actively participate in the decisions regarding his or her health; this information is a prerequisite for any procedure and treatment, including the participation in scientific research. 5-Right to Free Choice Each individual has the right to freely choose from among different treatment procedures and providers on the basis of adequate information. 6-Right to Privacy and Confidentiality Every individual has the right to the confidentiality of personal information, including information regarding his or her state of health and potential diagnostic or therapeutic procedures, as well as the protection of his or her privacy during the performance of diagnostic exams, specialist visits, and medical/surgical treatments in general. 7-Right to Respect of Patients‟ Time Each individual has the right to receive necessary treatment within a swift and predetermined period of time. This right applies at each phase of the treatment. 16 8-Right to the Observance of Quality Standards Each individual has the right of access to high quality health services on the basis of the specification and observance of precise standards. 9-Right to Safety Each individual has the right to be free from harm caused by the poor functioning of health services, medical malpractice and errors, and the right of access to health services and treatments that meet high safety standards. 10-Right to Innovation Each individual has the right of access to innovative procedures, including diagnostic procedures, according to international standards and independently of economic or financial considerations. 11-Right to Avoid Unnecessary Suffering and Pain Each individual has the right to avoid as much suffering and pain as possible, in each phase of his or her illness. 12-Right to Personalised Treatment Each individual has the right to diagnostic or therapeutic programmes tailored as much as possible to his or her personal needs. 13-Right to Complain Each individual has the right to complain whenever he or she has suffered a harm and the right to receive a response or other feedback. 14-Right to Compensation Each individual has the right to receive sufficient compensation within a reasonably short time whenever he or she has suffered physical or moral and psychological harm caused by a health service treatment. 17