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Health & Education

Health Options

Most people who plan to move to Spain will already have researched with the appropriate government authority to ensure that they receive at the least a basic level of state health benefits; and may even have looked also to private health insurance schemes to cover any particular issues they may have. The main document required will be the European Health Insurance Card (EHIC) that replaced the E111 from January 2006, and gives the carrier admission to state-provided medical treatment in the European country they are visiting. Thus you will be entitled to treatment in the same way as a resident  of the country you are visiting. However, even with an EHIC you may be asked to contribute to particular costs of your care that are not covered in the agreement between the UK and Spain for particular treatments and conditions.
If you are retiring to Spain, or have specific medical conditions like diabetes, or receive disability entitlement then you will also need the form E121 and will normally obtain the document once you advise them of when you plan to move abroad. The E121 is only valid once it has been registered with the sickness insurance scheme in Spain; and also you will need to have documents that show proof of your Spanish address, and residence (empadronamiento) in the local authority. Thereafter you will be assigned a GP in the nearest health centre.
What should not be forgotten is that here in Spain there is no discrimination between the private and public sectors in regards to health options. Consequently, it is possible to fast track certain procedures to obtain privately the appropriate tests, scans and results that you can then present to your assigned consultant in the state health sector. It is frequently the case here in Spain that private specialist clinics can offer services such as x-ray, MRI scans, ECG tests, liver function tests, specific blood or urine tests, endoscopy and many others. Thus allowing you the patient the choice to, either stay on the state waiting list until such procedures as recommended by your consultant are available, or to have such tests done privately within a few days without prejudicing the doctors advice at the next appointment. In this way there is a comfortable relationship between both the state and private sector; and with private test costs often much less than in the UK then for many expats this gives greater peace of mind. 
For more details and advice see
http://www.direct.gov.uk/en/Over50s/TravelAndLeisure/TravellingAtHomeAndAbroad/DG_10026843 . And also

Spain Rights & Obligations of citizens in the Public Health Services of Andalusia, Spain In accordance with the Andalucian Health Act 2/1998, published in the Official Gazette of the Government of Andalucia number 74 of 4th July. Revised June 2008

Your RIGHTS AS A USER of the Healthcare system are as follows – 

To receive health care under conditions of equality, without discrimination for any reason, respecting your personality, human dignity and privacy. 
To be offered the available healthcare, benefits and services deemed necessary to care for your health. 
For you, your relatives or companions to receive information in comprehensible language on everything related to your process, including diagnosis, treatment, prognosis, expected stay in hospital and alternative treatments. 
To receive information on the health services and benefits to which you may have access and the necessary requisites in each case. 
To be offered information on health prevention and promotion programmes carried out in your primary healthcare centre. 
To be informed on collective health aspects of special interest, incidence or risk. 
To be received personally on arrival at a health centre, and especially in hospital, to be informed of all matters that can make your stay more comfortable. 
To receive clear and comprehensible information on treatment, surgical procedures and diagnostic tests that involve risks, before your written consent is obtained. 
To know about and give prior written authorisation to procedures used  in a teaching or research project which under no circumstances may entail an additional risk for your health. 
To choose from the options submitted by your doctor, and to refuse any health intervention, except in the cases established by law (risk to public health, incapacity and urgent intervention in cases of risk of irreversible injury or danger to life). 
To be accompanied by a relative or person you trust at all times during the healthcare process , provided that clinical circumstances so permit. 
To have all the information concerning your care in any health centre kept confidential, and to have access to the personal data obtained during your care. 
To have a written record, or record on technical support  (ie storage information disk, chip, etc), of your process kept in your medical record. The information, which must be in one record for each health institution, will include your state of health and evolution, as well as the tests and treatment you receive. 
To have access to your medical records, using the established procedures. 
To receive a report on discharge from hospital, on completion of a specialist consultation, and on discharge from emergency. 
To be issued a certificate attesting to the state of your health. 
To be assigned a doctor and a primary healthcare centre to treat you, although you may opt to choose another doctor and health centre. 
To choose your general practitioner and pediatrician from among those practicing in your village, town or city, and also from among the other doctors in the health district corresponding to your address. 
To choose a specialist for consultations, when in the opinion of your GP or pediatrician, you need to treated by such a specialist, and to receive care from the same specialist during your process. 
To choose a hospital within the Public Healthcare System of Andalusia if you are waiting for an operation. 
To have a second medical opinion on your process, in the terms established. 
To know the name and function of the professionals who treat you. 
To be operated on within the term established in ruling legislation for each of the procedures of the Public Health System. 
To receive healthcare in an acceptable time depending on the process, and to be offered information on waiting times for consultations, tests and operations for the various processes. 
To have the Charter of Rights and Obligations available in all health centres. You are also entitled to make complaints and suggestions and to receive a reply within the established periods. 
To participate in the public healthcare system through the Area Health Boards, represented by Consumer and Users Associations and to express your opinion through different social research models, and to receive information on the resulting measures for improvement. 
To have all appropriate actions taken that, together with the care for your process  and aimed at reducing and relieving suffering and pain both in critical situations and in the process of death, in accordance with maximum respect for autonomy, Integrity and human dignity. 
To have your living will, declared using the established procedure, taken into account. 
To have the information on your genome kept confidential and not used for any kind of discrimination. You are also entitled to obtain the advantages deriving from available new genetic technology in accordance with the ruling legislative framework. 
To use information and communication technologies, in accordance with the development of such technologies in health services, with criteria of accessibility, security and continuity. 

Your OBLIGATIONS AS A USER of the Healthcare system 

To comply with the general instructions on health common to the entire population, and those of the health services, in accordance with the established provisions. 
To respect the rules established in the centre, and to respect the personnel providing services in it. 
To be responsible for the use of the resources and benefits offered by the Public Health Service of Andalusia, basically as regards the use of services, pharmaceutical benefits, orthoprosthetic benefits procedures and disability (unfitness to work) procedures. 
To take care of facilities and collaborate in their maintenance. 
To comply with the administrative rules and requisites for use of and access to healthcare benefits. 
To sign, if you refuse treatment, the pertinent document in which it will be clearly stated that the patient has been sufficiently informed and refuses the treatment suggested. 

The Spanish Education Experience some observations 

At Tropicana we understand the importance that education plays for any parent considering re-locating to Spain. The difference in language is just one aspect but the education style and process in itself may also appear poles apart. Here we offer some views by users and providors on the Spanish education system here on the Costa Tropical, an area that is fortunate to have not only excellent state schools facilities but offers an International School in Almuñecar and world class universities in Granada city. We are extremely grateful to parents, teachers and head teachers for their in-depth and honest assessments in contributing to this piece. 

Susie, a mother of 3 (aged 4, 8 and 11) all attending local state schools writes
Taking children away from their environment, friends and school, can be a daunting decision for any parent to make. When our family planned to move to Spain back in 2002 we found it more than a little frustrating and un-nerving that there was very little information available concerning the education system here in Spain. And so, from my own personal experience let me offer you some basic details about the schooling options that are available here on the Costa Tropical; and which have improved enormously over the last few years, now providing an excellent standard of state education. 
Spanish Schools - can be state (public) or privately owned, with schooling compulsory between the ages of  6 and 16 years old. There are 6 years of primary education and 4 of secondary education, and although the academic year runs from September until June, the children start compulsory schooling in the September of the calendar year in which they are 6 years old.
Below the age of 6 years, schooling tends to be optional; although it is common to send children to school from about the age of 3 years even if starting infants school at this age is not compulsory.
Foreign children entering the Spanish state system at primary level generally have no problems learning the language or fitting in with their new friends and teachers, and with most pupils being fully integrated after their first term then it can be quite a revelation to hear your bi-lingual child after just a few weeks at school.    
Enrolment and Admission - entrance to state schools is established by a point system, and as in the UK, location is the main factor. Extra points can also be gained by having siblings in the same school, or being defined as Familiar Numerosa - that is a family of  3 or more children.   
Generally, to apply for a place at a Spanish school which is publicly funded, you need passports to prove nationality (or D.N.I. if your child is a Spanish citizen), the child's FULL birth certificate and if applicable, other documentation which shows who the parent/s or guardian/s are, marriage papers if relevant, (or Libro de Familia if a Spanish citizen), documentary evidence of domicile in Spain - i.e home address in Spain, or if applicable, work place, and empadronamiento: the certificate that registers yourself and family members as citizens of the local municipality. In some regions, child's vaccination certificates will be required together with any evidence of disability. 
Timetable - the academic year runs from the middle of September until the end of June and is divided in three terms of Autumn, Winter and Spring. There are no half-terms as such but there are other local holiday and festival days which usually amount to 4 or 5 days from each term though not necessarily consecutive. School hours usually start at 9.00am to 2.00pm, with an hour or half hour break during the morning depending on the child’s age. Many schools offer lunch clubs and after school activities for working parents, but this very much depends on the schools facilities and is a service funded by the parents. This is simply for the reason that in Spain, with the family being so central to daily life, the majority of pupils tend to eat lunch at home together.
Generally there will be a maximum of 25 pupils to each class, with one class teacher and individual subject teachers. From Year 1 of Primary school your child  will normally have the same class teacher for the first  2 years, and they will closely monitor each child’s progress and performance, and are available one afternoon a week to discuss with parents your child’s development and also any particular worries you may have.
In Primary School the main subjects, as in the UK, are studied daily, and include, mathematics, language, geography and science. In addition, most schooling at this level will also incorporate 2 or 3 hours of music, sports, English, art, and religious instruction each week.
At Secondary (ESO Educación Secundaria Obligatoria) compulsory level education, again the same subjects are offered to students aged 12 to 16 years) together with other topics that including French, physics, chemistry, science, history, art, woodwork, extra music, sports, and so forth – but with the day starting a little earlier at 8.30 am.
Assessment - pupils reports are produced at the end of each term with marks awarded for class work, homework, and exam results. Most students from the age of 8 upwards will be tested on their studies every 3 or 4 weeks to ensure everything has been fully understood by all pupils; while those not passing the end of term requirements will in effect be kept down a year until they attain the required level. However, Spanish schools offer an excellent system that provides for individual instruction and assistance to all pupils who need extra attention in particular areas outside normal schooling.
There are no OFSTED reports or STAT tests undertaken in public schools, much is still teacher assessed, following the strict curriculum offered to all pupils. Students in Spain do not take GCSE's, but instead, a range of subjects are offered leading to the school Leaving Certificate and subsequent graduation from ESO (secondary). Graduates of the ESO (Secondary) can then progress to the 2 year post level Bachillerato, which is equivalent to A levels in the English system. Students, aged 16 to 18 years who have not been successful in graduating from ESO, can study for a technical certificate at alternative colleges. 
Each school has a resident Child Psychologist who randomly tests the pupils each year and is available, by appointment, to discuss with parents any problems relating to school or home. At the start of each term he/she would be present with the class teacher to outline the requirements of the pupils for that year and point out any particular issues that may be important to follow, particularly within the infants programme (ages 3 – 6).
Generallly, school uniform was once only worn in private schools however it is now becoming more popular in public schools throughout Andalucia. Books and materials must usually be paid for by the parents, although free (subsidised) text books have gradually been introduced over the last couple of years, and are now provided for by the schools themselves. Also there is usually a list of materials that must be purchased at the beginning of each year, including exercise books, stationery, and so forth.
Afternoon activities are encouraged and are very popular with students. Activities include chess, basketball, English, sewing, gymnastics, tennis, football, athletics, drama, swimming, ballet and dance, art, music and much more. Some of these classes are organised by the schools, and others in the town´s municipal sports halls. But although parents must pay for such extra-curricular activities, they are nevertheless very reasonably priced, and being fair and affordable for all families then consequently most children tend to take 2 or 3 such activities each week. Most schools will also offer extra classes in the main subject groups to help those pupils who need extra tuition. All classes are usually an hour long twice a week and the approximate cost would vary from 10 Euros to 60 Euros per term.
Further Education – is available for those students with Spanish qualifications equivalent to A levels at the appropriate grades and are offered the same opportunity to attend universities in England and Wales as home students. However, there is usually an entrance test (in Spanish) for admission to Spanish Universities, whereas an entrance test  is not generally needed for students wishing to study at a British University, unless studying law or medicine. Students with foreign qualifications such as 'A' levels, wishing to study at a Spanish University, can take a different University entrance test (in Spanish), offered by UNED, Spain's equivalent Open university. 

Nigel, a teacher at the privately run Almuñecar International School writes
My first visit to the school was in April, and I began teaching here in September 2008.
The first thing which struck me was the stunning location: a three tier building on the side of a hill overlooking the town of Almuñecar, the bays and, above all, the mountains. There can be few more beautiful school settings in the world, but the six buses, which bring in the students from far and wide, have a struggle to ascend a steep, narrow road, horns blasting, twice a day! I suppose the residents get used to it…
The second thing which struck me was how small the school is: about 330 students from infants to 18 years old, and I had come from an English comprehensive senior school with about 1100 students, aged 13 to 19. (We had 200 in the Sixth Form!)
My third observation, following from the above, is that the school is quite a close community, despite the wide catchment area (some students take an hour to get here.) Being in a small school means that the staff will know most of the students in a short time, even those they do not teach, although there is a clear separation between the primary and secondary sectors.
Almuñecar International School is a quiet school! The classrooms are small but so are the classes, and my Year 10 group, is unusually large with 18 students. In England I was teaching over 30 in some groups. There are no bells, except at lunchtimes, but the students nearly always arrive on time. The atmosphere is calm and purposeful but not laid back. Students are courteous, articulate and well behaved. Detentions and referrals are rare. There is no department for students with special educational needs, but there are some as this is a comprehensive school, and there is provision for them via individual plans, advice and discussion between staff.
It is also very international. English is the main classroom teaching medium for students who are mainly of British or Spanish origin, but also from a number of other European countries. Most of the staff and students are at least bilingual, and change readily from one language to another depending on their situation and grouping. This is fascinating to me as a bilingual Welshman! The school is very welcoming. The staff and students are friendly, happy and helpful, and this gives a good atmosphere for a new teacher. 
Finally, you need to be fit to work here, as the bottom row of teaching rooms, the huts, are down several rows of external steps, and the Staffroom is on the top floor: a long way up in 35 degrees in Summer! 

Sue Richards, Headteacher at the Almuñecar International School (AIS)
Having come, as have most of my secondary staff, from  a large  school in the UK, the size of AIS and the possibilities for education by knowing every individual and teaching in small groups are a fantastic bonus.
AIS was set up twenty years ago by a group of Spanish parents concerned to offer a different style of education, primarily for their children but then for the children of others. It is non-profit-making and funded entirely through fees. The school is accredited both by the British Council and British authorities and also by the Spanish government. Our children spend 20% of the week on their Spanish studies and 80% on the National Curriculum. We are members of NABSS (the National Association of British Schools in Spain) who provide support and monitoring. In Primary, pupils quickly become bilingual and integration is excellent. We recruit fully qualified and experienced teachers from the UK system and from Spain for the respective parts of the curriculum. Secondary pupils at AIS may gain both their GCSEs and Cuarto de ESO, thus enabling them to continue studying anywhere in Europe. In the Sixth Form we ask for a minimum of 5 A* to C grades and B grades in subjects to be studied.  We offer a full range of A levels and the majority of our students study 3 to 4 A levels plus Spanish. Our students enter universities in the UK, Spain, Finland, Germany, Russia and many other countries. As a result of the distance travelled by our pupils and the breadth of our curriculum, the school starts at 10 and ends at 5, with a 3 course lunch provided in the middle of the day.
Academic monitoring is continuous with an excellent scheme in Primary, a combination of half-term effort and attainment grades, combined with the NFER CATs scheme, the Yellis and Centigrade tests at different levels in Secondary. KS2 and KS3 SATs have been taken, but marked in-house, using the approved mark schemes and students are given personalised guidance with University applications.
We do not select pupils by ability, but by whether they are going to settle well with us. Most pupils have a ‘Listening Day’, where they spend a day getting to know us and we them. Unfortunately, we have no provision for Special Needs teaching and would discourage the enrolment of pupils with extreme Special Needs, but a number of pupils with specific learning difficulties have done well here. Our emphasis is on effort and pupils are encouraged to do their best, leading to examination results of which we are very proud. Pupils at AIS are very welcoming to others, most people remember what it was like to be new.
Our entry system  is very clear. Where classes are full, many in primary are, pupils are put on a waiting list and places are offered as soon as they become available. At the moment we have some spaces in the first 3 secondary years, because we become a 2 form entry school from Year 7. We do not normally accept pupils into Years 11 and 13, because of the incompatibility of examination boards.
Currently we have about 330 pupils on roll and the British curriculum is divided into 4 sections, Primary under a Head of Primary and Key Stages 3,4 and 5 under Key Stage Co-ordinators. The Spanish curriculum is overseen from 3 to 18 by our Directora Tecnica and I bear overall responsibility for the whole school. All this is in addition to our class and subject teachers. Pupils are therefore constantly monitored and encouraged. In Spanish their progress depends on age and motivation. Those who join us in Primary nearly always leave us effectively bilingual. Those who arrive in their teens, sometimes unhappy to have been uprooted, take longer. If students are motivated and don't live in a British 'bubble' in certain urbanizations, they find it possible to join the first language Spanish groups very quickly.
For more information, or an appointment then contact the:
Almunecar International School
Urb. Los Pinos s/n 
Avda. Capitán Rodríguez
18690 Almuñécar Granada 
Tel: +34 958 635 911
Fax: +34 958 639 003
Email:  fjacobs@almunecarinternationalschool.com
Website: http://www.almunecarinternationalschool.org/

Edit: 03.2015