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HEALTH

‘It’s like walking a tightrope’: Life after lockdown in Denmark

It's been a big week for Denmark. It became the first country in Europe to start reopening schools and day care institutions after lockdown from the coronavirus. Emma Firth looks at the concerns and practicalities of Denmark’s first stage of reopening.

'It's like walking a tightrope': Life after lockdown in Denmark
Re-opening of Laessøesgade School in Aarhus on Wednesday, April 15, 2020: Mikkel Berg Pedersen / Ritzau Scanpix

On Wednesday, around half the country's primary schools, nurseries and kindergartens opened their doors to greet their children back. But it was not the same place the children had left just over a month ago.

As parents dropped off their children in a staggered approach, the first routine of the day was washing hands. This has to be repeated at least every two hours.

There could not be any hugs as friends were reunited and for those in nurseries, many of their usual toys were not there – to reduce the amount of twice daily cleaning. Outside play and learning in small groups is a key part of the day now, along with sitting at desks or tables at a two-metre distance.

Re-opening of Laessøesgade School in Aarhus on Wednesday, April 15, 2020: Mikkel Berg Pedersen/Ritzau Scanpix

It's an anxious time for everyone involved. I've spoken to teachers who although supportive of the reopening, are worried as to how they can meet all the requirements, on top of not getting sick. 

“Every time you look around, the kids are touching each other” one teacher told me. “How many times can you tell them off for that?”

The worry is that if children pick up and spread infection, whether that’s a common cold or the coronavirus, there’s a big knock-on effect.

Parents, teachers and pædagog (nursery workers) would have to take time off, either for themselves who have become unwell or to look after their own children, leaving institutions without enough staff to keep up with the new guidelines.

The government has however pledged extra funding for institutions to employ more staff to meet the extra work load.

A pupil washes their hands at the Korshoejskolen Public school in Randers, Denmark on April 15, 2020: AFP

So parents are adjusting to a new way of life for their children while others have decided to keep them at home.

Many day care institutions, mine included, have asked parents if they can do this because there is no longer a safe amount of space for the children, under new requirements.

Interestingly, 40-50% of parents told their institutions that they needed the space, with the rest opting to keep their children at home, according to the National Association of Local Authorities (Kommunernes Landsforening).

“I definitely think that there are parents that are both unsure and that will just wait and see with time,” says Jacob Bundsgaard, chairman of KL. “I am also pretty sure that more and more parents will see that it is actually a good and safe offer that is being given and who therefore choose to send their children to daycare.”

The vast majority of the 62 municipalities that answered the Kommunernes Landsforening questionnaire have been able to offer a daycare place to everyone who has wanted it.

However, the municipalities of Esbjerg, Hedensted, Gladsaxe and Copenhagen haven’t been able to. Parents in Copenhagen and Gladsaxe don’t have to pay while they’re not using day care facilities.

Plans are currently being put in place to try and creatively use other available space and playgrounds, even Tivoli in Copenhagen. 

Stengård School in Gladsaxe Municipality receives first pupils after reopening, Wednesday, April 15, 2020. Photo: Ólafur Steinar Gestsson / Ritzau Scanpix

Reopening after lockdown is not an easy task. But the government is confident that Denmark is ready, as the curve continues to flatten. 

346 people have died so far with the coronavirus in Denmark. The number of infected patients in hospital has been steadily declining since the beginning of April. There are currently 317 patients with the coronavirus in Denmark's hospitals.

These figures are better than the government had hoped for – so much so that they’ve announced for more professions to reopen next week.

This includes dentists, physiotherapists, hairdressers, beauticians, tattoo parlours, driving schools, research laboratories and courts. The opposition party wanted to extend that to even more, including high schools.

It’s both welcome and concerning news to many, as Denmark continues to step into the unknown. 

Driving instructors have expressed their concerns as to how they can keep at a safe distance from pupils when teaching. Others are also waiting to hear about the guidelines they need to adhere to, in order to reopen safely.

The hairdressers Zenz in Indre By Copenhagen canceling customers after lockdown was announced. March 18, 2020: Ida Guldbæk Arentsen/Ritzau Scanpix

As people start to re-enter life after lockdown, the big question is whether everyone keeps to the health authority instructions of “væsk hænder, nys i ærmet og hold afstand” – wash hands, sneeze into your sleeve and keep a distance. This is what Prime Minister Mette Frederisksen says is vital to the reopening working.

But a new study from Aarhus University shows a decline in the number of people following health authority guidelines. Michael Bang Petersen, one of the researchers behind the study says the decline started when the number of infections started to turn in Denmark.

Only time will tell how Denmark responds to the first phase of reopening after lockdown. The government has said it will take three to four weeks before we see the results. 

It's walking a tightrope, as Prime Minister Mette Frederiksen put it. And Denmark's nerve and world-renowned trust, is being tested.

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HEALTH

EXPLAINED: What to do if you face a long wait for healthcare in Sweden

Sweden theoretically has a "healthcare guarantee" limiting your wait to see a GP to three days, and to see a consultant to three months. The reality is somewhat different. Here's what you can do if you face a long wait.

EXPLAINED: What to do if you face a long wait for healthcare in Sweden

What is Sweden’s ‘healthcare guarantee’? 

Sweden’s “National Guaranteed Access to Healthcare” or vårdgaranti, is a right to care, protected by law, that has applied in Sweden since 2005. You can see the latest version of the relevant laws here and here. Here is a summary of the guarantee on the website of the Swedish Association of Local Authorities and Regions (SKR).

Under the system, all patients are guaranteed:

  • contact with a primary care centre by phone, in-person, or by video-link on the day they seek care 
  • an appointment with a doctor, nurse, physio, or psychotherapist within three days of seeking help 
  • an appointment with a specialist doctor or consultant within 90 days of seeking help 
  • treatment or operation within 90 days, if the specialist considers this necessary 

Does the guarantee mean I have a right to treatment? 

No. If the doctor at the primary care centre, after examining you and questioning you, decides that there is no reason to refer you to a specialist doctor, they do not need to do so. 

Similarly, if the specialist doctor, after examining you, decides that no treatment is necessary, then your case is considered completed.  

Can the waiting times to see a specialist or to get treatment be longer than 90 days? 

Absolutely. In fact, they very often are. 

According to the Swedish Association of Local Authorities and Regions (SKR), in February, 32 percent of patients had been waiting 90 days or more to see a specialist, and 43 percent of those who had seen a specialist had been waiting for treatment for more than 90 days.  

The situation in primary care was a little better, with 80 percent of those seeking care in contact with their primary care centre on the same day, and 83 percent having their case assessed by a doctor or nurse within three days. 

In addition, if you agree with your specialist doctor that you are willing to wait longer for an operation, then that wait doesn’t get counted in the statistics. 

So what can I do if I’ve been waiting longer than the guaranteed time? 

In reality, it’s actually less a guarantee than a target.

In primary care, there is no way for individual patients to complain that they have had to wait too long to see a doctor or nurse, or to cut their waiting times by citing the guarantee. 

“There’s no system for enforcing that guarantee,” says Emma Spak, the primary care doctor who doubles as section chief for SKR’s healthcare division. 

It would make no sense to set up a complaints line for those who have had to wait too long for phone contact with their primary care centre, she points out, when they could instead talk to patients seeking a primary care appointment in the first place. 

“It’s more of an incentive system for the regions,” she explains.

Every primary care unit and every region reports their waiting times to the national waiting time register, and then as part of the access agreement between SKR and the government, the regional health authorities receive a bonus if they meet their waiting times goal, or if they improve their waiting times. “That’s one way of sort of enforcing this guarantee,” she says. 

When it comes to specialist treatment, though, patients do have the right to demand to be examined or treated by an alternative specialist or hospital if they’ve had to wait longer than 90 days.

If your primary care centre issues you a referral to a specialist, and the specialist cannot then offer you an appointment within 90 days, the specialist, at the same time as offering you a later appointment, will often put you in contact with a unit at the regional health authority who will offer to find you an alternative specialist, either within the region or elsewhere in Sweden. 

The regional health authority will then have to reimburse any extra travel or hotel costs incurred by the patient.  

Similarly, if after examining you, a specialist cannot offer you treatment within 90 days, they will normally put you in contact with the same unit. 

Some regions have a phone line for people who have been waiting too long, or else you can contact your specialist or primary care centre and ask for information on seeking an alternative specialist. 

What happens if I don’t want to travel to see a specialist or get treatment? 

If your regional health authority offers you an alternative specialist, either within your region or in another region, so that you can get treated within the 90 day period, and you are unwilling to travel, then you lose your rights under the guarantee. . 

“If you’re in Gothenburg, and they say you have to go to Stockholm to get your treatment, and you say, ‘no, I want to go here, then then you’ve sort of forfeited your right, and you have to take what’s on offer,” Spak says. 

What happens if I agree with my specialist to wait longer? 

If your specialist says that they can treat you in four months, but also offers you treatment elsewhere within the guaranteed 90 days, and you choose to be treated by your specialist, then that counts as a patient choice, which will not then be counted in the statistics. 

“The specialist might say, ‘I don’t think you will get any worse for waiting two months extra, and if you wait five months, then I can make sure that you get your surgery done here, and we can make sure that you get all the aftercare and everything here as well,” Spak says. 

But these patient decisions are also counted in the statistics, and if a region sees a sharp rise in patients choosing to wait, SKR will tend to investigate. 

“If some region all of a sudden has a lot of patients choosing a longer waiting time, then we will call them and ask what’s going on here, because patients don’t tend to want to wait extra,” Spak says.  

Can I get financial compensation if I’ve been waiting too long? 

No. 

What other ways are there of speeding up the wait for treatment? 

Don’t underplay your symptoms

When drawing up their timetable for treatment and assessment, specialists will tend to give different patients different wait times depending on the urgency of their case.

For this reason, it’s important not to underplay your symptoms when visiting a primary care doctor, as they will tend to include a few lines on the urgency of your case when they write their referral. 

Stress your flexibility 

If you are unemployed, a student, retired, or have a very flexible job, it is worth telling your primary care doctor about this, because they may write in your referral that you are able to make appointments at very short notice. The specialist may then put you on their list of people to ring if one of their patients cancels. 

“Sometimes I write in my referrals that this patient could easily come at short notice, so please put the patient on the list for people you can call if there’s a time slot available,” Spak says. 

If you haven’t told your primary care doctor this, it’s not too late. You can ring the specialist yourself and tell their receptionist that you are very flexible, and ask to be put on the back-up list. This is particularly useful if you’re waiting for a scan, but you could also potentially work even if you’re waiting for heart surgery or a hip replacement. 

“If they’ve accepted you as a patient, and they’ve made sure that you fulfil the criteria for having that scan or whatever, then you can call them and say, ‘I have a really flexible job, I can come anytime if you have a gap,'” Spak says.

“A lot of people do that, because they can have [back-up] waiting lists. If you tell them ‘I work around the corner and I only need 15 minutes to be there’, then they might call you if someone doesn’t show up.” 

Ring up your specialist 

The queue system tends to be quite ad hoc, with no strict rules over who should be treated first, so it is often possible to reduce your wait by ringing up your specialist a few times a month, just to bring your case to their attention. Sometimes the receptionist will remember a slot that has just come free and bring forward your treatment while you are still on the telephone. 

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