Growing numbers of the NHS’s medical and nursing staff come from overseas, and their English is so poor they cannot communicate effectively with patients

 

By John Naish

When Jan Middleton woke in her hospital bed at 2am, she feared immediately that her life was in grave danger.

She had already undergone an operation to remove a brain tumour but had been readmitted after developing a serious post-surgical infection.

So when she woke in the middle of the night to discover the infection had spread, causing new lesions to open up on her face, Ms Middleton, 54, realised she needed help quickly.

‘It was terrifying, and made worse by the fact that I had been told the brain infection put me at a high risk of meningitis and stroke,’ she says.

‘I told the nurse, an Asian lady, that she needed to call the on-duty doctor straight away.

‘But her English was extremely poor. She kept repeating, “What you saying to me? I don’t understand. Your English not good.” ’

After trying for half an hour to get through to the nurse, Ms Middleton was exhausted — and very scared.

In desperation, she pulled out her mobile phone to dial 999 for help.

‘I was on the tenth floor of the hospital. I couldn’t get down to A&E on the ground floor on my own,’ she explained.

‘But I couldn’t wait until the morning. When I started to tell the nurse that I was calling 999, she seemed finally to understand and bleeped for a doctor. But it had taken a 30 minutes.’

Ms Middleton, an articulate and resourceful former lawyer, eventually received the emergency attention she wanted. But she had fallen foul of a burgeoning problem in Britain’s hospitals — one which many other patients are not nearly so well equipped to handle.

Growing numbers of the NHS’s medical and nursing staff come from overseas, and their English is so poor they cannot communicate effectively with patients.

Yet, far from tackling this dangerous situation, the European Union is set to reinforce rules which ban English tests for doctors and nurses from the EU before they are allowed to work here, branding it a ‘restraint of free movement’ of workers.

The European directive, currently being debated in Brussels, insists that British employers can only test medics from Europe after their poor English has endangered patient care, flagging ‘serious and concrete doubt about the professional’s sufficient language knowledge’.

And, as Jan Middleton can attest, that is already happening in our hospitals with alarming frequency.

After her first experience of the problem in 2009, at London’s Charing Cross Hospital, she was moved to the nearby Chelsea and Westminster Hospital, to have her infection monitored.

But after ten days of having blood samples taken from the same place on her arm, she had become very sore.

‘A phlebotomist (blood taker) arrived whose first language was not English,’ Ms Middleton says.

‘She kept trying to take blood from the same site, which hurt, so I tried to explain that she would need to find another vein.

‘She walked off and consulted with a nurse who spoke the same foreign language as her — I don’t know what language it was. But I believe they were Far Eastern.

‘Then they both left without taking a sample. I later found out that they had written on my notes that I refused to allow them to take my blood.’

Ms Middleton attributes this to another language mix-up, adding: ‘Not taking blood could have had extremely serious ramifications, as it was in the middle of the process of trying to stop an infection.

‘These incidents did not only cause me distress, but impacted on my medical care.’

She complained to the Imperial College Healthcare NHS Trust, which is in charge of the Charing Cross Hospital, about the first incident. The response left Jan seething.

‘They said they were offering language lessons to foreign nurses,’ she says.

‘It seems unbelievable to me that they would knowingly recruit people who don’t speak English and use NHS money — paid for by the taxpayer — to do it.’

Her story adds to a growing list of incidents involving language confusion among doctors and nurses whose English is poor.

Most notorious of all is the case of 70-year-old David Gray, who died in Cambridgeshire in 2008. He was killed by Daniel Ubani, a German doctor of Nigerian origin, who administered ten times the normal dose of diamorphine.

Dr Ubani said he was confused about the difference between drugs used here and in Germany.

A British inquest ruled Mr Gray’s death was manslaughter, but the doctor was prosecuted in Germany where he was fined and given a suspended jail sentence.

The General Medical Council and the Nursing and Midwifery Council — along with royal colleges representing doctors, surgeons and nurses — all argue that failing to test foreign medics’ English exposes patients to serious risks.

The organisations have united to call for urgent action to tackle the problem, and for the EU proposals to be changed.

The General Medical Council (GMC) has written to Brussels pointing out that it has already had to strike off one EU surgeon who — to the horror of the doctors and nurses assisting him during a high-risk operation — would only speak in a foreign language.

And the GMC adds that it has been forced by EU regulations to register doctors from Europe whose grasp of English was so poor they had to use interpreters to apply for their permits to work here.

‘This is a serious cause of concern to us,’ says the GMC, adding that the employment of doctors whose English simply wasn’t up to the job had led to several disciplinary cases.

Indeed, in the case of Dr Ubani, his poor English meant he was refused work by the NHS in one part of the country — but was later accepted for work in Cornwall. This then enabled him to work in Cambridgeshire.

Niall Dickson, chief executive of the GMC, has said: ‘The proposals on language requirements will raise serious concerns for patients.

‘We will study the detail carefully but it remains our view that the final directive should provide greater safeguards.’

According to evidence given in the House of Lords this year, more than 88,000 foreign-trained doctors are registered to work in Britain, including 22,758 from Europe. They account for almost a third of the total.

In the past 12 months 3,179 nurses from other EU countries have registered with the Nursing and Midwifery Council — although it is not known how many went on to work in hospitals.

All non-EU doctors and nurses coming to work from abroad have to undergo rigorous English exams.

The current situation is a deeply confusing mess for NHS employers — because no one seems really to know where they stand.

In January the Health Secretary Andrew Lansley said he believed employers effectively have the right to check any doctor or nurse’s language skills.

But the GMC and the Nursing and Midwifery Council (NMC), say the EU’s ‘freedom of trade’ ruling takes precedence over Lansley’s decree.

Professor Norman Williams, the president of the Royal College of Surgeons, and Sir Richard Thompson, the president of the Royal College of Physicians, recently issued a public statement calling for ‘urgent action’ to enable employers and regulators to check EU doctors’ English.

Amid this turmoil, fewer than one in ten NHS hospitals is checking whether nurses from Europe can adequately speak English before turning them loose on the wards, according to Freedom of Information requests obtained by the Mail in January.

The resulting problems were outlined by Katherine Murphy, chief executive of the Patients Association.

She said: ‘We get a lot of calls from relatives saying elderly patients are trying to ask for more pain relief or that they want something different to eat and the message just isn’t getting across.

‘Often these patients, who are physically very weak, just give up. It’s abysmal.’

Such problems are not restricted to hospitals. John Catchpole, 67, from West Sussex, who works in graphic design, says the foreign staff at his mother’s care home struggled to keep track of residents’ medication.

‘My mother Winnie was in a care home in West Sussex before she died aged 92 in 2010, and we constantly came up against the problem of medical staff who couldn’t communicate properly,’ he says.

Mr Catchpole says the qualified nurses at the home did not have a strong grasp of English, and the communication problem was intensified by the fact that their patients were mostly deaf or hard of hearing.

‘On a number of occasions, I found the nurses could not tell me what medication my mother was on as their spoken and written English was so poor.

‘They couldn’t pronounce even the most common antibiotics such as amoxicillin. One young woman from Slovakia who worked there couldn’t even understand the questions that I asked her.’

He adds: ‘It is downright dangerous to be working with elderly people who are on lots of medication when you can’t even say or write down correctly the name of the drugs they’re on.

‘My mother suffered with dementia for eight years before her death, and amid such conditions, her own little world was probably the best place for her to be.’

Such problems seem increasingly common, according to Stephen Burke, the director of the website for care users, goodcareguide.co.uk.

‘A number of reviews on Good Care Guide have commented about the poor language skills of nurses in care homes,’ he says.

‘Reviewers have posted examples of where older people have gone unfed, without drink or left in soiled sheets because of communication problems.

‘One reviewer was devastated by the way she was told about her mother’s death by someone who couldn’t speak English well.’

In fact, the current EU rules seem so ridiculously confusing that a company teaching English to foreign nurses working in the UK has found itself effectively barred from operating in Britain.

Instead, it has to send tutors abroad to teach the nurses before they arrive.

The specialist school, called English for Nurses, was set up last November by Kate Fowler, a Bristol-based nurse, and her German-born colleague Sabine Torgler.

Ms Fowler explains: ‘The problem is that UK authorities and employers are so worried about the EU ban on language-testing that they won’t even approve our courses for teaching English to overseas nurses who are already here — in case they somehow constitute “testing”.’

Instead, the school’s tutors are travelling to Germany and Austria to teach nurses there before they reach England. So far, the school has taught more than 100 nurses in this way.

Ms Torgler, who moved to Bristol eight years ago, knows how difficult it can be for nurses from abroad to understand the specialised type of English that is regularly used in the NHS.

Despite having previously lived in Australia, she found it took her more than six months to adapt to the terminology employed on Bristol’s hospital wards.

‘I had a good basic understanding of English when I came to work in Britain, but the sort of English that enables you to work safely in a hospital is just not as simple as ordering a cup of coffee in a restaurant,’ she explains.

‘Early on, I was working in a head-injury unit when an elderly lady told me she wanted to “spend a penny”. I thought that she wanted to go down to the kiosk to buy a snack.

‘One of my German colleagues told me that she spent her first days on an NHS ward not knowing what a “handover” was. This is where nurses discuss patients’ cases as they change shifts. It is absolutely vital to safe health care.

‘If you don’t know such things, you are a burden to your English colleagues. But nevertheless, you can come to Britain from the EU, get registered with the NMC and find a job when you only understand 70 per cent of what your new colleagues are saying.

‘The 30 per cent that you don’t understand is very probably the most important bit.’

Around the country, some NHS trusts have taken initiatives to help foreign staff understand local idioms.

In Norfolk, the Queen Elizabeth Hospital has set up classes to help foreign nurses learn local colloquialisms, such as ‘blar’ (cry) and ‘hull up’ (vomit).

Doncaster Primary Care Trust has produced a Yorkshire-English dictionary to help foreign doctors working in the area translate their patients’ medical conditions.

Dr Lis Rodgers, the Doncaster GP who compiled it, said that many overseas doctors have perfect English, yet still struggle to make sense of the region’s slang.

The dictionary will help them grasp that ‘bins’ means glasses, ‘bits’ means genitals, and that a patient ‘popping their clogs’ is not taking part in a local dance tradition.

Ms Fowler says she has discussed the new Brussels directive against language tests with experts in European health care regulation.

‘The consensus is that the directive will most likely not be changed,’ she says.

‘That will compound a lot of existing difficulties.

‘Our health service would grind to a halt without overseas nurses. But they need support to communicate.

‘They desperately need to learn the sort of medical English that is constantly spoken in hospitals, on top of the English they learn at ordinary language schools.’

Sadly, if the EU gets its way, it’s clear we cannot be sure that hospital staff will speak decent conversational English, let alone the sort of complex technical terminology that can save lives, or at the very least, not put them in danger.
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