Nigel Farage is spot on about inadequate English in the NHS. Speaking in the House of Lords, Lord Winston, professor of fertility studies at Imperial College London,   has warned that the employment of nurses from within the EU and the European Economic Area (EEA – this is the EU and countries with looser trade arrangements with the EU such as Norway and Switzerland) in the NHS is resulting in nurses whose English is inadequate for the job.  This he attributes to the fact that nurses (and doctors) from within the EU do not have to pass an English test because that would breach the freedom of movement of labour within the EU.  Medical staff coming from outside the EU are subject to an English test.

Describing the situation as intolerable, Winston went on to say: “It is not right for fellow practitioners to have to work with these individuals…But most of all it is not right for citizens of our country, who at times when they are unwell and becoming patients in our healthcare systems need to be absolutely certain that the practitioners to whom they are exposed are competent, meet the standards required of medical practitioners in our country and therefore can with certainty provide the quality of care that citizens in our country deserve.”

Winston’s criticism is welcome but does not deal with the wider problem of inadequate English within the NHS.  The problem extends across the full range of foreign nurses and doctors wherever they come from.  I can vouch for this from my recent experience of a large central London hospital.

In 2009 I spent ten days in the hospital.  During that time I encountered few nurses or doctors who had English as a first language. Some spoke English adequately but most did not.  Those who were inadequate fell into three classes:

  1. Those whose comprehension and understanding of the language was simply inadequate.
  2. Those who had accents so thick it was very difficult to understand them.
  3. Those who could speak English competently but who could not readily understand English if it was either colloquial or deviated far from ‘BBC English’ (received pronunciation) .

These deficiencies were amplified by the fact that sick people are frequently not at their most coherent and if someone is not absolutely fluent in the language they speak, understanding on both sides, that of the patient and the medical staff, will be very difficult.

The most bizarre conversations I heard between foreign medical staff and patients were those where both the nurse or doctor and the patient did not have a firm grasp of English. It was quite clear from their responses to one another that neither side had a clue about what the other was saying.  It would be interesting to know how many suits for damages for malpractice are started against the NHS   by patients without good English.

The problem of language stretches beyond the nurses and doctors to technicians such as radiographers, the clinic administrators, the pharmacists, the porters, the ward orderlies and the cleaners. There is ample opportunity for these people to make serious mistakes simply because they do not understood what is said to them.

The problem is exacerbated where the work has been contracted out to private operators not under the control of the hospital. During my stay in hospital I discovered that these services had been placed in the hands of three separate private operators:  patients’ meals, ward cleaning and the maintenance of multi-media installations (TV, radio, Internet, phone). This produced a constant flow of people into wards over whom the ward sister had no control.

Why has Winston not gone further in his criticism? Possibly because the pressures of political correctness make it difficult for him to criticise medical staff coming from outside the EEA as they are commonly black or Asian, whereas those from the EEA are mostly white.  Also as a doctor, he will be naturally reluctant to criticise fellow doctors wherever they come from.

Others have been less reticent, at least about EEA doctors. Jim Morrison, chairman of Burton Hospitals NHS Foundation Trust, has said: “I don’t want to sound racist but some of the worst-speaking doctors I have come across have been from Europe.” The British Medical Association has also expressed great concern about EEA doctors, some of whom have needed interpreters when working.

The number of foreign nurses and doctors in the UK has increased massively  in recent years. In  2006 the Royal College of Nursing reported that 90,000 foreign nurses had registered in the UK since 1997 and after  language tests for EEA nurses were removed in October 2010, 1,500 registered in the following five months.

As for doctors, in 2008 nearly half of the 277,000 doctors registered  in the UK had obtained their first medical degree abroad and in 2011 around ten per cent of doctors registered  (22,060) were from the EEA.

Why has this massive influx occurred and is still occurring?  It is difficult to explain on the face of things for British trained  doctors and nurses have been unable to find work in Britain because of the foreign influx. The answer is probably the same as it is for jobs generally in the UK; those responsible for employing  health staff are giving preference to foreign staff over native Britons because they are cheaper, easier to sack and less likely to complain about poor conditions or treatment.  The employers may also have been influenced by the constant contemptable  claims of politicians and others with access to the mass media that British workers generally  are not up to the job.  When the practice becomes institutionalised it becomes the norm.

It is also probable that British hospitals generally recruit nurses and doctors through agencies which deal largely or solely in foreign medical staff.  In those instances the jobs will never appear of the open labour market.  Where that happens there are obvious opportunities for corrupt practice. For example, agencies paying a kickback to the person who employs someone they supply. It is also possible that foreign staff may pay bribes to those making staff appointments to get the job, something most people from abroad would not find odd because it is the norm to pay bribes in  their country of origin.

The Sunday Telegraph (11 9 2011) reported that Health Authorities are still  assiduously recruiting nurses and doctors from abroad despite  thousands of  medical  posts being scrapped in Britain: “More than 10,000 doctors and nurses who trained overseas registered to work in Britain in the first 12 months of the Coalition. There was a 53 per cent rise in foreign nurses who registered with British regulators, from 2,804 to 4,303, while the number of foreign doctors increased by eight per cent from 5,359 to 5,811. The number of nurses from outside the European Union, where an immigration cap applies, went from 635 to 1,307.”  Where recruitment is done through an agency each nurse or doctor employed can result in  the NHS paying a fee which can be as much as £11,000 for a single person employed.  Dr Peter Carter, the Royal College of Nursing’s general secretary said: “It is incomprehensible and unacceptable to have these sorts of recruitment trawls abroad when so many staff are being laid off, and so many newly qualified nurses can’t find work.”

What applies to doctors and nurses applies to all the other staff in a hospital, including those working for private contractors on contracted out work.

Just as immigration into Britain generally has swelled mightily since the late 1990s, so has the employment of immigrants in the NHS. Since the late 1990s I have been attending as an outpatient the hospital where I was an in-patient two years ago. When I started the large majority of staff both medical and administrative were British.  Now they are in the minority.  At a time of high unemployment there should be no difficulty in employing mostly British staff at the non-medical level.  We could also employ many more British nurses and doctors if we did not drive them abroad by filling positions with foreigners.   That, together with very stringent English tests for foreigners where these are required, would remove the problem of doctors and nurses with inadequate English.

To achieve control over who we may or may not allow into Britain to work will require Britain’s withdrawal from the EU and any other treaties which affect our ability to control our orders.


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