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Language – a barrier to patient safety

The Royal College of Surgeons (“RSC”) has called for all foreign clinicians coming to the UK to work to undergo clinical language tests. It follows data that shows that in one year alone, 29 medics from the European Economic Area (“EEA”) were accused of having an inadequate knowledge of the English language.

At present, it says only clinicians entering the country to work from outside the EEA are subject to stringent language tests that focus on their ability to understand and communicate clinical terminology, as well as English in general. Those coming in from the EEA have only been required to prove a general understanding of English and it is feared that patients are at risk at the hands of doctors and nurses who are unable to communicate effectively about illnesses and treatment.

The problem also extends to dentists, with the RCS’s freedom of information request revealing that in the 2014/2015 period, there were 145 complaints of poor communication by EEA dentists, but only 27 against those from elsewhere in the world. It is thought that EU law prevents regulators from using the same stringent tests used with non-EEA applicants for fear of contravening the free movement of workers within the EU and EEA. This may mean that staff that are unable to fully understand instructions given to them, or unable to explain to a patient what is happening, are being placed on the front line of healthcare.

The Department of Health has said that tough rules are in place to test and monitor language skills and that the reported cases represent just 0.002% of NHS staff. The General Medical Council has also suggested that things are improving, and the powers are already there to deal with European applicants without the necessary language skills. It said

In the past we were not able to check doctors from Europe. Now we can and the difference is clear – this has been a huge step forward for patient safety. Since 2014 nearly 1,100 doctors from Europe have not met our English language requirements and cannot therefore practice in the UK”.

The recent decision to leave the EU may alleviate the RCS’s fears in the long term, as in theory there would be little stopping regulators imposing the same language tests on EEA and non-EEA applicants. But in the meantime it remains to be seen whether or not a major incident or even death has or will arise out of poor understanding of clinical language, and what impact that would have on the NHS and other healthcare providers.

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