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Unfair NHS English language testing rules must go with Brexit

16 Aug 2016

Professor Nigel Hunt, Dean of the Faculty of Dental Surgeons

Is it fair that a doctor from New Zealand will have to prove their English language skills in a clinical setting to be able to practise in the UK while a doctor from the EU only has to prove their everyday English skills?

Reading how the prospect of Brexit
has made EU colleagues working in the NHS feel is incredibly sobering. It’s unacceptable that dedicated individuals that put the health of this country at the heart of what they do feel unwanted in the UK and, in some appalling cases in the last few weeks, are the victims of racist abuse.

Eleven per cent of doctors, 17% of dentists, and 16% of nurses registered in the UK are from the European Economic Area (EEA). Whatever the outcome of those Brexit negotiations, it’s essential that all staff, regardless of their nationality, feel welcome and that we can continue to attract the best staff to work in the NHS. I want to reiterate my absolute support for non-UK staff working in the NHS expressed in this letter to the Times. The NHS needs you.

That said, it is unquestionable that staff from anywhere in the world must be able to communicate clearly in English with colleagues and patients. The FDS are concerned that patient safety is sometimes being put at risk because EU rules prevent testing of the clinical  English language skills of dentists, doctors and nurses. Post-Brexit negotiations offer an opportunity to strengthen checks and protect patients.

As our new briefing paper explains, EU law currently makes it impossible to insist applicants demonstrate their English skills in a clinical context. Changes to UK law in 2014 mean regulators of healthcare professionals, such as the General Medical Council (GMC), can ask EEA applicants to demonstrate their everyday language skills. Since these rules were introduced the GMC has prevented over 1,000 EEA doctors from practising in the UK due to poor language skills. Applicants usually demonstrate their English proficiency via the International English Language Testing System (IELTS) which, for example, asks candidates to describe the town or city where they grew up.

However, EU law still prevents regulators from testing EEA applicants’ language skills in a clinical setting e.g. medical terms, ensuring consent, describing a procedure and possible side-effects. This is because regulators are not allowed to put requirements on EU health professionals over and above what UK professionals must achieve.

The number of doctors and dentists who have faced allegations relating to their poor English language skills is still unacceptably high. In dentistry 67% of fitness to practice cases before the General Dental Council (GDC) during 2008-2013 included an allegation that came under the umbrella of poor communication. The fact that EU law prevents regulators from checking EEA applicants’ English language proficiency in a clinical setting has to be contributing to this.

A colleague told me of a parent who had to make an appointment with a hygienist in order to understand an orthodontic plan for her daughter as she’d struggled to understand her EU dentist’s explanation in English. She was taken aback when the hygienist explained that teeth were to be extracted, something she’d not appreciated when the plan was explained to her by the dentist.

In contrast to EEA applicants, the professional regulators are able to test the clinical language skills of applicants from outside of the EU. Doctors usually demonstrate their English language skills in a clinical setting by taking the Professional Linguistic Assessments Board (PLAB) test. Questions can include a description of a series of symptoms in a patient and ask for a candidate’s assessment of the likely diagnosis and treatment options. Dentists will have to pass the Overseas Registration Exam (ORE), alongside the IELTS.

While we remain in the EU, the regulators must find ways to encourage applicants from the EEA to demonstrate their English language skills in a clinical setting voluntarily. Once we have left the EU, FDS want to see the same language rules apply to all non-UK professionals, regardless of where in the world they come from.

Moving to another country to pursue a passion for caring for people is a very noble and remarkable thing. Learning a new language can be hard work and daunting. The UK’s doors should absolutely remain open to non-UK medical, dental and nursing professionals wanting to work in the NHS. However, we must also remain realistic and acknowledge that the ability to clearly explain complex medical issues to patients in English is crucial to providing the level of care they expect and deserve from the NHS.

Professor Nigel Hunt is Dean of the Faculty of Dental Surgery at the Royal College of Surgeons.

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