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English lessons

Dr Mike Milanovic, the head of University of Cambridge ESOL Examinations, which teaches and certifies English language proficiency, talks to NHE about the role of NHS trusts in ensuring foreign staff have adequate language skills.

The standard of English possessed by foreign staff working in the NHS is a subject of frequent concern for many patients, newspapers – and for ministers too.

Although non-EU staff must verify English language competence via the rigorous IELTS test, there are rules that stop the GMC conducting similar testing of people coming from the within the EU, which prompted a recent letter to a newspaper from the presidents of the royal colleges of surgeons and physicians, saying it could put patients at risk.

Health secretary Andrew Lansley has promised to strengthen checks at a local level, although the relevant European commissioner, Michael Barnier, has claimed that the EU rules often cited are a myth, and that it was the UK’s own decision to impose a ban on strict language checks. He said in a newspaper article that the checks “…are not explicitly imposed by EU law. But neither are they outlawed. So this is a matter for member states to decide.”

There is certainly confusion over the issue. Dr Mike Milanovic, the head of University of Cambridge ESOL, which certifies English language competence for four million people a year at 2,500 global examination centres, said using an external frame of reference, such as the Common European Framework of Reference for Languages (CEFR) would be very helpful.

This grades a person’s English on a six-step ladder, from A1 to C2, with an A1 speaker only able to converse, read and write at the most basic level, while a C2 speaker can talk about complex and sensitive issues, understand colloquial references, appreciate the finer points of complex texts and so on.

Dr Milanovic said a frontline clinical member of staff should be at least C1, telling NHE: “That is near the top end of the proficiency continuum.

“It would make a great deal of sense to have a mechanism in place to allow hospitals and NHS trusts and so forth to verify that the staff they’re getting from within and without the EU have an adequate command of English that isn’t going to endanger anyone.

“In an ideal world, you’d want all your staff to have adequate levels of English to deal with all situations they’re likely to come up against. Of course, it’s not an ideal world, so you end up establishing minimum standards, and so when we talk about C1, that’s not the desirable standard necessarily – it’s the minimum we would expect.

“My personal view is that the critical factor is that the hospital, or the employer, understands the concept of a language proficiency scale.

“They can then look at the different roles they have, and designate levels of proficiency that will allow those people to operate effectively in the roles they’re going to be doing. Then they need to designate publicly available, secure, reliable examinations that they can put on a list, and say ‘if you come to us with a certificate at this level, we’ll take that as evidence that language competence per se will not prevent you doing the job’.

“They will not be able to verify it themselves, not in any reliable way – the only reliable way is through external certification.

“Employers might use that as one of the criteria they look at, or offer language improvement classes for people to work on their English, perhaps making them mandatory, or charging for them, or saying ‘you can have a job but you need to go from B2 to C1 and we’ll offer you six months work of English to support that’, for example. As far as I’m aware at the moment it’s very much left up to the individual staff members – but of course for the NHS, funding is the issue.”

Dr Milanovic also said it was important to remember that multilingual staff also bring many benefits to the NHS.

He explained: “There’s a great danger that when we start talking about language standards, we confuse that with some type of racial discrimination, and it’s not about that at all; it’s about patients and patient care. Obviously, when people come in from other countries and cultures, most of us recognise that it enriches our society. It allows for them to communicate with patients from that background and all of that helps in building mutual understanding, which is so important.”

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