English language training opportunities that assist access to and performance in healthcare jobs are under threat, says Paul Gander

English for speakers of other languages (ESOL) has, like other areas of skills development in the NHS, taken a number of knocks over recent months.

Ring-fenced budgets for individual learning accounts have been dismantled, and health service restructuring means many training managers have moved or left. Specifically with English, changes to ESOL provision from the Learning and Skills Council mean funding is more difficult to access.

Because fewer practitioners are recruited from overseas, there is also a widespread perception that language is no longer a hot issue for the NHS. Race for Health national director Helen Hally explains: 'Back in the 1970s, there were large cohorts of non-English speaking staff, which kept many hospitals running, but we don't have that any more.'

When it comes to practitioners from overseas, Helen differentiates between formal knowledge of language and the practical subtleties of usage and idiom. 'Given all the hurdles they have to jump, language tends not to be an issue in its own right for these professional grades,' she says. 'But idiom does.'

Heatherwood and Wexham Park foundation trust head of training and development Jenny O'Shea says in the past practitioners recruited from the Philippines were more familiar with American English, and had trouble understanding local accents on the ward. Groups were sent on a course with a specific clinical bias at Bracknell College .

But it is not only the professional grades which can benefit from English skills development. South Thames College head of ESOL Sue Westfold runs regular 10-week courses at The Royal Hospital for Neuro-Disability in Putney.

The three-hour weekly classes involve mixed-level groups of staff working in domestic healthcare. 'This has proved to be very successful, as it provides ESOL training in a context relevant to students' needs,' says Jenny.

Enlisting support for skills development is not always easy. Of its 'skills escalator' system, the Department of Health says: 'In theory, staff can progress from cleaner or porter to consultant or chief executive.'

Ealing primary care trust's learning and development section uses skills escalator courses to improve numeracy, literacy and English language. But head of partnerships and diversity Stephen James says: 'Where staff do have a basic skills need, the workplace may not be the place where they would choose to raise it as an issue.' Staff are more likely to see any discussion of basic skills needs as a threat than an opportunity, he suggests.

Jenny has discovered other barriers to overcome. When Heatherwood and Wexham Park trust won an in-house bid for housekeeping, it found itself with 120 new staff, many from the Indian subcontinent, 75 per cent of whom did not have English as their first language. Around 70 per cent of this majority group were illiterate in their own language.

'Classes were set up at East Berkshire College , but managers couldn't allow all of this to be organised in work time,' says Jenny. When class times were split 50-50 between working and non-working hours, numbers began to drop off, she explains.

The same 50/50 time split is available for other ancillary staff, says Jenny. She wonders whether other language groups such as Poles, now well-represented in portering, would be more motivated to improve their skills. Stephen suggests skills development needs to be presented positively.

Staff can usefully be tested as well as trained in English. The International English Language Testing System (IELTS) provides possibly the most useful and widely recognised measure of overall ability in English. Scores out of nine are given for listening/reading and writing/speaking components. Earlier this year, the Nursing and Midwifery Council increased required scores for overseas applicants.

But at Race for Health Helen distinguishes between real and apparent language needs: 'A staff member's spoken English may be good enough to perform their role on one level, but their literacy in English may not be sufficient for reading instructions, and so on.'

So even where nurses already have proven English, they can still benefit from additional training. South Thames College has worked with St George's Healthcare trust to provide a programme on communication and cross-cultural awareness for nurses from overseas. Run four times over the past five years, it has focused on nurses from the Philippines and Spain.

'As nurses are in direct contact with patients, they require a greater sophistication in learning to communicate with a vast array of people, often with different regional accents and colloquial terminology,' says Sue. Specific areas such as telephone skills have also been focused on in the South Thames College courses.

There are other linguistic loopholes. As the NMC explains, European Union rules on freedom of movement mean regulators cannot legally enforce formal testing on applicants from the European Union. This does not prevent individual trusts and employers from requiring specific test scores when recruiting.

In fact, NHS Employers emphasises the responsibility of those who do recruit to ensure an applicant's English, along with other basic skills, meets the required standard. Deputy director Sian Thomas says: 'An IELTS score of 7.5 is a widely recognised level for doctors. Other grades may not need a high level in the more academic skills, while they do need good spoken English, and a prospective employer can specify this.'

Sian points out that there is less overseas recruitment now than even a few years ago, and consequently less pressure on managers to provide pre-recruitment and in-service language training. 'Even three or four years ago, it was still fairly common to do training with prospective staff. Now it is largely left up to the individual,' she says.

These attitudes are reflected in the low levels of interest reported by local training providers when courses are offered. Tower Hamlets College director of quality improvement Joanne Delaney is a trained ESOL teacher. She notes that initiatives such as the Learning and Skills Council's 'train to gain' scheme depend on employers coming forward. She warns: 'If an employee can communicate reasonably well, the issue of language will often only arise when something goes wrong. Under normal circumstances, it is an easy issue to overlook.'

But language training should be more than an insurance policy in a multilingual workforce. It can play a significant role in staff motivation and retention and support career progression. Pre- and post-recruitment, it can also form a vital bridge to many parts of the population which have the greatest trouble accessing healthcare.

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