Dr Mike Milanovic gives advice on getting English language requirements right in the medical sector

Media coverage of recent incidents has put the spotlight on the competencies of foreign healthcare staff working in the UK. Despite the controversy and some of the resulting political rhetoric, we’re all aware of the valuable contribution overseas professionals bring to the healthcare sector.

However, those working in frontline services need to be able to use English effectively and to a high standard in order to communicate appropriately with patients, other members of staff and carry out a large range of language associated activities.

Primary care trusts regularly use overseas doctors from within and outside the European Economic Area to deliver care to patients. This increases the need to have systems in place to maintain public confidence in this area. 

Currently, the General Medical Council requires non EEA staff to prove their English language skills using the International English Language Testing System (IELTS), one of the world’s most widely used and effective English language tests. This continues to ensure that the majority of non EU professionals working in healthcare have a high standard of English in all four skills – reading, writing, speaking and listening.

A concern with the current system?

As the recent report from the House of Commons Health Committee pointed out, EU legislation prevents the GMC from requiring tests of language competence for doctors from within the EEA. Needless to say this has the potential to create difficulties, as we have already witnessed and this issue needs to be addressed quickly. A number of organisations are campaigning to ensure the law is amended so that doctors from within the European Union are also included in the language assessment process.

Amendments such as this will take time, so what immediate steps can PCTs take to ensure that their foreign doctors and nurses have a good command of English?

Setting the standard

Firstly, it is important to set a required minimum level of language proficiency for workers in the healthcare sector. This would provide PCTs with a benchmark to assess a doctor or nurse’s ability to use English effectively across a range of contexts.

The Council of Europe’s Common European Framework of Reference for Languages (CEFR) is a good place to start as it is one of the most commonly used systems to describe language ability. Cambridge ESOL was one of the organisations that supported the development of this tool which represents language ability on a scale from A1 for beginners to C2 (see Table 1) for those who have mastered a language. The CEFR helps employers and educational institutions to understand levels of language proficiency and what they mean in terms of real life performance. 

So what should be the minimum level of language proficiency in the healthcare sector? Before we answer this, we must ask: how linguistically demanding is the role? For instance, if you are setting the minimum English language requirements for a frontline healthcare role, then a level C1 of the CEFR may be sensible for such a demanding professional environment. To help explain this, it’s important to look at what an individual can do at this level. Users at the C1 level can converse easily in English, and are easily understood by native speakers and learners from other countries. They can understand complex verbal discussion and read long documents, all of which are crucial skills for healthcare professionals who need to deal with people and information in their work.

However, getting this right is not just about setting the right level, you also need reliable qualifications you can trust. IELTS and Cambridge English Advanced are ideal tools for the C1 level. Both of these measures are developed by Cambridge ESOL and based on extensive research to ensure they are reliable and fit for purpose. Other qualifications will be more suitable for different levels.  

Provide the support

While a minimum level of language proficiency based on the CEFR is important for new staff, it is equally important to ensure that overseas workers already in employment meet this level too.

PCTs can make use of flexible language assessment tools to easily determine the existing level of language proficiency amongst their foreign staff by carrying out a benchmarking exercise. If someone’s knowledge of English falls short of the required standard, they may then need to provide extra learning support to help the individual attain the required level of language proficiency.

Day to day needs and qualification ladders

When offering language support to employees, I would encourage PCTs to choose programmes that provide a series of attainable goals targeting the minimum acceptable level required for the role they need to play. It’s important to remember that successful language learning is not just about knowing grammar and vocabulary, it’s about knowing how to communicate in real-life situations – therefore any English language programme used must provide practical scenarios to ensure it fully aligns with the environment workers operate within and that it covers all the language skills they are likely to need.

Public confidence

Recently, public confidence in the language ability of foreign healthcare workers has come under scrutiny. A national scheme for the sector could be the answer, but it would need to be linked to reliable, fair and internationally recognised and available qualifications to be effective. Until existing legislation is changed, the responsibility of checking a foreign worker’s language competence lies with the PCT and I would encourage trusts to take sensible steps towards ensuring those employees whose first language is not English, meet agreed minimum standards.  This can be achieved by using the approaches outlined in this article - benchmarking to establish levels, supporting through learning provision and assessing individuals using internationally recognised qualifications which are linked to an international framework.