20 September 2011
Green Paper on Modernising the Professional Qualifications Directive
The Patients Association (PA) was founded in 1963. We are an independent national charity operating in
the UK, which highlights the concerns and needs of patients. Through our Helpline, correspondence and
research we learn from patients the key issues that are of concern and work towards improving the
healthcare we all receive. Our work includes:•
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Campaigns to support Patients’ Rights
Lobbying Government to address healthcare issues affecting patients
Speaking out for patients and carers
Providing information and support to help patients
We are responding specifically to questions 13 and 14 within the Green Paper regarding the language
skills of professionals and the reform of the automatic recognition system.
In the UK, debate on the need for healthcare professionals in particular to have a good understanding of
the English language before encountering patients has gained greater prominence in recent years. We
believe that in order to be able to provide effective care and treatment, healthcare professionals need
to be able to communicated with patients. This is impossible without a good grounding in English.
Furthermore, with regard to the automatic recognition system, we welcome the move to examine its
effectiveness in ensuring that standards are high across the European Union. However, we have focused
on several areas in particular, including healthcare professional’s understanding of the healthcare
system of the member state they are looking to work in and the need for better regulation of healthcare
professionals coming into a member state for the first time
We hope that you will find our comment informative and helpful. I would be more than happy to answer
any questions you may have with regard to our response.
Yours faithfully,
Katherine Murphy
Chief Executive of the Patients Association
The Patients Association PO Box 935 Harrow Middlesex HA1 3YJ Helpline Tel: 0845 608 4455 / 020 8423 8999
Office tel: 020 8423 9111 fax: 020 8423 9119 e mail: mailbox@patients-association.com web: www.patientsassociation.comCompany Limited by Guarantee Registered Charity No 1006733 Registered in Cardiff No 2620761 Registered
Office: P Block, The North West London Hospitals NHS Trust, Watford Road, Harrow, Middlesex HA1 3YJ
3.5 Question 13 – Which of the two options outlined above do you prefer?
We are concerned that some healthcare professionals from non-English speaking countries are not
proficient enough in the English language to provide safe and effective care in the NHS hospitals. When
one is providing care to any patient it so important to be understood, it is unreasonable not to expect a
certain proficiency in the language of the host nation
Patient safety must be paramount and we are concerned that poor communication as a result of poor
language skills could put patients at risk. The Patients Association of the United Kingdom operates a
Helpline which patients can phone for advice and support. Often they just want to tell someone about
their experiences in the National Health Service (NHS). In particular, we hear from elderly patients or
their relatives about the poor care they have received in some UK hospitals. This has led to the
publication of reports detailing the worst experiences we have been told about.1 We have heard from
patients phoning our Helpline that language skills amongst healthcare professionals present a particular
problem for patients and hamper communication skills. Obviously in a healthcare situation, effective
communication is vital and could mean the difference between life and death. One patient who phoned
our Helpline told us the following:
“I felt the communication between me and my Consultant was strained as I struggled to understand
them. I also felt that my care was compromised as I was not able to fully grasp the long-term nature of
my condition given the lack of understanding.”
The code of conduct as it now stands does not provide the protection that patients in all hospitals
deserve and any clarification would need to include an explicit need for understanding the language of
the host nation before being able to conduct treatment or care. A member of the UK House of Lords,
Lord Robert Winston, spoke recently in the House of Lords on this issue.2 He noted that from his
experience working the Eastern European countries in particular, some healthcare staff struggle to
communication effectively in their own language never mind a foreign language. The explicit clarification
in the code of conduct which we believe would be necessary to raise language skills standards to an
acceptable level is unlikely given the current European Union infrastructure which we believe is
misguided with regards to medical and nursing staff.
With regard to introducing a rule into the Directive which is specifically applicable to healthcare
professionals where there would be a one off control of languages skills, we believe this may be
workable but do not think that it should solely be the responsibility of the employer to ensure that all
their staff have the right skills and expertise to enable them to do their job, including a good grasp of the
language of the host nation. There should be a duty of care on the Government and the appropriate
national professional regulators of the host nation to ensure that healthcare workers are proficient
enough in the language of the host nation. This could be a one off control that does not interfere with
the recognition of their professional accreditation but would limit their ability to practice before their
first contact with patients. Failure to pass this language control should bar healthcare professionals from
being able to practice outside of their home nation.
1
2
Patients Association, Listen to Patients, Speak up for Change, 2010, London
HL Deb, 8 September 2011, c449
4.1 Question 14 – Would your support a three-phase approach to modernization of the minimum
training requirements under the Directive?
We welcome the move to modernise the automatic recognition procedures for medical professionals.
Some member states’ education systems are more advanced than others and there needs to be
recognition of ongoing changes to medical education across the European Union. There do need to be
minimum training periods in order for healthcare professionals moving across the European Union have
sufficiently consistent experience. We would also call for the bar for minimum training standards to be
set high in order to fall in line with the UK which already had stringent controls for healthcare
professionals trained in its Universities. Healthcare professional from other member states should also
be prepared to undergo revalidation procedures once they are practicing in a host nation. For example,
the General Medical Council (GMC) in the UK is currently reconstructing is revalidation procedures and
the Patients Association of the UK have called for there to be regular revalidation of medical
professionals. This would apply in particular to those who leave the UK and return to medical practise.
Furthermore, the GMC in the UK has recently published a report which has called for induction training
for doctors new to the NHS.3 This was as a result of research which has shown that some doctors do not
have a sufficient understanding of UK medical procedures. In 2008, the case of Dr Daniel Ubani shocked
the UK when he caused the accidental death of David Gray due to his inadequate understanding of UK
procedures. Dr Ubani was from Germany and was performing locum duties for the first time in the UK. It
was ruled by a coroner’s inquiry that he was “incompetent” because he did not have a full enough
understanding of NHS procedures yet he was still able to register as a doctor in the UK. This case has left
some patients concerned about the training their doctors have received in UK procedures, if any, and
shaken confidence in the qualifications and expertise of doctors from abroad.
Healthcare professionals working in member states outside of their home nation must have a thorough
understanding of the procedures of their host nation before they can begin to practice there. We
welcomed the call by the GMC to support newer doctors through induction programmes whether they
straight out of training or from abroad. While induction programmes should never by a substitute for a
robust medical education, we are conscious that there are variations in medical training across the
European Union. We believe that we need much more effective safeguards and regulation to prevent
unsafe care from happening in the first place. Failure to complete an induction programme on medical
practices in the host nation, established by the appropriate national professional regulator, should bar
healthcare professionals from other member states from practicing in that host nation. This should be
incorporated with the system for automatic recognition of accreditation.
We also note recent comments from the UK regulatory body for nurses and midwives, the Nursing and
Midwifery Council (NMC) about the registration of nurses from member states. They told a committee
of inquiry at the UK House of Lords that they had to operate a two tier system to accommodate
European Union rules on free movement of persons. This included having to allow the registration of
nurses and midwives who had no professional experience for 20 years despite concerns about their
understanding of modern nursing practices. This is patently unreasonable and we believe it has to
potential to put patients’ lives and wellbeing at serious risk. Patients deserve to be treated by
competent nurses who understand medical and administrative procedures as they currently stand, not
what they were 20 years ago. We believe the system for automatic recognition should include provision
3
General Medical Council, The state of medical education and practice, 2011, London
to bar the recognition of healthcare professionals who have been out of professional practice long
periods of time,
In conclusion, while we do agree with the modernization of the automatic recognition system, more regard
needs to be given with the system to have greater regulation of the skills and understanding of healthcare
professionals when they move from their home nation to another member state.