The NHS Language Barrier

Have you ever been to see a doctor when feeling unwell who had little or no comprehension of the English Language? I have, and though fair to say I do not enjoy visiting doctors or feeling unwell, mine were not experiences which endeared the NHS to me.

One such time with a twisted ankle I hobbled in on crutches which I had been loaned from a hospital visit a few days earlier and with my injured leg raised, slightly extended and in the absense of a shoe visibly wrapped; the doctor "read" my notes whilst I stood (not being sure if I should sit in the chair or climb aboard the examination table), the Doctor then stood behind me and lifed my shirt from my trousers.... He could not read English and had wrongly assumed from my limp that I had a back problem - at least that was the nature of the misunderstanding as I read it and I am sticking to that. An angry exchange followed, and I left as promptly as my crutches and good leg would carry me. I tried to warn (in a civil tone) the handful of people who remained in the waiting room that stood between myself and the outer world that the doctor did not seem to understand English, and failed in a visual diagnosis that I had a bad leg.  They looked on with the same vacant glare that is nationally recognised of a UK GP's waiting room where we preparing to take leave of our senses, go into a trance and "make do" with the service we are to receive.

Luckily for me, no harm done, I went to the chemist and simply purchased some pain-killers which I assumed would have been the end result if my trip to the doctors surgery had of been resulted in me leaving with a prescription. That was my first and last experience of that particular GP surgery.  This particular experience was the first of a few, because as we all know the NHS is staffed with a number of people in different positions from around the world with varying comprehensions of English. It is our own fault that we do not have enough home-grown, English Speaking front-line staff, but if we weren't poaching them from abroad we would on the current size of the NHS have a massive shortfall.

However, this experience has always left me cautious to the potential pitfalls of Doctors and Nurses who quite frankly can't communicate and as such are a danger to all of us, be it a through Nurses not being able to read and understand a medical chart, or through the inability of a Doctor to understand a patient describing potentially life threatening symptoms. There are other dangers of course when you set of down the road of setting out why it is dangerous not having a satisfactory level of communication between patients and NHS staff, and of course between two or more members of NHS staff.

The case in the public eye today relates to Dr Daniel Ubani who administered a lethal dose of a drug (Diamorphine) to a pensioner resulting in his death during his very first out-of-hours surgery. Dr Ubani's poor grasp of English is at the root of the case, and he had already been turned down for work by one NHS trust because of it. The Health Select Committee has reported in the wake of this case:

"If the General Medical Council had been able to carry out language and competence checks on EEA (European Economic Area) doctors wishing to practise as GPs, lives might have been saved. As a matter of extreme urgency, the Government should press for change to the relevant EU Directive to enable the GMC to test the clinical competence of doctors and to undertake systematic testing of language skills."

That's right, we are testing Doctors and Nurse's who come from abroad to work here for their grasp of English, but not if they come from other EEA countries because EU Law forbids it on the grounds that it inhibits free movement of people across the EU. What's more, people are dying as a result.

To me, it simply beggars belief that we allow people to work in the NHS who cannot write perscriptions in English, or potentially understand such simple phrases as "nil by mouth". You do not need me to rant about the insanity of it, it is clear. What's more, in my company we routinely test UK based EEA staff for their grasp of French and German when they are dealing with customers based in France and Germany; to not do so would be disastrous for our revenue.

So why no public outrage when it comes to our beloved NHS and people winding up dead?

What this case does highlight is how subservient the UK to the EU, and more importantly by our own initiative. Do you think that the French allow Doctors to work who can't adequately speak French?  Of course not!

The General Medical Council has addressed this particular concern with Health Secretary Andy "Lashes" Burnham to request an end to the ban on language tests. Mr Burnham's response was to point out that the ban stems from an EU Directive and has primacy in our law, and as such there is absolutely nothing at all the Government of the UK can, or will do about it - to do so would result in the UK being fined by the EU.

Understand? We can't test Doctors and Nurses travelling here from other countries in the EEA/EU for their comprehension of English even though it is resulting in the deaths of patients because the EU says so, and to go ahead and do it was to risk getting fined... even though this particular law is flouted in other EU countries, such as France. Andy Burnham additionally points out that the EU directive cannot be reviewed until 2012.

The Government and the Opposition Parties cannot do a thing about this issue, so they just will not talk about it. That, right there is our modern politics. We are supine to the real government in Brussels and as I said the other day, the reason all of the parties (or collectively, "the Westminster Party") seem the same these days is because they are; they are governing in the wastelands that the EU has left for them or just not got around to yet, which is not a whole lot in the grand scheme of things.

There will rightly be much talk during this General Election about the NHS but you will not get a policy or a commitment from any of the main parties on the issue if testing NHS Staff to ensure an adequate level of English because they know that they can't do a damned thing about it; not that they want you to know this of course, these kinds of issues might have people questioning whether in that case we should be in the EU at all, and that is an issue they definitely do not want to talk about between now and election night.

Are You Outraged?

I have a shocking and appalling story to share:


Senior Staff at an animal sanctuary where up to 600 Cats and Dogs have died will all escape disciplinary action and legal proceedings.  Even more galling, is that all of the senior staff involved have found lucrative new positions elsewhere, and the Chief Executive walked away with a £200,000 pay off and a pension worth £600k. 

After publication of an independent report the truth of what had been going has finally emerged.  Animals were abused and neglected by staff that were described as hostile.  Animals were left in humiliating and undignified conditions.  The report concludes that the impact on them was "unimaginable".  Many animals were living amongst their own faeces, when their spaces were frequently left in an unclean condition by staff.  There is also an allegation that food was left in sight but out of reach of hungry and ill pets.

The authors of the report investigated the reasons why such poor conditions were allowed to have come about and decided that it was a combination of staff having an uncaring attitude and with managers being in denial about the problems whilst holding their focus on cutting costs and hitting government targets which would have allowed them to operate in a more profitable fashion.  There was said to be a culture of fear and bullying and staff were told openly that if they did not comply with efforts to hit targets they would lose their jobs.

The report itself followed an inquiry chaired by a specialist in criminal negligence, which found 9 of the 11 board members had indeed left their roles; none of them faced any internal disciplinary actions. A review of the accounts reveals the extent of the pay-offs.

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Now at this point of the post I need to stop you from reading and make a frank confession.  Everything you have just read is completely false... I made it up for a reason I hope to now make apparent.  Firstly, let me just say that I would consider the above scenario to be an abhorrent situation, one worthy of national news.  Thankfully it is not true.  Secondly I apologise for the deception.  My aim was to evoke an emotional response and to ask you now to consider how you felt when you read the above story.  My guess is that most people would be between angry and outraged.

Now, I am going to lead you to the reason for my deception, and this time it is a real story which I heard about earlier today but have just read the details on tonight on the Daily Telegraphs website.  I link to it, but will reproduce the first few paragraphs below, and invite you to contrast the details to my fictional story above.

Bosses at scandal-hit Stafford Hospital escape scot-free


The senior managers who presided over one of Britain’s worst hospital scandals, in which up to 1,200 patients died, have all escaped being disciplined, it has emerged.


No one on the board at Mid Staffordshire NHS Foundation Trust has faced censure and all of them were either paid off, walked into another job or allowed to remain in post. The man who ran the hospital trust received a large pay-off despite his part in the scandal.


Martin Yeates, the former chief executive, left the trust “by mutual agreement” with a pay-off of £400,000 and a pension worth £1.27 million, it has been alleged.


The lack of disciplinary action emerged after the publication of a damning report into the treatment of patients between 2005 and 2008.


An independent report commissioned by the Government found that patients were abused and neglected by hostile staff and were left in humiliating and undignified conditions. The impact on them was “unimaginable”, the report said.


Patients, most of whom were treated at the trust’s main hospital in Stafford, were “robbed of their dignity”, left in soiled bedclothes, unwashed and in states of undress in full view of others, it found.


Families of patients had to clean lavatories and public areas themselves, while food and drinks were left out of reach and, it was alleged, patients drank out of vases.


Attitudes of staff were at times “uncaring”. Managers were “in denial” about the problems and were concentrating on cutting costs and hitting targets to achieve foundation trust status, the report said.


There was said to be a culture of fear and bullying with staff concerned they would lose their jobs if targets were not hit.


The report followed an independent inquiry chaired by Robert Francis QC, a specialist in clinical negligence, who has acted in previous high-profile inquiries. It found that 18 of the 22 board members who ran the trust over the period under investigation had now left their roles, with none facing disciplinary action.


Many went on to senior, well-paid lucrative positions elsewhere in the NHS.


Mr Yeates, 51, did not give evidence in person to the inquiry due to ill health and is not thought to be working. The trust’s most recent accounts show that he had built a pension pot worth more than £1.27 million by the time he stepped down, entitling him to annual payments of more than £65,000.

You will probably have noticed that I not only substituted animals for people, but also changed the number of cases and values. 

If you have come this far and I am sure a number of people will not have, you may still be questioning my deception at the beginning.  When I heard a snippet of this news earlier today (and not the full story) it was put to me that if the (real) story had of broken today and had of involved animals instead of real people, this would be on every front page, it would have been addressed in Parliament and we would have all been talking about it at our places of work and in the pubs.  In considering this, I found that even though I too have lost a member of my family, well, let's say lack of due care from a member of NHS staff (went unpunished) and have another loved one who is permanently in the care of NHS staff (most good, some bad) I was a little taken back by the suggestion and found almost immediate agreement that it would indeed be considered a bigger deal, or more shocking if that were the case.

The fact that this will likely be a one or two day story and probably will not stoke a fire under all of us is actually quite telling about how accepting we have become of living in the client state.  It would almost seem immoral to some to even question the behaviour and incompetence of the frontline staff and management of the NHS.  Has the malaise now grown so deep that many of us, even those of us who have been closely affected in the oast cannot find outrage when these appalling situations occur?

Food for thought I felt.

No Rest For The Wicked

From the BBC

Seven hospital staff have been suspended for their part in the game, played in mid August.

The game involves being pictured lying down with arms by your side and toes pointing towards the floor.

A hospital official said: "Disciplinary hearings are yet to take place and we cannot predict the outcome."

The images, since removed, were posted on the social networking site Facebook under the title Secret Swindon Emergency Department Group.

Great Western Hospital medical director Dr Alf Troughton said: "A number of staff were suspended following allegations of unprofessional conduct while on night shift duty in the hospital during a weekend in August.


"This did not involve patients and we are satisfied that at no time was patient care compromised.

"The Great Western Hospital sets high standards for staff behaviour at all times and therefore takes any such breaches extremely seriously.

"The allegations have been thoroughly investigated and seven members of staff remain suspended pending formal disciplinary hearings."

A little harsh wouldn't you say?

Paedophile Gets Viagra On NHS

I was just on Twitter when I spotted this link and I am not sure if I am a day behind or seeing a story from tomorrows paper.

What the hell is happening to our society when a known Peadophile with form stretching over 30 years and is out of Prison because a judge was concerned about his age and health is being handed sexual stimulants by the state?

This is NOT a symbol that we are a part of an enlightened society; it is however a wake up call that we are a long way down the wrong path, and from what I can tell the handbrake on the handcart is broke!



Update 22:22: Seriously folks, WTF?!

A Few Thoughts On The NHS "Debate"..

Daniel Hannan is again grabbing the political headlines by giving some talks in America about the drawbacks to Socialised Medicine, and dispelling some of the myths there about how the NHS really is over here.

The most annoying and depressing aspect of this is the immediate attempts by the British left to smear Hannan and shut down a debate before it has even happened. Andy Burnham even went so far as to suggest that Daniel Hannan is “unpatriotic”… I know few people Andy Burnham seriously, but still he is a Minister, and to make such a suggestion is not just comically inaccurate, but a calculated insult.

Here’s what I want to add to the debate. Firstly I am like most people in the UK, my family and I have had good experiences of the NHS and we have had dreadful experiences, but I have not experienced to any degree healthcare in any other country first hand. So, my experiences and opinions stem from a bubble of prescribed ignorance.

If we can have the debate, it needs to be wider than offering the US system as the alternative, there are others. Dan has pointed this out already but he and Douglas Carswell’s preferred alternative is that of the model used in Singapore, and this is the alternative that they set out in their book, The Plan, published last year. [In contrast to another smear, this time allegedly from Tom Watson, who claimed Dan Hannan was going abroad casting assertions that he would not make at home.] I have read The Plan, and from memory their healthcare idea is to have citizens save through health schemes their own money to pay for healthcare to be drawn upon as it is needed, additionally people will need insurance to pay for more expensive healthcare should it be required. The poorest in society will be provided for by the State, as and when it is needed. The system itself becomes open to price influence and consumer pressures and will naturally seek ways to compete for custom by improving service and offering competitive pricing. Medical staff will naturally seek to be better so that they can themselves do better. When the system fails, individuals can seek recompense openly and fairly.

This may not be exactly as was written in “The Plan” but is the motion at a high level.

The well off do have the advantage of being able to pay for better doctors and facilities; but in contrast to the UK system now this will be more widely available than is currently available to the smaller, but wealthier who can still buck the system. Perversely the less than 10% who can afford to do so in the UK now, simply buy their way to the front of the queue and will likely end up in the same operating theatre, with the same doctor using the same tools, the other 90% or so have to wait their turn for a slot to open for their treatments.

So, what troubles me is; why exactly is it so offensive to the British Left that alternatives systems are discussed that may actually improve the state of health in the people of this country? There is compelling evidence that there are other systems employed in the developed world where a UK equivalent could save more lives; so it cannot be a body count issue.

It is of course because the NHS is the bedrock of the Socialist argument in the UK; it is held up as universally popular and universally acknowledged as being a success. But away from the Government and out of the mainstream press that is not entirely how everybody views the NHS. If you tug at the threads of the NHS and show that things can actually be done better, cheaper and more efficiently then the whole of the Labour Parties core beliefs can come into question. The criticism and attacks we hear from Labour come from a position of fear, rather than of confidence.

I gave it some, but not really a lot of thought over the last week, and I am personally in no hurry to bring down the NHS. Firstly, there has been no debate and no consensus that an alternative should be sought. This however I would like to contribute to. Secondly, as with all change the fear of change clouds the uncertainty of the potential of improvement. Without more cheerleaders and an inspired vision it is hard to have confidence that a change would be successful… but that can change.

The fear stems from the certainty of what almost certainly will go wrong. Though I am not convinced the whole of the NHS is behind the notion that the State must run all, there would be enough organised opposition to ensure that any moves to change will be fiercely opposed. We can be sure of this fact because we have the benefit of history on our side. Also, no matter what changes are made, and no matter how good things get, we can only move from an imperfect system into a different imperfect system, and it is there that those who are ill served and neglected will be held up as the victims of what I would assume will fast be referred to as corporate healthcare.

So, as is probably evident, I am personally clearer on the fact that I think we should just be open and allow ourselves the luxury of talking about how we could make things better, than I am on how I personally would advocate how we can really make improvements. But the more everyone talks, the clearer these positions and alternative will become. That is the benefit of living in a free society, power and change can emanate from public debate, rather than from those who prescribe how they think we should governed.

If you are still convinced we can do no better than to allow the State to run the Health Service, I invite you to imagine for one moment a contrasting example. In your mind’s eye, look at how the State has taken more and more control in the past 40 years of Education. Think about how things were in all terms, does the money the rich have buy more or less of an advantage today compared to 40 years ago? What standard of service do the poorest get? Are the standards better or worse than 40 years ago? Now ask yourselves the same questions of your food supply?

Perhaps a bizarre example, but what I am trying to illustrate is that in 40 years, through private enterprise, Supermarkets like Tesco’s & Sainsbury’s, as well as your local stores and restaurants have done more for food and diet equality to the people of the UK than the State has done for education equality. For the few of you who scoff, I invite you to now image the reverse scenario, if food supply was a ring fenced competence for Government? Would it be cheaper, or as widely available? Try to imagine how that would affect yours and everyone standard of living. In that bizzarro world, you would be hard pushed to imagine how the free enterprise system could be providing food much more easily and cheaply, but we know it to be possible.

Hopefully, such an example illustrates that it is not unpatriotic to simply aspire to live our lives free from State control. Also, just because we don’t yet have all of the answers to how we can make things better, the first step is to talk openly and to include everyone in those discussions, because everyone is affected. Then hopefully, down the line and with popular consensus try some new ideas out for real giving them a real chance to succeed or fail.

Finally, and just because I think it is important to mention something that is sometimes, strangely ignored and occasionally spun inaccurately. The NHS is free at the point of use, in that an ambulance driver no more needs a credit card than does your GP’s receptionist; but the NHS is not free. It is in fact very expensive and consumes a big chunk of the taxes we pay.