On 17 May, 2012, The NHS employers website published an article called ‘Consultation on responsible officer regulations’ advising that surveys for public opinion on the amendments to regulations relating to Responsible Officers (RO) are to be submitted to the Department of Health by 13 July 2012. According to the website, consultation by the Department of Health will be in three areas, namely:
1. Deciding the role of the NHS Commissioning Board in nominating and appointing Responsible Officers
2. Deciding the role of Responsible Officers in assessing the language competence of overseas-trained doctors who are working in England.
3. Establishing whether a local authority will come within the definition of 'designated bodies' if the local authority has a connection to a public health doctor and whether a local authority could act as a responsible officer for this doctor.
As an EMP (English for Medical Purposes) specialist, my main interest is in the area of language competency assessment of overseas trained doctors. The background to this issue is the fact that currently in the UK only non-EU healthcare professionals (doctors, nurses, physiotherapists, dentists etc) have their language skills assessed. I am a non-EU nurse who had to pass each of the four skills of an IELTS (International English Language Testing System) at a minimum of 7.0. English is my first language. The UK is unusual in comparison with other English-speaking countries in that EU health care professionals do not have their English language skills tested before working in the UK.
Recently, this anomaly was reviewed at European Parliament level which started the process of the testing of all overseas-trained doctors but not all overseas-trained nurses for various, to my mind, bizarre reasons. Leaving this aside, I was interested to read Chapter Three of the ‘Consultation document: Responsible officers in the new health architecture’
Looking through the chapter, I came across a few points which raised questions in my mind about the effectiveness of the current system and likely effectiveness of the mooted system.
First, I read that the The National Health Service (Performers Lists) Regulations 2004 already require Primary Care Trusts (PCTs) to refuse to admit overseas-trained doctors, dentists or opticians to a Performers List if the PCT does not feel that the applicant ‘has the appropriate English language knowledge to enable them to carry out their function as a doctor in the PCT’s area.’ The idea being that the The Performers List ensures that the overseas doctor is ‘fit for practice’ i.e can work safely by being able to communicate effectively in English and therefore safe patient care is ensured.
Responsible officers in England (other countries in the UK have different regulations) have the same or similar functions to the PCTs . However, whilst ROs have a duty to check that
medical practitioners have the required qualifications and experience for the job, there is no specific duty to check language competency.
On the other hand, The Coalition programme for government committed to ensure that foreign ‘healthcare professionals’ (did this include nurses?) have an adequate level of language competence so that NHS patients are not put at risk or harmed because of communication break downs.
Looking at the situation of doctors (as the nurses’ situation hangs in the balance) ,The Coalition agreement would tend to suggest that the RO legislation needs to be amended to make it clear that the function of a Responsible Officer explicitly extends to the testing of language competency before an overseas-trained doctor can set foot in a hospital and communicate with patients and colleagues. My first thought was, ‘ How is this to be done?’
The following section (section 3.7) talks about assessing language in a ‘proportionate way’ including a ‘proportionate use of language tests’. My next thought was ,’ Which language tests are they thinking of ? This is not explained or mentioned from what I can see.
The only reference to ‘how this competence would be assessed’ seems to be in stating that guidance would be sought from the GMC and the NHS Commissioning Board. ‘Guidance could also be amended quickly to take account of changing circumstances, such as any scheme intended to apply across healthcare professionals more generally’. I presumed this to refer to nursing.
Again, the proposal that ROs will notify concerns regarding language competency to the GMC does not include any clues about how the RO will assess language competency.
Cost was also alluded to but felt to be quite low, as ‘Under the existing system PCTs and NHS Trusts are required to undertake checks’ so it was felt there would be no change in test costs. But, I still felt I was missing something. What tests? My understanding was that there is no testing of EU doctors allowed so how can there be existing costs for ‘checks’ or are these ‘checks’ informal conversations with prospective doctors which are costed as admin time?
My final musings were about the ROs and their own competence to assess language competency. Surely this should be done by language specialists? If not, why did I have to undertake an IELTS test ( a language test administered by language specialists) before I was able to apply for nursing registration in the UK? It is already a silly situation whereby doctors and nurses (and other health care practitioners) from English-speaking countries who most probably count English as their first language have to front up for an IELTS test when their European colleagues who probably do not count English as their first language, do not. Having said that, in most English-speaking countries, everyone fronts up to prove their language competency before registering as a doctor or nurse or similar.
In Canada, nurses sit a CELBAN Canadian English Language Benchmark Assessment for Nurses which specifically tests the ability to speak the English required for the healthcare environment . In other words, EMP. The question of whether IELTS is an appropriate language test for healthcare workers is another issue, however, at least it is a language test of some sort and of international recognition.
Many NHS hospitals have English classes for overseas doctors and nurses already working in the system. Obviously the need is recognized but it would seem a little like closing the stable door a bit too late.