Lost in translation

Nurses from EU countries don’t have to show they can speak English, yet a lack of understanding can affect care they give

CONCERN HAS been raised over the English language capabilities of some foreign staff working in the health sector with fears that communication difficulties are putting vulnerable patients at risk.

Some health professionals and patient groups claim there are some individuals who don’t have a sufficient command of the English language to carry out their duties safely but say there has been little reporting on the issue by concerned staff or members of the public for fear of appearing prejudiced.

“We’ve had a lot of complaints from patients who say that they can’t understand what health professionals are saying to them, who don’t understand the diagnosis they have been given or what medication they are meant to be on, and who have been left feeling like they weren’t able to properly communicate what was wrong with them,” said Janette Byrne of Patients Together,

The recently published report into the Leas Cross nursing home drew attention to this issue by highlighting the difficulties that families of residents had in communicating with nursing staff and care assistants.

It noted that many families had complained that many staff at the nursing home seemed to have little or no English and stressed that the ability to communicate fluently in English was essential, particularly when employees were charged with looking after elderly and highly dependent patients, many of whom may have hearing and concentration deficiencies.

While the Leas Cross report has highlighted the language difficulties involving care assistants working in private nursing homes, there is a concern that the problem is more widespread and may also affect staff working in the public health sector.

Currently, non-EU qualified nurses who wish to register in Ireland and do not have English as their first language, must demonstrate proof of language competence by having internationally recognised English language qualifications.

Similar rules apply to applicants who wish to register as professionals with the Medical Council. However, at present there is no such requirement in place for nurses from EU member states for whom English is not their primary language, or for care assistants who are not governed by An Bord Altranais, the regulatory body for nurses.

Nursing Homes Ireland (NHI), the representative body for the private and voluntary nursing homes sector, accepts that there is a difficulty with some employees’ levels of English and said it believes that care assistants should offer proof of language competency.

Sinead Fitzpatrick, practice development facilitator with NHI, said the organisation was preparing an induction pack for its members to give to new staff.

The pack, which is based on the HIQA National Quality Standards for residential care settings and An Bord Altranais guidelines for working with older people, contains a competencies skills assessment for employees and an ongoing annual appraisal.

The Irish Nurses Organisation (INO) also concedes that there is an issue with some health professionals’ level of English but says it believes the vetting procedures employed by An Bord Altranais to assess the language capabilities of nurses, ensures that those who are unable to communicate well in English are unlikely to be approved.

“It is less of a problem than for care assistance groups principally because the nurses who come to this country are required to do a six-week orientation before they get on the register, which includes an assessment of their proficiency in English,” said David Hughes, deputy general secretary of the INO.

“Generally there will be some sort of vetting for those coming into the public health system but where there may be a problem is that there would be a great reluctance on the part of people doing the vetting to make language a big issue unless there was a real impediment for fear of being accused of racism,” he added.

Earlier this year two cases of disciplinary action were taken by An Bord Altranais over registered nurses’ poor command of the English language. In one case, a nurse was found guilty of professional misconduct for failing to demonstrate a knowledge of written or spoken English that would enable her to carry out her duties effectively.

In the second more serious case, a Polish midwife working at the Rotunda hospital was struck off the nursing register after it was found that her poor command of English meant that she was seen to pose a substantial risk to the safety of mothers and babies.

While such cases are rare, they have led some patient support groups to question the vetting procedures employed by bodies such as An Bord Altranais and the Medical Council and to call for better monitoring of all non-national health staff.

“Professionals need to have above adequate English so that they can communicate effectively with patients because if they aren’t able to do this, important information can and will be lost,” said Stephen McMahon, chairman of the Irish Patients Association (IPA).

“Given this, there’s a responsibility of the various regulators to ensure that the professionals which are on their registers have the necessary competencies in all areas, including English,” he added.

Ursula Byrne, acting director of regulation at An Bord Altranais, said the body was concerned about the lack of requirement for nurses from the EU registering to work in Ireland but said its hands were tied at present because under the terms of the directive covering recognition of professional qualifications, it could not make testing of language competence a pre-requisite to registration.

Ms Byrne pointed out though that the two language-related disciplinary cases heard earlier this year were the only ones to have come before the board and should be seen in the context of there being 67,572 individuals on the nursing register.

Nonetheless, even such a low number of cases is too much, according to patient rights groups. “We’re very mindful that without foreign nationals our health system would have collapsed long ago and are anxious that this not be seen as an attack on such people but we want to see better monitoring of staff to ensure that they have sufficient English to carry out their duties safely and effectively for the benefit of all patients,” said Janette Byrne.