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With better English, refugee doctors and nurses could ease NHS staffing crisis

NHS staff are drawn from all over the world. Stefan Wermuth/Reuters

The Nursing and Midwifery Council has changed its English language requirements. Nurses trained in the European Economic Area who wish to register to work in Britain must now also demonstrate English to level 7 of the International English Language Testing System as those from non-EEA countries have been required to do. It follows a General Medical Council ruling in 2014 that brought in the same requirements for doctors.

It is of course vital that healthcare workers are able to understand sufficient English to communicate with patients and each other. One widely reported incident involved Daniel Ubani, whose speaking skills convinced his employers that he was safe to practise in the UK despite his lack of formal NHS training or language assessment. On his first shift, he administered a lethal dose of diamorphine to his patient, later admitting he had confused morphine with another drug.

However, the NHS faces budget cuts and a desperate shortage of staff. Of the 1.7m NHS staff around 11% are from overseas, and with fewer applications from British citizens to study medicine NHS chiefs will continue to look abroad for new recruits.

Shortage on one hand can be met by the other

Even as this search for overseas staff continues, thousands of displaced people are arriving in the UK, such as those seeking asylum from wars in Iraq and Syria. Many are qualified medical staff – there are now more than 1,200 registered refugee doctors in the UK – but because they don’t carry with them the documentation needed to demonstrate their skills and practice under General Medical Council rules, they must be retrained, which is a time-consuming and costly process.

An NHS Employers briefing document suggested that retraining refugee doctors costs around £25,000, cheaper than the £250,000 cost of training a new doctor, and quicker.

Figures from the British Medical Association show that in 2008 about 68% of registered non-EU refugee doctors attempted to obtain the necessary professional and linguistic requirements to work in the UK. The first stage is to undergo IELTS English language training. In my experience from teaching them, despite being highly motivated, well-educated and with good access to English language materials, many struggle to pass the test. They face many of the same problems that all learners of English face: the complexity and breadth of the language at higher levels, differences with their first language, and a lack of opportunities to practice what they’ve learned.

Making better use of the skills people already have. VGstockstudio/

Giving refugee healthcare workers opportunities to practice their language skills, for example through public-facing, part-time volunteer work, will provide greater exposure to using the language at higher levels and in different contexts. As part of my PhD research I’ve talked to people who feel that it would be extremely beneficial if they were able to practice their language skills in a medical context, as this would reflect the academic nature of the IELTS test, but in the currency of their professional field. This may be complicated to organise in the short-term, but the long-term benefits are clear.

Another frustrating factor is the change from medical training, which focuses on the rigid learning of facts, to language training, which is taught differently and focuses more on demonstrating a flexible use of what is learned. Many feel “deprofessionalised”, feeling their specialist medical knowledge will suffer while they focus on learning English. On top of this is the inherently difficult circumstance of being displaced: trying to survive abroad, look after family, and the application process for leave to remain.

The eligibility of overseas doctors to work in the UK has long been controversial – from the days of Indian doctors arriving in the 19th century, to Belgian healthcare workers arriving in Britain after World War I. Or even British doctors’ suspicions that foreign doctors who took refuge in the UK during World War II were granted permission to practice in order to build support among the profession for the creation of the NHS.

More needs to be done to help make use of the untapped resource of highly-skilled refugees and asylum seekers coming to the UK. Ignoring the wealth of talent arriving on our shores is a lost opportunity and, comparing the costs of retraining refugee healthcare workers compared to training new staff, the latter will cost the taxpayer more. Focusing on teaching English skills won’t just help newcomers into work. It will help head off bigger issues of social integration in the long run – and all from spending comparatively little on providing better targeted English language teaching for those displaced professionals arriving here.

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