On March 7 2018, the House of Commons Library published a Briefing Paper outlining the language testing requirements imposed upon healthcare professionals who qualified outside of the UK. Proficiency in English is one of the skills that healthcare professionals that work within the UK need to possess. However, the UK’s ability to regulate the standard of language skills held by applicants who originate from within the EEA has been hindered due to its membership with the EU.

As a current member of the EU, the UK is not allowed to test the English language skills possessed by European applicants before granting registration with the relevant healthcare regulator. This is a result of the Mutual Recognition of Professional Qualifications (MRPQ Directive) imposed by the EU on its member states. The Directive permits the qualifications of EEA and Swiss applicants to be recognised within the UK without any further testing.

The language skills of healthcare professionals outside the EEA, however, can be assessed by regulators within the UK prior to granting registration.

A fundamental issue has arisen in relation to the registration of a large proportion of healthcare professionals who have qualified within the EEA. Without an ability to test the fitness to practise (which includes language skills) of these applicants prior to granting registration, the checks applied before registration are not on par with applicants from outside the EEA, and can in some cases, hinder the UK’s ability to recognise issues which may touch on patient safety ahead of registration. One such example was seen in the case of Dr Daniel Ubani.

This case concerned the death of a patient in 2008 as a result of a fatal overdose administered by Dr Ubani, who qualified as a doctor in Germany. The dose contained over ten times the recommended amount of diamorphine.

The case resulted in a widespread call for an improvement in the regulation of medical professionals who have obtained their qualifications overseas. In 2010, the Coalition Government agreed to ‘seek to stop foreign healthcare professionals working in the NHS unless they have passed robust language and competence tests.’ Additionally, the General Medical Council (‘GMC’) called for tougher powers to assess the language skills of European doctors in the same way as it can for doctors originating from outside the EEA. We previously blogged on this topic, as can be seen here.

In 2014, the Medical Act 1983 was amended to extend the GMC’s power to enforce language controls for doctors. These changes:

  • Gave the GMC the power to refuse a licence to practise in circumstances where the medical practitioner was unable to demonstrate the necessary knowledge of English; and
  • Created a new strand of impaired fitness to practise, relating to having the necessary knowledge of English

In order to include these powers while complying with the MRPQ Directive, the amendments distinguished between the registration of doctors and the licensing of doctors. While the GMC still cannot assess language capabilities when granting registration, it can impose a requirement to provide ‘evidence of English language competence’ prior to issuing a licence to practise in the UK. Therefore, if an applicant’s language skills are not of an adequate standard, they cannot practise within the UK even if they are registered as a result of the EU Directive on Mutual Recognition.

In 2016, changes came into force which allowed the regulators of other healthcare professionals to assess English language skills using a similar two-part process. This framework focused on a distinction between the recognition of qualifications and the granting of registration. The framework applies to nurses, midwives, dentists, dental care professionals, pharmacists and pharmacy technicians originating from the EEA.

The Health Committee’s 2017 Report ‘Brexit and health and social care – people & process highlighted the negative impact of increased language controls on the number of medical and nursing applications received from Europe. While increased language testing controls may lead to a decrease in applications received, emphasis must be placed on the fundamental importance of adequate language skills. This is especially vital in relation to medical professionals for reasons relating to patient safety.

In response to the Health Committee’s recommendations, Jeremy Hunt indicated that the issue of inadequate language controls would be addressed following Brexit as their current form does ‘not seem logical.’

It is important to note that presently, the UK can only test an applicant’s basic English language skills in relation to general, non-medical topics if they originate from the EEA. It cannot assess an applicant’s clinical English knowledge, which includes his/her ability to describe clinical procedures, use medical terminology and outline important side-effects or symptoms that patients should be aware of. Medical professionals originating from the rest of the world, however, must demonstrate an adequate standard of language skills in relation to a clinical context.

Commentary

Few would disagree that the language skills of all healthcare professionals must be rigorously and specifically tested in a medical context prior to granting registration (or a licence to practise). This should be the case for all healthcare professionals, regardless of whether they originate from within or outside the EEA, as it is fundamental to their practical ability to carry out their role competently and safely. Patient care and safety must always be paramount.

An assessment of their proficiency in English only in relation to general topics that are irrelevant to their professional ability is an inadequate safeguard against the potential consequences in the clinical setting. In order to practise in a clinical environment, an applicant’s clinical English knowledge must be assessed. Brexit may provide an opportunity for the UK to introduce improved language testing for all healthcare professionals regardless of which overseas country they are applying from. Such rigorous new standards are likely to result in a high quality healthcare workforce, regardless of their origin. This must be a win for patient safety.