Do we need a bilingual health and social care workforce?

Dafydd Trystan looks at how the NHS could better support Welsh speaking patients.

Iris (not her real name) was admitted to hospital having had a small stroke. She was distressed, incoherent and the nurses caring for her were very concerned. They had an initial conversation about whether she should be sectioned under the mental health act for her own safety. Within four hours Iris was well on the road to recovery – the shift changed and a bilingual nurse took over Iris’ care. Iris was perfectly lucid in Welsh – though in considerable discomfort – but was having real difficulty expressing this in English. In due course Iris received specialist support to address the impact of the stroke from one of the few bilingual specialists in speech and language therapy.

Jac, as young children do, broke his arm while out playing in the local woods. His concerned parents took him to A & E and his mum was doing her best to calm Jac down. The consultant at A & E didn’t help – he objected to Jac talking Welsh to his parents – and insisted that if he was going to get better he’d have to speak English.

James was a teenager in the South Wales Valleys. He had a small operation under general anaesthetic at his local hospital. As the anesthetic wore off, he was in pain and shouting, but in Welsh, his first language. The staff caring for him, didn’t really know what to do, but one remembered that Dai the porter spoke Welsh. Dai was duly summoned, who told everyone who’d listen that James was saying that he had excruciating pain in his right foot! Pain relief was duly administered and by that evening James was happily conversing again in both languages.

These three vignettes – all based on real life experience of the health service in Wales, serve to underline the importance of, at the very least, being aware of the bilingual context of Wales. In each case care was improved by the provision of a service in Wales – or at the very least a sensitivity to the fact that for many people, particularly in stressful situations – it is far easier to express yourself in your first language. And if you aren’t entirely convinced, and are fortunate enough to have learnt a second language – maybe French or Spanish – the next time you are ill try explaining how you feel in that second language!

So what is to be done? Major strides forward have been taken by the Welsh Government in recent years with their ‘More Than Words’ strategy – and there is currently a consultation on the follow on strategy. But, the big challenge is the workforce, and that is why the Coleg Cymraeg Cenedlaethol is hosting a seminar later this week discussing the development of a bilingual health and social care workforce. If effective patient care is to be at the heart of the Welsh NHS then it follows that the care must be appropriate to the patient, and sensitive to their language needs. There is increasing international evidence that providing care in the first language of the patient improves patient outcomes i.e. people get better faster!

In recent years the Coleg Cymraeg, in partnership with Welsh Universities has invested heavily in lecturing capacity across Wales to deliver health and social care courses in Welsh. We have seen developments in Nursing, Medicine, Biomedicine, Genetics, Pharmacy, Midwifery, Speech and Language Therapy, Occupational Therapy, Social Work – and more developments are planned. This investment is starting to have an influence with some over 200 students now studying with parts of their course in Welsh.

But students are only one part of a more complex jigsaw. The vast majority of the NHS workforce in 10 years time is already employed by the NHS – so there is a need to tackle training in the workplace too. A key part of the forthcoming seminar will be a discussion around the kind of training needed – and to kick off the discussion the Coleg suggests a pyramid model.

Our view is that developing Language awareness is a core skill that could and should be developed for all health and social care professionals in Wales. Building on a recently launched MOOC (Massive Open Online Course) for Language Awareness in Social Work (a partnership between the Coleg Cymraeg and the Care Council), there are models that could be developed to provide such training efficiently and cost effectively.

At another level, there are significant numbers of students and staff who could be encouraged to make more use of their Welsh when communicating with patients. Some staff may not be confident discussing diagnoses in Welsh – but may well be able to discuss a range of aspects about a patient’s daily life in Welsh. This would in many cases improve care.

And at the apex of the pyramid is the need for a health and social care professionals who can practice confidently bilingually. This is particularly true for those dealing with vulnerable groups – younger people, older people and those with mental health difficulties. Moving towards offering university courses fully bilingually is a major step in the right direction here.

Some work therefore has been completed already, but there is so much more to be done – and much to be discussed at the seminar. Crucially, however if we are to improve the quality of care delivered to Iris, Jac and James and many more like them – there is undoubtedly a major task ahead of the next Welsh Government strategy on Welsh in Health and Social Care.

Dr Dafydd Trystan is Registrar of the Coleg Cymraeg Cenedlaethol The ‘Bilingual Workforce for Health and Social Care’ seminar is held at the Royal Glamorgan Hospital on the 25th of February. Registration is free – contact Lisa Haf – [email protected] to register.

12 thoughts on “Do we need a bilingual health and social care workforce?

  1. If we take this seriously we must also expect our health professionals to become competent in all the other first languages that are spoken in Wales now too.

  2. If you really want to sort out a language problem in the NHS I would start with all the English speakers who can barely get service in their own language. There are millions of us!

  3. It should all sort itself out in time as fewer and fewer people remain Welsh first language.

    The details of those most comfortable using Welsh are on page 47. As you would expect, amongst non fluent Welsh speakers 98% are most comfortable using English or they have no preference for Welsh. 2% have some language other than English or Welsh that they feel most comfortable with.
    Fluent Welsh speakers make up 11% of the population and of those only 40% are most comfortable using Welsh. That’s 4.4% of the population and falling rapidly. It makes more sense just to make sure that the present school age population is well versed in English.

    This is from the recent Health and Social care survey:-

    “64% of Welsh speakers said they would prefer to communicate in English with health and social care
    staff, 17% preferred to communicate in Welsh, and 19% had no strong preference. In the last 12 months,
    31% had used Welsh to communicate with health and social care staff and 69% had not used Welsh in
    this way. Of Welsh speakers who would prefer to communicate in Welsh, 73% had actually used Welsh. 14% of
    Welsh speakers who preferred to use English had communicated in Welsh with health and social care
    staff in the last 12 months. Of Welsh speakers who had no strong preference, 52% had actually used
    Welsh to communicate with health and social care staff.”

    The NHS should stop being so concerned about a small group which in reality has few real problems and concentrate on more important aspects of health delivery.

  4. no. This would serve only as protectionism for jobs for Welsh speakers… which somehow isn’t considered racist when protectionism re: British jobs for British people rightly is. You can wrap it up any way you like but the drive behind this is not at all innocent!

  5. I am entirely sympathetic to this. What happens when in our urban areas people start speaking Urdu or Somali? Shouldn’t our hospitals have either trained staff or specialist translators on call able to communicate in any language which has a substantial community of speakers in the area? Welsh speakers are entitled to sensitive treatment. The same is true for speakers of other minority languages. Whereas Welsh provision should be available in most areas of Wales, other language provision could be restricted to the few urban areas where speakers make a significant minority.

  6. “These three vignettes – all based on real life experience of the health service in Wales”

    hmmm ‘based’ maybe… but definitely embellished! The bit about the consultant insisting that somebody should speak English in order to get better is a rabble rousing misquote if ever I saw one! Also I very much doubt that the consultant ‘objected’ to Jac speaking Welsh…. asked if he could speak English perhaps.

    As for James… a teenager in the South Wales Valleys unable to communicate comfortably through the medium of English? Really?!?

    I would suggest that if Mr Trystan wants to manufacture a Wales where Health and Social Care jobs are restricted to less than 500 thousand Welsh speakers (and the rest of us monoglots look elsewhere for employment) then he really ought to make his ‘vignettes’ just a little bit less suspect.

    Of course the solution here is simple: where there is a need then translators or a representative proportion of the healthcare staff be bilingual. Of course this is already the case but doesn’t fit with the oppressive aim of ensuring that EVERY member of staff is bilingual just in case one of these obscure and embellished (and non life threatening I might add) vignettes might arise. This as I said before is fuelled by protectionism and nationalism… nothing to do with quality of health/social care

  7. Here is another vignette. A consultant in a south Wales hospital, working with nursing staff, came up with a grass roots initiative that by getting patients to fill in a simple form, would more effectively ‘triage’ day case patients saving hundreds of thousands of pounds and shortening waiting times. They took the initiative and got on with it. It was immediately effective and ran successfully for nearly six months until a language nazi officially complained (in English !) that the form was not bilingual. Timid managemen, fearful of political correctness, ordered the in-house form to be withdrawn immediately and also said that funding was not available for Welsh translation. The initiative died a death and the system reverted to its old inefficient methods.

  8. So, just for completeness…“Do we need a bilingual health and social care workforce?” NOPE!

  9. How can it possibly be racist to try and help health professionals understand peoples’ language preferences? Of course people speak English on the NHS Direct line, because more often than not they are not aware that the Welsh option exists. Why do some people seem to look for any discussion on the Welsh language so that they can attack it and hope it soon disappears? As for the claim that these vignettes are “embellished” here’s a link to the BBC story:

  10. “because more often than not they are not aware that the Welsh option exists”

    Not true… us monoglots are painfully aware that a Welsh option exists because we are read a list of options (in Welsh first) therefore we know very well that you ‘press 1 for Welsh’ and ‘press 2 for English’. The whole process of getting through to actually speaking to someone takes twice as long. I presume this is not the same for 999 calls… but then again nothing would surprise me as far as Cymraeg and common sense goes.

  11. ” I presume this is not the same for 999 calls… but then again nothing would surprise me as far as Cymraeg and common sense goes.”

    Well…strange as it may seem our esteemed Assembly is, as we speak, trying to row back on their commitments under their new Welsh language service provision:-

    They have inadvertently failed to ensure that emergency announcements are given in English first. The Welsh language commissioner is apparently holding them to the requirement that all announcements, even emergency announcements, are given in Welsh FIRST. This will allow the chosen few to evacuate buildings, threatened with terrorist bombs for instance, before the monoglot riff-raff.

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