DON’T call the midwife
You couldn’t make it up: The NHS hired a Polish maternity nurse – who in 17 months didn’t deliver a SINGLE baby because her English wasn’t good enough. Then she sued them for being demoted. Insanity? Read her defiant story and you be the judge . . .
‘Sometimes they say that I speak good’
‘In hospital I did translating for Polish patients’
ARRIVING here from Poland, Barbara Fall had one ambition. ‘I came here to work for women in England,’ she said. ‘I came here to take care of them and their babies.
‘And I thought I would love England. But now, I don’t know what to feel.’
The 38-year-old isn’t the only one left scratching her head, because in the 17 months that she worked at a hospital in Lancashire, the Polish-trained midwife did not deliver a single baby.
Instead, her time at Burnley General Teaching Hospital ended with her being suspended from the midwives’ register.
The reason? Her inability to communicate in English.
Indeed, it is claimed the mother-of-two’s language skills were so bad that she struggled even to answer the phone. And that such were her shortcomings she had to be supervised at all times.
When colleagues warned management about what was going on, Mrs Fall was quietly demoted.
Furious at her treatment, she promptly resigned and took her former bosses to an employment tribunal on the grounds of racial discrimination.
But the farce continued as translators had to be called in amid concerns she could not follow proceedings.
Having lost her claim, Mrs Fall was then suspended from practising after being reported to The Nursing and Midwifery Council (NMC).
‘The panel was of the view that patients would be at a real risk of harm should Mrs Fall be allowed to practise without having the necessary knowledge of English,’ the NMC’s Fitness to Practice Committee concluded.
Tory MP Philip Davies’s conclusion was even more to the point: ‘A colossal waste of taxpayer money’.
But the reality is much more complex — and raises serious questions about the NHS’s recruitment of foreign healthcare workers and its impact on patient safety.
Because if Mrs Fall’s English was so bad, why was she not only given the job in the first place but then promoted?
And why, as she told the Daily Mail this week, was she tasked with translating for Polish patients at the hospital, some of whom were undergoing complex emergency operations?
It all comes down to the fact that faced with staffing shortages over the past decade, hospitals have increasingly looked abroad for nurses and midwives. Many who answered the call came from Europe.
But in contrast to staff coming, from, say, Australia or New Zealand, who have perfect English, under rules on freedom of labour, staff from the EU were able to register to work in this country without checks on their English.
That meant regulators such as the NMC were not allowed to set tests at a national level, but instead had to rely on individual trusts and hospitals to carry out their own assessments.
How thorough they were was entirely down to them.
It wasn’t until 2016 that the system changed and language tests were finally introduced. (As we shall see later, Mrs Fall, failed such a test when she took one in January this year.) But even then, these tests were ‘watered down’ when it emerged foreign staff found them so tough they were being put off from applying for jobs here.
In plain English, the whole thing is a bit of a mess. And not helped a single bit by cases such as Mrs Fall’s.
‘You have got lots of foreign doctors and nurses here and I’m not sure that their language is better than mine,’ she told the Mail.
It was in 2013 that Mrs Fall travelled to Britain to make a better life for herself and her two children. She had trained as a midwife and worked in a Polish hospital for five years.
‘I wanted to work here,’ she told me, speaking in English that could be described as broken. ‘I knew that England needed midwives and I thought I will continue my profession here.’
During the course of our exchange she sometimes found it hard to understand what I was saying and had to ask me to repeat several questions. I, in turn, could not make out everything she said.
On arrival, Mrs Fall applied to register as a midwife with the NMC, going on the register in May 2014.
To do this, her training, work history and midwifery skills were assessed to ensure she would be able to competently practise in the UK. But there was no separate language test.
At that time, the shortages of nurses and midwives had become a real issue for the NHS. For nurses, the driver had been a reduction in the amount of money allocated for training home-grown nurses from 2010. For midwives, the problem was a rising birth rate, the retirement of existing staff and an increasingly complicated workload caused by older mothers.
Faced with these shortages, trusts went looking abroad to fill vacancies. In 2014 alone, more than 7,000 nurses, midwives and health visitors were recruited from abroad, the vast majority from Europe.
With the NMC unable to test language skills, employers were left to assess their English. For some this could consist of nothing more challenging than a Skype interview.
Mrs Fall, who lives in Manchester, found her job by attending a jobs fair run by East Lancashire Hospitals NHS Trust in 2016. In recent years, the Trust has struggled with shortages of nurses and midwives and has been forced to recruit staff from India and beyond.
In June 2016, Barbara Fall was taken on as a Band 3 maternity support worker on a salary of £18,000 a year. The profession is divided into bands according to seniority, with Band 1 being the lowest.
As a registered midwife, Mrs Fall could have started at Band 5 but, according to a spokesperson for the Trust, agreed to start as a support worker ‘so she could become familiar with protocols, practises, guidelines and clinical terminology necessary for working in the NHS’.
They say that they were pleased to appoint her and that her spoken English was ‘good’.
In January 2017, Mrs Fall was duly promoted to Band 5 and given a pay rise of at least £4,000 a year. As would happen with any newly qualified midwife, the plan was for her to be closely supervised as she adapted to her new role.
But the Trust says that a number of issues quickly became apparent, and that despite their attempts to address them and to give her one-to-one support, her ‘ understanding of NHS guidance and medical terminology did not improve sufficiently to enable her to provide safe, personal and effective care to mothers and babies as a midwife’.
They stress that during this time she did not deliver a single baby.
But Mrs Fall says this was only because she was placed in the post-natal unit — and was no reflection on her abilities.
What about her language problems?
She admits that, after starting at the hospital, it was suggested she might benefit from extra English classes. She enrolled at a college for ten hours a week tuition, but said she was never formally tested at the hospital.
‘Sometimes they say they are happy about my English, that I speak good, but I don’t know to be honest,’ she said.
What about claims that she struggled to use the phone? Mrs Fall says that she did use the phone, but was put off by colleagues laughing at her.
‘Even when I worked in Poland, when you start working somewhere you are a little bit shy when you have to pick up the phone because you don’t know people,’ she said. ‘You don’t know what to ask, and when you know that everyone is laughing at your English it is difficult.’
She also claims that she was made to feel unwelcome by the other midwives.
‘When someone doesn’t write your name on the board or you don’t know what to do, that is really difficult,’ she said.
‘Every day I was working with a different midwife, and by one of them I was told to do this and the next day I would be told by another one that I shouldn’t do this,’ she said.
In October 2017, she was demoted to Band 2 — her bosses having decided that even some of the duties of a Band 3 worker were ‘ beyond her language competency’.
The following month, Mrs Fall quit her job and sought legal
‘Everyone will think I made a serious mistake’
advice. She found a solicitor willing to represent her on a no-win-nofee basis and decided to sue the Trust at an employment tribunal.
Initially, she claimed constructive dismissal, but when that was ruled not to have met the necessary criteria, she launched a claim of racial discrimination. The hospital says it was ‘surprised and disappointed’ that she had decided to take this action.
‘Throughout Mrs Fall’s time at the Trust, she expressed her appreciation of the continued support and learning opportunities we provided, to enable her to take up a position as midwife,’ the spokesperson said.
The case was heard this summer in Manchester, with a translator on hand to help Mrs Fall.
Why was this, I ask. ‘Because they weren’t sure that I can speak English, what I can understand, what I cannot understand,’ she said. ‘It is a little bit funny because in hospital sometimes they asked me to be a translator for medical cases. I did translating in hospital for Polish patients.
‘When they came to the maternity unit or another unit, I was phoned by telephone and they would ask me to come there and translate.’
She says she even helped during emergencies, for example going into theatre to translate during a C-section.
In response to this claim, the hospital says it was unaware Mrs Fall had acted as a translator, but that if it did occur it would have been in the presence of a qualified midwife or obstetrician.
Mrs Fall duly lost her employment tribunal, though the hospital had to pay its own legal fees.
It declined to say what the bill was, adding it had no choice but to defend the action vigorously ‘ as the reputational damage of such a claim is extensive’.
In August, Mrs Fall’s case reached the NMC’s Fitness to Practise Committee, having been referred by the Trust.
‘It is alleged that she lacks the necessary knowledge of English to practise safely and effectively,’ records from the meeting read.
‘The panel noted that the referral by the Trust included broader allegations of lack of competencies, skills, knowledge and confidence to practice unsupervised as a midwife. However, these allegations were not the subject of any charge and there was no evidence to support them.
‘The panel accordingly disregarded these allegations and limited its remit to the charge.’
Evidence considered by the panel included the results of an International English Language Testing System (IELTS) test that Mrs Fall had sat in January 2018. To pass, she needed to score seven out of ten in each of four categories — listening, reading, writing, speaking. She had scored four, five, five and seven respectively.
From this, the panel concluded that her language skills were insufficient to allow her to practise safely or effectively. They suspended her from the register for 12 months to give her time to improve her English.
I ask Mrs Fall about her failure in the IELTS test. She says it was ‘very difficult’ and that it did not focus on the sort of medical English a midwife might use.
‘So even if you are good on that test you can be bad on medical English because you must be prepared particularly in medical language for work in hospitals,’ she said.
She is not alone in that criticism. In November last year, the NMC announced that foreign applicants could now choose between the IELTS test and another test, the Occupational English Test.
This was in response to complaints that IELTS was too ‘academic’ and did not involve enough health-related vocabulary.
It also came in the wake of a sharp drop in the number of European nurses registering, which some blamed on the difficulty of the tests.
The NMC insists that the introduction of an alternative test does not mean that standards have been lowered.
Mrs Fall is now working for a private firm as a carer for the elderly and the disabled. She says she continues to study English.
She says she remains unhappy with the message the suspension sends out.
‘ In Poland, if they suspend someone it means this person has done some serious medical mistake so I am very upset because if I go back to Poland if I say that I was suspended in England no one will believe me that my issue was my English. Everyone will think I did something very serious.’
In the meantime, hospitals here continue to look abroad for staff.
A spokesman for the NMC said: ‘We have stringent processes in place to ensure that nurses and midwives joining our register can communicate effectively in English. While we’ve only legally been able to ask nurses and midwives from the EU to show us that they meet our English language standards since January 2016, we have been able to request this evidence from people outside the EU since 2005.
‘Employers also have a responsibility to ensure their staff can communicate clearly in English.’
As for the Trust, it added: ‘ We pride ourselves on being a diverse workplace which reflects the population it serves. We continue to actively recruit and provide employment to people from Europe and beyond.’
And with the Royal College of Midwives warning that the NHS is short of 3,500 midwives, that’s a situation that is likely to continue for many years to come.