After nearly 20 years, it's time to get serious

I normally wouldn't comment on an organization's response to a formal consultation without reading the whole thing. But because the British Medical Association have gone to the media with the aim of publicizing the key points of their position on the Welsh Government's proposal to improve Welsh-language services in health, social services and social care, I feel justified in commenting on what they've said.

The BMA’s response to the consultation said: “While Welsh-language service provision for some patients is essential, and does need to be recognised and effectively supported, it should not be a one-size-fits-all policy. If the aim is to improve patients’ experience of care, government efforts and investment would be better placed in tackling waiting times and filling staffing vacancies with the best professionals to deliver the best care.

“Today, the NHS is at breaking point; everyday we hear the same warnings. Imposing duties to offer NHS services in Welsh in a sector which in some areas is struggling to offer any service at all to its population is quite another.

“The time, and financial situation, is not right for imposing language duties on NHS organisations aiming to deliver world-class healthcare, but which in reality are many light-years away from that.”

Western Mail, 14 May 2012

The first paragraph contains a typical straw man argument. Nobody is suggesting that there should be a "one-size-fits-all policy" in respect of the Welsh language. But if the BMA is in fact acknowledging that a Welsh-language service is, to use their own word, "essential" for some patients, then we should welcome their acceptance of that. It's a start.

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Next, the BMA uses the argument that because the NHS is struggling, efforts to improve the service would be better directed elsewhere. The implication is that the standard of medical care is more important that the language in which it is delivered. My response is to point to the English NHS to see whether they accept that argument. Only a few months ago the UK government introduced new language rules on doctors working in the English NHS:

     Foreign doctors must prove they can speak good English

In essence, the GMC has been given explicit new powers to be able to take action against doctors when there are concerns about their ability to speak English, and at a local level "responsible officers" are to be appointed to ensure that doctors have adequate language skills. In practical terms, this means that even the very best doctors in the world will not be allowed to treat patients in England unless they have adequate language skills. It blows out of the water the BMA's silly suggestion that the "best professionals" should be appointed irrespective of their language skills.

Why should we accept lower standards in Wales? The same mechanism set up for assessing an employee or prospective employee's skills in English is just as appropriate for assessing an employee's skills in Welsh as well, so no additional administrative or cost burden would be imposed. Neither does it cost any more to employ someone who speaks both Welsh and English rather than just English. Nobody is advocating that every medical or care professional in Wales should speak both English and Welsh, but registering their language proficiency is an important step towards ensuring that sufficient Welsh-speaking health and care workers are employed and, more importantly, readily available to provide a service appropriate to the level of demand. This might well mean that Ysbyty Gwynedd in Bangor will need 70% of its front line staff to be able to speak Welsh, but that Nevill Hall Hospital in Monmouthshire would only need 10% of its front line staff to be able to.

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Lastly, the BMA claims that "the time and financial situation is not right" to impose any language requirements on the NHS. My response to that is much more dismissive. The Welsh Language Act of 1993 imposed a duty on all public bodies to treat Welsh and English on the basis of equality. Almost two decades have now passed, including times of economic boom and an unprecedented amount of money being poured into all public services, but especially the NHS.

But how did the NHS in respond to its obligations under that Act? There are some honourable exceptions, but in the main the NHS in Wales did not take them seriously. Getting a service in Welsh, either in health or social care, is generally more a matter of luck than of planning or forethought by the organizations that should have been providing it.
 

     

As it happens, today marks the start of a non-statutory public consultation by the Welsh Language Commissioner about the new language standards which will be applied under the new Welsh Language Measure. The consultation documents are here but, as we can see in this news item, the media focus seems to be on the private bodies that have now come under the scope of the Measure.

     

For me, a more important aspect of the new Commissioner's role will be to get public bodies which largely ignored their obligations under the old Act to now start doing what they should have been working on for the last twenty years. The old Welsh Language Board did not have any way of enforcing the old Act, it could do little more than name and shame those bodies which failed to do what they agreed they would; but the new Commissioner now has powers to set standards and some powers to enforce them.

The standards haven't yet been finalized and there is no way of knowing to what extent the Commissioner will have the appetite to enforce those standards when they are—and of course the BMA were responding to a similar consultation exercise by the Welsh Government, which has a different and more direct responsibility for the standards of health and care services in Wales—but my advice to Meri Huws would be not to go gunning for the bodies newly brought under the scope of the Measure.

To start with, it will be better to use enforcement powers on those public bodies which should have been doing much more than they have over the last twenty years ... and the providers of health and social care services should be right at the top of that list.