Do we need a bilingual health and social care workforce?

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.