El Gazette provides, without doubt, the widest and most up-to-date coverage of ELT issues from around the globe. For example this month’s edition reports on protests by teachers and parents against the planned extension, beyond the 3 hours currently in place, of English classes in state schools in Taiwan. Furthermore, El Gazette continues its campaign against UK Borders’ preposterous ban on oversees student wishing to study English in the UK but, wait for it, with an unsatisfactory level of English. UK borders argue that it is these students with a low-level of English Skills who are most likely to abscond once inside the UK. El Gazette show two studies from Australia which explode that myth and suggest that factors such as poverty and political repression in the country of origin are much more likely to lead to students “absconding”. However, for all its good points, which are many, EL Gazette’s politics are those of a corrupt self-interested ELT industry. This is well-demonstrated by its throw-away piece on Dr Urbani, a German doctor responsible for the death of a British patient, David Gray, entitled “EU Docs must take English” (appearing in the July edition).
The Creation of the Urbani Myth.
El Gazette quotes the Commons Select Health Committee, which looked into this unfortunate death, and who concluded, “if the General Medical Council had been able to carry out language and competency checks……..lives might have been saved”. Nowhere, however, did anyone say EU doctors must take English. There were arguments about the language competence and, more importantly, general competence of non-UK EU doctors practising in the UK but this title is wholly misleading. This is not a business opportunity to train all EU doctors but a need to ensure that those wishing to practise in the UK have all the necessary skills. Indeed, EL Gazette, follow the UK Tory press, in demonising “foreign doctors” rather than looking at the shocking truth behind this death, namely privatisation of the National Health Service, incompetence and greed (the three being inextricably linked). Something the Select Health Committee were too cowardly themselves to acknowledge.
We should start therefore by giving more background to the case. Dr Urbani, was a specialist cosmetic surgery and anti-ageing medicine (yes, cosmetic surgery and anti-ageing medicine) who travelled by plane to the UK to undertake a 12 hour shift providing out of hours care in Cambridgeshire. Dr Urbani was called out to a patient, 70 year-old David Gray, who was complaining of kidney pain, and duly administered 100mg of diamorphine (a drug of which he had no experience and ten times the recommended dose). Tragically, Mr Gray died as a result of Mr Urbani’s actions.
During the inquest there were questions concerning Dr Urbani’s level of English and it emerged that the EU had rules forbidding the General Medical Council from testing EU doctors for language or any other competency. Of course, the rightwing press followed with inflammatory pieces against the European Union and foreign doctors. This was despite two important points of information which were either under-reported or not reported at all. Firstly, Urbani’s level of English was discussed primarily because he had previously been refused work by another Health Authority (again, for out of hours cover) because, among other things, they were not satisfied with his level of English. Headline sunk without a trace, or at least it should have been. Basically, and this is our second point, there is no EU directive that instructs any institution to employ persons not capable professionally or linguistically of carrying out the specific duties required of them. Here is what an EU representative said of existing legislation, we quote at length from the Independent:
The Commission said foreign doctors working in the UK were covered by EU laws providing for the mutual recognition of professional qualifications across borders. That included doctors setting up permanently in the UK and those staying for a limited time to provide temporary shift cover.
“In both cases, linguistic requirements apply, so once a doctor is authorised to work in the UK they have to have the right knowledge of English to do their job properly,” said the spokesman.
The level of knowledge of English depended on the specific medical job – with more stringent requirements for doctors working directly with the public than for those based in a laboratory and not in professional contact with the public.
“The Professional Qualifications Directive says that language requirements can be imposed, but they need to be proportionate and on a case-by-case basis.
“The competent authority cannot impose a general test regardless of a doctor’s situation; they have to give the doctor an opportunity to demonstrate their level of English.”
That, explained the spokesman, could mean providing proof of language qualifications, or “coming in for a chat”.
But, ultimately, a visiting doctor could be subjected to a language test.
“If the competent authority is not convinced that the doctor has the right level of English they can then impose a language test.
“So the EU Directive does not forbid the competent authority from imposing tests in such circumstances.”
This would seem both fair and logical, unless of course one was jaundiced by xenophobia. The issue was whether Mr Urbani was indeed equipped to serve as an out of hours GP in the UK, and, if not, what was he doing there? Whilst the issue of language skills was raised at the inquest, there was no specific mention in the verdict that it was this that led to the patient’s death. The coroner ruled the death of David Gray amounted to gross negligence and manslaughter and that Mr Urbani was “incompetent and not of an acceptable standard”. Indeed, the employers of Mr Urbani, a private medical company employed by the NHS, argued at the inquest that Mr Urbani’s language skills were sufficient for the job; which all leaves us to ask why a GP with no knowledge of a particular medicine should prescribe it in such high dosage without first carrying out some rudimentary checks. It is here, that we should begin to understand the wider picture.
At the inception of the National Health Service it was deemed that each UK citizen would be entitled to free 24 hour health care from cradle to grave and, up until, 2004, the job of out of hours belonged to local doctors. In 2003, however, the pro-market Labour Party, negotiated a whole new contract with GPs which increased their salaries significantly and exempted them from the out of hours service provided they welcome and administer new privatisation measures in the NHS. Whilst some honourable (and well-remunerated) GPS organised to ensure that out of hours remained “in house” and under local management (consistency of care from GP surgeries to out of hours) many health authorities contracted private medical companies. Mr Urbani was paid 45 pounds an hour (less than his UK counterparts) for his services that night but had to pay for his own flights and the car rental.
Most disturbingly there is a significant drain of German Doctors into these private medical organisations in the UK given, on the one hand, the high reputation of the German Health Service in general and their medical training in particular and, on the other, the vast differences in pay between doctors in the UK (average 127.000 US dollars) and in Germany (average 56,000 US dollars). Moreover, whilst German doctors working in the UK are, of course, pleased with the increases in salary they are less enthusiastic about the lower standards of care they find in the UK.
An Accident Waiting to Happen.
And finally, we get to the real villains of the piece. The people who have benefitted most from the privatisation of the NHS and the people always keen to put profit before people’s safety. Take Care Now, Dr Urbani’s employers had apparently failed to heed previous warnings on the use of diamorphine by German doctors (yes a particular problem had been identified with German doctors and their lack of knowledge about this drug). We quote the independent again at length:
An inquiry into Take Care Now which provided out of hours care for five Primary Care Trusts has revealed that the death of David Gray in February 2008 might have been avoided if the company had acted on previous incidents involving overdoses.
The report by the independent health watchdog, the Care Quality Commission is a devastating indictment of the provision of out of hours GP services in Britain and serves as a warning to ministers on the risks of privatisation. Out of hours services have increasingly been taken over by commercial organisations since family doctors were permitted to relinquish responsibility for them in 2004. This week Andrew Lansley announced a major shift of budgetary power in the NHS to GPs who are expected to be responsible for buying and monitoring out of hours services in future. Mr Gray, 70, died after he was injected with 100mg of diamorphine – 10 times the recommended daily dose – at his home in Manea, Cambridgeshire. The fatal overdose was given by Nigerian born Daniel Ubani who had arrived from Germany the day before, spoke little English, was tired and had never used morphine before.
The CQC inquiry, published today, revealed that there were two previous incidents involving overdoses of diamorphine, prescribed by doctors from Germany working in Suffolk in April and August 2007, the year before Mr Gray’s death. In both cases the patients survived.
Diamophine is not routinely used in Germany and following the incidents a senior clinician warned Take Care Now that a patient would be killed if nothing was done. The company was advised that information and labelling of drugs in the pack given to locums should be improved but it failed to act on the advice.
The inquiry also found that “staffing levels were unsafe” and that the Primary Care Trust, (charged with contracting services) did not understand what they were buying” and failed to monitor the service.
The chairwoman of the inquiry concluded:
“Take Care Now failed on many fronts. Not only did it ignore explicit warnings about the use of diamorphine, it failed to address deep-rooted problems across its entire out-of-hours service. This had tragic consequences for Mr Gray.
So there we have it. It was greed and privatisation that killed Mr Gray not the European Union and the lack of language testing. El Gazette should be ashamed of itself for further propagating xenophobia and trying to turn this tragedy into a marketing exercise, EU doctors must learn English. We would argue that people must learn health and profit don’t mix, like teaching and profit don’t mix.
Some readers might think we are being hard on El Gazette for a throw-away titbit of no more than 60 words. Yet we would argue that it is the greed and dishonesty of the ELT industry that damages the reputation of English language teachers. As teachers we want to help students communicate in English but we don’t want to create false scenarios to compel students to do so. We don’t want to push methods simply because they are in the interests of the industry. And we don’t want to appeal to xenophobia simply because it can earn us a quick buck.
Despite all its excellent campaigning against UK Border’s visa restrictions on foreign students, not once has it taken English UK to task on its role in this fiasco. It was English UK who raised the whole issue of bogus colleges and tens of thousands of bogus students before a parliamentary committee. Where on earth did it get those figures from? Why did it see fit to raise a moral panic in return for increased profits? Of course, its racism rebounded in the form of visa restrictions.
This blind spot to everything concerning its industry leaders and this belief that xenophobia is okay if it’s in the interests of ELT is what weakens the campaign against UK Borders and what makes the paper a whole lot less interesting. Rather than worry about students absconding, EL Gazette should campaign for the right of students to study where they want, irrespective of their country of origin. If the UK is a useful place to study English, then people wishing to do so should be allowed to do so; without being treated like a potential criminal. In this brave neo-liberal world capital can flow unhindered from country to country but, in contrast, huge walls are being built everywhere to stop humanity from doing so. To quote Pink Floyd, the article entitled EU docs must learn English is just one more brick in the wall.