Healthy English

Introduction to Healthy English

From India to Nigeria, Spain to Egypt, workers from more than 200 countries work for the NHS. Almost one in five of all workers were born overseas, making the workplace a rich network of different nationalities, cultures and styles of English.

Working in a language that isn’t your mother tongue can be challenging, especially as the UK is renowned for having some strong regional accents and dialects which add another layer of complexity.

Healthy English has been developed to work in parallel with TALC – Teaching and Learning Consultation Skills. It addresses the language and communication needs of international health and care staff, their trainers and colleagues working in the UK.

Whether you are a GP, a member of a clinical team working in a hospital, a trainer, a trainee, a nurse, a care worker, a practice manager, a member of the telephone and reception staff, or a patient, this site will help you become a better user of English. There is a range of activities and explanations to help you develop appropriate language and communication skills for the health and care context.

Before each section – and sometimes, within sub-sections – there is a note to trainers and educators about what to look out for when observing the communication of the trainee in action, and how to point out areas that need working on.

We hope that you enjoy using the site. If you’re new to it, it is worth starting by reading the Introduction and Advice for Trainers section; and then read and/or listen to the 6-part article in Section 1: Working with Native and Non-Native Speakers of English.

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Module 1 – Working with Native and Non-native Speakers

Module 2 – Cultural Differences

Module 3 – Colloquial and Informal Language

Module 4 – Questions and Eliciting Responses

Module 5 – Communication Skills and Barriers

Module 6 – Mastering English Verb Tenses

Module 7 – Pronunciation 

Module 8 – Support for Speakers of Specific Languages

The following problems have been experienced and shared by trainers who have had GP Registrars with English language or communication difficulties:

  • Cultural differences in expression/behaviour lead to patient or staff conflict e.g. the perception of an abrupt manner, inappropriate laughter or smiling. Excessive speed of language, or low volume can sometimes be very difficult to understand.
  • The GPR might have a poor understanding of the NHS system, having just arrived from overseas.
  • Some GPRs come from a culture of doctor-centred consultations which can be difficult to change.
  • Difficulty with written English leads to problems with spelling and accurate written clinical note-keeping.
  • Concern from trainers about the GPR making the grade to pass the summative assessment video, MRCP oral and video due to English language problems has been expressed. Problems with social isolation in the peer group and community can be significant.
  • Problems with seminars and teaching due to cultural differences and poor understanding have been reported.
  • Prejudice from patients and staff due to English language problems and poor understanding of the GPR has occurred on occasions.

What can Trainers and Educators do?

From the outset, a trainer and the trainee can agree to a communication and language support contract. The empathy here centres on understanding that coming to work in a different culture and in another language is by no means easy.

So, asking the trainees to explain how they would describe their cultures and how their languages work, and how those languages are different from English is a useful way to start. For a trainer to have these insights is invaluable. Permission can then be obtained from the trainee for the trainer to highlight language and communication weaknesses and suggest ways to deal with them. Equally, the trainee can be encouraged to ask for help, correction or clarification.

Non-native English speakers may keep quiet when they do not understand something out of fear of appearing incompetent, failing examinations and assessments, or even losing their jobs; so, keeping an open line of communication is crucial. Most importantly, trainees need to know from the outset that everyone is there to help and support them.