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Is the English level requirement of the Health and Care Worker visa enough to provide a high standard of care?

Healthcare visa

Overview

Almost 130,000 visas were issued to overseas carers between March 2022 and 2024 as employers increasingly looked to other countries to reduce staff shortages across the care sector[1].

Overseas carers make a vital contribution, but face many challenges when communicating with patients and service users, especially those with complex care needs, who are distressed, confused and vulnerable, and who use language that the visa’s English requirement simply does not prepare carers for.

Unless addressed, misunderstandings and miscommunication can become endemic and negatively affect the care provided and the morale of staff involved.

This article looks at the B1 English level required by the Health and Care Worker visa, analyses what this indicates overseas carers can and can’t do, and suggests how targeted language and communication skills training can resolve the problems so many carers and their employers are currently facing.

[1] https://migrationobservatory.ox.ac.uk/resources/briefings/work-visas-and-migrant-workers-in-the-uk/, https://migrationobservatory.ox.ac.uk/resources/briefings/migration-and-the-health-and-care-workforce/

What English level is required for overseas carers to work in the UK?

When applying for a Health and Care Worker visa, an overseas applicant must demonstrate a B1 level of English in the four language skills, as defined by the Common European Framework of Reference (CEFR). This is achieved by scoring a 4.0 in the four papers of the IELTS test, or an equivalent score in one of the other tests recognised by the UK government[1].

[1] https://www.gov.uk/health-care-worker-visa/knowledge-of-english

What’s a B1 level?

The CEFR, created under the leadership of the Council of Europe, defines a B1 level as a set of ‘can do’ statements:

  • Can understand the main points of clear standard input on familiar matters regularly encountered in work, school, leisure, etc.
  • Can deal with most situations likely to arise whilst travelling in an area where the language is spoken.
  • Can produce simple connected text on topics which are familiar or of personal interest.
  • Can describe experiences and events, dreams, hopes & ambitions and briefly give reasons and explanations for opinions and plans.[1]

As a UK reference, a B1 level is equivalent to the level a student taking their first year of an A level course would be expected to have[2].

[1] https://www.coe.int/en/web/common-european-framework-reference-languages/table-1-cefr-3.3-common-reference-levels-global-scale
[2] https://students.leeds.ac.uk/info/1000026/get-ready-to-go/747/languages

Is a B1 level sufficient for overseas health and care workers?

B1 is an intermediate level of English. A B1 user has the language skills to enable them to travel, engage in familiar conversations, write simple texts, describe opinions, and give brief reasons and explanations.

At work, a B1 user can function well with predictable language situations, communicate with people who speak clearly (and patiently), read straightforward reports and write simple emails.

Given the extraordinary reach of English, there are millions of people globally with a B1 level English who are capable of achieving the test scores required for the Health and Care visa. However, does a B1 level cover what health and care workers need to do?

What carers can do with B1 English

It certainly covers some of what carers do. Taking observations or having everyday conversations around food, drink, personal care and mobility, for example, can be predictable, following familiar question and answer formats, with only a limited range of responses. These scenarios consist of relatively small sets of language that a carer can quickly learn through repeated practice, especially when supported by managers and colleagues.

What carers cannot do with B1 English

However, there are many more demanding care scenarios which require a higher level of language and communication skills to manage them successfully.

Patients and service users may be confused, distressed and angry, for example. They may speak with unfamiliar accents and dialects, and use idiomatic language that is never taught at school or when preparing for a formal English test. Their care needs may be complex, they may be living with dementia or be hearing impaired. None of these scenarios are uncommon, and expecting a carer with a B1 level of English to manage such conversations effectively without considerable support is unrealistic.

In many interactions, language needs to be carefully considered to elicit the right response from a service user or their family. The language used to ask questions, give instructions, reassure, gather information, show respect, and give advice can make a big difference in how a carer is perceived. How a carer communicates is often just as important, whether it be tone, level of empathy, active listening, or how they include the patient in decision-making. Getting this consistently right is essential to the delivery of a high standard of care.  

Solving the problem: improving overseas carers’ English language and communication skills

While a B1 level does not prepare carers to engage in complex language and communication scenarios, it does mean that they have a strong foundation they can build on.

We recommend that carers with a B1 level undertake a programme that focuses on learning the work-specific language they need to communicate with greater accuracy, sensitivity and confidence.

Some of this work can be undertaken as self-study, so learning new vocabulary and grammatical structures, for example, or practising listening to a variety of accents and dialects. And some can be undertaken with a teacher, ideally in small groups, where carers can activate and practise the language they have learnt, get feedback and further input from their teacher, and develop their own peer support relationships. Once an appropriate level has been achieved, regular mentoring check-ins can be scheduled to address any ad hoc language and communication issues as they arise at work.

Because the sets of language used in care are relatively narrow, a lot of ground can be covered quite quickly, enabling learners to apply it to their work and learn further from the feedback they get from colleagues, patients, service users, and their families. We’ve seen how carers’ confidence at work has blossomed after only a few weeks.

In conclusion

While a B1 level of English allows carers to work effectively in familiar, everyday interactions where communication is relatively predictable, it is not sufficient for managing more complex interactions, dealing with unfamiliar idiomatic language, a variety of accents and providing care to those experiencing more challenging emotional states.  

This issue can be addressed by instituting a targeted language and communication skills programme for overseas carers, which combines self- and tutor-led study. Learning is applied in the workplace as the programme progresses and then fed back to lessons for review and improvement. Further support can be developed alongside from peers, managers and ongoing mentoring.

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