Barbara Rymell
PFD Report
Partially Responded
Ref: 2023-0482
1 of 2 responded · Over 2 years old
Response Status
Responses
1 of 2
56-Day Deadline
22 Jan 2024
Over 2 years old — no identified published response
About PFD responses
Organisations named in PFD reports must respond within 56 days explaining what actions they are taking.
Source: Courts and Tribunals Judiciary
Coroner’s Concerns
I am concerned that those working with vulnerable people who are in a position of trust and responsibility must be able to demonstrate a sufficient proficiency in English to enable to summon appropriate emergency medical attention when needed. Vulnerable people, by very definition, are unable to often appreciate the need for help; take steps to keep themselves safe and/or summon help for themselves when they need it. By being unable to speak the native language of England with any proficiency I am concerned that deaths will continue to arise where those who are young, disabled, suffering from a mental impairment or who are elderly and in need of urgent medical help will not have this summoned for them if those who are engaging with emergency professionals are unable to communicate effectively. The Court looked at evidence of the B1 English test. Examples from the paper were as follows: “I __________ that book last year” (options are bought, have bought, had bought) “The town, ________ is very beautiful, has lots of parks” (options are which, where, what). This level of comprehension is comparable to a KS2 curriculum being studied by Year 6 students sitting their SATS exam and appears to be wholly insufficient for those working in the direct care and protection of vulnerable people, as demonstrated in this case by carers who were alone (i.e. no English speaking members of staff on duty) being unable to explain to medical professionals the presenting condition of the patient.
Responses
The Home Office does not believe raising English language requirements for Skilled Workers is appropriate or practical. However, the government plans to tighten Health and Care visa requirements from Spring 2024 by limiting sponsorship eligibility to CQC-regulated care providers, and will keep immigration requirements under review.
AI summary
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Dear Mrs Marsh,
Thank you for your letter of 27 November 2023 to the Home Office, following the investigation into the death of Barbara Jean Rymell. I am replying as the Minister of State for Legal Migration and the Border.
I would like to start by expressing my sincere condolences to the family and friends of Barbara Jean Rymell. I would also like to place on record my thanks to you for this investigation and for raising the matter of concern contained within your report.
Unfortunately, the information provided to us by your office has not allowed us to determine the immigration status for those individuals involved in this case. This means we cannot confirm whether they were on an immigration route which required them to demonstrate English language as part of their application or not.
The immigration system contains a wide variety of routes which allow people to come to the UK to work, study, for cultural exchange, and as dependants joining family members. The English language requirement for immigration purposes has two functions. The first is to ensure the person can undertake the activity for which they are coming to the UK, for example to study or, if working, the job, including understanding any safety information relating to the job and to be able to bring any concerns to their employer.
The second function is to help migrants to integrate into the UK. This will include ensuring they can engage with local services such as healthcare, education, and other public services which people will need to use in their day-to-day lives.
Both are important, and we believe strike a balance between ensuring the safety and integration of migrants and the ability of businesses to bring in the labour they need. Importantly, these immigration requirements are the same for all sectors who are eligible for Skilled Worker visas and reflect the level of English which is necessary should people wish to apply for indefinite leave to remain and ultimately citizenship if they choose.
I receive representations on a regular basis from sectors who argue that the English language requirements are too high for their sector. Unfortunately, it would prove very difficult, both to assess and also to manage, a system where we had different English language requirements for different occupations.
Since February 2022, the main route for care workers wishing to come to the UK has been through the Health and Care visa, which is part of the wider Skilled Worker visa. Those arriving on the Health and Care visa must demonstrate that they meet the ‘B1’ standard, and details of the levels can be found at: https://www.coe.int/en/web/common-european- framework-reference-languages/table-1-cefr-3.3-common-reference-levels-global-scale.
English language can be proved in various ways, but the most common is through passing a Secure English Language Test (SELT). Alternatively, they can meet the requirement if they are from one of the listed majority English speaking countries, or if they have a suitable qualification which was either taught in the UK, or taught or researched in English. Qualifications obtained outside the UK need to be confirmed by ECCTIS. ECCTIS provides official UK national agency services on behalf of the UK Government in qualifications, skills, and migration.
However, there are a number of immigration routes, other than Skilled Worker, where individuals are permitted to work, without first needing to seek approval from the Home Office. These include dependants of workers or students. Dependants, which is defined as a partner or children under 18 years of age, are not required to work, but where they choose to, do not need permission from the Home Office for any employment. Dependants are also not required to demonstrate that they meet the English language requirements unless they are applying for indefinite leave to remain (settlement).
There are a range of other routes which have general work rights, including those on the Hong Kong British Nationals (Overseas) route, those who have arrived through humanitarian routes such as the Ukraine schemes, or Afghan relocation schemes, recognised refugees, and those who arrive under Youth Mobility Scheme arrangements. The purpose of these routes varies from cultural exchange to humanitarian, but all permit people to work whilst in the UK without seeking prior agreement and none of them have an English language requirement.
In addition to those routes listed above, asylum seekers who have had a case outstanding for more than 12-months, though no fault of their own, may also apply for permission to work. Where this is granted, these individuals may only work in occupations contained on the Shortage Occupation List. This would include as a care worker, which was added to the list of shortage occupations in February 2022.
This creates a mix of immigration routes with different purposes, but where people could end up working in social care. Raising the English language level in those routes which have an English language requirement would be very difficult, and imposing such a requirement on routes which do not have such a requirement would in some cases defeat the purpose of the route as it was intended.
I absolutely recognise that ensuring the safety of those who require care is a very important issue, but the responsibility for ensuring that employees can fulfil the requirements of their role primarily rests with employers. An employer should ensure their overseas staff can speak English to an adequate standard. The employer should consider the merits of requiring higher levels of English language than necessitated by immigration requirements – on the basis that it may be required for the settings overseas staff will be working in. In some cases, a higher level of English than required for a visa may be
required to work in a particular role. This is already the case for many health and care workers who require professional registration. For example, the Nursing and Midwifery Council require a higher level of English before a nurse can join their register. The same is true of doctors who must register with the General Medical Council, dentists with the General Dental Council and many allied health professionals who are required to be registered with the Health and Care Professions Council. All of these bodies have language requirements for those working in the profession which are higher than the requirement set by the immigration system.
Unlike those listed above, there is no requirement for care workers to be registered with a professional body, but an employer or organisation must be registered with the Care Quality Commission (CQC) where the organisation is providing regulated services. The CQC provides regulatory oversight of the quality and safety of care provided by health and care providers. Under regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, employees are required to have the qualifications, competence skills and experience which are necessary for the work to be performed by them. It is the responsibility of a care provider to ensure the individuals they hire are suitable for the role. To meet this regulation, providers must ensure they have robust recruitment procedures, undertaking relevant checks, and a procedure for ongoing monitoring of staff to make sure they remain able to carry out the duties required of them.
Given the points which I have set out above, we do not believe that raising the level of the English language requirements for Skilled Workers would be appropriate, nor do we think it would be practical to set different levels for different sectors. In any event, it would not fully address the concerns you have raised for all the reasons set out earlier.
However, the Government has recently announced that it will tighten the requirements for care workers coming to the UK on the Health and Care visa. Most relevant is the fact that only care providers who are regulated by the CQC will be eligible to sponsor care worker and senior care worker applications from Spring 2024. We will keep immigration requirements, including those relating to English language, under review as part of this work.
Thank you for your letter of 27 November 2023 to the Home Office, following the investigation into the death of Barbara Jean Rymell. I am replying as the Minister of State for Legal Migration and the Border.
I would like to start by expressing my sincere condolences to the family and friends of Barbara Jean Rymell. I would also like to place on record my thanks to you for this investigation and for raising the matter of concern contained within your report.
Unfortunately, the information provided to us by your office has not allowed us to determine the immigration status for those individuals involved in this case. This means we cannot confirm whether they were on an immigration route which required them to demonstrate English language as part of their application or not.
The immigration system contains a wide variety of routes which allow people to come to the UK to work, study, for cultural exchange, and as dependants joining family members. The English language requirement for immigration purposes has two functions. The first is to ensure the person can undertake the activity for which they are coming to the UK, for example to study or, if working, the job, including understanding any safety information relating to the job and to be able to bring any concerns to their employer.
The second function is to help migrants to integrate into the UK. This will include ensuring they can engage with local services such as healthcare, education, and other public services which people will need to use in their day-to-day lives.
Both are important, and we believe strike a balance between ensuring the safety and integration of migrants and the ability of businesses to bring in the labour they need. Importantly, these immigration requirements are the same for all sectors who are eligible for Skilled Worker visas and reflect the level of English which is necessary should people wish to apply for indefinite leave to remain and ultimately citizenship if they choose.
I receive representations on a regular basis from sectors who argue that the English language requirements are too high for their sector. Unfortunately, it would prove very difficult, both to assess and also to manage, a system where we had different English language requirements for different occupations.
Since February 2022, the main route for care workers wishing to come to the UK has been through the Health and Care visa, which is part of the wider Skilled Worker visa. Those arriving on the Health and Care visa must demonstrate that they meet the ‘B1’ standard, and details of the levels can be found at: https://www.coe.int/en/web/common-european- framework-reference-languages/table-1-cefr-3.3-common-reference-levels-global-scale.
English language can be proved in various ways, but the most common is through passing a Secure English Language Test (SELT). Alternatively, they can meet the requirement if they are from one of the listed majority English speaking countries, or if they have a suitable qualification which was either taught in the UK, or taught or researched in English. Qualifications obtained outside the UK need to be confirmed by ECCTIS. ECCTIS provides official UK national agency services on behalf of the UK Government in qualifications, skills, and migration.
However, there are a number of immigration routes, other than Skilled Worker, where individuals are permitted to work, without first needing to seek approval from the Home Office. These include dependants of workers or students. Dependants, which is defined as a partner or children under 18 years of age, are not required to work, but where they choose to, do not need permission from the Home Office for any employment. Dependants are also not required to demonstrate that they meet the English language requirements unless they are applying for indefinite leave to remain (settlement).
There are a range of other routes which have general work rights, including those on the Hong Kong British Nationals (Overseas) route, those who have arrived through humanitarian routes such as the Ukraine schemes, or Afghan relocation schemes, recognised refugees, and those who arrive under Youth Mobility Scheme arrangements. The purpose of these routes varies from cultural exchange to humanitarian, but all permit people to work whilst in the UK without seeking prior agreement and none of them have an English language requirement.
In addition to those routes listed above, asylum seekers who have had a case outstanding for more than 12-months, though no fault of their own, may also apply for permission to work. Where this is granted, these individuals may only work in occupations contained on the Shortage Occupation List. This would include as a care worker, which was added to the list of shortage occupations in February 2022.
This creates a mix of immigration routes with different purposes, but where people could end up working in social care. Raising the English language level in those routes which have an English language requirement would be very difficult, and imposing such a requirement on routes which do not have such a requirement would in some cases defeat the purpose of the route as it was intended.
I absolutely recognise that ensuring the safety of those who require care is a very important issue, but the responsibility for ensuring that employees can fulfil the requirements of their role primarily rests with employers. An employer should ensure their overseas staff can speak English to an adequate standard. The employer should consider the merits of requiring higher levels of English language than necessitated by immigration requirements – on the basis that it may be required for the settings overseas staff will be working in. In some cases, a higher level of English than required for a visa may be
required to work in a particular role. This is already the case for many health and care workers who require professional registration. For example, the Nursing and Midwifery Council require a higher level of English before a nurse can join their register. The same is true of doctors who must register with the General Medical Council, dentists with the General Dental Council and many allied health professionals who are required to be registered with the Health and Care Professions Council. All of these bodies have language requirements for those working in the profession which are higher than the requirement set by the immigration system.
Unlike those listed above, there is no requirement for care workers to be registered with a professional body, but an employer or organisation must be registered with the Care Quality Commission (CQC) where the organisation is providing regulated services. The CQC provides regulatory oversight of the quality and safety of care provided by health and care providers. Under regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, employees are required to have the qualifications, competence skills and experience which are necessary for the work to be performed by them. It is the responsibility of a care provider to ensure the individuals they hire are suitable for the role. To meet this regulation, providers must ensure they have robust recruitment procedures, undertaking relevant checks, and a procedure for ongoing monitoring of staff to make sure they remain able to carry out the duties required of them.
Given the points which I have set out above, we do not believe that raising the level of the English language requirements for Skilled Workers would be appropriate, nor do we think it would be practical to set different levels for different sectors. In any event, it would not fully address the concerns you have raised for all the reasons set out earlier.
However, the Government has recently announced that it will tighten the requirements for care workers coming to the UK on the Health and Care visa. Most relevant is the fact that only care providers who are regulated by the CQC will be eligible to sponsor care worker and senior care worker applications from Spring 2024. We will keep immigration requirements, including those relating to English language, under review as part of this work.
Report Sections
Investigation and Inquest
On 9th August 2022 I commenced an investigation into the death of Barbara Jean Rymell, aged 91 (“Barbara”). The investigation concluded at the end of the inquest on the 21st of November 2023. The conclusion of the inquest was death by Misadventure. The medical cause of death was recorded as: Ia) mechanical obstruction of respiration Ib) presumed fall downstairs Ic) – II) senile myocardial atrophy, dementia, general frailty. I recorded in box 3 of the Record of Inquest that: Barbara Jean RYMELL, aged 91, was left unattended on a mechanical stair lift at her care home (Ashley House Residential Home) on the evening of the Eighth of August 2022. Risk assessments identified that Barbara was not permitted to use the stair lift unaccompanied or unattended due to her physical and cognitive limitations. Whilst left unattended, Barbara has left the mechanical chair and proceeded to try and ascend the stairs. She has fallen causing her head to become wedged in between the chair seat and the stairs at an awkward angle, meaning it was not possible for care home staff to free her, or administer first aid due to her body position. Barbara’s breathing was compromised as a result of her entrapment, and she was pronounced deceased on the arrival of the paramedics.
Circumstances of the Death
Barbara became a resident of Ashley House Residential Home in Langport (“Ashley House”) on the 8th August 2022. She took up residency on discharge from hospital where she had had an inpatient stay as a result of a fall in the community. On becoming a resident of Ashley House Barbara had a known diagnosis of dementia, which sometimes affected her memory. She was at a high risk of falling and had blurred vision. All in all, she was a relatively frail elderly woman with known risks around her mobility and she relied on others to keep her safe. Barbara was the only resident with a bedroom on the first floor of Ashley House. This could only be accessed via the stairs (which Barbara was incapable of ascending or descending safely) or the mechanically operated stairlift (which Barbara was not permitted to use unattended or unsupervised.) On the evening of the 8th of August 2022 two carers were on duty; neither of whom were native English speaking nationals; one was Romanian and the other was Indian. I was told that in order to be able to work in the UK, those requiring a Visa (as the two carers on duty did) must prove that they can read, write, speak and understand English to at least Level B1…. [that they must demonstrate that they] can understand the main points of clear standard input on familiar matters regularly encountered in work”. Applicants for a Visa must have passed a Secure English Language Test (SELT). It transpired during the Inquest that one of the workers on the evening of the 8th August 2022 had never passed the SELT, so was not qualified or permitted to work in the UK. At 19:27 one of the carers called 999 to request an ambulance. It was clear, on the evidence, that Barbara had been left unattended on the mechanical chair for around five minutes. This was clearly contrary to the rules and procedures of Ashley House. During those five minutes she has left the seat of the mechanically operated stairlift (possibly unfastening the seat belt) and proceeded to climb the stairs; which she was unable to safely, due to do physical limitations and her underlying cognitive impairment. She has fallen on the stairs, falling downwards. There were no witnesses to this incident but Barbara has been found, having fallen awkwardly, landing with her head trapped under the chair for the mechanically operated stairlift. Care staff were unable to free her because of the positioning and angle at which she was entrapped within the mechanics. On calling 999 (copies of both recordings were played at the Inquest) it was obvious that neither of the care staff were sufficiently proficient in English to be able to: (i) Explain clearly the nature of the medical emergency. An internal audit by the ambulance service revealed that the call-handler had selected an incorrect pathway. The correct pathway that should have been selected was “entrapment” but at no time during the call did the carer give any information that would have indicated that this was the presenting problem. The carer repeated used the word “blocked” which added no assistance, clarity of explanation of the events that were unfolding. (ii) Understand the difference between “bleeding” and “breathing”. This made any meaningful triage of Barbara’s condition virtually impossible. The call handler followed the script to ask if the patient was conscious and breathing (i.e. to ascertain clinical emergency and determination of a priority response) but this assessment was severely hampered given the carer did not appear to know or understand the difference between bleeding and breathing. (iii)Understand the difference between “alert” and “alive”, which presented all of the same problems as referred in in (ii) above. Paramedics arrived on a category 2 response and, on arrival, it was clear that Barbara was beyond medical help. She was pronounced deceased at the scene. CORONER’S CONCERNS During the course of the inquest the evidence revealed matters giving rise to concern. In my opinion there is a risk that future deaths could occur unless action is taken. In the circumstances it is my statutory duty to report to you. The MATTERS OF CONCERN are as follows. – I am concerned that those working with vulnerable people who are in a position of trust and responsibility must be able to demonstrate a sufficient proficiency in English to enable to summon appropriate emergency medical attention when needed. Vulnerable people, by very definition, are unable to often appreciate the need for help; take steps to keep themselves safe and/or summon help for themselves when they need it. By being unable to speak the native language of England with any proficiency I am concerned that deaths will continue to arise where those who are young, disabled, suffering from a mental impairment or who are elderly and in need of urgent medical help will not have this summoned for them if those who are engaging with emergency professionals are unable to communicate effectively. The Court looked at evidence of the B1 English test. Examples from the paper were as follows: “I __________ that book last year” (options are bought, have bought, had bought) “The town, ________ is very beautiful, has lots of parks” (options are which, where, what). This level of comprehension is comparable to a KS2 curriculum being studied by Year 6 students sitting their SATS exam and appears to be wholly insufficient for those working in the direct care and protection of vulnerable people, as demonstrated in this case by carers who were alone (i.e. no English speaking members of staff on duty) being unable to explain to medical professionals the presenting condition of the patient.
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Data sourced from Courts and Tribunals Judiciary under the Open Government Licence.