Everyone who works in the NHS knows the system is in meltdown. The crisis is not just a temporary seasonal affliction brought on by the harshness of winter, but an accelerating slide towards disaster, symbolised by lack of hospital beds, long waits in A&E departments and an ever-increasing demand on GPs.
I have been an NHS doctor for more than two decades, having come to Britain from Germany in the mid-Nineties.
The health service used to be one of the best features of this country. It deserved the widespread admiration it received, not only for its principle of equality of treatment for all, but because of its standards of care.
But in recent years I have seen a drastic decline. It is no exaggeration to say that the service is now on its knees. The explanations for the crisis are clear.
There’s the soaring demand through the growth in the elderly population and immigration; the failure to recruit enough staff and to ensure that additional money gets to frontline services, rather than disappearing in the evermore Byzantine management layers of the NHS; plus the costly impact of medical advances and the justified expectation of the public to be able to benefit from them.
Just as important is the waste of resources through inefficiencies, misguided priorities and continual structural change.
As a GP, I am constantly frustrated by the burden of paperwork as a result of top-heavy, interfering bureaucracy. We don’t have good management in the NHS, but micro-management.
Yet there is another cause of the crisis. It is one that is hardly ever mentioned because of political sensitivities, yet it is causing real difficulties in practices such as mine.
I am referring to the problems created by the number of patients who are unable to speak English, even if they have lived in this country for a long time.
The language barrier means that the NHS sometimes struggles to offer an effective service to such patients.
Moreover, there is the additional strain on resources because of the need to use interpreters or translation phone lines, as laid down by NHS policies.
Consultations with non-English speakers tend to be twice as long because everything has to be spelt out slowly or repeated through others. As a result, there is less time available for other patients.
This is now a major issue in our increasingly multi-cultural society, especially in urban areas where migrant communities have been encouraged — in the name of celebrating diversity — to hang on to the tongue of their native lands.
On the patient list at my own practice in the heart of Lancashire, I would estimate that close to three-quarters of people live in a household in which English is not the first language.
Of these, around a quarter — most of them older Asian women — don’t speak any English.
Some argue that this is not really a problem and that in a spirit of tolerance the NHS, along with other public services in Britain, should just adapt.
Only this week, Cambridge University professor Wendy Ayres-Bennett said that British people should think of integration as a ‘two-way street’ and learn ‘some of the community languages of the UK, such as Polish, Punjabi and Urdu’.
Conversely, when the Government put forward the suggestion this month that migrants should have to undergo compulsory English language courses, there was a predictable outcry amid accusations of racism against newcomers.
But I find this negativity absurd. Learning English represents empowerment, not oppression.
The real bigotry is exercised by those who want to trap migrants in their enclaves, preventing them from enjoying all the richness that Britain has to offer. What could be more culturally chauvinistic than denying people the tools with which to participate in our society and communicate with their fellow citizens?
As a migrant myself, I feel particularly strongly about this.
When I arrived here from Germany more than 20 years ago, I didn’t for a moment think that I could manage in this country by sticking to my native German. I never expected official documents to be translated into German, nor interpreters to be laid on for me. I felt it my duty to develop a good command of English, especially once I began to work in the NHS.
A few years ago, I was offered an attractive job in France. I was certainly tempted, not least because the pay and conditions were better than in the NHS. But in the end I turned it down.
The main reason was my insufficient command of French, which I feared would be a detriment to my professionalism.
My husband, a surgeon, wanted to work in Belgium during his training. Despite most Belgians being fluent in English, he learned the language before taking a post there. Yet today in my job in Lancashire, I continually face language difficulties of a different kind.
The British state should never have wilfully allowed this form of mass social exclusion to develop. It is bad for patients — and bad for the NHS.
On a regular basis, I conduct consultations with middle-aged Asian women who do not speak a word of English despite having lived here for decades.
To provide a translation, they will often bring along one of their children, who is sometimes as young as seven. How can a child be expected to understand complex, adult health problems?
At my practice we have several multilingual receptionists who occasionally help with interpreting. But that means taking them away from their other busy duties.
One alternative is to use the NHS’s translation telephone helpline. But it is very expensive at a time of over-stretched funding, and makes consultations extremely long-winded because every exchange has to be repeated. Even worse, I am not always confident that the translators have the full medical knowledge to grasp what I have I said and to relay the information properly to my patient.
In fact, this danger was confirmed to me once when I was using the language line with a patient, and then, at my request, one of our reliable multilingual receptionists was able to come into my room.
Immediately, she established that the helpline had mistranslated my advice.
Nor are the language difficulties confined to GP practices.
I am aware of many cases where a non-English speaking patient, requiring an interpreter, has been booked for a hospital appointment. Then the interpreter has not turned up, so the appointment has had to be postponed: a further waste of time and money.
Yet, NHS policy states that no relatives should be used for translation and every patient needing help must be provided with an interpreter in person or via telephone.
If everybody in the NHS adhered to this policy, the healthcare for this group of patients would grind to a halt or the cost for translation services would explode.
All this would be resolved if people who want to access taxpayer-funded services are required to speak English. That is why I support compulsory classes. At present, it is far too easy for some residents to lead entirely separate lives, wholly divorced from the British mainstream.
An Asian person in my Lancashire home town can have an Asian doctor, an Asian solicitor, watch Asian TV and shop in Asian stores, effectively treating England as a foreign country.
That is no way to build a cohesive society with a shared set of values because the inequalities are extending into the next generation.
Children growing up in non-English speaking families cannot get the same help with their homework as their classmates. Teachers cannot talk to parents easily when there are problems, so these children are disadvantaged even if they speak English very well.
So how can non-English speakers be made to attend such classes?
Well, there is one straightforward way: entitlement to receive welfare could be made dependent on a willingness to learn English.
A refusal to do so could lead to the withdrawal of benefits.
Those who want to receive subsidies from the taxpayer should not be allowed to avoid their basic duties as citizens.
For too long, the British state has bankrolled social exclusion, and one of the results has been to increase the strain on the NHS. The current crisis means we must now take a more radical approach.
Dr Schmitgen is writing in a personal capacity.