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Dementia sufferer, 91, died after becoming trapped in a stairlift when foreign care staff could not understand the difference between ‘breathing’ and ‘bleeding’ meaning the ambulance could not triage her correctly


A senior coroner has issued a warning about the inability of foreign health staff to speak English after hearing how carers looking after an elderly woman who died did not know the difference between ‘bleeding’ and ‘breathing’.

Barbara Rymell, 91, who suffered from dementia, died after she became trapped by a mechanical stair lift after a fall at the care home she lived at with staff being unable to free her, an inquest heard.

The report found that in a 999 call, her two carers – one Romanian and one Indian – were unable to explain to the emergency services what had happened to her, and did not understand the difference between their patient being ‘alive’ or ‘alert’.

Their lack of English ‘severely hampered’ the call handler’s response and made a ‘meaningful’ assessment of her condition ‘virtually impossible’, the coroner said.

Following the call, Mrs Rymell’s case was classified as ‘serious’ rather than requiring an ‘immediate’ response and when paramedics did arrive at the care home she was dead.

The inquest heard how Barbara Rymell had passed away at the Ashley House Residential Home in Langport

The inquest heard how Barbara Rymell had passed away at the Ashley House Residential Home in Langport

Senior Coroner for Somerset, Samantha Marsh, has now written to the Home Office and the Helen Whatley, minister for Health and Social Care to warn of the potential for future deaths if English standards are not addressed.

In a highly critical report she said the current test for foreign health staff is ‘wholly insufficient’.

The Taunton inquest heard Mrs Rymell’s death occurred on her first day as a resident of Ashley House Residential Home in Langport.

The dementia sufferer arrived at the home on August 8, 2022, from hospital having suffered a fall in the community and was known to be frail with blurred vision and at a high risk of falling.

‘She relied on others to keep her safe,’ the coroner said.

She was the only resident with a bedroom on the first floor but she was incapable of using the stairs or the stairlift on her own, the inquest heard.

Mrs Marsh said in her report: ‘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.

‘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. 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 it was obvious that neither of the care staff were sufficiently proficient in English to be able to 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 repeatedly used the word ‘blocked’ which added no assistance, clarity of explanation of the events that were unfolding.

‘They did not 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.

‘[The carers were also unable to] understand the difference between ‘alert’ and ‘alive’, which presented all of the same problems as referred 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.’

The inquest concluded Mrs Rymell had died of misadventure as a result of her fall, a combination of her dementia and frailty and ‘mechanical obstruction of respiration’.

But Mrs Marsh said she had been shown evidence that at least one the carers’ understanding of English did not meet the standards required to work in the Britain.

‘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,’ she said.

‘[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.’

Addressing the government in her Prevention of Future Deaths report, Mrs Marsh said: ‘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.’

Mrs Marsh said she did not believe the current English test for foreign workers was appropriate for staff working in a medical setting.

She cited two examples where applicants were asked to fill in the appropriate missing word in the sentence.

‘The Court looked at evidence of the B1 English test,’ she said. ‘Examples from the paper were as follows: ‘I [XXX] that book last year’ (options are bought, have bought, had bought).

‘The town [XXX] 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.’

Mrs Marsh told the Home Office and Mrs Whatley that they have until the 22nd January 2024 to respond to her concerns.

‘In my opinion action should be taken to prevent future deaths and I believe your organisation has the power to take such action,’ she said.

MailOnline has approached South West Care Homes for comment.  



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