There is no getting around the death of Barbara Rymell. When I read the Telegraph’s story about this 91-year-old who died while care home staff struggled to speak English to a 999 operator, it sounded too tailored to anti-immigrant prejudices. Surely this was nothing more than sensationalist reporting. Then I read the Regulation 28 report issued to the Home Office and the Department for Health and Social Care. The Coroners and Justice Act 2009 requires coroners to report any circumstances which they believe could create ‘a risk of other deaths’. The report in the Rymell case, prepared by the senior coroner for Somerset Samantha Marsh, does indeed raise concerns about the English language skills of care home staff and does so in fairly stark terms.

On 8 August last year, Rymell was left unattended on a stair lift at Ashley House residential home in Somerset. This was despite the risk assessments saying she was too physically and cognitively incapable to use the machine on her own. Marsh determined that Rymell, left sitting there, had attempted to climb the stairs herself but had fallen, ‘causing her head to become wedged in between the chair seat and the stairs at an awkward angle’. This impaired her breathing and staff were unable either to free her or administer first aid. She was pronounced dead upon the arrival of the paramedics. The death was recorded as misadventure with ‘mechanical obstruction of respiration, presumed fall downstairs’ and ‘senile myocardial atrophy, dementia, general frailty’.

According to Marsh, neither of the two carers on duty that evening were ‘native English speaking nationals’, one being Romanian and the other Indian. After finding Rymell lying on the stairs with her head trapped under the chair, one of the carers called 999. However, the coroner says it was ‘obvious that neither of the care staff were sufficiently proficient in English’ to ‘explain clearly the nature of the medical emergency’. Their grasp of English was so limited that they didn’t understand the difference between ‘bleeding’ and ‘breathing’ or ‘alert’ and ‘alive’. The coroner said the carers’ inability to understand basic English ‘made any meaningful triage of Barbara’s condition virtually impossible’ and ‘severely hampered’ the call handler’s attempt to find out if Rymell was conscious and breathing.

There is nothing in the report to suggest that the carers’ poor English was causative of Barbara’s death. Nonetheless, Marsh was sufficiently concerned by the findings to state that ‘there is a risk that future deaths could occur unless action is taken’. Specifically:

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.

She goes on to warn that ‘deaths will continue to arise’ where vulnerable people require emergency medical attention but are being cared for by staff ‘unable to speak the native language of England with any proficiency’. Acquiring a visa to work in the UK involves proving your ability to speak and understand English to Level B1 and passing a Secure English Language Test (SELT). Marsh, having looked at the Level B1 test, describes it as ‘comparable to a KS2 curriculum being studied by Year 6 students’. She concludes that it ‘appears to be wholly insufficient for those working in the direct care and protection of vulnerable people’. As for SELT, one of Rymell’s carers hadn’t actually passed the test, so according to Marsh ‘was not qualified or permitted to work in the UK’.

Perhaps this case is just a fluke. Perhaps there aren’t more widespread problems with the English proficiency of care sector staff. Perhaps it is highly uncommon for frail and vulnerable people to be left in the care of those who cannot communicate proficiently in an emergency. Perhaps it is unheard of for migrants to obtain a visa without passing SELT or while being unable to comprehend English at a Year 6 level. But given the dismal state of both the Home Office’s immigration regime and standards in the residential care sector, I suspect otherwise.

It would be easy for those of us who believe in legal immigration to avert our eyes from Marsh’s report

It would be easy for those of us who believe in legal immigration to avert our eyes from Marsh’s report. To pretend its glimpse into the skills profile of low-paid migrant workers is fatally skewed. To console ourselves that there are no lessons to be learned from this incident, only a tragedy to be weaponised by anti-immigrant bigots. This would be a mistake for several reasons, not least because believing in immigration is not the same as believing in the inalienable right of any sector of the economy to have uninterrupted access to cheap labour regardless of the risks. Nor is it the same as believing that we should overlook where the Home Office’s administration of immigration is dangerously slack and focus only on where it is objectionably harsh. Believing in immigration is not about burnishing your progressivism or signalling your high-status attitudes. It is about ensuring that the UK maximises the opportunities of inward migration while minimising its drawbacks.

Migrants who are unable to proficiently understand the primary language spoken in the country to which they have migrated is very much a drawback. If you cannot speak English with enough proficiency to make a 999 call, you should not be working in residential care. That is not an anti-immigrant statement and only the chronically London-brained would think otherwise. No one has an inalienable right to migrate here. If you get the opportunity to work in the UK, you accept obligations that you must meet or you render yourself ineligible to remain.

The carers’ English may not have made any difference to the timing of Barbara Rymell’s death.   The stated medical cause of death was unrelated. However, she deserved dignity in her final years. She deserved to die knowing that the people she was relying on to care for her could call for help quickly in an emergency. Regardless of the causes of Barbara’s death, Marsh’s report is clear that there is a risk in respect of future deaths.