Healthcare professionals, including doctors and nurses, have been advised to steer clear of expressions like ‘the early bird catches the worm’ and ‘it’s raining cats and dogs’ to ensure they don’t inadvertently offend international patients.

This directive comes from the Lancashire Teaching Hospitals NHS Foundation Trust, which has incorporated this guidance into its diversity and inclusion training. The Trust emphasizes that such phrases might not resonate well with people from different cultural backgrounds and could require additional explanation for both international patients and colleagues.

Aimed at cultivating an inclusive atmosphere, the guidelines also propose avoiding terms such as ‘chairman’ and ‘mankind,’ suggesting ‘chairperson’ and ‘humankind’ as more inclusive alternatives.

The comprehensive 17-page document underscores the importance of using language that is both considerate and inclusive. It suggests that adopting such a communication style is vital for fostering a healthy society.

By promoting an inclusive environment, the NHS aspires to more effectively address the diverse needs of the communities it serves, ultimately contributing to a more robust and healthier society.

‘By fostering an inclusive environment, the NHS can better meet the diverse needs of the populations it serves, ultimately leading to a healthier society overall,’ it adds.

Critics said the training manual, first issued in November 2024 and reviewed every three years, reads like an April Fool’s joke and cautioned that the policing of language in the NHS was on the rise.

The trust, which runs Royal Preston Hospital and Chorley and South Ribble Hospital, spent £100,723 last year on salaries for diversity and inclusion staff and has faced mounting financial pressure.

People in Trafalgar Square shelter under an umbrella while it is ‘raining cats and dogs’ (raining heavily)

It was placed in financial special measures last year after recording a £42.1million deficit since the previous November.

NHS England subsequently warned that directors could be replaced if the financial situation did not improve.

The trust employed the equivalent of 2.3 full-time equality and diversity staff in the 2024/25 financial year.

The highest-paid earns £48,526, while newly advertised nursing roles offer salaries of £31,049.

The document says: ‘English phrases or sayings like “it’s raining cats and dogs” may need to be explained to international colleagues or patients.’

The guide recommends avoiding other worlds such as ‘guys’, suggesting ‘gender neutral terms’ such as ‘colleagues’, ‘team’ or ‘members’ as alternatives.

It also instructs employees to use ‘they/them’ instead of male and female pronouns if the gender of a patient is unclear.

Early bird catches the worm – a robin fights with a strong worm in the early morning on the lawn

Lord Young, founder of the Free Speech Union and Tory peer, said the NHS guidance could lead to witch hunts against staff members for using everyday terms.

He told The Telegraph: ‘This sounds like an April Fool, but the reality is that these busybodies are constantly churning out new language guides, banning an ever-increasing number of words and idioms.’

Lord Young said guidance such as this will gradually result in more employees being investigated for being culturally insensitive.

He added: ‘The result is that more and more NHS employees, particularly older employees, are finding themselves under investigation for being “culturally insensitive”, which is code for “racism”.

‘If you’re not fluent in “woke-ish” – which is a constantly changing modern dialect – you will eventually be cancelled.

‘Indeed, that may be the point of this language policing – to force older employees to take early retirement and make way for more pink-haired zealots.’

A Lancashire Teaching Hospitals NHS Foundation Trust spokesman said: ‘As a large specialist Trust, we are proud to have a diverse workforce and to serve people from many different communities.

‘It is well known that certain informal phrases or idioms are not always easily understood by everyone, including people with autism or whose first language is not English, so it makes sense to raise awareness of this.

‘This helps ensure that within our busy hospitals, communications with our patients and colleagues are as clear and effective as possible.’