How a misleading headline turned NHS guidance into a culture war myth
This Telegraph headline is not true.
The subheading is not true.
The first paragraph is not true.
And I don’t believe any of this was a mistake…
The story
The Telegraph broke this story about diversity and inclusion training delivered by the Lancashire NHS Trust with materials originally published in 2024.
Unfortunately, the document itself is not publicly available online, so I can’t do a deep dive into the source material, but I can use the Telegraph’s own article for clues and some context, as they extensively quote the document.
The article covers several areas of the training, such as referring to someone as they/them if they don’t know the sex of the person involved, and using the word “chairperson” rather than “chairman”, but the section that grabbed the headline spot was the section on idioms.
Idioms
An idiom is “an expression whose meaning is not predictable from the usual meanings of its constituent elements”, such as kick the bucket or hang one’s head.
So idioms are, by their very definition, impossible to understand for non-native English speakers, or just anyone who hasn’t come across them before!
The Telegraph quoted directly from the Lancashire training material:
Cultural sensitivity
Be aware of cultural differences and avoid idioms (idioms are phrases that are common in a language or culture that mean something different from how they literally sound, such as “the early bird catches the worm”) or phrases that may not translate well across cultures.
Two points to note:
- The guidance says to “be aware of”; it does not ban the use of idioms, or “order staff not to use” them.
- The idiom that they used to illustrate this was “the early bird catches the worm.”
The Telegraph went on:
It adds: “English phrases or sayings like “it’s raining cats and dogs” may need to be explained to international colleagues or patients.”
Without access to the 17-page document myself, I don’t know if that sentence was in the same Cultural Sensitivity section or elsewhere. It feels safe to assume that if it had been linked to that initial paragraph, they would have quoted the whole paragraph in full. But instead, they’ve had to add it on as an extra.
Either way, it’s true that idioms such as “it’s raining cats and dogs” would need to be explained to international colleagues or patients, regardless of how good their English is. This should not be headline-worthy.
Other examples of idioms
When I posted a thread on Twitter and BlueSky about this story, people sent me examples of idioms they had come across that had caused confusion:
A day after I gave birth, I was asked by the midwife or nurse checking me whether I had “spent a penny”. I had been in the UK for almost 10 years by then and was fluent, but had never come across that idiom before and had no idea what she was asking.
As a 6-year-old staying in hospital on my own, I found everything very daunting. So when a nurse asked me if I wanted to “spend a penny”, I thought she wanted money.
She was very insistent, so I became very worried because I had no money with me, and I didn’t know why she wanted it.
As a child, I went to the GP, and he asked How are your waterworks?’ I didn’t understand, because in my family, waterworks meant crying. And I’m British.
I once told a Filipino nurse that a patient sounded like he had ‘a frog in his throat’, he panicked, ran towards him and asked where it had come from. It’s hard to change the way we speak sometimes, but we should remember that things don’t always translate well.
Given that around 20 per cent of all NHS staff are not British, avoiding phrases that can’t be translated literally makes sense.
Autism
There is also NHS guidance on autism that includes:
Some people on the autism spectrum understand language very literally. Avoid phrases that don’t say what they mean. Like “it’s raining cats and dogs”. Use clear, everyday language.
I hope we can all agree that, in healthcare especially, avoiding confusing or ambiguous phrasing that may be misunderstood or confusing to non-native English speakers, autistic people, or even children who simply haven’t come across that phrase before, would seem like a good idea.
So why the fuss?
The headline
Let’s take a look at the Telegraph headline again:
NHS claims its “raining cats and dogs” is culturally insensitive.
Firstly, the idiom that was actually used in the Cultural Sensitivity section was “The early bird catches the worm”.
If you’ve been reading my Substack for a while, you might already have an opinion as to why the headline writers at the Telegraph went with “Raining Cats and Dogs” rather than “Early Bird Catches the Worm”. More on that shortly…
Secondly, saying ‘let’s be culturally sensitive and avoid idioms that other people may not understand’ does NOT mean the idiom itself is culturally insensitive.
The training material does not suggest that the phrase “it’s raining cats and dogs” is culturally insensitive.
On to the subheading:
Doctors and nurses in Lancashire told some idioms risk offending ‘international colleagues or patients.’
Notice the quotation marks around ‘international colleagues or patients’, which do not include the word offending.
That’s because the guidance didn’t say anything about offending anyone. The ‘international colleague or patients’ quote comes from:
“English phrases or sayings like “it’s raining cats and dogs” may need to be explained to international colleagues or patients.”
Saying that idioms may need to be explained to non-native English speakers does NOT mean those phrases will be considered offensive to them.
The Telegraph produced many quotes from the guidance, which is, unfortunately, all I have to go on, but none of them back up the claim that anyone is offended by idioms. Given how extensively the article quotes the document, it’s notable that no such claim appears.
The article conflates two entirely different ideas:
- Comprehensibility (will someone understand this?)
- Offence (will someone be upset by this?)
The NHS guidance addresses the first, while the headline invents the second.
Lancashire NHS Foundation Trust
The Telegraph published the response from the Trust:
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.
Islamaphobia
Given that the section on Cultural Sensitivity specifically mentioned the idiom “the early bird catches the worm” and not “raining cats and dogs”, why did the Telegraph not use the following headline?:
NHS claims “the early bird catches the worm” is culturally insensitive
Unfortunately, we have no way of knowing why the Telegraph decided that “raining cats and dogs” was a more click-worthy phrase than “the early bird catches the worm”. It’s a mystery…
But if you look at the comments on the article or any of the discourse on social media, you will see the (ironically) Pavlovian response to the word “dog” in any story about “foreigners”. They jump to shouting about Muslims and spew the most revolting Islamophobia.
GB News knows this, too. Their headline was:
NHS orders staff not to say ‘it’s raining cats and dogs’ over fears it will offend foreign patients
The Sun went with:
WOKE FURY ‘Raining cats and dogs’ & ‘early bird catches worm’ are now dubbed OFFENSIVE phrases by ‘woke’ NHS in new 17-page guide
The Daily Mail:
Doctors told to avoid phrases such as ‘raining cats and dogs’ and ‘the early bird catches the worm’ to avoid offending foreign patients
This predictably led to right-wing accounts on Twitter posting tweets such as:
God Save Great Britain@GSGB01
🚨WOW: The NHS has ordered staff not to use the phrase ‘It’s raining cats & dogs’ in fear of upsetting people from other cultures and religion. Britain has gone absolutely insane.
10:18 AM · Apr 19, 2026 · 188K Views
1.05K Replies · 1.9K Reposts · 6.41K Likes
And that is how we get from:
NHS guidance on trying to use language that is clear and easily understood by everyone
to
“The NHS has ordered staff not to use the phrase ‘it’s raining cats and dogs’ in fear of upsetting people from other cultures and religions.”
If the Telegraph had run with the more obvious “early bird catches the worm” headline, no one would have made the jump to religion and Muslims.
Critical assessment
As I said at the start, the heading, subheading and first paragraph are all factually incorrect:
- The NHS did not claim “it’s raining cats and dogs” was culturally insensitive
- Staff were not told idioms would “offend” anyone
- Staff have not been “ordered” not to say “it’s raining cats and dogs”
As a rule of thumb, if you see any headline in any right-wing media that suggests something British is offending a particular group of “foreigners”, you need to take it with a bucket load of salt! (Excuse the use of an idiom there!)
- Pay close attention to quotation marks, particularly in headlines, and notice what is included and what is implied.
- Always read the article in full – the reality will usually be buried somewhere near the end.
- Try to locate the source document being discussed when possible for vital context.
- Stay sceptical of all culture war or WOKE headlines…
This article first appeared on Emma’s superb SubStack blog, Monk Debunks, to which you can subscribe.
