English language tests for overseas nurses: too hard, or not tough enough?

Amid concerns that the NMC’s English language standard for overseas nurses is too high, and is a significant barrier to recruitment, employers are urging the regulator to think again.


Amid concerns that the NMC’s English language standard for overseas nurses is too high, and is a significant barrier to recruitment, employers are urging the regulator to think again

Many feel the English test is too hard, but the NMC says it has to be robust.
Picture: Alamy

Hayley Purcell admits she felt apprehensive about receiving the results of a test designed to ensure she was proficient in English.

After months of preparation, at a cost of several hundred pounds, the Australian had achieved a very good result overall, with 7.5 out of a possible nine in the International English Language Testing System (IELTS).

However, her failure to reach the required score in just one of the exam’s four components means her dream of living and nursing in the UK has been put on hold, perhaps forever.

‘I missed out by half a mark,’ says Ms Purcell, 42, an emergency nurse in Adelaide. ‘When I saw the results, I went a bit numb, then I got angry and ended up crying with frustration. “How could it be like this?” I thought. It’s such an obstacle. 

‘I also find it a bit insulting,’ she adds. ‘I’ve been speaking English all my life, and I’m obviously able to do it.’

Long, costly, unfair

Nurse recruitment is an issue across the UK, with internationally trained nurses traditionally used to fill gaps. But there are concerns that the language requirements for overseas nurses, which are set by the Nursing and Midwifery Council (NMC), are not pitched at the correct level. 

While some, including the Royal College of Surgeons, have suggested the level is not high enough, others say the current requirements are too stringent and have urged the NMC to think again.

Ms Purcell’s plight is all too common, according to leading healthcare staffing agency HCL Workforce Solutions. In a report published in April, the agency says efforts to recruit overseas nurses are being stymied because they have to score a minimum of seven out of nine in each of the four components of the test.

HCL operations manager for international recruitment Teresa Wilson, one of the report’s authors, warns that the process takes too long, is costly and unfair, and is preventing nurses who want to work in the UK from taking up posts. 

The report, IELTS and Declining Nurse Recruitment; Don’t Blame Brexit, points out that UK nurses only need grade C in GCSE English, and that the average IELTS score for native English speakers is 6.9, lower than the pass rate required for overseas nurses.

‘We have to look at it dispassionately, and we don’t have evidence that it’s too high – it’s on a par with other UK regulators’

Emma Broadbent

HCL’s own statistics show that less than a fifth of its European Economic Area (EEA) and other overseas nurses have achieved IELTS academic level seven. It cites examples from trusts across the country that have found the language requirements a barrier to recruitment. 

For example, at the Royal Wolverhampton NHS Trust just eight out of 220 overseas nurse applicants met the required level. ‘Of course, it is important that nurses speak good English, and language testing is an essential step in recruitment of overseas nurses,’ says Ms Wilson. ‘But the current system means people are being trained to get through the exam, not be a better English speaker.’

The NMC has agreed to look at the issue again, following feedback from oranisations, but its director of registration and revalidation Emma Broadbent says it isn’t clear-cut.

‘Some people feel it’s getting in the way of recruitment, but others think the standard is right, or not high enough,' she says. 'We have to look at it dispassionately, and we don’t have evidence that it’s too high – it’s on a par with other UK regulators, and lower than some.’ 

Must be robust

At its meeting in July, the NMC agreed to review the written element of the exam, the part that most people struggle with, says Ms Broadbent. It will also be looking at other language tests to see if they would provide a suitable alternative. 

But she believes it would not be right to change from the ‘academic’ to the ‘general’ IELTS exam. ‘Nursing is a graduate profession and our view is that an academic test seems appropriate.’

She says the NMC wants to be fair, but stresses that its role is to protect the safety of the public. ‘Nurses are speaking to people, and they have to listen to people, including those whose first language isn’t English. They also have to keep good patient records. It has to be a robust test,’ she says. 

Asked about whether she believes the IELTS test is adding to nurse recruitment difficulties, Ms Broadbent is quite clear. ‘The NMC is not here to solve workforce issues,’ she says.

‘What is emerging is a recognition of the need to be confident that the language requirements are fit for purpose, rather than a blunt instrument’

James Buchan

Workforce expert Professor James Buchan, of Queen Margaret University in Edinburgh, says the NMC language requirements have had an impact on the number of applicants, and the time taken to process applications. 

‘Ease of registration should obviously not be the priority – that should be patient safety and protecting the public,’ he says. ‘But what is emerging is a recognition of the need to be confident that the language requirements are fit for purpose, rather than a blunt instrument,’ he adds. 

‘If an outcome of any change is that the registration process is made more straightforward, then that is an added bonus.’

Even before the new language requirements for EEA nurses came in, some employers had taken the decision that overseas recruitment was not proving cost-effective. 

Good retention

‘Retention of staff recruited from the EU has been good, with low attrition. However, the last recruitment of overseas staff happened before the current requirements for IELTS were introduced,’ says Amanda Cheesman, assistant director of nursing with Wrightington, Wigan and Leigh NHS Foundation Trust, which has decided to focus instead on ‘growing’ a local nursing workforce. 

‘The decision was made before Brexit that we would not be pursuing any further international recruitment for the foreseeable future,’ she says. 

Others, however, are taking steps to try to improve the pipeline of new nurses and avoid excessive agency costs, including paying the IELTS fees of prospective employees.

Meanwhile, in Australia, Ms Purcell is watching and waiting, hoping that the NMC will change the system so that she does not have to sit the IELTS exam again. ‘I could have been a long way through the process of moving to the UK by now,’ she says. ‘I would still like to live and work in the UK but I don’t think I could go through it again.’

How do the NMC requirements compare?

The International English Language Testing System (IELTS) is used to test English language proficiency. It works on a scale of one to nine – where nine is ‘expert’ and one is ‘non-user’ – and tests skills in four components: listening, reading, writing and speaking.

There are two versions of IELTS: academic, for people applying for higher education or professional regulation, and general. IELTS is used by many regulators, including the NMC, which requires overseas applicants to the register to achieve an overall average IELTS score of seven out of a maximum of nine.

Applicants have to score seven or higher in each of the four components. The rules for EEA nurses were brought into line with those for non-EEA countries a year ago. 

NMC requirements are less stringent than those of the UK doctors’ regulator: the General Medical Council insists on an overall average of 7.5, again with a minimum of seven in each of the four components.

Requirements also vary around the world. According to the NMC, nurses in New Zealand must achieve the same standard as in the UK but midwives must achieve an overall average of 7.5 or above.

Jennifer Trueland is a freelance health writer 

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