Overseas recruits’ English exam: a proper safety check or red tape?

The director of workforce at a trust that struggles to recruit nurses from outside the European Union because many fail to pass the required English test decided to sit the exam himself.

Thomas Simons of East and North Hertfordshire NHS Trust wanted to understand the challenges faced by health professionals abroad who want to work in the UK.

Prospective UK registrants boost their chances with language training so they can achieve the required score on the IELTS exam

Picture credit: Alamy

The International English Language Testing System (IELTS) exam is used by the Nursing and Midwifery Council to ensure nurses trained outside the EU have the language skills necessary to communicate and practise safely in the UK.

Prospective registrants must complete the academic version of the test, scoring at least seven in the listening and reading categories and the same in the writing and oral sections.

A minimum overall score of seven out of nine is required by the regulator for non-EU trained nurses before they even apply to be registered. From January this year EU-trained nurses could begin to use the same test score as evidence their English is up to standard.

Nursing is now on the shortage occupation list and the Migration Advisory Committee said last month that the profession should stay on the list because of national shortages.

However employers are concerned the threshold required by the NMC is too high and that the health service is missing out on vital nursing talent.

Mr Simons wrote to the NMC with a number of suggestions for tailoring the system to make it easier to recruit from abroad. One of his ideas is lowering the pass mark to 6.5.

Trust representatives have been recruiting in the Philippines and the organisation is helping 140 nurses waiting to work in the UK with their language skills so they can achieve the required score.

‘I wrote to the NMC outlining concerns I had about how the IELTS was being applied to overseas nursing recruits,’ Mr Simons explains.

‘In doing this, I sat the test myself to understand the challenges our colleagues recruited from other countries faced.’

Mr Simons found parts of the reading test unnecessarily complex and felt the listening test was too complicated, with questions having little relevance to nursing (see box).

Sample question from the IELTS academic writing test

You should spend about 40 minutes on this task.

Write about the following topic:

The threat of nuclear weapons maintains world peace. Nuclear power provides cheap and clean energy.

The benefits of nuclear technology far outweigh the disadvantages.

To what extent do you agree or disagree?

Give reasons for your answer and include any relevant examples from your knowledge or experience.

Write at least 250 words.

‘Representatives of the NMC have been in contact about the concerns raised and I do hope they will start to address them soon, given the pressures faced by the NHS in filling vacant nursing posts.

‘As stated in my letter, I support completely the requirement for a level of language proficiency, but this has to be balanced against the wider patient risks from the over-reliance on agency staff.’

Royal Wolverhampton NHS Trust has been acting as the lead for an overseas recruitment hub for the West Midlands. It has made about 400 offers of employment to nurses from the Philippines arising out of trips to the country since the end of last year. Yet only four have started working for the trust so far.

Director of human resources Linda Holland says: ‘Converting offers we have made into nurses working at the trust is proving to be a painful and protracted process – the main issue being the IELTS.’

Ms Holland, together with the trust’s chief nurse Cheryl Etches, recently met the NMC to propose changes to the IELTS scoring system.

‘We would never compromise patient safety in any way,’ said Ms Holland. ‘We asked them to consider accepting an average score of seven across all categories.’

She said the trust established that with its proposed changes, 58 of the 95 nurses who have sat the test, would have passed. Under the current system, only five did so.

‘This is the sort of evidence the NMC hasn’t seen before and we brought up the fact nurses are having to sit the test multiple times,’ she said.

A nursing education team at the trust is working with the nurses to provide them with pre-test support.

‘It costs the nurses half their monthly salary to take the test. They may be able to fund it once or possibly twice, but beyond that they would be struggling,’ says Ms Holland. ‘We have been looking into making an upfront investment to help with cost, but it is a complex conversation to have as there are no guarantees.’

The trust also employs nurses from Spain, Portugal, Italy and Greece, and has run training for staff who qualified overseas to help them with the Black Country dialect.

Number of overseas-trained nurses joining the NMC register

Patient complaints

But Patients Association chief executive Katherine Murphy says that the organisation’s helpline has been receiving calls from patients complaining of communication difficulties with nurses from other countries, and a lack of understanding of processes and procedures.

She says: ‘Many hundreds of nurses from other countries make a valuable and important contribution to healthcare in the UK. However, it is essential the public has confidence that the care they receive is safe.

‘The NHS must ensure nurses can communicate’

– Katherine Murphy

‘The NHS must ensure nurses from other countries are competent enough in English to communicate.’

Head of IELTS at the British Council John Gildea, says an overall score of seven is often specified by employers who want to be sure the people they recruit have the ability to communicate effectively in English in a wide range of real-life contexts.

‘IELTS is taken by more than 2.5 million people annually and trusted by governments, universities, healthcare providers and other employers worldwide,’ he adds.

Unite professional officer for regulation Jane Beach argues that given nurses must be able to communicate with the patients they are caring for, the IELTS should be retained in its current form if deemed the most appropriate test.

‘Any changes should not cover up the government’s lack of workforce planning, which has created shortages and we shouldn’t be putting patients at risk to make up for it,’ she says.

NMC chief executive Jackie Smith says: ‘Any changes we may make in the future will be evidence-based and will not undermine public protection.

‘We are mindful of the staffing pressures in the health service and we are looking at how we can be flexible with the way our language requirements are met, while retaining the IELTS level.’

RCN director of nursing, policy and practice Donna Kinnair says: ‘Language competence is paramount and it’s right the NMC works to ensure staff have the language skills to do their jobs.

‘However, with a nursing shortage, the NHS needs staff from overseas to ensure safe staffing levels are met. It’s therefore important recruits get these tests in a timely manner, and that the quality and impact of the tests are monitored.

‘Employers too have a role to play in making sure recruits are supported in their language skills’.

See feature page 18

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