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EU nurse recruitment set to decline with new language testing rules


The recruitment of European Union nurses is expected to become increasingly difficult following the introduction of new language testing rules, a government advisory body has been warned.

The Migration Advisory Committee was asked by the government to review whether nurses should remain on the shortage occupation list, after they were temporarily placed on it last year following national recruitment problems.

In its report, the committee recommended “reluctantly” that the profession be retained on the list, a move that will make it easier for trusts to employ nurses from outside of Europe.

As part of its investigation into the workforce, the committee was told the supply of nurses from within the European Economic Area – comprising the EU and other countries including Norway and Iceland – was “drying up”.

It was told the standard of recruits from these countries was declining and that there were concerns nurses would not be able to pass the new language tests being brought in by the Nursing and Midwifery Council.

“New language training requirements for registrants from the EU will further reduce the numbers of nurses wishing to come to the UK”

TTM Healthcare

The new rules, introduced on 18 January, require EU nurses to pass a test showing they are proficient in English if they cannot provide other evidence demonstrating their language skills.

Nurses must pass the test – the International English Language Testing System (IELTS) exam – with a minimum score of 7.0, which has been previously suggested to be at too high a level.

Comments made to the advisory committee by recruitment agencies, the Department of Health and “many other partners” echoed these concerns.

They said the ability of employers to recruit nurses within the EU was set to “further decline with the introduction to the nursing registration requirements of an increased standard of English language ability”.

In its evidence to the committee, the recruitment agency TTM Healthcare said: “The introduction of the new language training requirements for registrants from within the EU will further reduce the numbers of EU nurses wishing to come to the UK, which will put even greater pressure on the need to recruit overseas nurses.”

Nurses from outside the EU are already required to pass the IELTS test with a minimum score of 7.0.

But the report noted these nurses, from countries such as India and the Philippines, tended to have better English language skills than applicants from the EU due to the language being commonly spoken in these places.

The concerns over the impact of the new rules come at the same time the NMC has seen a surge in EU applications ahead of the change.

Recent NMC council papers revealed that in just one month the number of applications to work in the UK from EU nurses almost tripled, rising from an average of 700 a month in 2015, to 1,977 in January.

NMC chief executive Jackie Smith said it was “human nature” for people to apply before a change in rules, and that the regulator “couldn’t reach any conclusions to imply those are people who potentially don’t have the communication skills required”.


Readers' comments (11)

  • Well...good I guess.
    I would say that it amazes me that they weren't already requirements in place but it doesn't. Just the other day after three attempts at conversing with her nurse in English my mother had to switch to Spanish to make her understand her question! Due to her good grounding in foreign languages from her travels she was eventually able to get what she needed and no harm was caused by this arrangement but other service users won't be so lucky... Are we so desperate for nurses that we'll let those that can't even get 7/10 English words right care for the sickest and most vulnerable members of our population?

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  • I support of Anonymous @ 4.30pm, language and communication in real-settings is more important than testing in the general. I have worked with perfectly nice nurses, with good command of English, but were very poor at communicating that they were actually talking to you. Information was spoken with no sign-posting as to who it was they were speaking to. As such, it was not understood that a piece of information had been given to a particular person. In the example I gave, much of this could have been dealt with as part of an on-the-job probationary training. And by a Clinical Facilitator not via the ward staff training. Phrases such as 'excuse me (insert name)', then, after knowing you have a specific persons attention, proceed with what you intend to communicate.

    Would this be acceptable in a science lab? Or in surgery, regarding those assisting the surgeon? What about school teaching? Until Britain funds training, with space enough for clinical practice, you will source people from poor/less wealthy countries. Why Labour don't attack this practice as racist and imperialistic, I fail to understand. We are not attracting African-Americans with 2-degrees, who have a pull towards the first-line basic ward setting, and might transform practice and policy. Oh, no! We simply need to plug a gap in the most cost-effective (at first glance) way.

    I have a hearing impairment. Sound travels forwards, not backwards. Generally, getting anyone to have their face in eye-line is difficult enough. This is basic manners and commonsense. If people struggle with that, telling them you are hearing impaired will mean nothing as they don't understand hearing and distracting pitch sounds in the environment. That relates more to communication, not language ability. So it is relevant across the board.

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  • Minimum 7.0 in each of the four components! And that's the problem. IELTS test is an absurd and many of us call it the last UK Border Agency Officer.
    It is do-able though. I scored overall 8.
    PS. Only 1% of the native speakers achieves 9. That shows how difficult it is.

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  • As a South African nurse I passed the test on my 2nd attempt. The first time I failed by 0.5.
    I respect the standards however felt it was unfair that nurses from the EU were not subject to that entry test ( this was around 2013). South Africa and including Australia,New Zealand, Canada would have been required to undertake this test.
    Lastly I would say that it seems more reasonable to pass the non academic version as opposed to the academic version. The academic version was pretty steep and perhaps not quite necessary.

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  • Well it's ab

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  • I agree totally that we need a English language requirement, after working with a Greek RN who just smiles, as she does not understand what is being asked of her and just keeps saying yes thank you in response to any question, the good old NHS, are we so desperate we will put our patients and other members of staff at risk to employ a nurse WHO DOES NOT SPEAK the native language.

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  • It's outrageous that any Trust would consider employing staff who do not speak English. How are unwell patients supposed to communicate? If Brexit will keep poorly qualified nursing and medical staff out of this country, then bring it on.

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  • being able to comunicate and passing IELTS wilt 7 at academic level are too diffrent issues. 6.5 would bo more then enough

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  • I am a British citizen with a Bachelor of Nursing and a Master of Nursing in Australia. I thought it would be easy to transfer my APHRA registration to the UK, but I discovered that, as I qualified “overseas” and not in the EU, I have to go through the “overseas pathway”. I even have to take the IELTS test, despite having lived in the UK for over 50 years, having spoken English all that time, having been educated here, having ‘O’ and ‘A’ levels in English, and a BA (Hons) in English. I have also had two articles published in nursing journals, one of which was in the Journal of Advanced Nursing. I made enquiries with the NMC concerning the IELTS test, but was informed that there are no exceptions for “overseas” applicants, even if English is my first language. Ironically, I didn’t even have to sit the IELTS test in Australia, as my English qualifications were accepted there as proof of my competence.

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  • A copy of a letter of complaint recently sent to the NMC

    To whom it may concern,

    I'm writing to feedback some constructive criticism regarding the NMC's current language requirements for overseas applicants to the position of registered nurse in the UK. I have been introduced to it by way of my French partner, a registered nurse in France who has moved with me to the UK, and the IELTS process she is having to undergo in order to register here.

    The primary issue is that I am stunned and bemused by how high the bar has been set. I am, as any sensible person ought surely to be, in complete agreement that in a healthcare system where many potential employees are coming from many corners of the globe, a certain facility with the native language needs to be guaranteed. In fact I was a little shocked to learn that this has only been in effect since January of this year. Better late than never I suppose. But when I learnt that the required pass rate is higher than that necessary to embark on a PhD in Clinical & Health Psychology at Edinburgh University to choose one example, or to just under that which is required to study a PhD in Classics at Cambridge University to offer a second example, or the equivalent to that which is required to study medicine at Oxford University, I began to wonder, with what seems like profound understatement, if perhaps the bar is being set a little on the high side. Or in the words of anyone I've mentioned this to, once their jaw has been guided unblinkingly back into position: 'That's absolutely crazy!!' - which is the polite way of putting what is normally expressed in much more colourful euphemism - and in fact there then normally follows a period of continued wide eyed incomprehension and bemused silence while they attempt to ascertain if I'm being serious. I've never before had such an effective tool to induce dumbfounded incomprehension and jaw-dropping paralysis to any given audience as this. So much so in fact that I'm considering suggesting to the home office that our policing department phase it in to replace tasering, it's just as affective at stopping people in their tracks and has none of the associated side effects of electric shock.

    And to imply, which this surely does, that this facility with the English language is the equivalent of a native applicant to, or current employee of, the nursing sector, or many other sectors for that matter, well you might as well try and convince me that the earth is flat after all, or that you've looked into it and after serious exploration and deliberation, you've concluded that 2 plus 2 equals 5.

    To quote someone else commenting on this subject on the Nursing Times website:

    "The required IELTS level of 7.0 in all four sections is, frankly, ridiculous. It represents the same level as that required of doctors and a HIGHER level than you'd need to gain entry to most UK universities for graduate and even post-graduate studies. It is also known that 50% of applicants from English-speaking countries such as Australia and Canada fail to reach this standard on their first attempt. I would also postulate that 50% of the current UK-trained nursing workforce would fail to achieve 7.0 across the board, particularly on the writing section."

    And while safe practice is of course paramount, the same person goes on to to say:

    "The stated purpose of this requirement is to ensure that EU nurses have "sufficient command of English in order to practice safely": this epithet is used repeatedly in dismissing all the objections raised. And yet, by the NMC's own admission (in another recent document), there has never been a single case brought before the NMC where a nurse's language ability compromised patient safety. Not one, in all the years that overseas nurses have been propping up the NHS. NOT A SINGLE ONE! So all of this is to guard the British public from what?"

    So the question arises: Eh? I could understand it if the NMC were an organisation established to deliberately dismantle and undermine the NHS from within, because if so cutting off the supply of nurses to an already depleted arena would be a perfect, if slightly unimaginative strategy. But as I understand it this is not in fact the NMC's stated objective. On the contrary it is a regulator with the sole responsibility of setting and reviewing standards. Well all I can say is that I hope the Reviewing Department is by far more competent than the Setting Department. Unfortunately though after some further research it seems a review and consequent amendment has already taken place, the end result being the opening of the door by a portion of a fraction of an inch. So now the required results of 7 in each category can be achieved over 2 sittings of the test as long as no single score on either attempt is below 6.5. Wow that really does take the door from being firmly closed to barely ajar, just watch those applications flood through. And I'm sorry to engage in mild sarcasm but how about adopting a modicum of common sense here and setting the bar say no higher than that needed to read English and Related Literature at York University: 6.5 average with no single score below 5.5. It's just that it seems to me, and I imagine to anyone else with even the slightest talent for rational thought, that if this is good enough for entry to an English Literature department at one of our top Universities then it should be more than good enough for entry to our nursing profession. You may, and I fear will, though I hope not, be inclined to dig your heels in and continue to argue that black is white, probably to avoid an embarrassing climb down as much as anything, but please try and put any arising vanity and pride aside and acknowledge that you've got this spectacularly wrong. The consequences of not doing so can surely have no other effect but than to hurt our nations healthcare services by removing the one thing necessary above all else: the provision of staff.

    And I know from personal experience, which is admittedly anecdotal evidence, but never-the-less my partner understands and is understood in all our social situations (and by that I mean society at large not just friends) and that she has a proficiency with the language that is more than adequate to meet the demands of the profession she is trained for, and is an exemplary member of. In France she was picked out for special praise for her qualities of compassion, organisation, commitment to help and improve the lives of the patients in her care, and you are about to lose her, and I can only assume countless others, because she can't face going through this test another time, having failed to get to these ridiculously high levels twice already, and at considerable cost I might add - £150 each time for a test that takes a morning plus a 15 minute speaking test, when by comparison I have recently enrolled on a 5 week evening course at the very same price at a local university. Then, to continue this aside, you learn that these test centres are run for profit when they have a monopoly on the tests and that overseas nursing applicants (as well as many others I imagine) have no choice but to sit them, and these are often people who can little afford it. Fortunately for my partner I am able to support her, but that more than likely only makes her one of the lucky ones. In any case she is turning her mind to trying a different something else so that she can pay the bills. One more nurse goes by the wayside then. And that counter must be steadily rising.

    And to re-iterate the point let us not pretend that this required level of English represents anything like the norm with regard our native nurses. I would be willing to bet that if you tested all British/native English speaking nurses currently registered in the profession, that a tiny minority would achieve these levels in all four categories (especially written), and that is not an indictment on them but on the NMC and the bar that's been set.

    Randomly selected examples of IELTS requirements for entry to Universities for overseas students:

    University of York:

    Degree in English and Related Literature - Overall 6.5 with no less than 5.5 in individual elements.

    Degree in Law - Overall 6.5 with no less than 6.0 in individual elements.

    University of Edinburgh:

    PhD in Clinical & Health Psychology - Overall 6.5, with no less than 6 in individual elements.

    PhD in English Literature; also in English Creative Writing - Overall 7, with no less than 6.5 in individual elements.

    MSc in Modern & Contemporary Art: History, Curating & Criticism - Overall 7, with no less than 6.5 in individual elements.

    University of Oxford:

    Degree in Medicine - Overall 7.0 with no less than 7.0 in individual elements.

    University of Cambridge:

    PhD in Classics and also in American Literature - Overall 7.5, with no less than 7.0 in individual elements.

    And I could fill pages with these examples.

    Please acknowledge receipt and serious consideration of this complaint.

    Yours in bewildered hope,

    Mr J Gosling

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