Trusts have told Nursing Times they are finding it increasingly difficult to recruit from abroad, because nurses are taking several attempts to pass an English language test that has been criticised for being set too high.
Organisations are only able to employ a small portion of the nurses they originally planned to, because candidates are dropping out due to the problems with passing the test. It is exacerbating ongoing problems recruiting enough nursing staff to fill vacancies, trusts warned Nursing Times.
“We need to have an understanding about where candidates are struggling”
Meanwhile, those nurses that are able to achieve the required standard in the test – the International English Language Testing System (IELTS) exam – are taking between eight months and a year to do so, on average, creating major delays for trusts struggling to fill vacancies.
The Nursing and Midwifery Council brought in the IELTS language checks for overseas staff from European Union countries last year, in order to match the same system already in place for those coming from the rest of the world. Overseas nurses must pass the test before they can join the NMC register.
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But trust chief nurses are increasingly calling for the test to be reviewed over suggestions that it is more difficult than it needs to be.
Concerns were initially raised when it was brought in that the level required to pass – a minimum score of 7.0 across all elements of reading, writing, listening and speaking – was too high.
It was also claimed that the test only assessed academic knowledge of English, rather than focussing on more clinical elements of communication.
The nursing regulator saw a surge in applications from European nurses ahead of the test being brought in for EU applicants in January 2016, but registrations with the NMC from these staff have fallen over the past year.
Organisations have in recent years become more reliant on employing nurses from outside the UK due to shortages at home.
The EU had become particularly popular as a source for nursing staff, because it used to be possible to recruit within a couple of months – whereas other international nurses who were already subject to testing could take up to a year to pass and receive their PIN from the NMC.
However, since the introduction of language testing for EU nurses as well, the delays to recruitment are causing problems.
At Airedale NHS Foundation Trust, the organisation planned to recruit 50 EU nurses over the past year.
The trust’s interim director of nursing said the pool of recruits had shrunk since language testing had been brought in and that it was also taking far longer for candidates to secure their PIN.
“We have lobbied the NMC along with other trusts in our area”
It has employed 35 nurses so far, but 23 are still only able to work as healthcare assistants while they re-take the IELTS exam, even though they started at the trust between October and February.
“The European staff are taking those tests on a number of occasions and are just not managing to reach the scores – the average of seven across two attempts,” said interim director of nursing Jill Asbury.
“Those who started in October, we would have expected them to have passed their IELTS by now,” she said. “The fact that they haven’t is an issue for us, as we had planned for them to be in our workforce.”
Ms Asbury said she had been in conversations with the NMC about a possible review of the test to see if the level of pass could be reduced to below a score of 7.0, because she and other colleagues believed the bar had been set too high.
“We would like to see a review of the level. We need to have an understanding about where candidates are struggling. There will be other trusts than ours with greater numbers of European and international staff who they will be wanting to get through the IELTS,” she said.
She added that she also knew of other NHS trusts that tested candidates in their own countries, and which then saw a high number of recruits drop out if they failed the test.
At Peterborough and Stamford Hospitals NHS Foundation Trust, the time taken to recruit EU nurses has risen “dramatically” since the introduction of language testing, according to Helen Hutchings, the trust’s professional lead for nurse and midwifery recruitment.
Recruitment of nurses from outside the EU is also very challenging, with candidates taking on average six attempts to pass the IELTS, she told Nursing Times.
“We wouldn’t offer anyone a post before they have passed the IELTS in the future”
This means the quickest that the organisation has been able to take on nurses from abroad has been eight months since initial interviews – and some have taken up to two years.
From a recruitment campaign in 2016, the trust offered jobs to 47 nurses from the Philippines, but only 14 are currently working as nurses at the trust. Candidates who were taking too long to pass had their job offers removed.
“We had to make tough decisions to remove some candidates, after they were still trying to pass IELTS on their eighth or more time. Due to slow arrivals from the Philippines, we decided to go on two further recruitment trips to India in 2016, but we are seeing a similar picture emerging,” said Ms Hutchings.
She noted that IELTS experts she had spoken with were “quite clear” that it would be difficult even for a native English speaker to pass the IELTS exam.
She also highlighted that the trust only offered jobs to recruits who could already communicate to a high level at interview.
“We have lobbied the NMC along with other trusts in our area,” she said. “Although the NMC took action and allowed IELTS scores to be combined last year, this has had little impact.”
At Barking, Havering and Redbridge University Hospitals NHS Trust, chief nurse Kathryn Halford described similar problems with recruiting international nurses.
In April 2016 the organisation offered jobs to 170 nurses from the Philippines, but many have still been unable to pass the IELTS, while some have changed their minds about coming to the UK.
Around 50 have been removed altogether, because the trust’s policy is to cancel the offer of employment if a nurse fails the IELTS on two attempts.
This has meant it will end up taking on only 60 from that cohort – due to arrive between April and August – more than a year after they were interviewed.
“This is a significant problem for us, in terms of the cohort we recruited,” Ms Halford told Nursing Times.
However, while Ms Halford agreed the requirement for a score of 7.0 to pass was high, she said she did not believe it should be reduced.
Although she agreed with the change the NMC had already made last year – to allow nurses to combine scores from a first and second attempt.
“Our learning as a trust would be, we wouldn’t offer anyone a post before they have passed the IELTS in the future,” she said.
Meanwhile, a report by healthcare staff recruitment firm HCL Workforce Solutions – seen exclusively by Nursing Times – reveals that around 50% of the 1,972 nurses it has recruited from a sample of 14 NHS trusts since 2014 have either dropped out or been removed from the process due to several failed attempts.
Only 117 have been deployed and 887 are still going through the process.
The organisation’s director of permanent recruitment, Charlotte Fisher, and its operations manager for international recruitment, Teresa Wilson, told Nursing Times the difficulty of the test and increasing delays meant overseas nurse recruitment was reaching “crisis point”.
They also warned it came at a huge financial cost to trusts who often paid for candidates to take the IELTS, while filling the vacant posts with more expensive temporary staff in the mean time.
They called for a review of the test, saying even a small reduction to the level of pass would improve recruitment, while still ensuring nurses could communicate effectively.
“We are committed to working with organisations to better understand their concerns”
An NMC spokesman said it was aware of some of the concerns relating to its language testing, but that it did not “currently have any hard evidence on which to base a change”.
“IELTS is an internationally recognised means of testing language proficiency, which has been in place for over a decade,” he said.
“However, as a responsible regulator that continually looks at the suitability of all the standards we set, we have committed to looking at this standard and gathering further evidence over the coming months,” he told Nursing Times.
“We are committed to working with organisations to better understand their concerns but, at this stage, it is important to state that this decision does not indicate that we feel the current standard we require – IELTS level 7, is wrong or that we are committing to a change,” he added.