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New English test ‘improving’ overseas nurse access to UK register


Many more nurses are successfully passing a healthcare-specific language test that enables them to work in the UK, having tried and failed other tests multiple times.

The “much higher pass rates” reported for the Occupational English Test (OET) follow concerns that the only other test accepted by the Nursing and Midwifery Council was preventing competent nurses from taking up posts at trusts desperate to fill vacancies.

The NMC started accepting OET in November last year and, since then, the company that runs it has seen a huge surge in the number of candidates.

Early evidence presented at the first ever OET Forum held in the UK, suggests a much greater proportion of nurses who sit OET go on to achieve the required standards for NMC registration – grade B in speaking, listening, reading and writing.

Previously, the only way for overseas nurses wishing to practice in the UK to demonstrate their language skills was to take the International English Language Testing System (IELTS) exam.

However, there was concern the test – which purely tests linguistic ability – was getting in the way of recruiting nurses with the skills to practice safely in health and care services hit by severe shortages of qualified staff.

Results from a survey of candidates sitting OET found more than a quarter of those taking the test in the UK and Ireland – often healthcare assistants already working successfully in the NHS – had previously failed other English tests.

In all, the survey of more than 4,000 candidates – including 200 from the UK and Ireland – found nearly three quarters – 75% – had opted to take OET because it was specific to healthcare.

Meanwhile, 53% said they felt more confident about taking the test because it was content they could relate to, according to the survey by test administrator Cambridge Boxhill Language Assessment.

Sujata Stead, chief executive of Cambridge Boxhill, told the forum that numbers taking the test had shot up dramatically since it had been accepted by both the NMC and General Medical Council.

She said numbers had increased from five to 10 per month before NMC acceptance last autumn to almost 1,000 per month across the UK and Ireland.

Globally, the numbers taking the test have gone from 2,000 between August and September 2016-17 to 8,000 for the same period during the current financial year.

The company hopes to double the number of test centres across the globe within the next year, as well as increase the number of test dates with the aim of moving from one test per month to three or four dates per month in the future, she revealed.

The success of OET has been linked to the fact it tests language and communication skills within a healthcare context with nursing candidates asked to do tasks relevant to everyday practice, including role plays where they interact with “patients”.

The fact candidates can relate to the tasks and topics they are being asked to do means they are more likely to persevere with studying, with participants learning new and useful communication skills along the way, according to developers.

Recruitment agencies, language teachers, and researchers said there was evidence more people were able to pass OET first time round – especially those who had been supported to prepare.

Chris Moore, managing director of Specialist Language Courses – an OET test centre and course provider – said he was seeing “much higher pass rates”.

Of 54 candidates who sat OET, 30 passed with four grade Bs first time round – a pass rate of 56%, he noted at the event held at the Royal College of Nursing.

Meanwhile, of the 216 individual speaking, listening, reading and writing tests taken by those candidates, 176 – or 81% – were marked grade B.

Shannon Dudley, of health and social care recruitment agency HCL, revealed her firm had stopped mass nurse recruitment drives overseas because so many candidates were failing English language tests.

However, since OET has been accepted by the NMC the company has started recruiting in volume again.

One such exercise saw the company recruit just over 200 nurses from the Philippines in February this year. Of those, 43% passed OET and most achieved that first time round.

Ms Dudley said nurses were successfully passing OET after “multiple IELTS attempts”. “The OET exam pass rates are significantly higher than we have seen – especially with IELTS,” she said.

“OET is not the solution for all English language problems for healthcare professionals”

Ceri Butler

She said issues included the cost of the OET exam, at around three times the cost of IELTS, although most trusts were offering to cover the cost of one attempt for nurses who took up a job.

Meanwhile, many had to complete IELTS anyway due to visa requirements so decided to stick with that.

Researcher and policy adviser Ceri Butler, who has investigated the role of international nurses in the NHS and investigated the challenges faced by refugee healthcare professionals, said there was evidence language testing – and IELTS in particular – was a barrier to recruitment.

Her research with refugee doctors in the UK found most had sat IELTS multiple times. Failure to pass the exam had a big impact on their confidence and self-esteem and led to some giving up trying to work as a doctor in this country, she told delegates.

However, she highlighted that some of this group had been able to pass OET first time – including one who had previously failed IELTS 13 times.

Reducing the time it took for skilled healthcare professionals to return to practice was a “hugely positive” step, she said.

But there were inevitably questions about whether OET was simply “easier” than IELTS and more research was needed to examine the impact of the new test on the workforce, she said.

She also stressed the need for ongoing support for overseas professionals when it came to helping them work in an unfamiliar health system and feel at home in a new country – a key message to come out of the event.

“OET is not the solution for all English language problems for healthcare professionals – people still need English language support,” she said.

Lyn Middleton, associate director of nursing at Aneurin Bevan University Health Board, also highlighted the importance of ongoing support and mentoring for overseas staff.

For the past year, she has looking at ways to recruit “under-employed” overseas nurses who were already living and working in the UK but employed in support roles.

This has included developing a support programme to get nurses through the requirements of NMC registration, including English language with the OET test now the “preferred choice”, she noted.

“They don’t write referral letters but nurses do write referral notes and read referral letters”

Tim McNamara

Professor Tim McNamara, who developed OET, described the challenges of creating a language test that balanced the need to ensure patient safety with a fair assessment of communication skills that did not place “unreasonable restrictions on practice”.

Extensive research has been carried out with nurses and doctors to try and pinpoint the elements of communication that “really matter” in clinical practice to inform the content, he said.

From this month, candidates taking OET will be judged on new “clinical communication” criteria including key skills, like building relationships, understanding a patient’s perspective and the ability to translate complex medical terms into lay language – although grades will still be weighted towards linguistic elements.

Professor McNamara, from the school of languages and linguistics at the University of Melbourne, said the changes were designed to make the test more relevant and “allow a better fit with what the test is asking and what really matters in clinical settings”.

One issue that emerged at the forum was the fact nurses were expected to write a referral letter in the writing element of the test – shown to be the part candidates found most challenging – despite the fact this was not something most nurses do.

Professor McNamara acknowledged this section of the test may appear less “authentic”. However, he added: “They don’t write referral letters but nurses do write referral notes and read referral letters – they read referral letters from doctors quite a lot.”

He highlighted that the test was constantly evolving and there was a need to ensure it did “reflect the majority of written communication with nurses”.


Readers' comments (5)

  • Recognizing that an 'O' Level in English was far too culturally oriented to be used as an appropriate test for University entrance for STEM subjects for NNS, a consortium of British Universities (JMB / NEAB) commisioned (The now late) Dr Patricia MCELDOWNEY to design and implement what became the NEAB - UETESOL (University Entrance Test in English for Speakers of Other Languages). It was a radical & welcome transformation and for many years set the standard for the form of such examinations, their marking schemes and acceptable profiles across the receptive and productive skills (S, L, R, Writing)
    For reasons which were less than clear, the hard-edged and prescriptive IELTS test was aggressively "imposed" as the international standard for UETESOL and other areas of study and employment in UK.
    At last, and not before time, the inappropriateness of IELTS in certain sectors is being recognized. One can but hope that the spirit and practice of enablement "Pat" MCELDOWNEY brought will be reflected in this new test.

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  • HCSW

    This is dangerous. You might be a very skilled nurse from abroad, but if you cannot communicate at IELTS level 7, then you should never be registered. Yes, IELTS exam is difficult, but if you prepare yourself - you will achieve 7 (especially, now you can present it on two separate certificates)

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  • @HCSW
    Perhaps you miss the points
    1) It's not that IELTS is "difficult", it's that it's aimed at satisfying a specific market = Higher Ed. Not at those wishing to enter "Nursing".
    2) Whilst IELTS was designed for a specific market it's being used, inappropriately, as a test for ALL users of ESOL.
    3) What experience do YOU have of IELTS? Have you sat even one of the papers and had it marked objectively? Or maybe you're a (past or present) practitioner in the field of TESOL. (I can answer Yes to all those questions)
    4) Would you care to hazard a guess, or better still offer data, to inform the debate on what % of NS of English in "Nursing" could pass IELTS at what you state is the required level?
    5) Please remember that Tests of proficiency in ESOL examine the clearly defined skill areas of production (W & S) and reception (R & L), rather than some woolly concept of the ability to "communicate".
    Proficiency in the productive skills is much harder to attain than in the receptive ones as many of us may know from our holiday experiences "abroad".
    6) When you write "from abroad" are you clear in your own mind as to whom you are referring? I'm certainly not sure if you include NSs from, e.g. US(A), Australia, Canada. Should they too have to pass IELTS "at level 7" ?

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  • HCSW

    Ad1) There is an NMC requirement for all foreign nurses to achieve overall band 7 in IELTS, because IT DOES guarantee, that the nurse will be able to speak, write, listen and understand English language on the level required to practice safely in the UK. This requirement has already been lowered - you can present the two certificates to show, that you are able to achieve four "7"s Any further tweaking the requirements is dangerous. IELTS grading is exponential - e.g. I would have to be severely drunk to achieve an overall 5, as really - overall '5' is easy peasy.

    Ad2) The IELTS exam is very appropriate and accurate measurement of your language proficiency. Especially for foreigners. (Bear in mind, only 1% of the native speakers score overall 9 in all four modules)

    Ad3) I sat four IELTS exams over the last 10 years. Last score: 8.0, previous 7.5 with no component below 7; and the two first attempts years ago: 7.5 with one component below 7.0

    Ad4) I am confident, that my Uni cohort would achieve 7.0 with ease. That includes foreigners (as we had to pass IELTS to secure our place at the Uni!)

    Ad5) and so is IELTS: L, R, W, S - all four modules are present.

    Ad6) All candidates to the NMC register, whose first native language was not English. Candidates from Australia, Canada and the USA would pass IELTS with ease, the only discomfort to them is the exam fee.

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  • Just worked with a staff nurse, from Europe, English very poor, unable to understand.
    Has this test meant that the standard of English in the test has fallen!

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