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Exclusive: Agency warns of threat to overseas nurse recruitment from NMC language testing


Hundreds of international nurses are unable to take up job offers in the NHS, which is stalling overseas recruitment, because the level to which their English language is being tested is too high, a new report has warned.

The report, compiled by healthcare staffing agency HCL Workforce Solutions and shared exclusively with Nursing Times, said that while it was important to check communication skills, the level required to pass the International English Language Testing System (IELTS) exam was “unjustified”.

“The average time needed to obtain the mandated level currently stands at a minimum of eight months, resulting in an average 12 month turnaround”

HCL Workforce Solutions report

It claimed the score of 7.0 across all elements of the test – reading, writing, speaking and listening – was higher than the average result a native English speaker would be able to achieve.

In addition, some universities – such as the University of Gloucester – accept international students onto pre-registration nursing courses with an IELTS score at the lower level of 6.0, said the report.

Across a sample of 14 NHS trusts that HCL works with around 50% of the 1,972 nurses it has recruited have either dropped out of the process or been removed since November 2014 due to failed attempts of the IELTS.

Just 117 are now working as a nurse in the UK and 887 are still going through the process.

“The average time needed to obtain the mandated level currently stands at a minimum of eight months, resulting in an average 12 month turnaround time from hire to deployment,” said the report.

“There is a huge financial implication for the NHS, as well as the morale issue for the nurses”

Charlotte Fisher

The delays to recruitment have been worsened since the start of 2016, when the Nursing and Midwifery Council introduced language checks for the first time for European Union staff, to match the system it already had in place for those coming from the rest of the world.

Prior to this, EU nurses had, on average, been able to start practising in the UK as a nurse within two months of being recruited, which meant they were being increasingly relied upon to fill vacancies, those behind the report told Nursing Times.

But with language testing now affecting all overseas staff, the impact on recruitment had become “severe” and some trusts were having to revise their plans about how far international nurses are able to fill vacancies, said the report.

It noted that the UK currently had a shortage of nurses and altering the IELTS score slightly could help to fill many empty posts.

“The bar is so high for candidates to achieve… the reduced morale is a cycle they have to continue to go through”

Teresa Wilson

It estimated that if nurses only had to achieve an average of 7.0 overall – rather than in each of the four individual parts of the test – then around half of HCL’s 694 non-European nurses who have failed since 2014 would instead have passed.

The organisation also said that the areas where people fall down if they fail marginally are usually reading and writing – which are the more “academic” modules that involve, for example, writing an essay on an abstract subject rather than a clinical one.

It suggested that it would be more appropriate for nurses and aid recruitment if an alternative, general version of the IELTS were used instead.

The agency’s report chimes with a separate investigation by Nursing Times, also published today, in which trust nursing directors highlighted concerns that the test was hampering their ability to recruit overeas nurses from EU countries.

Charlotte Fisher, director of permanent recruitment at HCL, and Teresa Wilson, HCL’s operations manager for international recruitment, said the situation had not improved despite efforts to improve the support offered to candidates – for example, by bringing them to the UK and immersing them in the language while they trained to take the IELTS.

“The bar is so high for candidates to achieve that in addition to the cost implications, the reduced motivation and morale is a cycle they have to continue to go through,” said Ms Wilson.

“There are stories in the media that say registrations with the NMC have dropped due to Brexit, but that is not the case. Registrations have dropped because nurses can’t pass the IELTS exam,” added Ms Fisher.

They said they had so far not been seeing a reduction in the number of applications from international recruits, but this was now beginning to change as morale worsened.

Around 70% of any cohort of overseas nurse recruits would typically not succeed at all, they added.

HCL Workforce Solutions

Exclusive: English exam stalling nurse recruitment, says agency

Teresa Wilson

“That is not because their English language is low. Their English language is often deemed by the NHS interviewers as being of no risk. It is purely because this version of the IELTS is an academic one that is leading to failed attempts,” added Ms Wilson.

“Hospitals are not able to fill their staffing gaps, which are increasing, meaning they are having to use more agency staff which costs more money – not to mention the cost of training nurses for the IELTS,” said Ms Fisher.

“So there is a huge financial implication for the NHS, as well as the morale issue for the nurses,” she told Nursing Times.

“IELTS is an internationally recognised means of testing language proficiency which has been in place for over a decade”

NMC spokesman

A spokesman for the NMC 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 said.

“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.



Readers' comments (7)

  • Well, I achieved a 7.5 overall with 7 being the lowest mark (I am French). It is possible to pass the IELTS, however, one has to prepare for it and work very hard, in exam conditions, for a couple of months before sitting the exam.

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  • It is funny that EU nurses are complaining about the IELTS even now that they are allowed to combine 2 results.non EU nurses go through hell..first IELTS, then CBT then tier 2 visa application which is so complicated and on top of it all the tortuous OSCE after failing for any little reasons examiners can find....candidates have to return home after second attempt....lets not even mention the money involved....and waste of time....EU nurses should be glad IELTS is all they have to take and you don't even need to travel to take the usual we are minority so no one is even talking about one even cares...

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  • Coming from South Africa I had to sit the Academic IELTS, to be honest I think the general IELTS should be acceptable.
    Without being sarcastic I do believe a fair number of English nurses would battle with the Academic version.
    However if this is the standard the NMC wants then you must accept that inevitably you will have significantly reduced .

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  • Last year I had the pleasure of facilitating a programme for a group of EU nurses as part of my role. They spent time with an IELTS tutor and time with myself or other members of the Health Board learning how to adapt and modify their skills to working in the UK. Overall the wards were more than happy with their performance and communication skills but the IELTS process took it's toll. Of the group only 10% achieved a pass at first attempt which was hugely disappointing particularly as some achieved 8.5 in other areas! The Health Board was keen to support them and with the shortage of nurses had anticipated a much needed boost to numbers from recruiting abroad. I have since left that role so do not know how many are still here either working as HCSW's or now as registered nurses. It was a huge investment for the Health Board to make and highly frustrating to have such a low pass rate. All involved put in a huge amount of work and the potential registrants were highly motivated to succeed. Either averaging the score out or lowering the pass to 6.5 would have made a dramatic difference to the outcome.

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  • In my opinion overall score of 7 should be accepted, rather than 7 in each module. which is enough for interacting with patients and caring for their needs , as that's the basic requirement of being a nurse. But if the NMC's and immigration department's plan is not to bring more nurses into this country, then they should stop all this drama of IELTS and registration. its really time consuming and financially draining the poor nurses.

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  • In terms of patient safety an IELTS of 7 is a perfectly reasonable expectation for a health care professional. Are we really back to the dumbing down of nursing? Recruitment issues should not mean that we lower the expectations we have as a profession.

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  • 7 is achievable (especially if spread over the two tests) and this requirement should not be lowered. It is not easy, but if you put a little bit of an effort, you will score even more than that.

    The test should be cheaper, for sure.

    IMHO, patient safety is at risk if you go lower than 7. The IELTS grading is exponential and in order to get 5 or 6, it suffices if you know just basics of the basics.

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