In April, the House of Commons health select committee stated: “The government’s plan for our post-Brexit future should both ensure that health and social care providers can retain and recruit the brightest and best from all parts of the globe, and that the value of the contribution of lower-paid health and social care workers is recognised.”
Everyone knows the biggest challenge facing health leaders today is the workforce. While resolving this is not the job of the Nursing and Midwifery Council, the standards that we set in maintaining public protection are being questioned.
“The NHS and the wider healthcare system simply could not operate without EU and overseas nationals”
In January we released figures showing there had been an increase in the number of EU-trained nurses and midwives leaving our register and, at the same time, a significant fall in the number of new applications to join the register.
Although our data does not provide one clear answer for why this drop-off has happened, changes we made to introduce language testing for EU applicants undoubtedly had an impact. In response to a number of organisations asking us to consider lowering the score for passing the English language test, which is set at 7.0, we are taking stock.
The NHS and the wider healthcare system simply could not operate without EU and overseas nationals working within it. The workforce pressures we urrently face make it even more imperative that we recruit and retain highly skilled nurses and midwives, irrespective of where in the world they are from.
Our role as the regulator is to ensure the high standards we set for nurses and midwives are met by every applicant, and that those applicants are safe and able to provide high-quality care for patients and service users.
“Some have suggested the clinical experience of a nurse or midwife is more important than their grasp of English”
To join our register, nurses and midwives who trained outside of the UK must pass the well-established and internationally recognised International English Language Testing System (IELTS) test. Recently, criticism of the test from some employers suggests that requiring nurses and midwives to score 7.0 in the test is unreasonable.
Some have suggested the clinical experience of a nurse or midwife is more important than their grasp of English – and that should be more important than passing the language test.
However, the ability to communicate with a patient is paramount and the view being expressed by patient groups is one of deep concern at any suggestion that communication requirements are eased to reduce the pressure on workforce demands. And none of us ought to be surprised by the level of concern.
Nurses and midwives are increasingly working in more integrated ways as part of multidisciplinary teams. That ability to work together to deliver care does not rest only on their clinical experience but their ability to understand and communicate to one another clearly.
“We have to get the balance right – but not at the expense of protecting the public”
As an organisation, we will continue to listen and respond to concerns, and we will do everything we can to ensure that those nurses and midwives who wish to join our register can do so as quickly as possible. But they can only do that if their practice and language skills are of the standard necessary to ensure high-quality, safe healthcare for the public.
The General Medical Council expects doctors applying to join its register to achieve a score of 7.5. Let’s not forget this in the debate about what the public has a right to expect versus workforce pressures. We have to get the balance right – but not at the expense of protecting the public.
Jackie Smith is chief executive and general registrar of the Nursing and Midwifery Council