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New English language test agreed for European nurses

  • 10 Comments

European Union nurses who want to work in the UK will in the future be required to pass an International English Language Testing System exam if they cannot prove they are proficient in using English, despite concerns about the test’s robustness.

At a meeting today, the Nursing and Midwifery Council approved the policy and guidance for the new rules, which will come into effect next year.

“It’s important to remember what our core purpose is – it’s about protection of the public and patients”

Stephen Thornton

It brings rules into line with English tests for applicants from outside the EEA.

The council also agreed that any allegation against a nurse or midwife already on the register that raises concerns about their knowledge of English should in the future be considered grounds for fitness to practise procedures.

From January 2016, the NMC will require applicants from countries in the European Economic Area – which includes the European Union and Scandinavia – to produce evidence showing their English language competency.

This evidence will include either having passed the IELTS within the past two years, having trained on a pre-registration course that included at least 75% clinical interaction in English, or having practised for two years in a native English country that required language assessment for registration.

If they cannot demonstrate competence, the applicant will have to pass the IELTS test, with a minimum of 7.0 in each of the four areas of reading, writing, listening and speaking.

In an NMC consultation of on how to implement the new rules, almost 40% of the 723 registrants and organisations who responded said they did not agree with the types of evidence the regulator was proposing to accept, as previously reported by Nursing Times.

Most respondents who were unhappy questioned the use of IELTS, claiming that it only assessed academic knowledge of English and does not demonstrate competence in a clinical setting.

There were also concerns that the suggested minimum score of 7.0 was too high.

At the NMC council meeting today, council member Stephen Thornton noted there was a lack of support for the NMC’s plans on how to implement the language checks.

“I am pleased though that, despite that, we are going to move forward on this and hope we will support this because I think it’s important to remember what our core purpose is – it’s about protection of the public and patients,” he said.

He said the NMC would need to persuade organisations and individuals about the use of the IELTS.

“It is fundamental that you should be able to communicate and it’s about public protection and that’s our job”

Jackie Smith

When asked by a council member about the potential negative impact of using the test, NMC director of registration Alison Sansome admitted that when the General Medical Council introduced the IELTS test in 2014 “they did find a lot of [European doctors] failed that test initially”.

But, she said, that meant it was important for the NMC to communicate effectively with applicants to ensure they prepare fully in advance.

Meanwhile, NMC  director of strategy Jon Billings said the IELTS was very established, noting it was already used by other healthcare regulators.

NMC chief executive and registrar Jackie Smith said the regulator would be monitoring how many applicants fail the test.

She said: “It’s important that we provide information to the council on the numbers of EU applicants who fail the English language controls so we can understand the implications in respect of the flow of new applicants to our register.

“We are not apologetic about his – it is fundamental that you should be able to communicate and it’s about public protection and that’s our job,” she added.

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Readers' comments (10)

  • Ellen Watters

    leadres of the Nursing and Midwifery..Leadres.. I think some one else needs an English refresher.. ..:)

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  • Ellen Watters

    leadres of the Nursing and Midwifery..Leadres.. I think some one else needs an English refresher.. ..:)

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  • Another nail in the coffin for full time staffing levels. It almost seems as if there is a hidden agenda to create an over reliance on temporary agency staff (I wonder who really benefits from that?), or push nurses into healthcare assistant roles and get them to do the same job for less. Of course patient safety comes first but an academic test for a job in a clinical setting? A non UK nurse with 15 years intensive care experience is unlikely to put a patient at risk. Of course communication in a clinical setting is critical but that doesn't require such a high score on an academic language test. I think the fact that there are not enough nurses covering shifts and providing continuity of care will be far more damaging to both patients well being and even more so to NHS budgets. I am really starting to believe there is a conspiracy to destroy full time staffing levels. I just haven't worked out the agenda behind it yet. Perhaps it is a problem, reaction, solution approach that will ultimately be used to champion further privatisation? Nurses from beyond the EU that have the right IELTS pass and a certificate of sponsorship from a Trust are being refused visas by the Home Office. Go figure? To sum up, not enough home talent being produced, non EU candidates that qualify being turned away, qualified EU candidates that fail an academic language test rejected, greater shortages leading to more stress and a migration of homegrown talent to greener pastures? Am I missing something? Where is this all going?

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  • Nurse vacancies in Australia, Middle East and Canada available. IELTS score of 6 will do or not at all for the Middle East. Great life style, high pay, lower work load.
    If that doesn't suit why not register with an agency and open your own LTD company to further erode NHS budgets?
    Don't worry there will be loads of available work as European recruitment is about to drop by 75% come January 2016 lol.
    I know a very competent Spanish nurses that started recently who was only meant to be looking after 4 patients. On her first day she was left completely alone and managing 16 patients. Without her (and her contemporaries) I guess the current nurses will be looking after 25 patients on 20 hour shifts. Good luck

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  • Once again the NMC proves that it is totally disconnected from reality - every quote above from board members just makes them look more so:

    Council member Stephen Thornton "noted there was a lack of support for the NMC’s plans" but is nevertheless "pleased that, despite that, we are going to move forward on this" because "it’s about protection of the public and patients.” Presumably nobody told him that no UK patient has ever been harmed because of the language ability of a nurse. He continues: "the NMC would need to persuade organisations and individuals about the use of the IELTS." Well, he should know it's been used for some years now by NMC (for international applicants) as well as every other regulator - and it's universally unpopular!

    NMC director of registration Alison Sansome admitted that when the General Medical Council introduced the IELTS test in 2014 “they did find a lot of [European doctors] failed that test initially” but thinks the NMC just needs to "communicate effectively with applicants to ensure they prepare fully in advance". Oh dear, that's the standard line, straight from the IELTS website - a little more homework (like actually looking at the test!) might have revealed that its the writing test that causes all the trouble: band 7.0 often requires the examinee to write in English better than they can write in their own language (and better than a large proportion of our home-grown nurses).

    NMC director of strategy Jon Billings said the IELTS was very established, noting it was already used by other healthcare regulators. Great - but nine wrongs don't make a right!

    NMC chief executive and registrar Jackie Smith said "the regulator would be monitoring how many applicants fail the test.“ Newsflash, Ms. Smith - you'll never know, because nurses are not going to fork out on the application until AFTER they've secured the required IELTS score - you'll only see applications drop away to near-zero. And don't think you can compare figures with international applicants - nursing schools in India, Nigeria, Philippines, etc. offer their students extensive tutoring in how to pass the IELTS. European applicants won't be able to afford that luxury.

    But Ms. Smith crowns her contribution with “We are not apologetic about his – it is fundamental that you should be able to communicate and it’s about public protection and that’s our job.” The defiant tone is revealing, as is the (expected) reuse of the "public protection" excuse (for which there is no evidence, of course). She is right, though, about the fundamental need to communicate - unfortunately, an IELTS certificate (at any grade) does not improve the listening or speaking skills of an EU nurse's UK-trained colleagues or those of his/her patients (which, together, are the real problem).

    Take a look at the NMC's Code, specifically #7 - "Communicate clearly". The first four points amount to a good description of "patience and tolerance" in communication. Point 7.5, however, feels like a blunt bolt-on: "be able to communicate clearly and effectively in English." It's obviously there to support this IELTS 7.0 nonsense, but did it not occur to the NMC that indigenous nurses are the worst offenders? We SHOULD expect our own nurses to realise that a thick regional accent, obscure colloquialisms and generally sloppy speech habits can make it difficult for other English people to understand them, let alone non-natives (even if they do have an IELTS 7.0 certificate). Expecting our overseas colleagues to make up for our own national deficiencies as communicators is, frankly, an embarrassment, especially when the "solution" will cut off the supply of EU nurses and the overarching justification is a danger than has never occured.

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  • I don't wish to sound facetious but it is a fact that I heard the Scottish nurse with Ebola interviewed briefly on BBC TV News and did not understand one word she said.

    However, I wish her a speedy recovery.


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  • 11:28pm contd.

    "The system" is never going to allow the regulators to use anything BUT the IELTS test - it's run by the British Council, a quasi-charity that's important to the UK government, and represents 75% of the income that keeps them afloat.

    Nevertheless, even if we are stuck with IELTS, there's other things the NMC could and should have done differently:

    The biggest issue is the required score - 7.0 on all four parts (reading, writing, speaking and listening) represents a substantial hurdle for applicants. This is a VERY high standard, effectively the same as that required of doctors coming from overseas and higher than most UK universities require for entry to graduate and even post-graduate studies. The writing section is the most problematic - 7.0 on this module is very difficult indeed, requiring very few "mistakes" in punctuation, spelling, declension, tenses, sentence structuring, etc - in short, a level of written communication in English that is NOT required for any regular nursing duties. The NMC should lower the required score at least in the writing section to 6.5 or even 6.0 - doing so would not affect the "communication ability" of registrants.

    The overall 7.0 "average" required is not logical. Examinees will very rarely score equally across all four sections - they will usually score lower in the writing section (see above) than the others and will therefore inevitably achieve an "average" higher than 7.0 if they manage 7.0 in the writing section. So, by setting the requirement as they have, NMC are effectively asking for "better than 7.0" in speaking, listening and reading. Not fair.

    Non-EU nurses (and all overseas doctors) undergo a practical test, a component of which is a subjective assessment of their communication abilities in a clinical setting. The NMC seems to have ignored this important difference. The IELTS test is arguably the only viable choice when candidates are situated on the other side of the world, its limitations compensated by the practical test. The NMC has been remiss in defaulting to IELTS for EU candidates without adding some other mechanism in place of the practical test.

    The responsibility of the employer has been downplayed in all of this. Given the inadequacies of the IELTS, not to mention the large number of EU nurses already working in the UK without having sat the exam, the NMC should be issuing strict guidelines to employers. Without doubt, the majority of "offenders" (the source of the widespread reports of "nurses who can't speak English properly") are agencies who have employed nurses directly from EU countries with nothing more than an "amateur" (and commercially expedient) assessment of their language facility. If we DON'T see a flood of fitness procedures based on language then the NMC will have failed the profession by throttling future supply whilst tolerating the worst offenders. Will the agencies' clients demand that nurses supplied be in possession of IELTS 7.0 certificates, irrespective of when their PIN was obtained? - in the current market, I highly doubt it.

    ***CONCLUSION***
    The NMC has failed spectacularly to solve the problem, has left gaping holes and has throttled the last remaining source of nurses for an NHS that will, more surely than ever, remain desperately short of nurses for years to come. A shameful performance.

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  • Nurse vacancies in Australia, Middle East and Canada available. IELTS score of 6 will do or not at all for the Middle East. Great life style, high pay, lower work load.
    If that doesn't suit why not register with an agency and open your own LTD company to further erode NHS budgets?
    Don't worry there will be loads of available work as European recruitment is about to drop by 75% come January 2016 lol.
    I know a very competent Spanish nurses that started recently who was only meant to be looking after 4 patients. On her first day she was left completely alone and managing 16 patients. Without her (and her contemporaries) I guess the current nurses will be looking after 25 patients on 20 hour shifts. Good luck

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  • Wake up NMC and listen to experienced nurses and English language teachers. Please for once, just listen to the voice of the profession instead of riding roughshod over it as usual.
    With all of the above comments it must be very clear by now that the profession knows that you are wrong. Your actions are now endangering the very people you claim to protect - our patients. You have been presented with evidence,questioned about the safetyof this exam and yet you are still going to "move forward". Ok, so when you are desperate for nurses and the public is seriously at risk due to shortages,this decision will come back to haunt you. How dare you imply that nurses (or indeed anyone who disagrees with you) do not have our patients best interests at heart. Your job is to regulate professionally, you have not done this and as a nurse I have lost confidence in you as a regulator. Is the NMC fit for purpose?

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  • IELTS is very expensive (155 or 200 GBP), takes a whole day of my life and is valid only for the two years.

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