Foreign nurses who fail English test can still be hired by NHS

Foreign-trained nurses and midwives will be able to practise in the NHS even if they fail English language tests under controversial new rules.

Campaigners warn patients may be at increased risk of harm after the Nursing and Midwifery Council (NMC) watered down its requirements.

The regulator will currently only register staff trained abroad if they achieve a certain score in independently assessed reading, writing, listening and speaking exams. But they have agreed to admit those who marginally fail to make the grade if they obtain a letter from an employer vouching for their English skills.

The NMC announced on social media that its committee approved the change last week, with the new rules coming into effect from January.

Campaigners warn patients may be at increased risk of harm after the Nursing and Midwifery Council (NMC) watered down its requirements (stock image)

Campaigners warn patients may be at increased risk of harm after the Nursing and Midwifery Council (NMC) watered down its requirements (stock image)

This graph shows the country of training of all newly registered nurses and midwives in the UK over the past five years. Unsurprisingly, British trained nurses make the majority with about 120,000 joiners. India (about 21,000), Philippines (nearly 18,000) and Nigeria (nearly 5,000) are the biggest providers of overseas trained nurses and midwives registered to work in the UK

This graph shows the country of training of all newly registered nurses and midwives in the UK over the past five years. Unsurprisingly, British trained nurses make the majority with about 120,000 joiners. India (about 21,000), Philippines (nearly 18,000) and Nigeria (nearly 5,000) are the biggest providers of overseas trained nurses and midwives registered to work in the UK

The show the proportion of doctors and nurses joining the NHS in England based on where they originally trained. In both professions the number of UK trained joiners has decreased over time (red lines) whereas the number of non-EU trained professionals has increased (yellow lines). The proportion of EU professionals joining the NHS has declined over time, taking a sharp dive in the years after the 2016  Brexit vote

These charts, based on NHS workforce data, show the proportion of doctors and nurses joining the NHS in England based on where they originally trained. In both professions the number of UK trained joiners has decreased over time (red lines) whereas the number of non-EU trained professionals has increased (yellow lines)

Revealed: How the NHS is reliant on foreign-trained nurses

Some 23,444 foreign-trained nurses and midwives joined the NMC register last year, with two-thirds coming from India and the Philippines. 

Foreign-trained staff accounted for almost half of all new joiners, with the number rising by 135 per cent compared with the previous 12 months.

Of the top 20 countries recruited by the UK, four – Nigeria, Ghana, Nepal and Pakistan – were on the World Health Organisation’s ‘red list’, signalling major shortages of their own. 

This means trusts could not ‘actively’ recruit from these countries in line with the Department of Health’s code of practice.

However, the code does not stop individual professionals from seeking employment independently.

It comes as the NHS is critically short of more than 50,000 nurses and midwives, with one in ten nursing posts vacant. Health bosses are becoming more reliant on overseas recruitment to plug dangerous rota gaps.

Peter Walsh, chief executive of Action Against Medical Accidents, said: ‘Good communication between health professionals is absolutely vital for patient safety.’ 

He added: ‘There is a risk that employers who are desperate for staff may be tempted to vouch for someone’s English in a less-than-honest way, so that has to be taken into account.’

The NMC is changing its policy following an eight-week consultation, which received more than 34,000 responses.

It says the new approach provides a ‘fair and reliable’ system ensuring staff can communicate ‘safely and effectively’.

The regulator will now accept ‘supporting evidence’ when candidates have ‘narrowly missed passing the English language test’.

They must have been working in a non-regulated health or care role, such as a healthcare assistant, in the UK for at least one year within the past two years.

And their employer must provide evidence that they have the necessary level of English language competence.

A spokesman for the NMC said: ‘This proposal will allow employers to provide objective information… about someone’s use of English in a health and social care setting in the UK, including evidence from interactions with people who use services. This proposal will provide greater flexibility for people who are already contributing to health and social care in the UK without affecting the high standard of English language skills needed to deliver safe, kind and effective care.’

The regulator will currently only register staff trained abroad if they achieve a certain score in independently assessed reading, writing, listening and speaking exams. But they have agreed to admit those who marginally fail to make the grade if they obtain a letter from an employer vouching for their English skills (stock image)

The regulator will currently only register staff trained abroad if they achieve a certain score in independently assessed reading, writing, listening and speaking exams. But they have agreed to admit those who marginally fail to make the grade if they obtain a letter from an employer vouching for their English skills (stock image)

Some 23,444 foreign-trained nurses and midwives joined the NMC register last year, with two-thirds coming from India and the Philippines. 

Foreign-trained staff accounted for almost half of all new joiners, with the number rising by 135 per cent compared with the previous 12 months.

Of the top 20 countries recruited by the UK, four – Nigeria, Ghana, Nepal and Pakistan – were on the World Health Organisation’s ‘red list’, signalling major shortages of their own. 

This means trusts could not ‘actively’ recruit from these countries in line with the Department of Health’s code of practice.

However, the code does not stop individual professionals from seeking employment independently. 

Dennis Reed, director of Silver Voices, which campaigns for elderly Britons, said he would not be ‘completely comfortable’ being treated by a nurse that had failed to pass the language exams.

He added: ‘We would like to see all our nurses with perfect English but when there is such a shortage some patients may prefer to see a nurse with poor English than no nurse at all. 

‘Some nursing duties may not require such a command of English… it may be safer if they are only allowed to carry out those with lower risks.’

Matthew McClelland of the NMC said: ‘Internationally trained professionals make a vital contribution to safe, effective and kind nursing and midwifery across the UK. 

‘It is essential for public safety that nursing and midwifery professionals have effective English language skills and can communicate safely.’

The Royal College of Nursing said it backed the change. The Royal College of Midwives did not respond to a request for comment.

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