English language skills for EU and overseas midwives and nurses working in the UK: your views wanted

[RowanMumsnet]

Hello

We've been talking to the Nursing and Midwifery Council - the body that regulates nursing and midwifery in England and Wales - about our Postnatal Care Campaign. They are going to be writing a guest post soon for us outlining how Mumsnet users can feed in to a training curriculum review they're currently undertaking, but in the meantime they're seeking the views of service users on another developing issue.

The NMC currently requires all midwives and nurses recruited from overseas and the EU to be able to show they are competent in English. They can prove this language competence by taking an International English Language Testing System (IELTS) test. Currently, the NMC asks for a standard of 7.0 in each area – listening, reading, writing and speaking. Other medical regulators tend to have similar requirements, while the General Medical Council, which regulates doctors, requires overseas recruits to have a score of 7.5.

Because of a shortage of nursing and midwifery staff, there have been calls among some employers and agencies for the NMC to drop the required standard to 6.5. The NMC would like to find out what service users think.

So do please add any comments to this thread and we will pass them on to the NMC. If you have any queries, let us know and we will pass those on too.

More information on the IELTS test is available here, and more information about the process for registering midwives and nurses from outside the UK is here.

Thanks
MNHQ

It's difficult to separate my views as a service user from my views as a student nurse.

I've watched the example videos and where I believe a level 6-6.5 would be capable of tending to a person's needs, I think the level 7 example video is more representative of what good holistic care would require. Level 7 sounds far less scripted (not that level 6 is scripted as such but he's certainly having to think harder about the questions and answers) and as a service user I'd have no doubts that I was understood. The man in the level 7 example can express himself quite comprehensively. I get the feeling that there would be quite a bit of misinterpretation if level 6-6.5 were allowed to practice and that could be dangerous. I also think that there are situations in nursing where not only do you need to be absolutely certain that all parties understand, but you may not have the luxury of the time it would take to be sure of that.

I don't work in healthcare so my perspective is as someone who has been into hospitals over the years.

I've watched the videos that were linked to. As others have said, there is a world of difference between sitting in a quiet room one-to-one discussing famous people, and a situation where someone may be in extreme pain in a busy medical unit and their life (or that of their baby) is at serious risk.

Communication is a vital part of healthcare. It's not just about being able to relay the words a patient has used. It's about helping them to feel that they are being listened to and that the medical staff have understood the full picture.

I don't think the standard should be lowered. If there is a shortage of nurses, more should be done to encourage people here to go into nursing.

I watched the videos and I don't think that the standards should be dropped. It can be very confusing when you are talking to someone who makes mistakes with pronouns and tenses. The postnatal ward environment is chaotic and there wouldn't be time to clarify and make sure that all communication was well understood. I think this could be difficult for both patient and midwife. The extra language skills are important for having confidence in what the midwife says and for bilding rapport and trust.

6.5 would be fine. dropping it as a requirement (it wasnt necessary for eu until v recently) a complete disaster.

I also know a consultant within my place of work who obviously got a high enough score to become a consultant within the NHS (which I'm aware is higher than the requirement for nursing) and whilst he has good standard of spoken English he frequently (and I mean daily on this one) misunderstands what others in the team are saying to him- I.e his expressive language is significantly better than his comprehension. Other than being immensely frustrating in having to constantly try and reframe what you're trying to communicate it also makes me think that as a patient I don't want anything I say to be misinterpreted or have the stress in labour of having to repeat myself. I know this is but one example but I'm aware of plenty of other NHS professionals that this issue applies to as well.

I am dealing with patients on a day to day basis. I am also not british.
There is no way people will be able to look afetr patients properly if they have a lower level in English.
It's the issue of dealing with accents (both form the POV of the HCP to be understood by patients and for the HCP to understand the patients)

Fwiw my FIL has cancer and is struggling with his consultant because he doesn't always understand what they are telling him. Add to that the complexity of his diagnosis (terminal), he comes out having no idea of what is going on.
I personally know that there are people I still can't understand. I've bee in the uk for 17 years and my level is much higher than 7.5 (think writing a master etc...).

NOT A GOOD IDEA.....

One option to increase staffing levels would be for the government to spend a fairly small amount of money (in the great scheme of things it wouldn't take much really) to help applicants to improve their spoken English and comprehension. This would be after they had reached 6 or 6.5 already obviously.

I think if nurses were paid a fair wage in line with other professionals and didn't have to pay education fees, we wouldn't be having this discussion.
More uk citizens would apply to be nurses and there wouldn't be a shortage!

And yes I agree this is about staffing levels and trying to attract people when applications from the EU have dropped by 90%ish.

Tbh, this is something that should have been planned before hand. As well as training more nurses, wondering if people wouod still want to do the training AND pay for the uni fees etc etc)

Nurses more than any other profession in the health service need to have excellent communication skills. They are responsible for understanding and advocating for people at the most intimate level. It is essential that they are able to converse at a fluent level. So this is a big NO from me. We should be ensuring that nursing becomes an attractive profession for homegrown talent. For example the market is saturated with pharmacists yet they are able to command a higher wage from the outset. Why is nursing so poorly valued?

I'm a doctor and am familiar with the exam having helped a friend study for it

I don't think the level should be dropped and would support an increase to 7.5. Nurses, docs, pharmacists and other ahps have to deal with largely the same medical language and often distressed people in difficult situations with shouting/needing quick responses.

In fact, I'd be supportive of ALL HCPs having to sit the same language exam. I have worked with one or two HCPs who were UK citizens who trained here thus were exempt, but for whom English was a second language. I genuinely wondered how they got through school and uni, their spoken English skills were so low.

No, I think they should have to have the same score as doctors. Avoiding misunderstandings is crucial.

Maybe also some on-the-job or just before the job training on spoken English and role-playing of real-life scenarios. I can imagine some people might do well on the test but find day-to-day communication harder.

But I think that we should also be asking why so many nurses and midwives have to be recruited from overseas. Why isn't there also a push to offer more student places in the UK and more financial support for students, as well as to improve pay and conditions in these professions?

(On a separate note, I do some proofreading for students who I presume must have got a good enough score in the IELTS to get into university here, but their written English is sometimes terrible! Their spoken English might however be better).

Agree with others it should not be dropped.

I taught IELTS - admittedly a few years ago - and remember it as primarily an academic qualification. Nothing wrong with that, of course, but an HCP may be interacting with patients who use dialect or colloquialisms, and who may themselves not have sufficient self-awareness or cognitive abilities to vary their vocabulary so a non-native can understand. Nor should they have to!

I had a mild instance of this sort of thing when I presented at A&E with a post op complication that eventually needed major emergency surgery to correct. The consultant asked me how I felt - I had just been throwing up in pain - and I stupidly said "I've been better." Typical British response! He just understood that as I was feeling better and insisted on discharging me......

It's about so much more than academic language, it's about all the subtle cultural factors too.

Ghosts- the speaking part of the IELTS exam, is, IMO, of a much lower level anyway than the rest- another thing about it I don't like, despite it being my bread and butter!

Students accepted into UK universities will generally be required to have IELTS 6-6.5. Nothing higher usually. Writing is always the part of the exam that they get a lower bandscore on- because it's so very specific. (objective analysis of a graph etc) I repeat what I said earlier though- I'd love to see a British born and raised native speaker doing it justice, never mind my poor furrin students (and the HCPs!) It's bloody hard.

The point made by Johnny (and me upthread) remains though- a student could have grade 9 at IELTS (never met one, mind) and they still wouldn't have the productive (or receptive) skills to deal with an emergency room situation necessarily.

No, absolutely not. Especially considering the 'subject' matter!!

I've done IELTS back in 2006 to go to uni and achieved the standard that was required but cannot remember what it was 6.5 or 7.
We all are different and it is my personal experience but I was not a fluent speaker.

People train for months to pass these tests. They take courses that are designed to pass IELTS TOEFFL etc. not to learn the language. Although they do improve their language skills it is not the same as studying that language.

They are given past papers and they know how and what to say and adopt a certain style when doing speaking part of the test.

When I finally arrived in England I could not understand when someone asked what my name was (mostly local accent to blame) but also I was not able to carry out decent conversation.

And yet I passed the test with no probs at all.

My language improved very quickly and I wasn't responsible for anyone's well being apart from my own so that wasn't a big deal but if the standards of that test are still the same I'd say that the score should not be lowered.

No, no, no! How can any health professional do their job properly without speaking the language?

I'm an EFL teacher and think there's not much difference between 6.5 and 7.

I can say for sure that there are certain people who'd get a higher grade than that on the IELTS and would still be less than effective communicators IRL, and vice versa. So much of it is about test taking strategy and being good at tests and the testing mentality.

I really think lowering requirements is not the answer. Instead address staff recruitment and retention. Communication in English is essential to good care. I have encountered numerous problems with support staff in the hospital not having sufficient English to perform there tasks. Catering staff who could not understand my allergy questions. If the standard drop is not that large surely potential recruits could study to raise there IELTS score.

I don't think the information passed along by the NMC for this OP was as clear as it could have been, to be honest.
An article in the Guardian this morning reveals that the IELTS requirement was only brought in in January 2016, and that even nurses from English speaking countries are struggling to pass every aspect at level 7.
Nurses people on this thread have encountered who don't speak good English will have registered to work here prior to last year, it seems.
www.theguardian.com/society/2017/jun/24/english-speaking-ovserseas-nurses-fail-nhs-too-tough-language-test

I used to work somewhere that took in foreign students who needed to raise their English skills before going on to specialised training. Comprehension was often crap, regardless of the level they tested at.

So, while an IELTS score does indicate a cetain level of language, it's the ability to use that language in a situation that calls for major comprehension skills when the people involved may be in pain, distress, or there's an emergency going on.

I mean, I'm partly deaf, use hearing aids, but still have issues with understanding what I've heard, simply because I may not have heard correctly. Strong accents in particular can cause problems at times.

No absolutely not.
I was very recently at the receiving end of a nurse with inadequate English - not a biggie (fortunately) but she didn't understand requests from another hospital department concerning me, which meant I spent hours waiting for treatment.

The misunderstanding was only rectified when she came to get me to the phone because "your husband is on the phone" that I was able to talk to the other department myself. I don't have a husband. They said they'd been trying to get me for hours for a procedure but she kept telling them I wasn't there. I was.

And my poor mother was very upset when she was in hospital - she couldn't understand the staff and they couldn't understand her.

I think communication skills are so important in this role - it's not an area where there's room for compromise. I recently posted this experience in another thread - it might be relevant here too...

***

First pregnancy and I'd been feeling reasonably calm about things - but I had my booking in appointment with the midwife recently and am now really worried.

I'm booked into a large London teaching hospital where - unsurprisingly - lots of the staff trained abroad. I cannot stress enough that I have ZERO problem with this! My issue is that I have a very mild hearing issue which hardly has any impact on my day to day life - except that I really struggle to process spoken sound when a) there's lots of background noise or b) the person speaking has a strong accent.

Both of the midwives I met with had very strong accents and I could only understand maybe one in five words they said and kept having to ask them to repeat things. My husband was with me at the appointment and afterwards confirmed that it wasn't just me - they did have strong accents and even without my hearing problem, he struggled to understand everything that was said.

The midwives seemed great - knowledgeable, friendly and with a really nice manner. But I'm worried that I'll be in labour and simply unable to understand what's being said to me (the problem gets worse when I'm stressed and I'm sure there will be lots of background noise too). I get embarrassed and frustrated when this issue rears its head at the best of times - so the idea of dealing with it during labour is very upsetting. It can make the person with the accent feel like you're blaming them somehow - when I know that it's MY problem. I'm already starting to worry that the midwives will think I'm being awkward / difficult and hate me!

I'm not sure how to address this. I can't exactly ask for a midwife with Received Pronunciation (!) and I'm worried that expressing this issue will make me sound racist - which isn't the case. Any ideas about how to deal with this would be appreciated.

I genuinely think that a bunch of newly qualified British-born nurses need to sit the IELTS and their average score should inform this desicion. I've just looked at the writing test and the standard required for a 7 is far from trivial - as evidenced by the fact that degree educated Aussie nurses are failing to get a 7.

One of the issue with these (having done it) is that you can well be speaking the language well and for it to be your mother tongue but it also checks a lot of other things such as the understanding of a text etc.. in effect it's at the same time a test in English language (as in do you speak it) than it is a test in English (as the subject at school).

When I did the tes there was a British guy there who had to do it to get his visa to Australia. It was clearly not about whether he could speak English or not but whether he has a certain ability in reasoning, understanding of texts/oral etc... (in some ways, is he educated at least at A level level or not was my take)
This is also the reason why Im not surprised that some Brits will struggle with it. It's not an issue with language. It's an issue with reasoning.