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

I am a ward nurse. My trust has had issues with staffing so they have been abroad to both Europe and India multiple times to recruit. I have seen recruited nurses who simply cannot understand orders written or spoken. This in turn impacts patient care and means that the UK trained nurses have to work twice as hard as they have to support the foreign trained nurses as well as the students, junior nurses and carry out their jobs as well. It gets frustrating when you get one group of nurses trained in understanding the ways of UK nursing ie discharges, personal care etc and to be able to work without the constant hand holding and then they leave and you have to start all over again. This is what is causing the nursing shortage, extra responsibilities, the constant retraining of the new staff

Most of the recruited nurses simply do not stay beyond 6 months to a year, especially the European nurses as they have really struggled to get to grips with the way UK trained nurses provide personal hands on care and the whole social support on discharge. It is a whole different system to what the European nurses are used to. We have a complex system and UK trained nurses spend 3 years learning the system and how it works. These nurses are bought from abroad and are given a few weeks before being given patients and expected to be efficient and upto speed. Yes this is the problem with the lack of support given to the new nurses. They get their nmc registration and they are then let loose.

I have witnessed failed discharges, errors in medications, patient harm and miscommunication that could have proved harmful if a UK trained nurse had not been on hand to stop these from happening. This is not just one or two nurses but a large number of them simply because they didn't understand.

I am not able to speak a second language to a good enough level to be able to work abroad. I am in awe of those who are able to learn English as a second language and come here to nurse but I'm afraid that lowering the requirements is going to cause patient harm and will result in even more UK trained nurses leaving.

Definitely not. The language skills of some staff are already quite poor - I saw a mw antenatally who had a very strong accent from her home EU country such that I couldn't actually understand her. I would dread having her in labour.

Somerville- exactly- that's what I've been saying from the beginning of the thread.

I totally agree that non native speaker medical professionals need to have a very very good standard of English. IELTS is not going to help them whether at band 6.5, 7 or even higher.

It's like offering me a job interpreting in French for the UN based on me having a degree in comparative French literature.

There needs absolutely to be some measure to ascertain whether HCPs English is good enough. IELTS is never going to be that measure because that's not what IELTS is for.

As I said before also, I'd love some native speakers (doctors even) to do me an IELTS Writing test and see what band score I give them. Very few would hit a 6.5. But that doesn't matter because they're doctors, not academics who are going to be writing academic pieces in Anglophone universities.

Hi Everyone,

Thanks so much for your thoughts and ideas on this one - keep them coming.

Vintage maybe a bespoke qualification is needed.

I also taught Cambridge BEC and although more basic, it was much more practical. It dealt with a lot of jargon and colloquialism used in the workplace. Maybe we need to devise something for the kind of language patients are likely to use in stressful situations?

I am remembering things I have heard people say when describing real pain/ distress:

"I just felt all queer, all sixes and sevenses" my granny a few days after a stroke

"I was like yeah, no, not happening, not coping." A 18yo I know describing the feeling of failed anaesthetic

"Mortified is the word, and may have been slightly painful" mum at a baby group I go to describing emergency obs procedure during childbirth

I think as native speakers most of us could see through that phrasing to realise the person was describing sth fairly traumatic in each case. I am not sure IELTS would really enable understanding that type of expression.

Exactly!

Getting a 6.5 and above at IELTS is considered excellent- but if it's not relevant to what you are going to do with it, then it's worthless.

This Guardian article from April 2016 sums it up really:
www.theguardian.com/healthcare-network/2016/apr/08/english-language-requirements-foreign-doctors-not-fit-purpose

IELTS candidates probably won't have trouble with accent- but they certainly would (and do) with dialect and colloquialisms. The listening part of the test is the second toughest after the writing- (I have never managed to get 100% in the listening and I'm a native speaker IELTS teacher and examiner) but even a high band scorer is not going to get the nuances of all connected speech in long utterances. There are incomplete utterances in the listening- but again (and again and again) if the subject matter isn't relevant...

What HCPs need, would be an IELTS level exam, with content inherent to their jobs.

That's still not going to get non-native speakers to speak "better" English though at source though. The exam is the final product at the end of the day. What seems to be needed is a process which gets NN HCPs to the stage of being able to take such an exam in the first place.

(if the GMC would like a language consultant I'm open to offers )

Ignore the very non-IELTS inclusion of two "thoughs" up there.

As a registered nurse and as an employer, there is no way the standard should be dropped. There are already occasions when nurses struggle with the current level so to drop the standard further would put patients at risk and make the nurses lives harder as they are usually wanting to do their best.

Nothing substantive to add except that 40 years ago my mother did her PhD on what was then I think called the Doctors' Test, which was a healthcare-specific English-language test designed to assess whether non-English speakers could communicate well enough to work in the NHS. We seem to have gone backwards since then!

We should be training many, many more UK nurses - not stealing nurses from other countries and leaving their health services denuded and leeching from their societies investment.

Reinstate the bursary and open up more training spaces for both doctors and nurses. Properly invest in training our young people. A few years ago when my DD was applying to uni we went to some med/nursing open days - the speakers regularly said how there were 7+ candidates with all the right exam and test results for each place available but they were limited in numbers they could take on by the government. What a waste of talent.

Introduce more flexible shifts for nurses so they can arrange childcare - perhaps 24/7 daycare like in Grey's Anatomy (joke sort of) and a pay rise wouldn't go amiss!

A friend who is a nurse at a local hospital and her co workers are miffed that the Trust have recruited 150 nurses from abroad - on better salaries , a relocation package worth a few grand and accommodation for 6 months, dedicated staff to help with orientation and arranging for family to come here, get schools etc. My friend will end up training the new nurses, helping with language etc while earning less than them and living in a grotty flat - it does not seem fair.(She recognises this is not the nurses fault - management/culture in the NHS Trust). How can this be cheaper than giving a few perks, a small rise to retain UK based nurses?

The standard of English should not be dropped. Even though someone said it's fine in a shop or cafe, even that can be annoying if the person does not understand the nuances of your conversation and that is amplified 100 times if you are in a healthcare context.

I have had foreign dentists whose English has been top-notch and left me in no doubt of their competence. I had a foreign GP once, too and I had a lot less confidence in him because of his poor English.

Definitely not (to lowering language requirements)

I had a hugely traumatic first birth with DS which I think was mostly due to the fact that I had two midwives who barely spoke ANY English, and spoke to each other in their own language throughout my labour! I had never been in hospital before, didn't know what was going on and was absolutely TERRIFED. Sometimes other languages sound more panicked, or animated when you can't understand what people are saying. I was convinced something was wrong.
All my lead midwife seemed to be able to say is , "Is OK.... push..."

I would prefer that the standard isn't dropped.

No way.

Fil was in a new, multi-billion pound hospital. The hospital was gleaming, the staff were not. The hospital is in a deprived area and it offers plenty of employment opportunities. But the nurses were nearly all foreign and particularly on the phone we just could not make ourselves understood, nor could they understand us (and we speak in ordinary south-eastern accents).

Particularly I think a problem for patients is that most nurses will not understand colloquialisms or euphemisms when referring to body parts/ailments. Fil tried to tell a nurse he was having problems with his "water works" . The nurse didn't know what he was talking about.

To add to what everyone else's point, I don't think IELTS in its own is fit for purpose here at all.

When I first moved to the UK I had passed a number of English as a second language tests with near-perfect scores. My academic English was excellent (better than now!), I could speak easily and fluently, read scientific or fiction works and write academic papers. However when I started my first student job as a waitress I was utterly lost because I was not familiar at all with any of the colloquialisms and accents. Most of my interaction with native speakers had been with Americans, I had no idea what a typical English menu would look like as for a Yorkshire accent? No chance. Many of my colleagues had significantly worse English than me but could communicate much more effectively on the job because they had the right experience.

I'm not sure whether a bespoke test is needed or, actually, the current methodology combined with much more support for newly recruited nurses - proper immersions, extensive shadowing, more hands on training.

I believe there is a lot of great talent outside the UK that could benefit the NHS hugely but the system is failing both staff and patients if it doesn't offer adequate support.

A lot of language problems that people on this thread have encountered have not been improved by the government insisting on staff passing IELTS, though. To repeat, australian nurses who would certainly understand colloquialisms and different accentsare failing IELTS at level 7

And it is believed that many British nurses would fail it too.

There needs to be a language test that is designed and implemented especially for NHS nursing.

Which means that the IELTS is testing for other things other than just a handle of the everyday language.
The question is: is it needed fur nurses? It might well be because we are asking them not just to speak English and know the theory of nursing. We are also expecting them to learn and fit into a system that is fundamentally different from the system they trained in.
So the skills needed to pass that test might well be required to do that.

Fwiw I personally didn't find this test hard. Nor did a colleague of mine who did it at the same time than me. We didn't do any preparation.
We were both trained at degree level which is where, imo, things can get more tricky

perhaps 24/7 daycare like in Grey's Anatomy

I would kill for that kind of support through my training. I am absolutely reliant on family help. If anything happened to my parents, I'd have no choice but to quit. The lack of training spaces aside, this is a massive hurdle for many people to be able to go ahead with their training. Then, naturally, there's the fact that currently the government would rather recruit elsewhere (a very costly process in itself) than pay home trained nurses as well as they should, forcing people to choose between work that they love and pay that reflects their stress levels, level of training and the ever rising cost of living.

I agree with those who are saying that the IELTS is not testing all the right things, and is testing some of the wrong ones. if Aussie native speakers are failing it, it isn't fit for purpose. If people who struggle to communicate in real life situations are passing it, it isn't fit for purpose.

Health is a very specialised environment. I work in health research - no life and death emergencies, but a lot of specialist terminology involved. I am Dutch, the rest of my team are all English. We've been there varying lengths of time - I'm the longest serving at almost 10 years in post. Any time we get a new team member in, no matter how great their English is, they need time to get up to speed on the complexities of research language. The IELTS would not capture that either. I think in an acute health care setting, it's really important that any test of language captures what is appropriate and necessary for the context the staff member is going to operate in.

I worked with an agency HCA the other day who had just arrived from South Africa and it was pretty hard to understand her English. She was hoping to work here as a qualified nurse once she had passed the English test but I couldn't help thinking she had a long way to go.

Hello all

Thanks very much for all your thoughts and responses (and expertise ). Apologies for any vagueness in the OP - as some of you have rumbled, this is not our specialist area

The NMC is reading the thread and will be taking your points on board.

Thanks
MNHQ

it should increase to be on par with doctors. Decreasing it is an accident waiting to happen.