Thousands of qualified nurses recruited by the NHS from overseas are stuck working in unskilled jobs because of unnecessarily difficult language tests, according to researchers.
Nurses with British citizenship who have lived in the UK for years are among those in “regulatory limbo” because they cannot pass the language exams needed to register with the Nursing and Midwifery Council.
The nurses have already sat competence exams in English, and often have years of experience working with patients in the UK. Of 857 surveyed by Salford university, more than 600 had British citizenship, which includes English tests, 79% had lived in the UK for over a decade and 17 held master’s degrees in nursing. But they are unable to practise as nurses because they can’t pass OET or IELTS language exams, despite in some cases having an NHS employer to vouch for their language skills.
Jini Joy, 43, who came to the UK from India in 2007, said she had spent £3,500 on 10 attempts at the OET exam, which is designed to assess language proficiency for healthcare professionals. She passed the speaking and writing elements but struggled with the comprehension section, which requires candidates to read a text before answering 20 questions in 15 minutes.
She is now working as an assistant practitioner at an NHS trust, dealing directly with patients. “We are doing almost exactly the same job as the nurses but for lower pay. It’s not fair,” she said.
Critics say the exams demand an academic standard of reading and writing that many native English speakers – who typically need only a C at GCSE – would be unable to achieve. They are calling for an overhaul of the NMC’s testing requirements, which they say are “discriminatory” and worsen the UK’s nursing shortage by ignoring an “untapped doorstep resource”. The NHS is currently short of about 40,000 nurses and invests heavily in recruiting from overseas.
Accepting alternative proof of language skills – such as three years working in a healthcare setting, an employer reference and completion of British citizenship exams – could allow an additional 3,000 qualified nurses from India who are already in the UK to be added to the register, according to researchers, as well as hundreds more from other countries, including Nigeria and the Philippines.
Dr Dilla Davis, a lecturer in nursing at Salford, said the goal was not to “water down” standards and that safety was paramount: “The question is, is it fair? When you look at a native speaker, what is their literacy level and reading age? For the average person, it is not at a professorial level. But that is what we are asking of overseas nurses.” She added that the tests did not take into account the “cultural nuances of speaking”, while practical assessments did.
Currently, nurses recruited from overseas are required to pass the OSCE competence exam in English as well as either the IELTS language exam, which can include questions on any subject, or the OET.
Nurse and researcher Dr Agimol Pradeep, a liver transplant coordinator at King’s College Hospital, said many candidates were tripped up by the reading section. In the OET, they can be asked about anything from cancer treatments to cannabis use or genomics. “These are not everyday topics,” she said.
The calls for reform are backed by high-profile figures including Andrew Foster, chair of Manx Care on the Isle of Man, and Peter Mount, a former NHS trust chair in Manchester, who have jointly written to the health secretary, Sajid Javid, calling for an urgent intervention.
They claim there are “elements of racism, discrimination and exploitation” in the matter, with nurses wrongly “trapped into lower-grade” roles. “These are nurses who are considered good enough to give safe care to patients in care homes but are blocked from registered nurse jobs and appropriate salary for very poor reasons,” they wrote.
Mount told the Observer it was wrong that qualified nurses who had proved themselves competent English speakers were being excluded from registration in the midst of a critical nursing shortage. “We’re not for a moment saying, ‘Have no language testing’. We’re saying, ‘Give credit for experience,’” he said. “We’ve got cases of nurses who’ve taken this 15, 16 times. Some have given up and gone to work for Tesco.”
The Nursing and Midwifery Council said it was reviewing its English language requirements to ensure the approach was fair. It has set up an advisory group and scheduled a public consultation for the summer.
Matthew McClelland, executive director of strategy, said: “It’s essential that everyone joining our register can communicate well in English, wherever they trained.
“Nurses and midwives spend the most time with patients and people who use services, and effective communication is fundamental to high quality, person-centred care.
“Over 17,500 professionals who trained outside the UK joined our register in the 12 months to the end of September 2021 alone, and the vast majority of them have taken one of the English language tests.”
