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Lack of language skills tests 'illogical'

The testing of language skills among migrant nurses should be "anchored in European law", argues the Royal College of Nursing (RCN).

Currently, nurses trained within the European Economic Area (EEA) are subject to the European Commission's Mutual Recognition of Professional Directive of 2005.

Under the directive, regulators are not allowed to undertake any further competency checks, including the testing of basic communication skills in English.

The responsibility falls to individual employers to spot language problems - a practice that is claimed to have practical defects due to its lack of uniformity.

In response to the government's green paper, Modernising the Professional Qualifications Directive, the RCN claims nurses entering the UK from the EU must have adequate language skills and up to date training in order to practise safely.

The RCN believes regulators, such as the Nursing and Midwifery Council (NMC) should be responsible for the testing of language competency.

"The testing of language competency should be anchored in European law," said Dr Peter Carter, the RCN's Chief Executive and General Secretary.

"This is not to discriminate against nurses from any particular country, but rather to ensure that the highest standards of care and patient safety are maintained and that any barriers to that effect are removed."

Viscount Bridgeman criticised the current lack of language testing during a debate in the House of Lords on Wednesday (7 September), deeming it "illogical and inefficient".

"We have regularly expressed our concerns over elements of the EU Mutual Recognition of Professional Qualifications directive, which prevent competent authorities from systematically language testing migrating nurses who apply for registration in their country," said a spokesperson from the NMC.

"We believe this situation puts patients at risk.

"The European Commission are currently undertaking a review of the directive and we are working closely with other regulators across Europe and with the UK Government to articulate our concerns."

Your comments (terms and conditions apply):

"I think an English test should be introduced for all non-English speaking medical professionals and in addition knowledge and skills tests relating to the type employment applied for. I believe employers should not take on employees who do not have the relevant English knowledge and English skills. The individual himself/herself should be made responsible for
his/her English learning and this should be tested by the employing organisation. In the medical profession there are so many trained persons looking for employment particularly those who have taken breaks for child rearing who now have to retrain at their own expense in order to get back into a familiar workforce - whereas foreign medical persons can be
employed in what is for them a non-familiar environment in the UK where English is so vital in delivery of good effective and safe care. Without the necessary checks and balances because of 'freedom of movement'. We wait for an incident to occur before waking up to remedy what is avoidable by earlier action.Other EU countries have inbuilt safeguards for their residence why not Britain?" - V Henry, London

"As a 'foreign' nurse I understand the importance of a good command of the English language within nursing practice. I do agree that some of the overseas trained nurses may require more attention and patience from colleagues and patients when it comes to communication skills. I also agree that some sort of language testing would be appropriate but I
completely disagree with treating every overseas trained staff the same. I find it wrong and unfair to use arguments like 'I have complaints every day from (usually) elderly patients or their carers about the lack of language proficiency - especially with colloquial English - and also the lack of cultural understanding from foreign nurses and carers'. It makes it
sound that there is a big issue going out there and nobody acts on it. It sounds like some older people's wellbeing has already been put at risk because of lack of communication skills of their carers. It is a big thing to state that elderly patients became "depressed", "inconsolable" and suffer "apparent lack of care". If this scenario is real it calls for safeguarding actions. In my opinion it would be nice to have a legal way to impose competency and language testing for overseas nurses. It would probably help patients to feel more safe and reassured that they can communicate well with their nurses. It would also eliminate this permanent tendency of pointing fingers and blaming foreign nurses' skills for things going wrong in healthcare. I can say that I have never had complaints from my patients and I never had my competencies questioned or doubted. I work for the NHS but I also have the experience of nursing in the private sector" - AG, West Midlands

"I come from Malaysia and did all my nursing training in the UK years ago, and if my English language skill was not up to the mark something would have been done before completion of my training. I was expected to prove medical and health fitness and had to provide evidence of recent chest XR
reports, various immunisations and language ability checks before acceptance for training. I think the employer definitely should be responsible for ensuring that the potential candidate has the written and verbal language capability and cultural awareness. Patient safety and interest come first and all these are ingrained in the NMC codes of practice and professional conduct. How can care be safe and effectively delivered to the patient if the means to do it is missing?" - Name and address supplied

"It is vital that the NMC together with the local employer, should be responsible for testing language and general competency among ALL nurses. This is necessary to ensure patient safety and avoid distress when the nurse/patient cannot understand each other. It would hopefully eliminate
medication mistakes and improve patient/client care" - K Guthrie, Scotland

"I have complaints every day from (usually) elderly patients or their carers about the lack of language proficiency - especially with colloquial English - and also the lack of cultural understanding from foreign nurses and carers. Many patients and elderly people that complain to me are suffering due to lack of understanding and skills of foreign staff, and become very depressed, sometimes inconsolable, at their apparent lack of care. Some foreign nurses (usually trained) work in hospitals with many other local nurses there who can help with culturalisation and spot any skill gap; but many work in relative isolation, ie, primary care or private companies, and this is where the main crux of complaints to me come from.
It never fails to amaze me that while British born nurses have to jump through hoops to become a nurse or carer; agencies (especially care agencies) employ Polish, African and far eastern staff with only rudimentary checks, many of whom have only recently arrived, have no experience in dealing with vulnerable people let alone speak the language. I know many lovely, competent carers (of many nationalities) who have been put out of work by my local council, who have now given all contracts for home care to private agencies who employ only newly arrived foreigners who except below minimum wage. Some even have translation sheets" - BL, Wilts