The NMC is considering accepting employer English language references as part of a proposed overhaul of requirements for overseas applicants.
At a meeting on 26 May, the Council will consider approving a consultation on proposed changes to the NMC’s English language requirements, with a view to implementing any resulting changes from October this year.
It plans to consult on three specific changes – the scores it accepts for language tests, whether it can accept evidence of non-registered practice in English supported by an employer reference or other evidence, and whether it can accept non-nursing or midwifery postgraduate qualifications taught and examined in English.
It also plans to consult on whether the English language requirements should be the same for internationally trained nurses, nursing associates and midwives.
The NMC currently accepts three types of English language evidence – recent achievement of the required score in accepted English language tests; completion of a pre-registration nurse, midwife or nursing associate programme that was taught and examined in English, and included clinical interaction in English; and recent practice for one year in a majority English speaking nation.
However, it said over the last year it has received ‘a considerable amount of critical stakeholder feedback’ to its approach in a listening event with stakeholders in November, a Public Voice Forum in March, and formed an external advisory group to help inform potential changes.
Feedback included that the minimum standard to be achieved in the English language tests is ‘too high’ and that there is a ‘lack of supervised support, or lack of time to access support, to help prepare for English language tests,’ the NMC said.
Other feedback included that, ‘as there is a workforce crisis in health and social care, we should reduce our required test standards and accept alternative evidence,’ said the NMC.
The regulator said that while staffing shortages are ‘important context,’ they are ‘not a determinative factor,’ and ‘it is essential the requirements set give assurance that applicants have the knowledge of English necessary for safe and effective practice in the UK.’
There has also been ‘an increase in successful appeals by applicants,’ it added.
The NMC summarised: ‘We think there is more we can do to be flexible in the types of evidence we accept which would still allow us to have confidence that everyone on our register has the necessary knowledge of English.’
The nursing and midwifery regulator last reviewed its requirements in 2019 and accepts ‘there may be a case for change’, proposing to launch an eight-week public consultation in June, with final proposals made to Council in September, in order to implement any changes from October.
‘Whilst we want to ensure the register is accessible, all those on the register must demonstrate they have the necessary knowledge of English to be capable of safe and effective practice,’ the NMC said.
‘We must manage two competing risks. One is that we require evidence that is disproportionately difficult and therefore prevents qualified applicants from joining the register, thus exacerbating the shortage of professionals. The other is that we set our requirements too low and risk allowing applicants onto the register who are not capable of safe and effective practice.’
Gail Adams, Head of Professional Services at Unison, said the union ‘welcomes the NMC review,’ and that ‘it’s long overdue and has not maintained pace with demand.’
She said Unison has seen ‘a significant increase’ in cases being referred to its specialist unit for representation following rejection of their NMC applications to join the register on the English language requirement. The fact all have been upheld, she said, ‘demonstrates the assessment is not working, and is possibly wasting unnecessary time, energy and registrants’ money.
‘We are committed to working with the NMC on this issue, but cannot stress too strongly the urgent need for action.’
The proposal to accept evidence of non-registered practice in English supported by either a reference from the relevant employer or other evidence ‘marks the biggest area of change in terms of current requirements,’ the NMC said, and ‘would provide assistant registrars with further information to consider and could reduce the number of appeals.’
Matthew McClelland, executive director of strategy and insight for the NMC, said: ‘Of all health and care professionals, nurses, midwives and nursing associates spend the most time with patients and people who use services. Effective communication is essential to delivering the safe, effective and kind care that people have a right to expect.
‘We’re grateful to everyone who’s already shared their initial views, which have helped shape the options we’re proposing to consult on. We look forward to hearing more from the public, employers and our professionals to make sure our processes are fair and reliable for everyone.’
The proposed consultation comes after research warned hundreds of overseas nurses who have lived in the UK for years cannot work as a nurse because they are struggling to meet English language requirements.
Also in the meeting on 26 May, the Council will be asked to approve new post-registration standards, which have been updated following concerns they were ‘too generic’ to be applied to some community specialisms.