Analysis: The nurses set to benefit from English language changes

Ms Nyandieka had just made her third attempt at the OET exam when the Nursing and Midwifery Council (NMC) announced in September 2022 that it would change its English-language test requirements, following a consultation exercise. When she found out the changes would apply to her, she could not believe her dream of working as a nurse in the UK was “finally coming true”.

To pass the English-language test, an applicant needs to achieve a score of B in the OET, or 7 in the alternative International English Language Testing System (IELTS) advanced exam, in each of the listening, speaking and reading parts of the test, and C+ or 6.5 in the writing domain.

Those who do not pass first time can currently resit and combine pass scores from their two separate attempts as long as they are no more than six months apart. However, under the current rules applicants can only do this if they score a near miss of at least C+ (OET) or 6.5 (IELTS) in each separate part of the test. This is already the required score for writing, so there is no flexibility for that part of the test.

With the new changes, which are being introduced from early 2023, the NMC will accept combined test results as long as no part of the test is scored more than half a grade or point below the minimum required for the respective domains – which lowers the minimum score for writing to C or 6. Applicants will also have 12 months instead of six to retake the test.

Ms Nyandieka told Nursing Times she was “very happy” to find out that, once the changes are introduced, two of her attempts will combine to meet the OET standards. “I was all smiles,” she said. “I couldn’t believe this dream is now finally coming true.”

She will join South West Yorkshire Partnership NHS Foundation Trust, which is supporting her to gain her UK registration. She is one of three Kenyan nurses who spoke to Nursing Times about their experiences, and who were recruited to the UK by international recruitment agency NEU Professionals, before the Department of Health and Social Care moved Kenya to its amber list of countries, from which individuals should not be actively recruited.

NEU Professionals works with more than 50 trusts to offer English-language sponsorship to internationally educated nurses. Working with English-language training providers, the agency learnt that, on average, it takes three attempts to pass the English-language exam for someone who has not done any test training. As such, the aim of this collaborative approach is to provide candidates with a decent level of training so they can pass their exams first time.

Mary Wanjiru Mwaura told Nursing Times she had completed the English exam five times, only ever missing the mark on her reading subtest, which she said she found the most challenging. “It’s been a very disappointing journey. I won’t lie to you, I was crying every time,” she said.

“The journey has not been an easy one, especially when I was listening to these heartbreaking stories of these nurses who are skilled and qualified”

Agimol Pradeep

However, since coming to the UK and working as a healthcare assistant (HCA) at Cambridge and Peterborough NHS Foundation Trust, Ms Mwaura said she was able to practise her English, which she found had helped.

“I got an A last time I did my speaking,” she noted. “I got an A because of coming to the UK.”

The cost of the exam is something that had also affected Ms Mwaura. She said it was “very painful” to pay the money multiple times to retake. An OET test costs around £320, and the IELTS test is around £175. It is thought that some candidates can spend more than £1,000 trying to pass the English-language test.

The NMC announced in its changes that it would extend the period in which a person can combine their test scores from six months to 12 months, “to allow for greater flexibility and more time to prepare” before retaking the test. For many internationally educated nurses, this includes time to save money.

Kerry Ann Wykes, director of NEU Professionals and a nurse by background, explained to Nursing Times the expense some candidates face when trying to sit these exams. “We’re trying to make people and trusts understand how challenging it is for these nurses,” she said. “They want these nurses to come and work in the UK, but the nurse is expected to fund a lot of the fees themselves.”

Duncan Mandela was also recruited to Cambridge and Peterborough as an HCA, after previously working in Kenya as a mental health nurse. He said that, while the NMC changes were “a good thing”, he would also like to see the regulator reconsider the test scores they accept as a pass.

“To hear from patients and get an insight into people’s language skills in practice will be really helpful”

Matthew McClelland

“I know some nurses who have done their exams [and] their score is not that bad, but they’ve opted to go to other countries like the US, simply because they have missed a mark,” he said.

He encouraged those nurses who want to come to the UK “to keep on pushing”.

Agencies such as NEU Professionals work with companies like Specialist Language Courses (SLC), which helps nurses prepare for the OET or IELTS exams. Peter Rodway, director of SLC, told Nursing Times the decision from the NMC to allow greater flexibility in combing scores was “sensible”. He said: “It speaks to the understanding that everybody has – that first-time pass rates are low and people may need to combine two exam papers. So that’s a good thing.”

However, Mr Rodway added that having language controls was still “the right and proper thing to do”. “It’s important that nurses can practise safely and effectively and not make mistakes,” he said. “That’s super important and I think that shouldn’t get lost in the workforce pressures we are facing.”

The NMC will also be introducing another change to its English-language requirements next year that will allow applicants who have worked in a UK health or care setting for 12 out of the last 24 months to submit an employer reference as evidence of English-language proficiency instead of a test. This option will be available to applicants who have trained in English in a “non-majority English speaking country”, and those who only just miss the required score on an OET or IELTS test.

Matthew McClelland, executive director for strategy and insight at the NMC, told Nursing Times that this change could be utilised when  candidates “narrowly miss out on the score in one domain”. He said the regulator was trying to make this change “as person-centred as they can”, and supplementary information could include evidence from an employer as well as patient experience.

“I think safety and the ability to really genuinely hear from patients and get an insight into people’s English-language skills in practice, rather than in a classroom, will actually be really helpful,” he said.

Agimol Pradeep

Two nurses have been calling for changes to the NMC’s English-language requirements for a number of years and have collated hundreds of case studies. They are Dr Agimol Pradeep, liver transplant coordinator at King’s College Hospital, and Dr Dilla Davis, nursing lecturer at the University of Salford. They have been campaigning on behalf of thousands of India-trained nurses who have been unable to pass the language test and achieve registration, despite living and working as HCAs in the UK.

Dr Pradeep and Dr Davis told Nursing Times they were “overwhelmed” by the responses they had received from nurses who would be positively affected by the NMC’s changes. Dr Pradeep said: “The journey has not been an easy one, especially when I was listening to these heartbreaking stories of these nurses who are skilled and qualified. So, I was happy for those nurses and felt like we have achieved great success for [them].”

Dilla Davis

Meanwhile, Dr Davis said it was a “monumental” moment for them. “It is very seldom you find that dreams come true. It was not just for us personally… but this is for the 857 of our research participants who shared their story [with us],” she said.

The pair has called for the NMC to consider further changes to the requirements next year. Mr McClelland told Nursing Times that, once the NMC had got through the first set of changes, it would consider looking at others “over the course of the next financial year”.

One potential idea could be to revisit a proposal that was not carried forward from the consultation, which was around accepting post-graduate qualifications taught and examined in English as supporting evidence. Additionally, he said the NMC would be conducting exercises in 2023 to assess whether the current test scores they accept were correct.

Looking ahead, Mr McClelland said the regulator was “making pretty good progress” on beginning to implement the changes to the requirements for 2023. “We’re not quite at the point yet of being able to announce a date but, hopefully, we’ll be able to do that imminently and we’ll go from there,” he said.