Staffing is the issue keeping NHS leaders awake at night – and which consumes two-thirds of trusts’ spending. The fortnightly The Ward Round newsletter, by HSJ workforce correspondent Annabelle Collins, ensures you are tuned in to the daily pressures on staff, and the wider trends and policies shaping the workforce.

Concerns have been raised for many years about the English language test’s impact on the number of foreign nurses who can secure an NHS job. It has been argued the test is unnecessarily difficult and therefore a barrier to recruiting this much-needed staff group.

Former NHS chief executive and current Manx Care chair Andrew Foster and former NHS Confederation chair and NHS trust chair Peter Mount are pushing for the Nursing and Midwifery Council to urgently review the English language test.

“There are thousands of nurses, who came to the UK in the early 2000s and after, who had qualified as nurses in India but can’t get registration here because they have not passed the language test,” Mr Foster told The Ward Round. “It seems very stark that we have a workforce crisis and yet are not employing this valuable group.”

Mr Mount added: “The language requirements were to ensure patient safety, although when questioned NMC have no evidence of fitness to practise cases being brought against overseas nurses related to language weakness.

“I am aware of nurses who have taken these language tests over 10 times and have been living and working in care and health settings in [the] UK for over 10 years.”

The Ward Round understands a group of employers and nursing leaders approached the NMC about this again last year and a roundtable was organised in November 2021.

“We outlined the nature of the problem and suggested various short- and long-term solutions. For example, not needing to pass all elements of the test at the same time or a small lowering of the pass mark,” Mr Foster said. “I personally took the language test and although I passed, a lot of it is constructed in a way which will make it difficult – it is more exacting than it needs to be.”

However, both expressed frustration that nothing has happened to ease the situation since the meeting. “I don’t get a sense of urgency,” Mr Foster said.

In response, Matthew McClelland, the NMC’s executive director of strategy and insight, said reviewing the language tests is a priority for this year.

He added: “Our pre-consultation engagement started with a roundtable event in November, and we’re very grateful to colleagues who shared their personal experiences as part of that conversation. Since then, we’ve continued to gather views from professionals, partners and the public, to build a clear evidence base for changing our guidance.

“It’s essential we take the time to get this right, because our regulatory policies are a matter of public safety. We also have a statutory duty to run a public consultation, which we plan to do this summer. We’ll continue to keep stakeholders informed as the work progresses.”

However, Mr Mount described this timeframe as “ludicrously long”.

“We need these nurses and are busy recruiting more, while at the same time ignoring those we already [have].”

Progress on 50,000 more nurses?

Despite disruption caused by the pandemic, Mike Haslam, deputy director at the Department of Health and Social Care for the 50,000 nurses programme, told the House of Lords public services committee this week that “good progress” was being made to hit the infamous target.

He assured the committee the government was “on track” to meet it by 2025, through a combination of “increased domestic recruitment”, with “action also being taken on retention” and “strong international recruitment”.

He also promised an update would be published on the 50,000 more nurses commitment very shortly.

However, Mr Haslam added that numbers alone are not sufficient: “We need more staff, but we also need them to be working differently and in a supportive and compassionate culture.”

He acknowledged the workforce had been through the most difficult few years, and pointed to 2020’s ‘People Plan’ in terms of what is being done to make the NHS a better place to work.

This was echoed by Rob Smith, Health Education England’s workforce planning director. “We have been stressing the numbers are not enough… but we are pulling all levers at all levels,” he said, referring to current work being done on HEE’s Framework 15.

The ‘50,000 more nurses’ ambition was rightly interrogated by the committee. Lord Willis of Knaresborough asked: “I want to challenge you on 50,000 new nurses by 2025. This is in three years time, and you think this is perfectly possible.”

Giving the example of the September 2021 Nursing and Midwifery Council figures, Lord Willis put it to the DHSC officials there had been a fall of UK-based nurses by 4,500 over the last three years.

“In the next three years, to jump up to plus 50,000 is something quite frankly I hope this committee doesn’t believe,” Lord Willis said.

“We have had challenges with domestic recruitment”, admitted Mr Haslam, and said the maintenance grant – reintroduced in 2019 – was resulting in a higher number of student nurses. “It’s fair we look at alternatives to plug the gaps in the short-term.”

However, there was no discussion about how many nursing associates would be factored into the 50,000 nurses target. As HSJ revealed in 2019, NHS England estimated recruiting more nursing associates would reduce demand for registered nurses by 10,000. It will be interesting to see if this is still factored in when the 50,000 update is published.