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Information for nurses and midwives
Allegations of insufficient knowledge of English
Introduction
1
The Nursing and Midwifery Council (NMC) can investigate an allegation that a
nurse or midwife does not have the necessary knowledge of English to practise
safely in the United Kingdom by directing them to take a language assessment. 1
This guidance aims to help nurses and midwives who face such an allegation to
understand the process of language testing.
Investigation
2
If you have been referred to us because of concerns about your knowledge of
English, we will only investigate if your lack of knowledge of English could impair
your fitness to practise. 2 The key consideration will be whether or not you present
a risk to patient safety, for example, because you are unable to communicate
essential information about patient treatment to other healthcare professionals.
3
If we decide to investigate the allegation, we will normally direct you to take a
language assessment. In such circumstances we will write to you setting out the
assessment that you are required to take and the deadline for providing us with
the result. We will meet the cost of any assessment that we direct you to take.
4
We will not normally pay for your travel associated with the language assessment.
However, we may make an exception in cases of hardship to cover the cost of
travel when necessary. If you have a disability and need a companion to travel
with you, we can pay that person’s travel expenses. You should raise this with
your case officer as soon as possible.
IELTS assessment
5
The assessment that we will normally ask you to take is the International English
Testing System (IELTS). IELTS assesses the language ability of people who want
to study or work where English is the first language of communication. The
assessment has four different components: listening, reading, writing and
speaking. The listening, reading and writing components must be completed on
the same day. The speaking test can be taken up to seven days before or after the
other three tests. Further information about the IELTS test and how to prepare can
be found at www.ielts.org.
1
Pursuant to The Nursing and Midwifery Council (Fitness to Practise) (education, Registration and
Registration Appeals) (Amendment No.2) Rules Order of Council 2015
2
The Registrar decides whether the referral amounts to an allegation capable of impairing a nurse’s or
midwife’s practice under Rule 2A(2) of the Nursing and Midwifery Council (Fitness to Practise Rules)
2004 (‘the Rules’)
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6
IELTS is available worldwide, with test locations in all four countries of the United
Kingdom.
7
There is no such thing as a pass or fail in IELTS. The results are reported as band
scores on a scale from 1 (the lowest) to 9 (the highest). We expect all nurses and
midwives on our register to achieve a minimum score of 7.00 in each of the four
components. 3
8
The test centre will send you a signed certificate of your results, by post, 13 days
after you have completed the assessment. It is your responsibility to take the
IELTS assessment in sufficient time to provide us with the results by the date we
specified in our letter. This will normally be within a 60 day period. We may extend
this time period if a nurse or midwife requires reasonable adjustments to take the
assessment.
Non-cooperation
9
You have a duty to cooperate with our investigation and this includes any direction
that you take a language assessment. 4 If you fail to comply with such a direction
without providing us with a good reason, this could be relied upon by us as
evidence that your fitness to practise is impaired because you do not have the
necessary knowledge of English. The Conduct and Competence Committee can
draw inferences if you fail to undertake an assessment you have been directed to
take, or fail to provide us with evidence of the result. Failures such as these are
likely to be a strong indicator that you lack the necessary knowledge of English.
10
A failure to undertake an assessment or provide us with the result could
alternatively be treated as an allegation of misconduct, and is likely to be a factor
that we would consider in deciding whether or not an interim order restricting or
suspending your practice is necessary.
11
If you have provided us with a good reason why you were unable to comply with a
direction from us, we will consider whether to allow you more time to rearrange
your language assessment. There may, however, be cases where we decide to
proceed with the case on the evidence we currently have, and invite the Case
Examiners to consider the inferences the Conduct and Competence Committee
can draw from a failure to take the assessment or provide us with the results.
Interim Orders
12
We will apply to a Practice Committee for an interim order where it appears that
your lack of knowledge of English is such that it is necessary to restrict or suspend
your practice in order to protect members of the public, or that to do so would be in
your own interests, or otherwise in the public interest.
3
A score of 7 means the individual is a “good user who has operational command of the language”
Nurses and midwives are required to cooperate with all investigations under paragraph 23 of The Code:
Professional standards of practice and behaviour for nurses and midwife (NMC 2015)
4
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14
In carrying out our ongoing risk assessment relating to concerns about your
knowledge of English, particular factors which may be relevant in considering
whether an interim order is necessary are likely to include:
13.1
the severity of any potential or actual clinical risk, or any actual or potential
harm caused to patients through your alleged lack of knowledge of English
13.2
the score on your language assessment
13.3
any non-cooperation with our investigation, particularly a persistent failure
or refusal to comply with a direction that you take a language assessment.
All interim order reviews include a consideration of any material changes to the
risk posed by the nurse or midwife. If you are subject to an interim order because
of language concerns, any relevant evidence of your knowledge of English that
you send us during the investigation of your case is likely to be considered by the
Practice Committee reviewing your interim order.
Case Examiner decision
15
Once we have received the result of your IELTS assessment, your case will be
sent to the Case Examiners, with a report making a recommendation on whether
your fitness to practise is impaired. In general if you obtain less than 7.00 in any of
the four components of the assessment, we will recommend that you do not have
the necessary knowledge of English to practise safely. We will send you a copy of
our report and recommendation at least 28 days before the Case Examiners make
their decision. Within that time you can send us any written responses or evidence
that you would like the Case Examiners to consider.
16
Case Examiners will decide whether there is a case to answer in relation to the
allegation that your fitness to practise is impaired because you lack the necessary
knowledge of English to practise safely. 5 They are not restricted to considering the
results of the IELTS assessment alone but can take into account all relevant
circumstances. Therefore you can send in any evidence that you think is relevant
to whether or not you have the necessary knowledge of English to practise safely.
This can include:
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16.1
any written responses or evidence indicating you have the necessary
knowledge of English to practise safely;
16.2
any evidence that you have trained or practised in an English speaking
environment for a period of time;
16.3
any evidence that you have previously completed an IELTS assessment to
the required standard (for example, as part of a previous application to the
NMC register);
See the Language impairment guidance for more information.
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16.4
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any evidence that you have recently obtained a qualification that has been
taught and examined in English.
These factors are likely to be particularly relevant if you have averaged just below
7.00 in the IELTS assessment and it may therefore be less clear whether there is
a case to answer.
Conduct and Competence Committee
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If the Case Examiners decide there is a case to answer in relation to the allegation
that your fitness to practise is impaired, your case will be referred to the Conduct
and Competence Committee. This means that a panel will make a decision on
whether your fitness to practise is impaired and, if so, whether to impose any
sanction on your registration. The possible sanctions are a caution order for up to
five years, a conditions of practice order for up to three years, or a suspension
order for up to one year. 6
Hearing or a meeting
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It is your right to have your case decided at a hearing, if you so wish. If you
request a hearing, or your case is sent to a hearing, it will be held in public and
you (or your representative) will have the opportunity to attend and address the
panel as to whether or not you have sufficient knowledge of English to practise
safely.
20
You may also request that your case be decided at a meeting. However, we can
direct that your case is sent to a hearing if this is in the public interest. Meetings
are held in private and you will not be allowed to attend to address the panel. The
panel will not hear from any witnesses but will consider your case based on the
documentary evidence they have before them. You will have the opportunity to
submit further written representations or evidence to us before the Conduct and
Competence Committee meeting takes place.
Further language testing
21
In some cases a significant amount of time may have passed between you taking
the initial IELTS assessment and a panel of the Conduct and Competence
Committee considering your case. In those circumstances, the IELTS result may
no longer provide an accurate assessment of your knowledge of English and we
may direct you to undertake a further IELTS assessment. As set out above, we will
notify you in writing if you are required to do this and inform you of the date by
which you must provide us with the result. We will meet the cost of any additional
language assessment we direct you to take.
6
There is no option for a panel to make a striking-off order on the first occasion it considers an allegation
of this kind (Article 29(6) of the Nursing and Midwifery Order as amended)
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If you submit the results of an additional language test that you have taken
yourself, this will form part of the material that the panel of the Conduct and
Competence Committee will consider. We may direct a further IELTS assessment
after we have considered the results of any additional language testing you send
us.
Final hearings and meetings
23
At a final hearing or meeting, the panel will decide whether the NMC has proved
the factual charge on the balance of probabilities, whether your fitness to practise
is impaired by reason of not having the necessary knowledge of English , and
finally which, sanction, if any, to impose. Each of these decisions will be made in
separate stages. At the hearing you will have the opportunity to address the panel
and present any evidence you have at each of these stages. 7
Review hearings
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If the Conduct and Competence Committee imposes a conditions of practice or
suspension order on your registration, a review hearing will be held prior to the
expiry of the order. Before that review hearing takes place, we may direct you to
take a further IELTS assessment if it will assist the panel reviewing the order to
make their decision. For example, we may direct you to take a further IELTS
assessment if a significant amount of time has passed since your last assessment
and you have now provided us with evidence that suggests you may no longer be
impaired by reason of of not having the necessary knowledge of English. We will
again meet the cost of any language assessment we direct you to take.
Approved by Director of Fitness to Practise 15 January 2016
Effective from 19 January 2016
7
See Language impairment guidance for further information about what considerations the panel will take
into account
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