It is widely accepted that the health service in Britain and Northern Ireland is struggling to recruit and retain specialist medical and nursing staff leading to gaps in provision and spiralling costs as temporary personnel are employed on a short term basis.
There are well-founded fears that this situation will get worse after the UK finally withdraws from the European Union in 2019 with figures showing a 96 per cent decrease in the past year of EU nurses registering to work in Britain.
However, while this dramatic decline has until now been solely blamed on Brexit, there is also concern that a significant factor is a newly introduced English language test which all European and overseas nurses must pass in order to practice in the UK.
The International English Language Testing System (IELTS) is designed to test competence in reading, writing, listening and speaking English and costs £150 to sit the exam.
It was introduced in January 2016 by David Cameron's government as part of a plan aimed at helping control immigration. Under the scheme, foreign nationals working directly with people in public sector roles must be able to speak a high standard of English.
There is no disputing the fact that doctors and nurses must be able to communicate effectively and of course patient safety must be the absolute priority.
But the test has proved controversial because highly qualified nurses with English as their first language are finding it difficult to pass.
It has to be regarded as worrying when nurses from Australia, New Zealand and Canada are failing the written component, which asks candidates to write an essay on subjects that seem to bear little relation to nursing.
There is also the cost involved. A Greek nurse with specialist intensive care training has told The Irish News she has spent £1,000 in repeated attempts at the exam in Northern Ireland yet her scores would have been enough for a pass in the Republic where the marking system is more lenient.
In a further twist which many will view as frankly absurd, because the law change has been extended to cover the European Union, nurses from the Republic who want to work in the NHS could be required to sit the test to demonstrate they can communicate in English.
So far, the Nursing and Midwifery Council is resisting change saying that without clear evidence, it is not in the interests of public safety to lower the standards of English language competency.
As Janice Smyth, director of the Royal College of Nursing in Northern Ireland, points out, while patient safety is paramount, a balance needs to be struck.
That is particularly the case given the urgent shortage of skilled nursing staff in the health service.
