Nurses from the European Union are being allowed to register in Britain without meeting the same high requirements that apply to British nurses...
The nursing profession in Britain is under attack from a number of directions. The EU and the British government are developing a vision for nursing which entails fewer registered nurses supervising a growing number of unregistered staff. Also the EU is trying to grab control over the qualification for registered nurses itself.
On the surface all seemed to have been going well. In Wales and Scotland entry to the nursing profession has been at degree level for some years. Now, starting in September 2011, the entire nursing registration programme in England will go to degree only and the diploma programmes will be phased out. However these educational changes are being introduced at a time of attack on the NHS and the numbers of staff available to supervise the new students is reducing. And now, as a result of an EU directive, it looks as if the staff on the Nursing and Midwifery register for the UK may not have the new improved qualification at all.
The EU attack
For three decades EU legislation on mutual recognition of qualifications for regulated professionals has allowed EU nursing qualifications to be recognised in Britain. But the Nursing and Midwifery Council (NMC) as the regulator could set its own regulations and this meant that nurses who had an inferior qualification to the British standard could not join the register without further training. This included many nurses from Eastern Europe who did not have “equivalence” to the British qualifications.
Nurses demonstrating on 26 March.|
But last year a new EU directive was passed which overrules the regulator and relaxes the regulations, so that now nurses who do not meet the same requirements as British nurses are joining the register. The number of EU nurses joining the register has shown a sharp rise since the rules were relaxed.
In addition to the substandard qualification issue, this same EU legislation prevents the NMC from testing the language ability of applicants. In contrast the NMC has the power to make nurses from outside the EU, including Australia (!), take a language test prior to registration in Britain. The NMC is not happy about this limitation on its powers and has taken the lead in submitting evidence to the EU on behalf of 26 different regulators across Europe asking that they be allowed to conduct language tests, as failure to do so “puts patients at risk”.
At the moment the EU is maintaining its position that language testing is the responsibility of the individual employer. Health unions and patient organisations have also objected. But the Royal College of Nursing’s position is confused: it suggests the NMC should have the right to test individual EU nurses if it has a concern and is not advocating a test for all EU applicants. It is not clear how the individual approach advocated could be compatible with RCN policy on equal opportunity, which it advocates in all other matters.
The position of Patients Association Chief Executive Katherine Murphy seems a lot clearer. “How can we allow Europe to direct something as important as the delivery of safe care?“ she asked.
The government attack
If the government could see a ready-made source of cheap nursing labour – and does not care about the standard of their qualification or their ability to speak English – then it would soon be proposing a reduction in the number of nursing places at university. This is exactly what has happened: certain areas of the country have already been described as ”overprovided”, such as Scotland.
The nursing programme at the University of Glasgow – one of the best evaluated in the country and with one of the lowest attrition rates – is facing closure, which staff and students are opposing. In England reductions in nursing student places have been put forward for the next three years. By September 2013 there will be a third fewer nursing students starting their programme than in September 2010, despite a significant bulge in predicted retirements from the profession.
The government plans not only to replace registered British nurses with EU labour, some of whom will have inferior qualifications, but also to reduce the number of registered nurses altogether and replace them with healthcare assistants.
Of course assistants are not a new phenomenon, and most do an excellent job, but none is registered and so risks to patients remain. Healthcare assistants and their unions all want to see this role regulated to protect the public.
Legally, any assistant can only undertake nursing work that is delegated to them and is supervised by a registered professional. Any plan to radically reduce registered nurses means less supervision. A recent horrendous experiment at the Mid Staffordshire hospital with this type of “skill dilution” led to a significant number of patient deaths (soon to be explored further by a full public inquiry).
A way forward
As the Patients Association has indicated, the safest way is for individual countries to educate and employ their own nurses. But in the short term nurses and patients must demand loudly that no EU nurse can join the NMC register without a language test. Secondly, the regulator must be allowed to set the standard for joining that register and not be overruled by an EU directive. Thirdly, being legally accountable for the care delivered, the registered nurse must continue to determine how much of the care can safely be delivered by an assistant. ■