Over 5,000 internationally educated nurses and midwives have joined the Nursing and Midwifery Council (NMC) register in the last year, thanks to changes to its English language requirements.
The NMC revealed this week that over a quarter of internationally educated professionals who joined the register used supporting information from employers (SIFE) as evidence of English language proficiency.
“SIFE was not just a procedural workaround – it was a life‑changing opportunity”
Agimol Pradeep and Dilla Davis
The regulator introduced these changes to its English language requirements on 8 February 2023, following a wide-scale public consultation and months of campaigning from nurses.
The amendments mean that applicants who trained in English, but in a country where it is not a majority spoken language, can provide supporting information from their UK employer as evidence of English language proficiency rather than having to take an exam.
In addition, nurses relying on an English language test to show their competence can also submit supporting information from employers if they narrowly miss out on the required score by half a point or grade in one of the four language domains of the test.
In the latest NMC Council papers, published on 17 July, the regulator said 5,316 internationally educated nurses and midwives had provided SIFE as part of their English language requirements between April 2024 and March 2025.
It said this was 25.7% of the total number (20,671) of internationally educated professionals who joined the register during this time.
This was also a significant increase compared to between February 2023 and March 2024, when 2,706 professionals provided SIFE as part of their application.
Between April 2024 and March 2025, the NMC found that 5,196 nurses used the SIFE pathway, compared to 101 midwives and 19 nursing associates.
It said 63% of the SIFE applications were from India, equivalent to 3,350 professionals. A further 11% were from the Philippines (568 professionals) and 7% from Ghana (373 professionals).
Importantly, the council papers set out that data had indicated no fitness to practise referrals related to the English language competency of professionals who used SIFE to join the register.
The NMC said it would continue to monitor the impact of SIFE going forward.
liver transplant coordinator Dr Agimol Pradeep and nursing lecturer Dr Dilla Davis, both at King’s College London, have campaigned for years for the NMC to make changes to its English language requirements.
In a joint statement, they told Nursing Times that SIFE had been “transformative for countless internationally educated nurses”.
They said: “For the 5,316 professionals, SIFE was not just a procedural workaround – it was a life‑changing opportunity.
“Without it, many overseas-trained nurses, long embedded in UK health and social care settings, would have remained as unregistered support staff, effectively deskilled, underpaid, undervalued and stuck in dead end roles.”
From left, Agimol Pradeep and Dilla Davis
Dr Davis and Dr Pradeep’s campaign began in 2020, on behalf of thousands of India-trained nurses who were unable to pass the English language test and achieve registration, despite living and working as healthcare support workers in the UK.
“We are proud that we shed blood sweat and tears over this for nearly four years.
“Without this pathway, a significant quarter of internationally trained professionals would likely remain deskilled and under‑utilised,” their statement said.
“This underscores that language competence – as assessed through sustained, real‑world employer observation – is a richer and more meaningful indicator of communication safety than exam scores alone.”
More on the English language changes
