Image caption Polina Ralutin thinks the language test is too difficult

Polina Ralutin was an experienced nurse in the Philippines and keen to take up a post in the NHS, at the Lister hospital, in Stevenage.

First, she had to pass an exam testing her knowledge of the English language. But she was surprised to find she had to analyse a text on jam-making for the exam.

She told the BBC's World Tonight programme: "I had to look at a diagram of the process and describe how to make it - there was a time limit, and it was very difficult to achieve in almost perfect English - how to make jam."

Polina passed the exam and took up her post in April 2016. But she knows several other nurses who failed, and she believes the test is too difficult.

"I have good friends who had to take it three times," she says. "I know plenty of others who struggled so much with it."

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The exam is set under the International English Language Testing System (IELTS), run by the British Council, and used by many employers around the world.

It consists of four sections - listening, reading, writing and speaking - and the maximum mark is nine.

The Nursing and Midwifery Council (NMC) uses it to assess overseas applicants to work in the UK and requires a minimum score of seven.

Some NHS employers say the bar is too high and it is hindering the process of recruitment at a time when it is hard to fill vacancies.

Many failing

The East and North Hertfordshire NHS Trust runs four hospitals, including the Lister.

Management says it has found 140 nurses in the Philippines who are keen to come to the UK to work for the trust but who failed to get the required seven out of nine by half a mark.

Tom Simons, who is chief people officer at the trust, says he himself tried the test and passed but not with top marks.

"One section had a very heavy academic test - analysing a play and the light and shade - I found that quite challenging," he says.

He believes the test should be amended to focus on language relevant in a care setting.

"The language test has certainly had a significant impediment on our ability to bring nurses into the organisation quickly," he says.

The debate intensified last year, when the NMC extended the language test to applicants from the European Union.

Recent NMC figures showed the number of EU nurses applying to register to work in the UK had plunged by 96% between July 2016 and April 2017.

The NMC said the language test may have been a factor. Others pointed out the fall coincided with the aftermath of the Brexit vote.

Different test

The NMC is now looking at whether a different type of test might be required.

Chief executive Jackie Smith says: "We are working with organisations and agencies and asking them what they think might be a viable alternative.

"We will put that back to the council to see if that is something that could be offered without compromising public protection."

But she is adamant it is not a question of watering down the existing test.

"Communication is the thing that patients worry most about," she says. "Patients will say, 'I want to know that person listening or examining me understands me.'

"There is no prospect of us simply lowering the score in response to this."

Dame Donna Kinnair, of the Royal College of Nursing, says the fundamental problem is not the language test, but the failure to train enough nurses.

"We know that a good position to be in is to have nurses trained in this country," she says.

"So, while we are using nurses from overseas to solve our short-term supply, we need to plan for the long term."

Few would disagree with the need for long-term planning.

Some NHS employers, though, are for now focusing on the short-term challenge of finding more nurses like Polina to boost their staff numbers and provide high quality care to patients.