THE Royal Bolton Hospital is facing a nursing crisis this winter after struggling to bring in international recruits.

Health chiefs say they tried to bring in 140 nurses during a recent recruitment drive in The Philippines, but that stringent exams mean that only 21 of them may still be undergoing training by the time winter arrives.

They say 70 nurses pulled out of the process after the first interview and they then hit a stumbling block with the low pass rate in English language exams.

It means Bolton NHS Foundation Trust may end up incurring hundreds of thousands of pounds in agency costs to fill the gaps.

In April this year alone, the trust incurred £100,000 additional costs using the Thornbury nursing agency to fill gaps and ensure safe staffing levels in all areas.

New figures from the Nursing and Midwifery Council (NMC) show that for the first time in recent history more midwives and nurses are leaving the register than are joining, with homegrown UK nurses leaving in the largest numbers.

Speaking at the most recent of the trust board of directors meeting, director of nursing Trish Armstrong-Child said the nurses from the Philippines had been working hard to try to pass the exam but the pull-out rate was high because of the number of challenges faced in order to work in the UK.

She said: "We went out there to recruit 75 nurses last October, and on reflection we didn't manage expectations. What wasn't factored into it was process once they got here.

"From the agencies' perspective it has gone really well, to get 21 recruits through in a year is better than most.

"The nurses in the Philippines want to work in the UK — they really, really do — but it is such a difficult exam.

"They have to travel hundreds of miles for the exam which they have to pay for themselves, costing three months wages, and then it's a 70 per cent fail rate the first time. It is harder than a GSCE in this country."

The International English Language Testing System (IELTS) exam is almost three hours long and tests listening, reading, writing, and speaking abilities.

Participants are then given a score out of 10 for each skill and an average mark, with six out of 10 being rated 'competent'.

While recruits struggle with the test, Ms Armstrong-Child said the immigration process was not holding them back.

Recruits apply to the Nursing & Midwifery Council, sponsored by the trust and then go through 10 weeks' training in the hospital.

Three new employees have now completed training and work in the trust and the trust has also taken on 28 new starters at a local recruitment event in May.

However a further 21 international nurses are expected by October but will not be on the rota as fully-trained until 2018.

The trust's most recent annual report showed that it spent £9.4 million on agency staff in 2015/16, down from £10.5 million the previous year. The total staffing costs for the trust were £205 million.

The new NMC figures show that the number of nurses and midwives leaving the profession has risen 51 per cent in just four years, those under the age of retirement citing low pay and poor working conditions.

Between 2016 and 2017, 20 per cent more people left the register than joined it and 3,264 workers left the profession from April to May this year alone.

The Royal College of Nursing (RCN) and the Royal College of Midwives (RCM) called on the Government to scrap its pay cap as a matter of urgency to stem the numbers going.

The overall number of leavers — which includes UK, overseas and EU registrants — has increased from 23,087 in 2012/13 to 34,941 in 2016/17.

One of the questions the overseas recruits must answer is:

The chart below shows the number of men and women in further education in Britain in three periods and whether they were studying full-time or part-time. Summarise the information by selecting and reporting the main features, and make comparisons where relevant.