The nurses' union is worried that employing a large number of foreign nurses could hamper the national health service.

The president of the Malta Union of Midwives and Nurses, Paul Pace said the government's plan to recruit up to 300 foreign nurses would mean there would be whole shifts of non-Maltese speakers. "This could lead to problems. Once, a patient was trying to tell a foreign nurse he was suffocating but the nurse could not understand him because the patient was speaking in Maltese," Mr Pace said.

The government last week issued a call for tenders for recruitment agencies to engage foreign nurses in a bid to solve the problem of a shortage of nursing staff. According to Mr Pace, the country needs another 700 nurses and 300 students had to start the nursing course every year to keep up with the demand of increasing services.

Mr Pace said engaging foreign nurses could only be done as a short-term solution to solve the prevailing shortage but was not something that would work in the long term.

He insisted that Malta's health system could afford a small number of foreign nurses but a big group could lead to problems. "I envisage problems of nursing care," he said.

He said about 100 of the 2,400-odd nurses were foreign and an increase in foreign nurses would mean there would be entire shifts without a Maltese-speaking nurse. "There is definitely going to be a language barrier," he said. He continued that the problem could be mostly acute at St Vincent de Paul Residence, where the average age of inmates was 85 and most residents did not speak English.

He also voiced concern that foreign nurses would not have the same level of training and specialisation as their counterparts trained in Malta. Mr Pace argued that the Nursing and Midwifery Council, which reviewed applicants before they were employed, would not know how experienced the nurses were but only how many hours they spent in different departments.

The Health Ministry has said the nurses' professional qualifications were reviewed, assessed and approved before they were employed. It said the council was autonomous and was made up of both academic and clinical experts in the nursing field. Moreover, it liaised with other international regulatory committees, including the European Commission.