The internationally educated workforce (IEW) plays a significant role within the NHS. The health care system would not be able to deliver its services without them. Supporting this critical cohort of staff and ensuring that they have an equitable, positive workplace experience and career is essential to amplify their talents and to the delivery of high-quality patient care.

This guide provides practical advice and examples of how to support the IEW, as an essential part of promoting a more inclusive and diverse NHS. It will focus on how trusts can support the IEW by looking at the following topics:

  • Recruitment, onboarding, and induction.
  • Creating a sense of belonging.
  • Tools to address bullying and harassment.
  • High quality training and inclusive talent management.
  • Leadership and accountability.

These topics aim to support board members to have an increased awareness and understanding of the challenges that are often experienced by the IEW. The case studies within these topics provide practical interventions implemented by trust leaders that have developed a culture of respect and inclusivity, improved staff engagement, and improved workplace experience for the IEW. Each case study also contains top tips from trust leaders for action and impact.

The role of board members

Based on conversations with board members, below are four key areas where leaders can support their IEW.

Be a visible leader and engage with the lived experiences of the IEW

There is significant data (as referenced throughout this guide) evidencing the disparities experienced by ethnic minority staff in the NHS, with the majority of the IEW being part of this cohort. It is imperative that board members recognise the experience that the ethnic minority IEW face and how this can impact them alongside the additional pressures of coming to the UK and onboarding into the NHS.

Board members acknowledged that engaging with their IEW has led to an increased awareness of their lived experiences and the challenges they face. Examples of engagement activities included attending team away days and celebrations, hearing staff stories at board meetings, and contributing to staff networks. By having a better understanding of their lived experience, board members felt they were able to support their IEW more proactively by providing funding and resourcing and approving tailored programmes.

It is essential that board members are engaging and demonstrating active allyship in order to create hearts and minds change across the organisation. By listening to the lived experiences of the IEW it will make staff feel valued and increase their sense of belonging.

Apply a continuous improvement approach to developing the organisation's support offer

Board members acknowledged that delivering improvements in the experience of their IEW is an ongoing and iterative process, requiring leaders to address challenges and maintain open communication for continuous learning and success. Board members shared that this approach requires a collective effort from multiple directorates, with everyone having the same mission of creating a better working environment. Examples of continuous improvement approaches included actively seeking feedback via multiple channels and forums, utilising multi-professional teams' expertise and insights, and ensuring appropriate support and feedback loops for pastoral care teams. These approaches were also used for objective structured clinical examinations (OSCE), a multipurpose evaluation tool used to assess health care professionals' competency in a clinical setting through direct observation.

Having a multi-disciplinary approach encourages greater accountability for the experience of the IEW and the processes in place to support them. Board members are encouraged to review their work to support the IEW with an intersectional lens, considering whether actions relating to Workforce Race Equality Standard (WRES) and equality, diversity, inclusion (EDI) action plans will address structural inequalities experienced by the IEW.

Provide a comprehensive and holistic support offer for the IEW that recognises the needs of the individual beyond the workplace

Board members highlighted the impact that moving to a new country has on their IEW. Having a comprehensive package of support that recognised the holistic support needs of the IEW was seen as paramount to successfully recruiting, onboarding, and embedding international staff into the NHS and their new communities.

Leaders spoke of the need to:

  • Implement a framework to support their IEW into their new clinical roles, including dedicated training programmes and a buddy system.
  • Establish key links to the pastoral care team.
  • Provide ongoing support, such as assisting their IEW in finding accommodation beyond the trust-provided accommodation period, offering maternity guidance, and giving advice to the IEW wider family.
  • Establish an early tracking framework to audit and evaluate the career progression of the IE
  • Commit to appropriately funding and resourcing programmes, like the Stay and Thrive programme, which can be extended to other international cohorts.

By considering the whole employee journey and their needs beyond the workplace, the IEW are more likely to feel valued, supported and empowered to be their authentic selves at work. This can lead to higher retention rates and facilitate open feedback.

Providing support for receiving staff is crucial to success

Board members shared the importance of having support mechanisms for staff receiving their IEW. By developing an inclusive and welcoming organisational culture, interventions to support the IEW can be implemented with greater success.

The following areas of focus for board members were:

  • Supporting the OSCE and pastoral care team's wellbeing to ensure effective training and support for the IEW.
  • Ensuring support teams are appropriately resourced.
  • Delivering cultural competency and awareness training for receiving teams and directorates to foster a culture of support and belonging, and provide a welcoming environment where the IEW can thrive.
  • Embedding anti-racism within the organisation culture, with education as a key component of this.

In supporting the receiving team alongside the IEW, they will feel a sense of increased confidence and capability to engage with and support their new colleagues. Board members shared that they anticipate improved integration, and a more cohesive and inclusive team culture.

While board members emphasised the importance of providing support for receiving staff, it is important to note that these areas of focus are also important for the organisation as a whole.

The publication of NHS England's EDI Improvement Plan and Long-Term Workforce Plan (LTWP) further reaffirm the important role that the IEW have as part of the existing and future workforce.

The EDI Improvement plan outlines six high impact actions to address the widely known intersectional impacts of discrimination and bias. High impact action five places a requirement on NHS trusts to 'implement a comprehensive induction, onboarding and development programme for internationally recruited staff'. Success of implementation will be measured by:

  • Creating a sense of belonging for internationally recruited staff as measured by the NHS Staff Survey.
  • Reducing instances of bullying and harassment from team/line manager experienced by internationally recruited staff as measured by the NHS Staff Survey.

The LTWP outlines that the NHS will continue to rely on the IEW whilst growing the domestic workforce and beyond to meet patient demand. As such, the LTWP asks regulators to continue to streamline registration process for both domestic and international recruits.

Questions for the board

Below is a list of suggested questions that board members may find helpful as a check on progress. The answers should help prompt board level discussions about areas for improvement.

Recruitment, onboarding, and induction
  • Is the organisation providing sufficient support and guidance at the job advertisement stage to help potential candidates navigate the recruitment process?
  • Is the organisation providing sufficient support and guidance during the onboarding process to help the IEW integrate into our organisation?
  • What measures does the organisation have in place to assess the qualifications and skills of the IEW accurately?
  • How can the organisation improve its orientation and induction programmes to address the specific needs and challenges faced by the IEW?
Creating a sense of belonging
  • What initiatives does the organisation have in place to foster a sense of belonging among the IEW?
  • How can the organisation promote cross-cultural awareness and understanding amongst staff members to create a more inclusive work environment?
Tools to address bullying and harassment
  • What data sets and insights (e.g., Workforce Race Equality Standard/Workforce Disability Equality Standard/NHS staff survey/pulse surveys) are informing the development of interventions?
  • Are the existing reporting mechanisms and policies effective in addressing issues of bullying and harassment?
  • What resources and training are provided to employees to educate them about cultural sensitivity and respectful interactions?
  • How can the organisation improve its culture to prevent and address bullying and harassment effectively?
High-quality training and inclusive talent management
  • What strategies can leaders implement to support career progression and succession planning for the IEW?
  • Are there mentorship or coaching programmes available to assist the IEW in their career development?
Leadership and accountability
  • How can leaders demonstrate their commitment to supporting and valuing the IEW?
  • Are there metrics or indicators in place to measure the progress and success of efforts towards supporting the IEW?