The NHS is the largest employer in the UK with a workforce of 1.4 million, and with over 112,000 vacancies it is heavily reliant on internationally educated workers (IEW) to meet workforce demand. The King's Fund reported that 18% of NHS staff overall are from overseas, and while the data highlights the diversity of roles they undertake, over a third of doctors and a quarter of nurses are internationally educated.
The NHS has benefitted from international recruitment from its very inception (NHS England), with the IEW bringing a huge wealth of expertise and perspectives to the service. 98% of trust leaders have told NHS Providers that international recruitment and staffing is important in addressing workforce gaps in the long term. International recruitment will continue to be an important part of future workforce planning. However, this must be in tandem with a strong domestic training and recruitment pipeline, with international recruitment being conducted ethically in line with the government's code of practice.
Despite the importance and number of the IEW in the NHS, data from the Nursing and Medical Council (NMC), British Medical Association (BMA) and General Medical Council (GMC) highlight the inequality experienced by the IEW when integrating into their roles and beyond.
- International medical graduates (IMGs) feel they have less supportive teams (35%) compared to UK graduates (22%) (GMC, Workplace Experiences).
- Employers make disproportionately high referrals of black people and men to NMC regulatory processes, with those that have qualified overseas or trained outside of the UK having an increased risk of referral, the case going to investigation, and the case going to adjudication (NMC, Ambitious for change).
- IMGs have to navigate additional hurdles, including colleagues' assumptions and perceptions about where and how they qualified to meet the standards, as well as manage challenging everyday interactions in the workplace (BMA, Fair to refer).
The experiences that internationally educated workers face is not wholly exclusive to them, but greater consideration must be given to how NHS trusts plan for, recruit, onboard, and support their IEW.
By giving greater consideration to the needs of the IEW, trust leaders can start to address inequalities and improve progression, retention and development rates. In turn leaders can effectively deliver against commitments within the NHS people promise, as well as the more recent equality, diversity and inclusion (EDI) improvement plan. The EDI improvement plan contains six high impact actions which all NHS trusts and integrated care systems will be required to implement. Action five specifically relates to the need to implement a comprehensive induction, onboarding, and development programme for internationally recruited staff.