According to NHS Employers, 98% of NHS staff reported they have experienced incivility in the workplace, with 18.7% experiencing bullying and harassment from colleagues, and 12.4% experiencing it from their line managers. Bullying and harassment can have a significant impact on the mental and physical health of staff members, leading to increased stress, anxiety, and even depression. It can create a negative workplace environment that undermines collaboration, communication, and teamwork among staff members. This can lead to poor working relationships, increased tension, decreased morale, higher rates of absenteeism, reduced productivity, and increased turnover rates. These can all negatively impact the quality of care that patients receive (The NHS Staff Council, NHS Employers).

The Workforce Race Equality Standard (WRES) has consistently highlighted entrenched and increasing disparities in the experience of white and ethnic minority staff, with ethnic minority workers being more likely to experience bullying and harassment from both staff and patients. With one in six NHS employees being an ethnic minority internationally educated worker (UK Parliament), it is important to consider how their experiences may be further impacted by an increased likelihood of discrimination, bullying and harassment.

The WRES 2022 report, published in March 2023, found that 29.2% of ethnic minority staff reported harassment, bullying or abuse from patients, compared to 27% for white staff. Moreover, for 93.5% of trusts, ethnic minority staff had higher experiences of discrimination, bullying and harassment compared to that of white staff over the last 12 months. These disparities have persisted despite improvements against the data from previous years. Research from the Nursing and Midwifery Council (NMC) also found that employers make disproportionately high referrals of black people and men to their 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). Similarly, the Medical WRES (MWRES) 2021 report found ethnic minority doctors report a worse experience than their white colleagues when it comes to harassment, bullying, abuse, and discrimination from staff. Furthermore, the General Medical Council's (GMC) Fair to Refer report and the British Medical Association's (BMA) report: Why are we still here? describe the impact of international medical graduates (IMGs) being 'othered' with consequences that include disproportionate number of referrals to the GMC.

As the above data highlights, bullying and harassment can be particularly challenging for ethnic minority international recruits, who may already be experiencing feelings of isolation or disconnection due to language or cultural barriers. This can make them more vulnerable to harassment or discrimination and can exacerbate the negative effects of bullying and harassment on their mental and physical health (Nursing Times).

All staff in the NHS deserve to come to work without fear of bullying, harassment and discrimination. By taking steps to prevent and address bullying and harassment, trust leaders can promote a more positive working environment, improve staff morale and wellbeing, and ultimately deliver better outcomes for patients. Actions to address bullying and harassment for their internationally educated workforce (IEW) can include:

  • Developing clear policies and procedures which clearly outline acceptable and unacceptable behaviours and the steps that will be taken if a complaint is made.
  • Creating a reporting system that allows staff to report bullying and harassment without fear of retaliation. This system should be clearly communicated to staff and should include clear steps for following up on complaints.
  • Fostering a culture of civility and respect, sharing the impact of incivility, promoting diversity and cultural sensitivity and holding staff accountable for their actions.

Below are two examples of how trusts are addressing bullying and harassment for their IEW.

Building a positive organisational culture

Building a good organisational culture that addresses bullying and harassment can promote respect, inclusivity, and support within the workplace (The King's Fund, Making the difference). This is essential for ensuring the well-being and productivity of all staff members, including the IEW. It will also help to build trust and confidence among staff members, that their concerns will be taken seriously, and that appropriate action will be taken when concerns are raised.

Click here to explore this topic further with a case study from Mersey Care NHS Foundation Trust.

Educational resources

Interventions and equality, diversity and inclusion (EDI) initiatives to support the IEW can often take a deficit model approach. Providing appropriate education and support to existing staff can be a more effective approach to improving ways of working, and addressing bullying and harassment, as it can aid in bridging cultural awareness gaps and increasing cultural competency. These interventions can support wider behavioural and cultural change that leads to the IEW feeling more valued and better supported within their teams.

Click here to explore this topic further with a case study about Culture in health.