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  • Race equality
  • Cultural intelligence
  • Supporting internationally educated staff



Internationally educated staff play a vital role in the composition, skills, and experience of the NHS workforce. Despite this, data has consistently shown that they experience inequities in the workplace. The General Medical Council (2023) found that more international medical graduates feel they are not part of a supportive team (35%) compared to UK graduates (22%), and the Nursing and Midwifery Council (2022) found that their registrants who have qualified overseas or trained outside of the UK have an increased risk of referral to regulatory processes.

Cornwall Partnership NHS Foundation Trust (CFT) recognises the importance of creating a sense of belonging through an inclusive and compassionate environment for its staff and investing in specific support for an increasingly diverse workforce. The trust’s international nursing recruitment programme ensures these colleagues are well supported, improving their wellbeing and job satisfaction.

Debbie Richards, chief executive of CFT, said: "The health and wellbeing of staff is a priority at CFT. Addressing inequalities and embracing diversity is central to fostering an organisational culture which positively impacts all staff, their workplace experience and their wellbeing."


Comprehensive support for internationally educated staff

By region, the South West has the least diverse workforce in the NHS across all trusts, with only 12.8% of staff from an ethnic minority, compared to the most diverse region (London) at 49.9% (NHS England, 2023c). With over 4,000 staff members at CFT, 97% of those identify as white (NHS Staff Survey, 2023). Due to these figures, and the increasing national focus to address inequalities faced by staff, the board at CFT is acutely aware of the importance of supporting their ethnic minority staff and internationally educated workforce (IEW).

Overseas recruitment is complex, and internationally educated staff face many challenges in joining and integrating into the workforce. Staff at CFT who joined from overseas were no exception and faced challenges such as a sense of loneliness due to being far away from the support of loved ones, language complexities and difficulties with cultural adaptation – particularly due to the trust covering a more rural area of the country. Consequently, despite the positive opportunities and professional development that working in the NHS has to offer, the challenges of adjustment, and at times differential negative treatment, was having a significant impact on the sense of belonging of the IEW at the trust and their wellbeing.

CFT has deployed a comprehensive international nursing recruitment programme, with the aim of supporting nurses who are joining the trust from overseas by providing high quality pastoral care. The trust has employed an international recruitment support officer – a full time role dedicated to supporting the trust's internationally educated nurses throughout their recruitment journey, from pre-employment to deployment as UK-registered nurses. As well as providing emotional support and supervision for new staff to allow for effective integration into the trust and the community, the trusts' internationally recruited nurses have access to comprehensive practical support, such as accommodation for three months upon arrival and assistance with securing ongoing accommodation.

Alongside this, managers undertake training to ensure they have in-depth knowledge and skills to recognise various forms of discrimination and how to address them to support their IEW. For example, the workforce transformation team devised 'This Is Us', a programme to develop inclusive and compassionate leaders within the trust. Alongside this, 'Cultural Capability' workshops for staff explore unconscious bias, cultural judgement, prejudice, discrimination and power structures and asks staff to explore their own attitudes and beliefs and the inclusive teams training. Combined, these elements ensure the wider workforce are well-placed to integrate and learn from their IEW colleagues.

CFT's commitment to helping their IEW by working to provide a culturally compassionate environment allows staff to thrive as they navigate their new role and life in the UK, one staff member said: "When I arrived it was a lot of new faces, a new environment and a lot of things to get used to but my support officer was of great help by showing me around the community, ensuring I was comfortable and helping me to sort documents etc. My recruitment manager along with my OSCE trainer made me feel even more welcomed here. The induction trainings were insightful and prepared me for some of the skills I was expected to perform on the wards. Even though there were differences in the nursing skills here compared to my home country I was able to easily adjust."

Notably, from August 2022 to August 2023, turnover of the trust’s IEW through the international nursing recruitment programme was 2.7%.



Effectively integrating internationally educated staff at CFT and supporting them to feel part of a team has led to more effective collaboration, better communication and more confidence in team working. Developing an inclusive culture at CFT has led to a 7% increase from 2021 to 2022 in staff agreeing the trust proactively supports their wellbeing, and contrasting to national trends, between 2021 and 2022 there was a 5% decrease in staff considering leaving the trust (NHS Staff Survey, 2023).

International recruitment plays a significant role within the NHS and is an important part of workforce planning. Supporting this critical cohort of staff and ensuring they have an equitable, positive workplace experience and career by ensuring they feel a sense of belonging and value is essential to their wellbeing, workplace satisfaction and to the delivery of high-quality patient care. At CFT, this has been enabled by funding to install dedicated support and full board acknowledgement and endorsement of staff wellbeing as an organisational priority.


NHS Providers' Guide to supporting your internationally educated workforce provides practical advice and examples.

NHS Providers' Race Equality programme helps to embed race equality as a core part of the board’s business by encouraging hearts and minds change and building their confidence and capability to implement and embed accountability. The programme focuses on sharing research, evidence based interventions and lived experiences through a range of events and resources.