Supporting international NHS staff during national reform

The government’s 10 Year Health Plan for England (10YP) sets the strategic direction for healthcare over the coming decade, aiming to modernise the NHS through 'radical change'.

It commits to publishing a 10 Year Workforce Plan (10YWFP), which will replace NHS England’s previous 2023 Long Term Workforce Plan (LTWP) and focus on delivering a series of service reforms. Blink and you’ll miss it, but within this is a commitment to reducing international recruitment to under 10%, “to ensure sustainability in an era of global healthcare workforce shortages”.

This is a very ambitious target, given that currently 34% of new NHS recruits hold non-UK nationality. As work to meet this target begins, it is essential that the valuable role played by internationally educated staff in the NHS is not overlooked. Any reform to international recruitment must be accompanied by an explicit commitment to support the development and wellbeing of current and future international NHS staff.

In the absence of any such commitment in the 10YP, the 10YWFP (expected to be published this year) provides a timely opportunity for the government to do this. The 10YP’s aim to reduce international recruitment in the NHS is unsurprising.

The LTWP set out a similar intention, and health secretary Wes Streeting has been vocal about his focus on UK-based recruitment, emphasising the importance of growing domestic pipelines to ensure long-term workforce sustainability. This is welcome, and there is sense in approaching international recruitment more sustainably if it means building resilience into the workforce.

However, missing from the conversation is an emphasis on supporting and valuing the NHS’ internationally educated workforce; both those already in the NHS, but also those who will continue to be recruited from overseas (albeit on an intended smaller scale).

Data shows that, despite longstanding political ambitions, international recruitment is still increasing and has been one of the primary reasons for workforce growth among doctors over the last decade. While the reasons for seeking greater sustainability as part of the 10YP ambitions are sound, it is important to note the positives of increased workforce diversity and how it can directly benefit patient care. The 10YWFP must explicitly acknowledge this value in international recruitment.

Internationally recruited staff experience specific challenges in the NHS, which need specific solutions: sourcing accommodation, setting up bank accounts and getting to grips with new diagnostic methods are just some examples. Alongside this, instances of discrimination are frequent. International medical graduates are three times more likely to be referred to the GMC than UK graduates, a statistic which has always been stubbornly high.

NHS reform cannot be delivered without staff, and so it cannot be pursued at the expense of staff wellbeing. The latest NHS Staff Survey results show that instances of staff experiencing discrimination are at their highest since 2020, while 35% of internationally recruited staff have experienced bullying, harassment or abuse from patients or service users in the last 12 months (compared to 24% of UK recruits).

Conversations around reducing reliance on international recruits must not detract from the importance of supporting their wellbeing. The 10YP commits to treating staff “better” in the future – the 10YWFP must detail how this will be achieved.

It must also acknowledge that enabling wellbeing looks different for different staff groups. For the international workforce, many trusts have long running, targeted, local initiatives. Guy’s and St Thomas NHS Foundation Trust's Accelerated Preceptorship Programme supports internationally educated nurses as they integrate into the NHS, and the UK more broadly. The outcomes of this programme have been positive, with retention rates among internationally recruited nurses reportedly high.

Somerset NHS Foundation Trust (SFT) identified issues that were leading to poor retention rates among their internationally educated staff and, following development of a ‘Retention Roadmap’, implemented measures to better support this group (including introductory guides on the local area; information on how to open bank accounts; team-building days to integrate staff recruited from overseas with UK staff and a buddy system to reduce feelings of isolation). The actions taken by SFT have been successful, with improved morale reported and internationally recruited staff progressing within the organisation.

Sharing learnings from such initiatives, and other resources such as NHS Providers’ guide for trusts on how to support the international workforce, are important in fostering best practice. However, national policy must lead the way for best practice.

The NHS Equality, Diversity and Improvement (EDI) Plan - with its clear metrics, timelines and people-centred approach - has been impactful, reserving one of its six highest priority actions for the international workforce specifically (high impact action 5 requires trusts to “implement a comprehensive induction, onboarding and development programme for internationally-recruited staff”).

However, the 10YP made no reference to the EDI Improvement Plan, and an update on its progress is overdue. The 10YWFP needs to fill this gap: we hope that it will reaffirm commitment to the EDI Improvement Plan.

This is a critical time for the healthcare sector, with ambitious plans for the next ten years now set in motion. However, we risk entering a decade where narratives around internationally educated staff focus exclusively on reducing their numbers.

Alongside a continued focus on strengthening homegrown talent, it is vital that, in the months leading up to the 10YWFP’s publication, we reaffirm the value of the NHS’ international workforce, to ensure that targeted policies which guarantee their development and retention are implemented, and these valuable team members do not feel overlooked.

This article first ran in Public Sector Focus