As the health sector continues to rely on health professionals from overseas, we set out to explore what working in such a diverse workforce means for daily interactions in the workplace. For the Work-Int project, we’ve conducted almost 40 interviews with British and overseas health professionals about their daily experiences. This post explores some of the emerging findings of the research.
It’s worth pointing out at the outset that the group of doctors and nurses that we spoke to was an extremely diverse group. It included thirteen different nationalities and people in a range of different occupations, from consultant down to healthcare assistant, reflecting the fact that overseas workers are to be found in almost all levels of the health service. As you would expect, this diverse group of individuals come from different backgrounds, had different reasons for coming to the UK and different expectations on arrival. Nevertheless, some broad trends do appear and can be instrumental in helping us reflect on how we ensure that people coming to work in the British health sector are welcomed and integrated.
Unsurprisingly, one of the key elements to have a major impact on a person’s integration was the level of immigration restrictions associated with the region they had come from. In many cases this had an effect on the sort of post they ended up in. The most significant difference was found between those who had come from an EU country and those who had come from elsewhere. EU workers benefitted doubly: from free movement of labour within the EU, but also from the automatic recognition of their qualifications and the fact that they did not have to pass an English test. For those from other parts of the world, gaining the right to enter and work in the UK was more complicated. Getting registration with the General Medical Council (for doctors) or the Nursing and Midwifery Council (for nurses and midwives) was usually a more complicated process, with a significant amount of paperwork and delay involved. This has typically meant that nurses who have trained overseas have to undergo a six month adaptation period – whilst working at a level below their qualification (although the rules on this have recently changed). For doctors, immigration restrictions and the design of UK medical career pathways often resulted in doctors initially having to take up a position at a lower level or a position with fewer associated training benefits. Whilst deskilling of this type may be justifiable for a short period in order to allow people to adapt to a new system, we must ensure that people are able to progress to better positions without much delay.
These differences in ease of access to the labour market were noticed and commented on by participants. In particular, the fact that those from outside the EU were required to pass an English test whilst those from inside the EU were not, was raised as an example of an illogical, impractical and unfair requirement. This was seen to be particularly ridiculous in cases where people from outside of the EU had done substantial parts of their training in English, or where the working language was English (such as those from Australia and India). Once again, this is an area of regulation where rules have recently changed, so all new overseas doctors will have to pass an English test. However, the difference in rules still applies to nurses.
Part of the reason the English test was highlighted to us again and again is because of the crucial role that communication plays in the health sector workplace. Whether it’s communicating complex care needs between staff, clearly communicating care plans to patients, or communicating sensitively with families and relatives, communication came out as key component of effective working and an area where overseas workers faced more challenges. However, it seemed that often this was not simply about competence in the language and so perhaps not something that can be easily measured through a test. Instead, idiomatic expressions such as ‘spend a penny’, and terminology and acronyms could present difficulties. There were also challenges around understanding different accents – both on the side of patients understanding staff, but also staff understanding patients. This was something that required patience and tolerance on both sides.
People also talked about the challenges for staff from overseas to adapt to cultural norms of communication. Often this was about manner, tone, intonation and how often to say please and thank you. These subtle norms are often hard to pin down and elucidate, but are of fundamental importance to patients’ experience. Some straightforward advice and tips from people who have lived in Britain longer can help new arrivals understand these subtle norms of behaviour more quickly.
Whilst these different elements can lead to challenges in the workplace, the overwhelming majority of our respondents were extremely positive about the contribution made by overseas workers. There were many people who said that, quite simply, the organisation would not be able to run without them. Often it was pointed out that these were highly skilled individuals who were adding value to the organisation. This was a result not only of the skills they brought, but also the new ideas and suggestions for improvement. We heard many examples of how individuals made practical suggestions implemented in their team, from infection prevention measures to educational programmes. As the British healthcare system undergoes a period of substantial change, managers and staff at all levels must stay alert to the opportunities to implement improvements, but also must recognise the contribution made by migrant health professionals.