Listening and learning: Amplifying the voices of overseas-trained workers

Recommendation 1: Review and enhancement of the international recruitment guide and retention toolkit For NHS Employers and NHS England: • Commit to maintaining and enhancing the International Recruitment Toolkit and Guide with dedicated funding, ensuring the resources remain relevant, updated and actively used. • At the next review, ensure both the toolkit and guide include explicit references to Freedom to Speak Up, the role of Freedom to Speak Up guardians and the importance of fostering environments where overseas- trained workers feel confident to speak up. This should include assessing how these updates are implemented and their impact on effectiveness. • Incorporate findings and learnings from the review into future iterations of the guide and toolkit and collaborate with NHS England to evaluate their effectiveness in driving improvements. • Establish a robust process for monitoring the uptake and use of both the guide and toolkit by March 2026, ensuring their use is embedded across the NHS. • The National Guardian’s Office will seek a progress update on the implementation and outcomes of these recommendations by September 2026.

Recommendation 2: Tailoring Freedom to Speak Up arrangements to all workers For the National Guardian’s Office: • As part of its ongoing commitment, support NHS England and the Care Quality Commission (CQC) in developing resources to help regulatory and regional staff understand the challenges faced by overseas-trained workers in speaking up. • Work with NHS England to review the Freedom to Speak Up reflection and planning tool to ensure learning from this review is incorporated in the updated versions. • Engage stakeholders in 2025/26 to develop a framework for handling anonymous speaking-up cases, with publication planned for 2026/27. For healthcare organisations: • By September 2026, review their speak up arrangements in line with the Freedom to Speak Up reflection and planning tool, taking into consideration the findings from this review, particularly around ensuring: o Anonymous speaking up cases are considered and investigated as appropriate, with the same rigour as named concerns, and that this is communicated this to all workers. o Freedom to Speak Up Champion networks reflect workforce diversity, including representation from overseas-trained workers. For NHS England: • Seek assurance that by December 2026, senior leaders have effectively completed the Freedom to Speak Up reflection and planning tool, as directed earlier in this recommendation. This could be monitored through quarterly reporting by providers to the CQC, though the approach would be at their discretion. For the CQC: • Ensure that CQC’s Well-Led Inspections Framework seeks assurance that inclusive Freedom to Speak Up arrangements are embedded effectively and meet the needs of overseas-trained workers by September 2027.

Recommendation 3: Improving data collection and categorisation of overseas-trained workers to better measure speaking up progress For NHS England: • By August 2025, NHS England should review and update the framework for identifying and categorising overseas-trained workers in workforce data, including its application in the NHS Staff Survey. The updated framework should ensure all overseas-trained workers are accurately captured, regardless of their recruitment pathway or organisational moves, and address distinctions between nationality and training location. • The updated framework should be applied to the 2025 NHS Staff Survey, enabling meaningful analysis of overseas-trained workers’ experiences, including their sense of safety in speaking up and their confidence in appropriate action being taken. Results should be published by March 2026.

Recommendation 4: Addressing cultural barriers For NHS England: • Include cultural intelligence training for NHS staff, managers and leaders as part of NHS England’s Leadership and Management Framework programme by April 2026. • Consider the most effective route within existing workstreams and learning programmes to deliver cultural intelligence training to workers, managers, senior leaders and Freedom to Speak Up guardians, and ensuring this training is delivered on an ongoing basis.