NHS risks haemorrhaging ethnic minority leaders because of racism

The NHS in England faces a haemorrhaging of ethnic minority leaders because of continuing racism, exclusion and inequity in their everyday working lives. 

Research by the NHS Alliance suggests that nearly four fifths of NHS staff from ethnic minority backgrounds who are currently in or aspire to leadership roles have experienced racism.  

More than one in five said they expected to leave the NHS in the next three years.  

The report, Ethnic minority leadership in the NHS: progression, representation, retention and organisational culture says that despite a range of national initiatives, including the workforce Race Equality Standard (WRES), reviews and accountability standards, important questions remain about how much this has led to meaningful improvements for ethnic minority staff working in the health service. 

Further findings indicate that: 

Seniority offers no protection from racism, with ethnic minority staff at the most senior grades reporting some of the highest levels of isolation and covert discrimination.  

Aspiration remains high, yet confidence in progression is low, with less than one-in-ten believing they will “definitely” be promoted. 

Access to sponsorship, advocacy and influential networks continues to shape who progresses and who is overlooked. 

The findings focus on four themes: 

• Progression – survey findings show widespread dissatisfaction with progression opportunities and perceptions of unfairness. 
• Representation – despite examples of progress, many respondents report a lack of visible diversity within senior leadership roles. 
• Retention – the findings build on evidence that experiences of discrimination, exclusion, limited progression opportunities and unequal access to support, impact on decisions to leave the NHS. 
• Organisational culture – this is often seen as the key factor behind whether race equality initiatives are experienced as meaningful or symbolic.  

The report points to the “increasingly politicised environment” in which race equality work is taking place. However, it acknowledges that many NHS organisations are taking meaningful steps to improve race equality.

It sets out recommendations to help the NHS to “translate insight into action”. They include steps to embed anti-racist leadership, strengthen progression pathways for ethnic minority staff, and moving beyond mentoring to establish formal sponsorship opportunities.

The chair of the NHS Alliance BME Network, Dame Donna Kinnair, said: 

"These findings echo what we have long known: representation alone is not enough. Progression, belonging and psychological safety remain unevenly experienced. Structural barriers persist. Racism continues to shape the leadership landscape of the NHS.

"But this report also points to opportunity. With proposed ethnicity pay gap reporting, growing organisational awareness and a renewed focus on equity, the NHS stands at a moment where meaningful change is possible."

The chief executive of the NHS Alliance, Sir Ciarán Devane, said: 

"These findings offer further evidence of the corrosive and demoralizing impact of racism in the NHS.

"At this time of political and cultural polarization it has never been more important to recognize the vital importance of leadership diversity in the NHS.

"To have the best NHS we need to have the best talent. And that means being inclusive, being focused on developing and leading all our staff equally well. That is the only way for all of us to have the care we want when we need it.

"Yet we now face a very real risk of senior ethnic minority colleagues walking away, discouraged, disheartened and disillusioned. This also represents a huge loss of talent from the NHS.

"We owe it, not just to them but to all staff and patients, to ensure that the voices of ethnic minority staff are not only heard but shape the decisions that determine progression, representation and retention across the NHS."