Ethnic minority leadership in the NHS: progression, representation, retention and organisational culture
15 September 2026Long read
Foreword by Dame Donna Kinnair
As chair of the NHS Alliance BME Leadership Network, I am privileged to work alongside a strong and committed executive steering group and a dynamic, rapidly growing membership. Our members bring deep expertise, lived experience and a clear expectation that the NHS must now move beyond acknowledgement to meaningful action. They are leaders in their own right; leaders who understand the realities of discrimination, exclusion and inequity not as abstract concepts, but as experiences that shape careers, wellbeing and the quality of care delivered to our communities.
Yet it cannot fall to those who have endured racism, harassment or structural disadvantage to carry the responsibility for fixing the system. Our network exists not because staff from ethnic minorities should be tasked with solving the market failure in the NHS workforce, nor because they should shoulder the burden of ensuring racism has no place in policy, practice or patient care. Rather, our network exists because leadership—collective, evidence driven, courageous leadership—can convene the dialogue that the NHS has too often avoided.
What our leadership can do is create the conditions for a dialogue of equals, where evidence is centred, lived experience is respected and solutions are co produced with those who understand the system from within. What our leadership can do is act as a catalyst for change, influencing the influential, challenging complacency and ensuring that the voices of BME staff are not only heard, but shape the decisions that determine progression, representation and retention across the NHS.
This report, Ethnic Minority Leadership in the NHS, provides a stark and necessary reminder of why this work matters. The findings are clear:
- Nearly four in five respondents experienced racism in the last three years, with covert discrimination the most common form.
- Experiences of racism and inequity were linked to decisions about whether to remain in the NHS, with some long-serving ethnic minority leaders describing the cumulative impact of these experiences over their careers.
- Seniority offers no protection. Band 9 and very senior manager (VSM) leaders report some of the highest levels of isolation and covert discrimination.
- Concerns about fairness in career progression were raised, a finding supported by national WRES data showing that ethnic minority staff reported lower perceptions of fairness in career progression than white staff.
- Access to sponsorship, advocacy and influential networks continues to shape who progresses and who is overlooked.
These findings echo what many of our members have long known: representation alone is not enough. Progression, belonging and psychological safety remain unevenly experienced. Structural barriers persist. Racism—whether by omission, fear, belief or ‘straight, no chaser’—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.
Our responsibility as a leadership network is to ensure that this moment is not wasted. We must support our members to advance equity and inclusion, strengthen leadership pathways, and secure the opportunities emerging today to build a better NHS tomorrow.
Dame Donna Kinnair, Chair, The NHS Alliance BME Leadership Network.
Introduction
Leadership diversity within the NHS is important not only because it creates fairer opportunities for staff, but because leadership shapes organisational culture, workforce experiences and ultimately the quality of services delivered to patients and communities. The NHS serves an increasingly diverse population and leadership teams play a critical role in ensuring that organisational decision-making, service design and workforce strategies reflect the needs and experiences of the communities they serve.
At a time when the NHS continues to face significant workforce and service delivery challenges, ensuring that leadership talent is identified and supported has become essential. Leadership diversity is therefore not solely a workforce issue but an organisational effectiveness issue. When talented people are unable to progress because of organisational barriers, the NHS risks losing valuable skills, experience and leadership potential. Creating equitable leadership opportunities enables organisations to make better use of the talent that already exists within their workforce.
For ethnic minority staff, these wider benefits are closely linked to personal experiences of fairness, opportunity and belonging. The visibility of leaders from ethnic minority backgrounds can influence whether leadership is seen as attainable and whether progression is based on potential and capability, rather than barriers that are unevenly experienced across staff groups.
Leadership also shapes organisational culture. Leaders influence priorities, behaviours and workplace environments. As a result, the representation and experiences of ethnic minority leaders matter not only for those currently working within leadership positions, but also for those aspiring to be leaders who are considering whether progression within the NHS is achievable, equitable and inclusive.
The NHS has recognised for many years that racism and racial inequality remain significant issues affecting its workforce. Over the last decade, national workforce data, independent reviews and staff experience reports have repeatedly highlighted concerns relating to discrimination, inequitable career progression, underrepresentation in leadership, bullying, harassment, victimisation and a lack of psychological safety for ethnic minority staff.
In response, a range of national initiatives, reviews and accountability frameworks have been introduced, including the Workforce Race Equality Standard (WRES) in 2015. Reports such as Shattered Hopes by the NHS Confederation in 2022, Race 2.0: Time for Real Change by the NHS Alliance in 2022 and the NHS Race Equality Taskforce report by NHS Providers in 2025, have further highlighted the persistent experiences of racism and inequity faced by staff from ethnic minorities and the need for continued action to address longstanding disparities.
However, ten years after the introduction of WRES, important questions remain regarding the extent to which progress has translated into meaningful improvements in the lived experiences of ethnic minority staff. The WRES data presents a mixed picture. While reported experiences of discrimination from managers, team leaders or colleagues have improved in some measures, ethnic minority staff experiences of harassment, bullying and abuse from members of the public have worsened. Representation within some areas of NHS leadership has also increased, yet concerns relating to progression, inclusion, organisational culture and retention continue to be reported. The findings within this report suggest that increasing representation alone is unlikely to achieve sustained change if barriers to progression remain and leadership experiences continue to differ across staff groups.
The policy landscape is also evolving. Proposed legislative changes relating to mandatory ethnicity pay gap reporting are likely to further strengthen organisational transparency and accountability by increasing the visibility of disparities relating to pay, progression and representation. Due to statutory ethnicity pay gap reporting data not being previously reported through the NHS Workforce Race Equality Standard (WRES), the publication of this information may help to shine a light on:
- the pay disparities between different ethnic groups
- representation gaps at senior levels
- structural barriers in progression and recruitment
- the potential link, if any, between differential attainment in clinical, nursing and medical training and future career progression.
At the same time, race equality work is taking place within an increasingly politicised environment. NHS leaders have highlighted the need for continued support, guidance and visible leadership from national organisations to help maintain momentum, create safe spaces for meaningful dialogue and support organisations to address race inequality with confidence and consistency. This further reinforces the importance of embedding race equality within leadership practice and organisational accountability rather than viewing it as a standalone equality initiative.
The publication of the NHS Staff Standards in July 2026 further reinforces the importance of this agenda. For the first time, NHS trusts in secondary care will be formally assessed against standards that include how effectively they tackle racism, alongside other measures relating to staff experience, leadership and wellbeing. The standards recognise that addressing racism is not solely an equality issue but a fundamental component of organisational culture, leadership accountability and organisational performance.
This report is intended to support NHS organisations, board leaders and staff to better understand the experiences of employees from ethnic minority backgrounds working within the NHS and to inform practical actions that strengthen progression, representation, retention and inclusion within NHS leadership. It seeks not only to describe ongoing challenges, but also to identify actions that support meaningful and sustained change across the NHS.
