Conclusion

Five clear findings have emerged from this research:

1. Race equality continues to be seen by many as a workforce issue, rather than a leadership responsibility, leaving some leaders unclear about their role in creating change.
2. Race equality initiatives are not consistently experienced as resulting in meaningful improvements in workplace experiences or organisational culture. 
3. Progression is repeatedly linked to sponsorship, advocacy and access to influential networks.
4. Many participants lack confidence in organisational processes and feared raising concerns.
5. Representation has improved but equitable experiences of progression and belonging remain unequal. 

Participants described interpersonal experiences of racism including exclusion, stereotyping, microaggressions and unequal treatment. These experiences affected confidence, wellbeing and perceptions of fairness and belonging within NHS leadership environments. 

However, the findings also suggest that many of the challenges experienced by ethnic minority staff and leaders are more commonly associated with structural and institutional factors. Across all four themes, participants repeatedly described unequal access to sponsorship and influential networks, inconsistencies in organisational support, limited transparency within progression processes and a lack of visible accountability for addressing race inequality. 

Participants also questioned whether organisational systems, leadership behaviours and workplace cultures were sufficiently addressing longstanding disparities or creating environments where ethnic minority staff felt valued, supported and able to thrive. Many respondents distinguished between organisational activity and meaningful change, suggesting that initiatives were often visible but their impact on lived experience was not.

Overall, the barriers identified cannot be explained solely by individual experiences of discrimination. Rather, they reflect the ways in which organisational systems, leadership practices and workplace cultures shape access to opportunities, experiences of inclusion and confidence in leadership pathways. 

Perhaps the most significant finding is that race equality continues to be seen as a workforce issue rather than a leadership responsibility. When race equality is viewed primarily as an issue within the workforce, responsibility can become focused on staff networks, EDI initiatives or changing the behaviours of individual employees. This can leave leaders unclear about what they themselves can do to create change. 

Yet leaders have considerable influence over the conditions in which inequality can persist. They shape organisational culture and make decisions about how people are recruited, developed and supported. They also determine what is challenged and what organisations are held accountable for. Tackling race inequality therefore requires leaders to understand the role they play and develop the knowledge and capability to lead change. 

The findings are further reinforced by the publication of the NHS Staff Standards in July 2026. The new standards recognise that tackling racism is not solely an equality issue but a core organisational and leadership responsibility. They reinforce the expectation that organisations should be accountable not only for the actions they take, but for whether those actions result in meaningful improvements in staff experiences and outcomes.  

Ultimately, the findings presented within this report are not solely about leadership diversity. They are about the kind of NHS the organisation aspires to be. Leadership shapes organisational culture, workforce experience and the decisions that influence patient care. Creating equitable opportunities for ethnic minority leaders is therefore not only a matter of fairness for individuals. It is also an opportunity to strengthen leadership, improve organisational effectiveness and deliver services that are better informed by the diverse experiences and perspectives of the workforce and communities the NHS serves. 

The challenge for the NHS is therefore not whether change is needed, but whether organisations are prepared to demonstrate the leadership, accountability and collective commitment required to achieve it. 

As Joan Saddler OBE reflected: