‘It should not fall to those experiencing racism to fix the conditions that allow it to persist’

Being an NHS leader is hard. Every week I speak to those at the top of our sector and am awestruck by their ability to balance difficult decisions around safety and quality, around finance, and leading their staff amid relentless pressure.

At the same time, too many of our leaders face an added burden because they happen to be from an ethnic minority background. Our members tell us about having to lead while facing extra scrutiny or experiencing the isolation which comes with being the only person of their background in the room. For some, that heightened scrutiny brings a fear that they will not be afforded the same grace to make mistakes, to learn and to grow as their peers. They feel a pressure to continually demonstrate their competence, knowing that any misstep may attract disproportionate attention, reinforcing misconceptions that their appointment was a ‘risk’ in the first place, something that many have said they feel even more acutely following the tragic death of Professor Jason Arday.

On top of this, far too often it falls on leaders from ethnic minority backgrounds to shoulder the burden of ensuring racism has no place in policy, practice or patient care while experiencing the impact of racism themselves. This is a burden that’s neither fair nor sustainable.

It is no wonder that in the NHS Alliance BME Leadership Network’s survey of almost 1,000 leaders or aspiring leaders from ethnic minority backgrounds – backed up by one-to-one interviews and a conference discussion – nearly a fifth of respondents said they did not expect to be working in the NHS in three years’ time. Experiences of racism, limited progression opportunities, inadequate support and ineffective organisational responses were frequently linked to intentions to leave.

While our report, Ethnic Minority Leadership in the NHS: Progression, Representation, Retention and Organisational Culture acknowledges that ethnic minority representation in the NHS is improving, experience is clearly not. The challenge for all of us who care about the NHS and about our colleagues is not simply who gets through the door, but who is supported to succeed, progress and stay.

One NHS leader said when interviewed: ‘I am fatigued and emotionally burnt out from almost 30 years of NHS work.’ Another commented: ‘After suffering over 20 years of race trauma and the cumulative emotional, psychological and professional toll of sustained racial bias and inequity in the workplace, I need to heal.’

Nearly four in five survey respondents said they had experienced racism in the last three years, Band 9 and very senior manager (VSM) respondents were among the groups most likely to report covert discrimination and isolation within leadership environments.

‘We are not treated fairly. More is expected from a non-white person,’ said one leader. Another described ‘a hostile environment for Black and Brown staff’.

Despite all of this, aspiration for leadership remains high for staff from ethnic minority groups. But their confidence in achieving progression is much lower, reflecting concerns about fairness, access to opportunities and organisational support.

Too often race equality is seen as a workforce issue rather than a leadership responsibility, with focus on staff networks, equality, diversity, and inclusion (EDI) initiatives and changing the behaviour of individual employees. These are good of themselves but can leave leaders unclear about what they can do to create change and to ensure we lead all of our people all of the time.

Race equality must be seen as a leadership and board responsibility.

We, as leaders, have considerable influence over the conditions in which inequality can persist. We shape organisational culture and make decisions about how people are recruited, developed and supported. We determine what is challenged and what organisations are held accountable for.

Leaders, and particularly white leaders and allies, must understand the role they play and develop the knowledge and capability to lead the change.

The NHS Staff Standards published in the summer recognised that tackling racism is a core organisational and leadership responsibility. It will be important that these standards are fully implemented, including clear board-level accountability for tackling racism.

So, what does this require of NHS leaders?

First, we must take personal responsibility for developing anti-racist leadership capability. That means naming the problem, developing our understanding and acknowledging how racism shows up for ethnic minority staff and leaders. We must listen to and learn from both lived experience and the data. Most of all, we should apply a racial equity lens and be prepared to challenge inequity when we see it. The NHS Race and Health Observatory’s Seven Anti-Racism Principles provide a helpful framework for leaders and their adoption by the NHS was recommended by the Lord Mann review of antisemitism and other forms of racism in the NHS and healthcare regulatory system earlier this year.

Second, organisations must create transparent routes to progression. Talent should not depend on access to informal networks or having an advocate in the right room. Sponsorship arrangements must be transparent, monitored and evaluated to ensure equitable access.

Third, white leaders must share the burden. Ethnic minority colleagues must be included in shaping meaningful change, but they cannot be expected to carry responsibility for delivering it. It should not fall to those experiencing racism to continually identify it, explain it and fix the conditions that allow it to persist.

Ultimately, this is about whether talented people are recognised, supported and able to exercise genuine influence once they get there. It is about whether the NHS makes the best use of the expertise within its workforce and whether its leadership reflects and understands the communities it serves. And it is making sure we have the best people providing the best care.

Sir Ciarán Devane, chief executive, The NHS Alliance

This article first appeared in Healthcare Leader on 23 September 2026.