Life in the shadow of the snowy white peaks: race inequalities in the NHS workforce

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My son has a lot of questions about what I do at work and, although health and care policy is such a broad concept to grasp, he gets that a big part of what I do involves talking to people who work in (or around) the NHS. Recently I’ve struggled with his questions about a particular piece of research I’m involved in about race inequality in the NHS workforce. Racism is a reality that influences how many people – my son and I included – will experience life, including being at work. That doesn’t make it any easier or more comfortable to explain to an 8-year-old.

Past analysis has shown the people in the most senior positions in the NHS are overwhelmingly white and male – a phenomenon dubbed the ‘snowy white peaks of the NHS’. According to the most recent analysis, currently only eight per cent of NHS chief executives and chairs are black, Asian or minority ethnic (or ‘BAME’). The NHS Workforce Race Equality Standard (WRES) was introduced in 2015 and gives us the overview of the experiences of the BAME staff who make up 19 per cent of the workforce. White and BAME staff have very different and unequal experiences of the NHS as a workplace.

The WRES puts the spotlight firmly on NHS culture but, on its own, it can only tell us so much about the racial environment in the NHS. What is less widely studied is what the impact of racial discrimination is on a person (in this case a member of the NHS staff). It is this kind of real-life data and real-world stories which we hope will drive the cultural change needed to transform what happens in the workplace.

Over the past few months, I’ve spoken to a range of experts (those working in the NHS, academics, representatives from the national health care organisations) in order to hear their views about workforce race equality in the NHS. I’ve asked them how race inequalities show up (explicitly and implicitly) in health care from an employee’s perspective. According to interviewees, the experiences of BAME staff can range from open hostility (for example, being subject to racial slurs by patients or colleagues) to more subtle – but no less harmful – forms of discrimination (for example, ‘being set aside’ for career progression opportunities, negative ‘humour’ or social exclusion).

The experiences of BAME staff can range from open hostility… to more subtle – but no less harmful – forms of discrimination

What struck me the most was how some of the experts (some from a BAME background themselves) described the consequences of racial discrimination in the workplace: feeling isolated, misunderstood, undermined and ignored, among other things. Perhaps most unsettling was hearing about typical responses when BAME staff have spoken out about unfair treatment, for example denial (down-playing the racialised aspects of incidents or labelling them as simple misunderstandings) or indifference (telling BAME individuals to ‘just get over it’).

Of course, the experts are resolute that the culture within the NHS has to improve, but a few of the interviewees also admitted they are frustrated and weary too. Frustrated because progress has been slow despite several policy initiatives and weary because the fight for racial equality has largely been left to the very groups experiencing injustice and marginalisation – particularly challenging in an environment in which wider society does not fully comprehend racism and its emotional toll.

Our research will explore the lived experiences of BAME people working in the NHS. We would like staff from a BAME background to get in touch to share their experiences with us so we can understand more about what it is like to work in the kind of environment described above. Personal insights will help drive home what needs to change and how.

The fight for racial equality has largely been left to the very groups experiencing injustice and marginalisation

We also want to identify NHS providers where some improvement to the experience of BAME staff has been made and explore with them how that was achieved. So far this is proving more challenging than we had originally anticipated, particularly when trying to identify good practice exemplars of sustained improvement. But then, as pointed out by Sam Allen (chief executive of Sussex Partnership NHS Foundation Trust) during our recent online event, national bodies and regulators are more inclined to call up chief executives ‘if the money is sliding’ or targets have been missed than if the data are signalling issues around staffing, equality, diversity and inclusion.

The recently published Interim NHS People Plan states the NHS must recognise its ‘shortcomings’ in inclusion and diversity. The plan sets out an action to support boards to set targets for BAME representation across their workforce (including at senior levels) which goes some way to making the NHS more reflective of its patient populations. The bigger challenge is to acknowledge, address and change the behaviours that result in so many BAME people feeling marginalised and excluded. As my colleague Suzie Bailey says, this means practicing inclusive leadership every day and at every level – from foothill to peak.



Senior Researcher,
The King's Fund
Comment date
29 June 2020

Thanks Roiyah. It would be good to discuss this further. Can you email please, and the message will be redirected to me.

Roiyah Saltus

Academic Researcher,
Comment date
29 June 2020

Many thanks for the blog. Your research is very interesting. I am assuming it is confined to England? Perhaps we should have a chat about extending the work to Wales?

Adejoke Adeniran

Staff Nurse,
Comment date
05 May 2020

I totally agree with what people are saying about their experiences when it comes to racism at work. I have experienced it in the past and I ended up leaving my permanent post 7 years ago because of it.
Since then i work for the NHS as bank staff which I'm more comfortable with because if any manager misbehave i can easily stop going to his or her ward.
I think the problem I see with many of black people with my 17 years as a nurse is that we can't stand up to racism because we are afraid of losing our job or getting into trouble. The reason being that we have so many commitments to pay for so we tend to take so much rubbish from our white colleagues.
Before I tender my resignation in 2013 my husband was the one that gave me the courage to give the resignation letter, I wouldn't have got the gut. The day I gave my manager the letter was the most memorable day of my life with a sense of big relieve. I never look back since then and I'm so happy.
Racism is all over and everywhere but people at the top are in denial.

Memory Christi…

Staff nurse,
Comment date
04 May 2020

I do agree with everything about racism in the work place. I want to add something so simple that people are missing especially about why ABEM are most affected.
I have a permanent role but i do extra work to make ends meet.
During most of my agency work on weekends 99% of doctors and nurses on those shifts are from abem Asian Black and Ethnic Minorities.
Why... Socio-economic factors 1) big families to support or family commitments.
2) ambition to better one's self economically
3) different work ethic to white colleagues.
4) TO Afford better or suitable accommodation especially most don't have big or small inheritances from family members.
To sum up, the amount of time these groups have been or are exposed to the likelihood of getting the virus is about 50% higher than your average Caucasian British person.
Would be interested in what other researchers come up with.

Dr Liz Okokon

Clinical Scientist (health retired in Jan),
Healthcare Scientist - National Organisational & Professional Committee Unite in Health
Comment date
03 May 2020

2010 Equality Act introduced:
- my managers to Race Awareness training for Recruitment &
- me to the Only Black CEO of an NHS Trust. Top of 8A with PhD, I was mentored to break through "Glass ceiling" & take up Leadership role. But, for calling out the problem Culture of Bullying in NHS, I soon became "The Problem Black Woman". By End of 2010 "toxic work environment" left me in ITU. Despite being left Disabled, I returned to work - but within 4yrs I was the Victim of Bullying & Constructively Dismissed out of role as, one step from Consultant.
Union Lawyers say you cant win Race Discrimination claims & Disability Discrimination left me Pensioned out with Anxiety & Depression, just in time to self isolate during CoVid Pandemic that Disproportionately Kills Black and Asian & Ethnic Minority Bus Drivers, Health & Social Care Heroes💙 or is Racism Killing us?

Garrick Prayogg

Project Coordinator and Mental Health Lead.,
Cultural Diversity Network
Comment date
05 August 2019

I have worked in social welfare for 47, years, and Black and Asian Communities faces the same discrimination in promotion and retention since the 1970s.Over the years we have seen new equality laws and yet discrimination and racism continues. Following Stephen Lawrence inquiry MacPherson report and recommendation should have produced equity 26 years on we are still fighting for equality.
What doers this tell us about British Institutions' ?.

Tina Sparks

EssayShark UK
Comment date
26 June 2019

We need to consider minority race inequalities and to improve the workspace atmosphere to positive and balanced attitude without any racists vibes and talks. It's already so interesting to see more experts to do research and work more on it.

Freelance writer

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