Race inequalities for NHS staff: looking back on the WRES data

Many working in health care and health care policy will have been eagerly awaiting the publication of the government’s 10 Year Health Plan. Its launch possibly meant other issues received less attention, such as the publication of the NHS Workforce Race Equality Standard (WRES) 2024 data in late June.

The WRES was introduced across NHS trusts in 2015, giving us almost 10 years’ worth of insight into disparities between the experiences of white, Black and ethnic minority employees in terms of recruitment, career progression, representation and more. Headlines from the 2024 WRES report include that Black staff are the least likely to believe they have an equal opportunity to progress in their careers, and staff from Black and ethnic minority groups are still more than twice as likely as white staff to report experiencing discrimination from colleagues – a consistent trend since the first WRES report.

As I and others have said before, the annual WRES rarely deviates from the narrative of Black and ethnic minority staff having worse experiences at work than white staff. Looking back on nearly 10 years of WRES data, I’d pick out two areas where there has been some positive change:

• The representation of Black and ethnic minority people at senior management and board levels has progressively increased since the 2016 report (but as the 2024 report acknowledges, this is still not in proportion to the ethnic diversity of the rest of the workforce).

• There has been a year-on-year reduction in the relative likelihood of Black and ethnic minority staff entering the formal disciplinary process since WRES reporting began (although there was a slight upturn in the relative likelihood figure, from 1.03 in 2023 to 1.09 in 2024).

To help tackle its issues with inequalities in staff experience, the NHS published an Equality Diversity and Inclusion (EDI) plan in 2023, based on six ‘high impact’ actions for leaders. Below, I offer some brief reflections on the progress made (or not) against three of the actions:

• Embed fair and inclusive recruitment processes and talent management strategies that target under-representation and lack of diversity. The latest WRES report shows fair and inclusive recruitment is far from embedded in the NHS – for example, white applicants are more likely to be appointed from shortlisting than Black or ethnic minority applicants. On the other hand, the growth in ethnic diversity at senior levels could suggest that increased efforts have been made to develop Black and ethnic minority NHS leaders. Sadly, this potential focus on talent management hasn’t translated into Black staff believing the NHS supports equal opportunities for career progression.

• Create an environment that eliminates the conditions in which bullying, discrimination, harassment and physical violence at work occur. This is where WRES data shows just how little has changed; racism is still baked into the culture. The 10 Year Health Plan commits to introducing new staff standards to protect staff from violence, racism and sexual harassment at work, although these are due to be introduced in April 2026 so there is still some way to go before the conditions are eliminated.

• Chief executives, chairs and board members must have specific and measurable EDI objectives to which they will be individually and collectively accountable. Generally, there is a lack of transparency about whether and how NHS leaders have committed to tackle race or any other inequalities for staff. Without this, it cannot be known whether the warm words of leaders are being backed up with actions.

Sadly, this year the WRES data spells out yet again the NHS’s poor performance on its own ambitions for EDI. This blog comes at a time of a public backlash against the NHS employing senior managers generally, and senior EDI managers specifically. Or – as a newsreader put it to Wes Streeting – how can the NHS justify paying a ‘DEI manager’ (their words) a salary of £120k when the waiting list stands at 7.4 million?

But promoting EDI and tackling the elective care waiting list are not mutually exclusive. How staff feel and experience their work affects how they’re able to function and provide care. Furthermore, it should go without saying that the bullying, harassment and discrimination take a hard toll on the people experiencing it and may well make them leave their jobs at a time when the NHS can ill afford to lose its staff.

Then perhaps we return to the accountability point. Who is accountable for the dire state of NHS workplace culture? And what will it take to see things change?