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


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.

  • White applicants are 1.45 times more likely to be appointed to roles from shortlisting compared to BAME applicants.

  • 15 per cent of BAME staff report experiencing discrimination in the past 12 months at work compared to 6.6 per cent of white staff.

  • BAME staff are 1.24 times relatively more likely to enter the formal disciplinary process compared to white staff (although this figure has improved yearly since 2016).

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.

If you would like to participate in our research by sharing your experience of working in the NHS as a black, Asian or minority ethnic person, please get in touch.