Published On: 31 August 2015Tags:

The National Health Service (NHS) is the largest employer of black and minority ethnic people, yet research shows the NHS treat black and minority ethnic staff less favourably in their recruitment, promotion, discipline and career progression. In the wake of the Macpherson Inquiry (1998), the NHS launched the Race Equality Action Plan to address the absence of black and minority ethnic staff from senior positions. Research a decade later shows little progress, notwithstanding research demonstrating a powerful business case linking workforce race discrimination to patient experience. In 2015, a new initative commenced, the Workforce Race Equality Standard (WRES), which holds a mandatory element with measurable benchmarked outcomes. The WRES metrics focus on workforce, staff experience, and board composition.

Key messages:

  • The National Health Service (NHS) is England’s largest employer of black and minority ethnic people. 37 per cent of doctors, 20 per cent of nurses and 17 per cent of all directly employed staff are from black and minority ethnic backgrounds. Research shows the NHS treats black and minority ethnic staff less favourably than white staff in their recruitment, promotion, discipline and career progression, whilst black and minority ethnic staff are also significantly more likely to be bullied at work. The leadership positions of the NHS – both in executive and non-executive positions – are disproportionately white and often unrepresentative of the local populations served by NHS Trusts.
  • Despite previous efforts to tackle discrimination, notably the NHS 2004 Race Equality Action Plan, such discrimination has remained and shows little, if any, sign of improvement. The 2004 strategy, the Race Equality Action Plan, though characterised by ministerial support and some initial success, appeared to fail, at least in part, due to an absence of measurable, benchmarked outcomes and the absence of sanctions or incentives which meant little accountability or transparency as other priorities held sway.
  • New research demonstrating the scale and persistence of discrimination comes at a time when research evidence has demonstrated the link between the treatment of staff and patient experience and outcomes and, in particular, the links between patient experience and the treatment of black and minority ethnic staff.  Such research provides a powerful business case for tackling discrimination to improve patient care, especially when further strengthened by evidence that diversity in leadership benefits innovation and the likelihood that NHS organisations whose leadership more closely resembles that of the communities being served will be more sensitive to their needs.
  • A major new initiative to improve race equality in the NHS and better draw on the talents of its workforce was launched in April 2015, with the introduction of a Workforce Race Equality Standard, mandated by the NHS Standard Contract and to be inspected by the Care Quality Commission (CQC). This approach draws on UK and international evidence of other successful approaches to tackling discrimination and is introduced in the expectation that it will have greater likelihood of success than previous NHS efforts. It is intended that this approach should complement existing efforts such as the Equality Delivery Scheme (EDS2) and may be extended to other protected characteristics.


  • Leadership and equality in the NHS
  • Why does workforce race equality matter in the NHS?
  • Learning from the past?
  • Next steps
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Author(s): Roger Kline
Briefing series: Better Health Briefing Paper 39
Publisher: Race Equality Foundation
Publication date: August 2015