While figures for any NHS organisation may fluctuate over time due to a relatively small number of disciplinary cases each year, a persistent likelihood of entering the formal disciplinary process above 1.0 across the entire NHS workforce underlines an ongoing lack of racial equity that should be a concern for all NHS boards.

There are many potential factors that have and continue to contribute to the disciplinary gap, including:

  • Conscious and unconscious bias in disciplinary decisions and processes.
  • Lack of cultural awareness and sensitivity among managers conducting disciplinary procedures.
  • Systemic or structural issues that disadvantage ethnic minority staff, such as lack of advancement opportunities.
  • Organisational culture issues which could which could disproportionately impact ethnic minority staff, such as bullying, lack of compassionate leadership and ineffective teams.
  • Disparities in other HR/employee relations (ER) processes such as performance management and development opportunities that can feed into the disciplinary process.

Professional regulators have also acknowledged a disciplinary gap in fitness to practice referrals. The General Medical Council (GMC) has recognised the existence of inequalities in fitness to practice referrals for ethnic minority doctors and has set a target to close the disparity by 2026.

The Nursing and Midwifery Council (NMC) has identified a similar disparity with ethnic minority nurses and midwives being more likely to be referred by their employer than their white counterparts.

The disciplinary gap has significant implications for both the NHS and its staff. Some of the key implications for NHS leaders to consider include:

Impact on staff wellbeing: the disproportionate application of disciplinary policies can lead to feelings of stress, anxiety, and depression, which can affect both personal and professional lives.

Risk of losing talented staff: the disciplinary gap can lead to talented ethnic minority staff leaving the NHS. This can result in a loss of valuable skills and experience, as well reducing the diversity of the workforce.

Impact on patient care: there is a strong correlation between how staff are treated and higher staff turnover and absenteeism, higher mortality rates and lower patient satisfaction. Inclusive culture and equity for staff leads to better care for patients and improved patient experience.

Damage to the reputation of the NHS: the disciplinary gap can damage the reputation of the NHS as an employer and as a provider of healthcare services. It can lead to a loss of trust and confidence among staff and patients and can make it more difficult to attract and retain staff from diverse backgrounds. The case of Nurse Amin Abdullah, which led to guidance from NHS Improvement Learning Lessons to Improve Our People Practices, illustrated vividly how much damage, both personal and professional, can occur when employee relations processes do not follow best practice.

Legal and financial implications: if ethnic minority staff members are unfairly disciplined, this can lead to legal action being taken against the NHS employer, which can be both time consuming and costly.

Addressing this issue is a crucial part of any organisation's work on anti-racism as well as for promoting equality, diversity, and inclusion (EDI) within the NHS workforce, and for ensuring that all staff are treated fairly and equitably.

The NHS EDI improvement plan specifically references the impact of bullying, harassment, discrimination, and physical violence at work on both staff and patients within high impact action six. In recognition of this, NHS organisations are expected to review their disciplinary and employee relations processes.

Trusts need to review disciplinary and employee relations processes. This may involve obtaining insights on themes and trends from trust solicitors. There should be assurances that all staff who enter into formal processes are treated with compassion, equity and fairness, irrespective of any protected characteristics. Where the data shows inconsistency in approach, immediate steps must be taken to improve this (by March 2024).

High Impact six, NHS EDI improvement plan    NHS England