The case studies in this guide underline that leadership plays a crucial role in addressing the disciplinary gap within the NHS. Seven key themes emerge for NHS boards:

Set the tone for the organisation: NHS trust leaders set the culture, values and standards of behaviour within their organisations. The NHS People Plan, the NHS People Promise and the NHS equality diversity and inclusion (EDI) improvement plan all highlight the importance of creating a culture of belonging, where staff feel safe, supported and able to admit mistakes, all factors in the provision of good patient care. For this to happen, staff must be treated equitably and without discrimination. Board members must role model inclusive and compassionate leadership and communicate clearly and regularly the organisation's approach to discrimination and anti-racism, as well as the expected behaviours and values.

Demonstrate leadership commitment and accountability: the NHS EDI improvement plan sets out the requirement for all board members to have EDI objectives that are specific, measurable, achievable, relevant, and timebound (SMART) and be assessed against these as part of their annual appraisal process. Board members may consider a commitment to reviewing disciplinaries and grievance processes and promoting targeted strategies for closing the gap within personal objectives.

Review your data with curiosity: board members have access to multiple data sources which can be triangulated to identify trends and support needs across the organisation. The use of quantitative data from the NHS Workforce Race Equality Standard (WRES) and other internal sources (such as Freedom to Speak Up data and insights, employee relations data, and staff survey results by ethnicity and outcome) alongside qualitative insights from staff can help identify trends and areas that require support and improvement. Regular scrutiny and oversight of data can support the implementation of early interventions and aid progress towards equity.

Commit to having the 'uncomfortable' conversation: during the scoping of the NHS Providers Race Equality programme, trust leaders shared that they experienced discomfort and a lack of confidence to have conversations about race. Fear of saying the wrong thing or avoidance of a possibly 'uncomfortable' conversation can create barriers to embedding a culture of openness. In committing to have the difficult conversations, leaders can develop their own anti-racist practise and white allyship, increasing their awareness to inform their decision-making and behaviours.

Invest in training and education to help drive progress: investing in race equality support for board members and staff can create a more inclusive workplace and better staff and patient experience. This can include how to have conversations about race, how to increase cultural awareness and competence, and how to become an active bystander. This can support the development of inclusive processes, policies and decisions. In turn this can also increase confidence to actively address any issues related to discrimination or bias at an earlier and more informal stage.

Listen to and engage with staff: seek out opportunities to actively listen to the experience and views of staff and key internal stakeholders, including staff networks groups and trade unions, who can often provide valuable insights and support coproduction of interventions. Staff networks in particular, can be a valuable resource to an organisation, acting as a barometer of staff experience, and provide insight into the impact of interventions.

Develop your board diversity: having a diverse and values-driven board that reflects the diversity of your workforce, helps ensure that different perspectives and experiences are considered in decision-making processes. This is essential to the development of an inclusive culture, with policies and practices that address workforce inequalities such as the disciplinary gap. The latest NHS WRES data shows that 13.2% of board members recorded their ethnicity as black, Asian and minority ethnic (an increase of 38.1% compared to 2021). However, with an increasingly diverse workforce, the gap between board and whole workforce diversity is increasing.