Why we need to focus on race

Ethnic minority workforce representation is at just under one in three staff, higher than in the working population overall, and making them the largest minority community within the NHS. 

In some individual trusts the ethnic minority staff count is far higher than both the local and/or national average e.g., London North West University Healthcare NHS Trust has a 71% ethnic minority workforce against a London population average of 46.2%. 

The NHS workforce is disproportionately made up of women and those from ethnic minorities. Women continue to be underrepresented in leadership positions, and ethnic minority women have a disproportionately lower board presence than white women.

The NHS faces significant workforce challenges and needs to improve staff retention. Poor workplace experiences including inequity in access to development, also impacts on retention. 

The NHS has been increasingly reliant on overseas recruitment over the last few years, 23.8% of nurses, and 41% of doctors coming from overseas. The government’s 10 Year Health Plan for England sets out an ambitious commitment to reducing international recruitment to under 10%, “to ensure sustainability in an era of global healthcare workforce shortages”.  Whilst the move to increase the UK-based pipeline is welcome, this needs to be done alongside commitments to support the wellbeing and development of existing internationally educated staff within our NHS. 

In 2025, for the first time since 2015, the number of non-UK–qualified doctors joining the UK workforce plateaued rather than increased, fewer internationally qualified doctors found employment after joining the register which also drove a growth in leavers. However, rates of leavers also rose amongst non-UK doctors who had been employed rose by 26% to 4,880, (General Medical Council 2025). The Nursing and Midwifery council also reported an 8.5% increase in the number of internationally educated nurses leaving the register when compared to the same period the year before.  

Research conducted by LPC found that discrimination, inequality and a commitment to diversity and inclusion were found to be more significant in the decisions to leave employment by NHS staff than burnout. 

It is important that we create an inclusive and compassionate environment and invest in supporting our increasingly diverse workforce. Increased workforce diversity, coupled with an inclusive culture makes better business sense, with increased innovation, profitability, and productivity. In 2020, McKinsey found top-quartile companies for ethnic diversity outperformed those in lowest quartile for ethnic diversity by 36% in profitability. This increased to 39% in their most recent 2023 research which had an increased global sample size.  

The experience of ethnic minority staff can be viewed as a good barometer of the climate of respect and the culture in an NHS organisation as they often have the worst experience among minority staff groups. In improving their experience, reducing inequity and discrimination, we make improvements in organisational culture which positively impacts everyone, and improves the experience of all minority groups. 

When a sizeable proportion of staff are having an inequitable workplace experience, there will be loss of psychological safety. Maslow’s hierarchy of needs demonstrates that without the basics of physiological and psychological safety, we cannot develop the feelings of belonging that are needed to drive us forward in our aims to become inclusive and compassionate workplaces and support the workforce to achieve their full potential. 

In addition to this, the links between racism and its subsequent impact on health outcomes were identified many years ago.  In 2002, Nazroo and Karlsen found that: “over and above socioeconomic effects, both experience of racial harassment and perceptions of racial discrimination make an independent contribution to health. For example, those who had been verbally harassed had 50% greater odds of reporting fair or poor health compared with those who reported no harassment”. 

This inequity was brought back into stark focus by Covid-19 in 2020. Racism does not just present a moral and ethical issue but it is also a public health issue, with 63% of healthcare workers who died from Covid-19 being from ethnic minority backgrounds. 

Experiences of racism, whether interpersonal, institutional or structural, are associated negative impacts on mental and physical health for ethnic minority people, with the weathering impact of racism leading to poorer health outcomes over an individual’s lifetime. 

The King's Fund reported: "Among ethnic minority groups structural racism can reinforce inequalities, for example, in housing, employment and the criminal justice system, which in turn can have a negative impact on health". 

NHS staff belong to the communities that they serve. Improving our awareness of how to support and create a sense of belonging in our ethnic minority staff, and better understanding their needs, supports us to understand and meet the needs of our ethnic minority patients better and work towards achieving more equitable health outcomes. 

There are clear links between staff experience and patient experience. Better staff experience results in higher levels of psychological safety, improved staff health and wellbeing, reduced absenteeism, fewer mistakes, and staff who are better able to meet the needs of their patients.  

The civility saves lives campaign has identified and brought together evidence showing the impact of incivility goes beyond the individual who directly experienced the behaviour into the wider team and impacts on patient care. In creating organisations where the experience of diverse workforce adds to a culture of learning from one another, organisations will be able to better support diverse populations and improve their experience of our service. 

Our member survey showed that only 4% of respondents felt that race equality is fully embedded as a core part of their board’s business. All respondents described their ambition to listen more closely to staff about their experience. Leaders recognised the need for greater support for their workforce, particularly for those experiencing discrimination, but also shared barriers to progress which included discomfort with the lexicon of race and the fear of getting it wrong. 

NHS Providers also recognised the need to lead by example in this space and our four-year strategy made race equality a key priority. We have intentionally taken time to discuss, listen and think. To keep our focus on what this means for us personally and for the work we do – and we have had some challenging and difficult conversations as a result. 

As an organisation, we made a public commitment to becoming an anti-racist organisation. As part of this we published a statement which unites all of us behind a clear ambition, alongside an action plan which sets out how we embed a focus on tackling racism and promoting race equality throughout everything we do – in our influencing work with the national bodies, and in the support we provide to members alongside clear success measures so we can be held to account by our staff and members for translating our commitments into tangible change. 
 
A focus on race equality is not done at the cost of other protected characteristics, but in improving the experiences of the most affected group you improve the experiences of all.