Race inequality in the NHS

Some small advances, some reverses and some pockets of good practice but overall insufficient progress in tackling of race discrimination in the NHS in England has emerged from the latest Workforce Race Equality Standard report.

In its fifth annual assessment, the WRES shows that in 2020 Black, Asian and Minority Ethnic (BAME) applicants were even less likely to be appointed from shortlisting compared to white applicants than they were in 2019; white applicants were 1.61 times more likely to be appointed, up from 1.46 in 2019 and 1.57 in 2016.

Furthermore, BAME staff remain less likely to access non-mandatory training and continuous professional development compared to white staff, the report found, with the indicator showing the gap narrowing slightly over 2019 (1.14 vs 1.15) but widening over the five year period (1.11 in 2016).

The percentage of BAME staff believing that their trust provides equal opportunities for career progression or promotion increased in 2020 to 71.2 per cent compared with 69.9 per cent in 2019, but fell from 73.4per cent in 2016. The gap with white staff remained persistent at around 15 per cent.

BAME staff were 1.16 times more likely to enter the formal disciplinary process; this was, however, a reduction on 2019 (1.22) and 2017 (1.37).

There was clear progress improving race diversity in trusts’ leadership, with an increase in four out of the five years, reaching a new record of 10 per cent of BAME people in board membership in 2020 and a rise every year from 5.4 per cent to a high of 6.8 per cent of BME staff in very senior management roles. The overall proportion of staff in the NHS in England has also risen every year over the five year period, from 17.7 per cent to 21 per cent.

The report further found that 30.3 per cent of BAME staff reported experiencing harassment, bullying or abuse from patients, relatives or the public, up from 29.1 per cent in 2016. Compared to five years ago, the gap with white staff had widened, from one percentage point to 2.6 percentage points. A similar indicator where the perpetrators were other staff showed an increase over the past five years to 28.4 per cent, up from 27 per cent in 2016, although a slight fall compared to 2019 (29 per cent). The percentage of staff personally experiencing discrimination at work from a manager, team leader or other colleagues fell to 14.5 per cent from 15.3 per cent in 2019, but this was slightly higher than the 14 per cent recorded in 2016.

Over the five years that the WRES has been publishing, only four out of nine indicators have improved. The majority have in fact budged very little.

A separate target of reaching 19 per cent of BAME staff across every pay band was exceeded in two bands (one and five) with all the rest falling short, with the shortfall progressively increasing up the bands (just 6.8 per cent at VSM). 

A number of recommendations have been made against each indicator. Prerana Issar, NHS chief people officer, stated that: ‘no one organisation is doing everything well. There are pockets of good practice across all WRES indicators, but no single organisation is exemplary. Every organisation must face up to its limitations and, as set out in the People Plan, develop measurable strategies to overcome them’. Issar recognised that the results of the report were ‘impossible to separate’ from the wider context of the George Floyd murder and Covid-19’s disproportionate impact on BAME populations, arguing ‘it is right that we examine the findings with a view to quickening the pace of change.’

CSP director Claire Sullivan said: ‘This report tells us clearly that we are not making enough or consistent enough progress on tackling race inequality. We welcome the greater diversity in leadership positions but overall this report shows how entrenched racism is in the NHS and that government, employers and unions all need to up our game. The increased focus on anti-racism in recent months must not only be sustained but stepped up to encompass allyship and understanding of privilege, as well as building inclusive behaviours and workplace cultures. We have to do better.’