The economic case for going further

Evidence shows that diverse and inclusive organisations perform better. On the one hand, there are real costs when people experience racism and discrimination: they are less productive and motivated, and they are more likely to take sick leave or resign. On the other hand, additional value is created in organisations where workers feel safe, cared for, welcome and able to flourish in their careers.

Put simply, advancing race equity not only means that costs can be avoided: it can make an organisation's economic position stronger.

This is particularly important as health systems around the world, including our own, continue to face increasing pressures. The NHS is investing in technological and infrastructure improvements so that staff can spend more time looking after patients and less time dealing with complex processes, systems and paperwork.

We also need to see further advancing equity as a key lever for improving the economic position of the NHS and the healthcare industry overall.

What is the economic impact of further advancing race equity?

There are direct and indirect costs of bullying and harassment.

The estimated cost to the NHS of bullying and harassment is over £2.3 billion per annum,¹ and people who experience bullying or witness bullying behaviour are more likely to take time off sick or want to change jobs.² This is reflected in the NMC Register Leavers Survey, where lack of support from colleagues and experiences of bullying, harassment or discrimination were highlighted in the ten most common reasons for leaving the register.³ This is a real problem for a healthcare system that has cited international recruitment as crucial for boosting performance.⁴

There are direct and indirect costs of high staff attrition.

In the NHS, the turnover rate of nurses at a typical trust is 12%, the cost of replacing a fully-trained nurse is £12,000,⁵ and attrition across the entire NHS workforce is reported to cost the NHS £21.7 billion.⁶ Also, the number of nurses leaving the NMC register has increased since 2020, by 9% in 2021 and a further 3% in 2022.⁷ Reduced productivity, burnout, wasted time and money spent hiring replacements, and the cost of training are commonly cited indirect costs of high attrition.⁸

Diverse and inclusive teams perform better than their peers.

Companies in the US in the top quartile for race and ethnic diversity are 35% more likely to have greater financial returns than their respective industry medians.⁹ The National Institute of Health in the US found that healthcare organisations with more diverse leadership teams are likely to outperform their less diverse peers,¹⁰ and other research suggests that addressing systematic racism in healthcare organisations actually 'strengthens organisations and makes economies stronger.'¹¹ In 2015, the NHS found that a diverse workforce improves the 'efficient and effective running of the NHS'.¹²

The evidence suggests that we can boost performance, productivity and innovation in our healthcare system by advancing race equity. We can also reduce the costs associated with unhappy workers, bullying, harassment and high staff attrition. These economic benefits could be transformative for the healthcare sector - helping us to realise productivity gains and focus on improving patient care.

There is a clear economic case for going further.