Statistical case for going further

The healthcare system cares about the wellbeing of both patients and staff and recognises that race plays a role in how people are treated. Because of that, healthcare organisations have begun collecting data to understand the nature of workforce race equality and make sure leaders understand their responsibility in improving equality.

In England, all NHS trusts and healthcare providers are required to implement the Workforce Race Equality Standard (WRES).¹ From 2016 to 2023, data was collected from NHS staff around promotion and development, disciplinary processes and bullying and harassment. Although not a mandatory requirement, other organisations including Arm's Length Bodies (ALBs), private hospitals and healthcare charities have also implemented the WRES.² In Scotland, the annual Equality Monitoring Report captures data on recruitment, retention and employee development, looking at protected characteristics.³ As of 2024, there are plans to introduce the WRES in Wales.⁴ And in Northern Ireland, each trust collects equality monitoring information for their employees.⁵

In each workforce equality report, data is compared to the results from previous years to assess trends. The expectation is that healthcare organisations must show progress against key indicators of workforce equality over time. The ability to measure progress against such indicators represents a significant step forward.

However, the results of these reports also tell us that while we must continue measuring and understanding workforce race equality, we must also actively embed race equity into everyday practice and systems. With this imperative in mind, the data shows us that good progress is being made, but we still have further to go.

What do the existing workforce statistics tell us about why we need to go further?

The nursing and midwifery sector is becoming more diverse.

In 2023, 27.7% of all professionals in the UK registered with the Nursing and Midwifery Council were from Global Majority backgrounds, compared to 19.8% in 2019.⁶ Similarly, the percentage of registered nurses and midwives from Global Majority backgrounds working in the NHS increased from 17.7% to 24.4% in the same time span.⁷ This progress is a major testament to efforts that have already been made to drive recruitment in local communities and internationally across the healthcare system.

Progress has been made against key indicators of workforce race equality in recent years.

For instance, the WRES data shows that the number of board members from Global Majority backgrounds in NHS trusts has increased year on year at a national level. And while Global Majority members of staff across 46% of NHS trusts were still 1.25 times more likely to enter the formal disciplinary process than white staff, this is a significant improvement from 1.56 times more likely in 2016.⁸ This provides a positive sign that the NHS, the largest healthcare provider across the UK, is heading in the right direction in advancing race equity and that many of the existing initiatives aimed at reducing workplace inequality, such as EDI Advisory Groups, where staff can meet directly with senior leaders, are making a tangible impact. We must ensure that the healthcare sector across the UK continues to build on this progress.

However, staff members from the Global Majority are still less likely to be promoted into senior positions, and more likely to face disciplinary action, discrimination and harassment.⁹

In England, despite staff from the Global Majority making up over a quarter of the NHS workforce, only 11.2% of the people at the very senior manager (VSM) level are from the Global Majority. In addition, only 15% of board members are from the Global Majority - highlighting a significant gap between Global Majority members of staff in the workforce and in leadership positions.¹⁰ In Scotland, only 1.9% of people in Bands 8A-D are from Global Majority backgrounds despite making up 5.39% of the workforce. Additionally, 100% of the executive cohort of NHS Scotland is white.¹¹ In Wales, while the percentage of Global Majority directors is representative of the population, two out of twelve NHS boards are entirely white, and in Northern Ireland, seven out of eight NHS boards are entirely white.¹²

The latest data tells us that we are making progress in certain areas: representation at the board level has increased and the disproportionate likelihood of Global Majority staff entering the formal disciplinary process has decreased. But Global Majority members of staff are still facing more barriers to progression and promotion than white members of staff, and more of them are still experiencing harassment and discrimination.

There is a clear statistical case for going further.