Survey provides fresh assessment of race and inclusion in NHS


By Skills for Health | 19 January 2024

A study by Skills for Health suggests that Black NHS staff feel that the service is less inclusive when compared to their White or Asian counterparts.

The research surveyed more than 1,500 respondents on various aspects of inclusion in the workplace and on two key measures – psychological safety and perception of fairness – individuals from an Asian or Asian British or Black, Black British, Caribbean or African background recorded significantly lower scores than White colleagues did.

Roughly 40% of Black respondents rated their workplace as ‘very’ or ‘highly’ fair. This compares to 61% and 72% of Asian and White employees respectively.

Regarding psychological safety, which describes the belief that a person won’t be punished or humiliated for speaking up with ideas, questions, concerns or mistakes at work, 52% of Black respondents rated their workplace positively compared to 55% of Asian and 64% of White NHS staff. Only 39% of Black respondents agreed that no one in their organisation would deliberately act in a way that undermines their efforts, compared to 54% and 53% of Asian and White colleagues.

Black workers were also four times more likely than White colleagues to report skills needs in equality, diversity and inclusion.

On a more positive note, a mere 7% of respondents said that they felt that NHS leadership didn’t take the issue of inclusion seriously enough.

Despite identifying clear disparities between different ethnic groups, the study’s author – Skills for Health – stops short of concluding that a perceived lack of inclusion is a universal NHS-wide issue, pointing to the fact that experiences tend to vary depending on the employer and job role.

Staff working for acute trusts for example were less likely than those working for voluntary and community sector organisations to rate their workplace as ‘very’ or ‘highly’ inclusive. By way of comparison, employees working in primary healthcare services and community healthcare services drew similar responses to each other, suggesting that some NHS employers are performing better than others.

Jon Czul is Head of Consultancy and Research at Skills for Health – the team which carried out the research.

“The NHS has one of the most ethnically diverse workforces in the public sector – this is something that deserves to be recognised and celebrated,” says Mr Czul.

“However, if these findings are anything to go by, it is clear that there is still a way to go in parts of the system when it comes to certain aspects of inclusion given the disparities between Black, Asian and White respondents when it comes perceptions of fairness in the workplace.

“Whilst it would appear that NHS employers are getting some things right – perceptions of inclusive leadership for example are encouraging, so too the suggestion that inclusion (or lack thereof) is not a deep-seated cultural issue across the system as a whole. The fact remains that there is a pressing need, as borne out by the survey findings, for an expansion of skills training and shared learning to improve equality, diversity and inclusion, as well as broader targeted measures to widen workforce participation.”

Professor Habib Naqvi MBE, Chief Executive, NHS Race & Health Observatory – an organisation set up in 2020 to help tackle ethnic and racial inequalities in health and healthcare. Offering his reflections on the survey Professor Naqvi says, “This study helps to drive home the message that fostering a greater sense of inclusion remains a priority issue that NHS employers need to address.”

“We know from NHS workforce race equality data, and from findings from the annual NHS staff survey, that the NHS, as the biggest employer of Black and ethnic minority staff in Europe, needs to reinvigorate its commitment to tackling the long-standing challenge of race discrimination experienced by its staff. This is particularly true, given the record levels of discrimination faced by Black and ethnic minority staff during the Covid pandemic.

“Additionally, an independent review is also needed to better understand the ethnicity pay and progression gap across the NHS. The Observatory is ready to support the NHS with information, advice and evidence-based action to address workforce inequalities,” he continued.

About Skills for Health

Skills for Health is a not-for-profit organisation committed to the development of an improved and sustainable healthcare workforce across the UK. Established in 2002 as the Sector Skills Council for Health, they are the trusted provider of rostering solutions, eLearning, skills development, research, apprenticeship support, and national standards and frameworks for NHS and private healthcare organisations.


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