Key facts
- One in five black, Asian, and minority ethnic (BAME) managers in England's NHS plan to quit within three years due to racism and discrimination.
- Almost four-fifths of BAME NHS managers surveyed reported experiencing racism, exclusion, and obstacles to career progression.
- The NHS Alliance survey of 950 BAME managers highlighted a lack of diversity in senior leadership teams and "progression disparities".
- The proportion of BAME members on NHS boards has risen from 7.1% in 2016 to 17.3% in 2025.
- The NHS Race and Health Observatory has seen a growing number of inquiries from BAME NHS staff experiencing workplace racism.
The NHS in England is at risk of losing a significant number of minority ethnic managers due to widespread experiences of racism, exclusion, and discrimination, according to a new report by the NHS Alliance. The survey of 950 BAME managers found that nearly four-fifths have faced such challenges, with one in five now planning to leave the service within the next three years.
Participants described a lack of diversity in senior leadership, exclusion from informal networks, and "progression disparities" compared to white colleagues. One black senior manager noted being the "only brown face" in most strategic meetings, while an Asian manager cited a "culture of nepotism." A manager of African heritage highlighted the difficulty of feeling "seen, supported or inspired to progress" due to the absence of diversity at senior levels.
Despite an increase in BAME representation on NHS boards, from 7.1% in 2016 to 17.3% in 2025, the report argues that enduring institutional and structural racism means previous initiatives have had little impact. Victor Adebowale, chair of the NHS Alliance, stated that the NHS is "institutionally racist" and urged leaders to address race and racism as part of routine business.
The NHS Race and Health Observatory confirmed it has seen a rise in inquiries from BAME staff experiencing racism. Its chief executive, Prof Habib Naqvi, called the findings "alarming, but not surprising," emphasizing the serious consequences for staff wellbeing and retention, and urging leaders to confront normalized racism with urgency and accountability.
An NHS England spokesperson acknowledged that racism and discrimination are unacceptable and that while progress has been made in senior role representation, more work is needed to ensure equal opportunities. The spokesperson highlighted new NHS staff standards requiring trusts to take sustained action against racism with board-level accountability.