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Discrimination Still a Problem for an Expanding BME Health Workforce

The number of Black and ethnic minority (BME) staff working in NHS trusts in England rose in 2022 for the 7th consecutive year, according to latest figures. The increase was accompanied by a significant jump in the proportion of BME staff at very senior management (VSM) level, NHS England reported.

However, the NHS workforce race equality standard analysis also found that White applicants were more likely to be appointed from shortlists than their BME counterparts, whilst discrimination, bullying, and abuse remained a significant problem for BME health workers in particular.

The study authors said the latest results underlined the importance of "creating a compassionate and inclusive culture" in the NHS and required "concerted action to change structures and processes which embed discrimination and to challenge inequality".

There was an increase on last year of over 27,500 BME staff in 2022, with workforce representation rising from 22.4% to 24.2%. The proportion has increased every year since 2016, when it stood at 17.7%. The rise was attributed largely to an increase in internationally educated nurses and international medical graduates entering the workforce. However, the proportion of BME staff varied considerably by English region, with London having the highest proportion, at 49.9%, and the South West the lowest, at 12.8%.

The total number of BME staff at VSM level was up 69.7% since 2018 from 201 to 341. As a proportion, 10.3% of personnel at VSM level were from a BME background in 2022 – up from 9.2% the previous year, and from 6.9% in 2018. There were an additional 128 BME board members in NHS trusts in 2022, compared with 2020 – an increase of 38.1%. 

Equal Opportunities

The study found that White applicants shortlisted for posts were 1.54 times more likely to be appointed than BME applicants last year, which was a decrease from the 1.61 figure for 2021. This figure has fluctuated year-on-year since 2016 but without showing clear signs of becoming a level playing field between both groups, the study authors said.

The analysis also reported that BME staff were 1.14 times more likely to enter a formal disciplinary process in their workplace compared with White staff.

Discrimination and Harassment

Overall, around 1 in 4 of all staff members experienced abuse or harassment from the public, and as many from other staff. The percentage of BME staff experiencing harassment, bullying, or abuse from patients, relatives or members of the public last year was 29.2% for BME workers and 27% for White workers. However, the gap between the groups widened when harassment, bullying, or abuse by other staff members were looked at, when the figures were 27.6% and 22.5% respectively.

In 93.5% of NHS trusts in England, harassment, bullying, and abuse from colleagues was much more likely to be encountered by BME staff members than by their White colleagues.

Among other findings in the report:

  • 42.8% of women from a White Gypsy or Irish Traveller background experienced harassment, bullying or abuse from patients, relatives, or the public during 2022
  • Women from a Black background (19.8%) and women from an Arabic background (18.4%), experienced high levels of discrimination from a manager, team leader, or other colleagues
  • 35.4% of staff from a Black background believed their trust provided equal opportunities for career progression or promotion, with levels below those of other ethnic groups since at least 2015, irrespective of gender

Responding to the report, NHS Providers said trust leaders were determined to stamp out discrimination and harassment and to adopt a strategy of equality and diversity set out last year in the review into health and social care leadership, chaired by General Sir Gordon Messenger. Sir Julian Hartley, chief executive of NHS Providers, said: "Trust leaders and staff know there is still lots to do to improve equal opportunities, inclusive recruitment, and to reduce the ‘disciplinary gap’. It cannot be right that a section of the workforce is still more likely than their colleagues to face unfair treatment and disciplinary action.

"There’s no room for racism in the NHS, Britain’s biggest employer of people from ethnic minorities. Trusts are committed to ensuring that staff at every level are treated with dignity and respect."

In June last year, England's then Health and Social Care Secretary, Sajid Javid, promised a shakeup of management structures after the Messenger review identified serious shortcomings in the way the NHS and social care system were managed, including a "normalised" culture of discrimination, bullying, blame, and responsibility avoidance.