A major new report by the NHS Alliance BME Leadership Network has laid bare the persistent barriers facing ethnic minority staff seeking leadership roles across the NHS, with almost four in five respondents reporting experiences of racism in the past three years and many questioning whether career progression is truly equitable.
The report, Ethnic Minority Leadership in the NHS: Progression, Representation, Retention and Organisational Culture, draws on survey responses from 950 ethnic minority NHS staff and leaders, alongside interviews with senior NHS board members. It paints a picture of an organisation where progress on representation has been made, but where many staff continue to face structural and cultural barriers to advancement.
According to the findings, 86% of respondents in Bands 1 to 8 expressed a desire for promotion, yet only 33% believed they had any realistic chance of achieving it. More than half reported negative experiences relating to promotion and career progression.
Researchers found widespread concerns that progression within the NHS remains heavily influenced by informal networks, sponsorship and access to influential leaders rather than transparent processes.
One survey respondent said:
"Because I am not in with the right people, I am not friends with senior leadership outside of work."
Another added:
"All the leadership roles are given to people who are in the cliques or related."
Senior NHS leaders interviewed for the report consistently highlighted sponsorship as a key factor in career advancement.
One board leader said:
"You need people that sponsor you… who are advocating for you when you’re not in those rooms."
Another reflected:
"What’s always been a key turning point for me is when my bosses have advocated for me."
The report found that 72% of respondents disagreed with the statement that they regularly see people from their own background in leadership roles. Concerns were particularly acute among senior staff, with Band 9 and Very Senior Manager respondents reporting some of the highest levels of perceived isolation.
Respondents repeatedly linked visible leadership role models to confidence, aspiration and a sense of belonging.
However, interviewees also warned that representation alone is not enough. Several argued that increasing diversity in leadership appointments must be accompanied by genuine inclusion, influence and cultural change.
The report raises significant concerns about staff retention, with one in five respondents indicating they may not still be working in the NHS within three years. Researchers found that perceptions of unfair treatment at work were the strongest predictor of intentions to leave.
Among long-serving ethnic minority leaders, many described the cumulative impact of discrimination over decades.
One NHS board leader said:
"After suffering over 20 years of race trauma and the cumulative emotional, psychological and professional toll of sustained racial bias and inequity in the workplace, I need to heal."
The findings suggest that achieving a senior leadership position does not necessarily protect individuals from experiences of exclusion, isolation or racism.
Researchers concluded that race equality is still too often viewed as a workforce issue rather than a leadership responsibility. While many organisations have introduced anti-racism initiatives, participants frequently questioned whether these programmes were leading to meaningful changes in staff experiences.
One board leader summed up the challenge by saying:
"If some of us break through the barriers… we have to change the system."
The report identifies five key priorities for NHS organisations:
- Embed anti-racist leadership into leadership practice.
- Strengthen accountability and transparency on race equality outcomes.
- Implement formal sponsorship pathways for ethnic minority leaders.
- Improve reporting, support and advocacy mechanisms.
- Enhance measurement of ethnic minority staff experiences.
In the foreword, Dame Donna Kinnair, Chair of the NHS Alliance BME Leadership Network, said the NHS must move beyond acknowledgement and embrace meaningful action. She warned that representation alone will not solve longstanding inequalities affecting progression, belonging and psychological safety.
The report concludes that tackling race inequality is not simply about fairness but about strengthening leadership, organisational effectiveness and patient care. Highlighting the introduction of the NHS Staff Standards in 2026, the authors argue that NHS organisations now have a clear opportunity to translate awareness into measurable action.
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