– at every stage of the career pipeline – despite efforts to identify and eradicate them’, says Nuffield Trust report.

NHS Employers commissioned Nuffield Trust, a health policy think tank, to produce a report entitled ‘Attracting, supporting and retaining a diverse NHS Workforce’ (‘the report’). You can read the full report here.

The report states that ‘the NHS has made a number of attempts to tackle overt discrimination over a long period of time. However, the fact that discrimination still clearly exists within the NHS suggests that unless boards and individual leaders within organisations recognise and accept their responsibility to own and address structural discrimination, progress will continue to stall’.

Key findings

Based on literature reviews, interviews with NHS trusts and data analysis, findings include:

  • male nurses, with nine years’ continuous service, are more than twice as likely to progress by two pay bands (41%) as female nurses (20%)
  • black staff are more than twice as likely to face discrimination from a colleague and nearly a quarter as likely to be a senior manager as white staff
  • only two in five deaf healthcare professionals say they had reasonable adjustments at work during the pandemic
  • men account for only 1 in 9 (12%) of the nursing and health visitor workforce whereas women account for little more than a third of medical consultants (38%)
  • candidates with Bangladeshi ethnicity are, on average, half as likely to be appointed from an NHS shortlist than a White British person

Improving diversity and inclusion in the workplace provides various indisputable benefits including:

  • improved quality of care for patients
  • a more sustainable workforce supply
  • a positive impact on an individual's overall health and wellbeing
  • reduction in health inequalities
  • increased efficiency of services and cost savings from, for example, reduced staff sickness and formal disciplinary processes

Recent national policies such as the NHS People Plan 2020/21 (NHS England and NHS Improvement, 2020b) have reinforced commitments to improve diversity and inclusion.

The conditions necessary to drive improvement

The report points to shortcomings against the following conditions necessary to drive improvement, namely having:

  • sufficient understanding of the issues
  • evidence-based solutions
  • the resources for implementing the solutions
  • leadership and governance

NHS Employers summarised the current issues as follows:

‘Current issues

  • funding for supporting diversity and inclusion initiatives is inconsistent across the NHS
  • the responsibilities of an equality and diversity manager are wide ranging
  • the diversity data is limited in some areas, for example, sexual orientation, beliefs, marriage and civil partnership
  • initiatives are not routinely evaluated to measure the impact and so sharing of good practice is minimal
  • inclusive networks can lack support and direction’

Policies, procedures and training are not enough on their own

The report observes that ‘to date, interventions around equality, diversity and inclusion have typically focused on policies, procedures and training. In isolation these are unlikely to make a material difference’ (Dobbin and Kalev, 2016) and so employers need to think more broadly, for example:

  • culture change that creates collective engagement from individual experience is likely to be imperative
  • investing in analytics and further embedding accountability and transparency at organisational, team and individual level’

What can your organisation do?

Below is a list of actions provided by NHS Employers (some of which we have elaborated on):

  • Make inclusion a key part of the board’s strategy and ensure values and behaviours are role modelled throughout the organisation. (The NHS People Plan states ‘it is the explicit responsibility of the chief executive to lead on equality, diversity and inclusion, and of all senior leaders to hold each other to account for the progress they are making’)
  • NHS trusts should ensure their equality, diversity and inclusion teams have access to continuing professional development, and are equipped with the skills, knowledge and leverage (for example, appropriate seniority) to support and challenge their organisations
  • Integrated care systems (ICS), should consider pooling resources/budgets to make improvements across their system
  • Think about the language used and be clear about the positive action taken to address inequalities in the organisation/system
  • Ensure vacancies are advertised throughout the local community to increase applications from a wide range of the local population
  • Provide equality impact assessments and cultural awareness training for all staff
  • Have diverse recruitment panels and ensure recruiters have the necessary diversity and inclusion training. Consider training inclusion ambassadors (to identify bias or discrimination) and to sit as equal members of recruitment panels. Where necessary they can clarify and challenge decisions that the interview panel make
  • Review job descriptions and person specifications to ensure there are no equality or cultural barriers
  • Support inclusive networks to demonstrate that diversity is valued in your organisation and use the networks to support your aims
  • Improve data and analyse information to see where you can make improvements; Equality, diversity and inclusion teams should be supported and adequately resourced to consider monitoring and evaluation routinely in programme design and throughout implementation. This will require developing the monitoring and evaluation skills of these staff and ensuring they have sufficient capacity to apply them – these competencies could be linked to career development/competency frameworks where trusts feel this would be beneficial. Trusts also have a role in identifying and encouraging relationships with existing teams that can support with methodology and analysis (for example, quality improvement)
  • Focus on one or two things at a time to ensure clear improvements are met and targets achieved


The report recognises that ‘the events of 2020 – including the murder of George Floyd, the Black Lives Matter movement and the Covid-19 pandemic – have helped to propel the significant, longstanding issues of structural and institutional discrimination and systemic inequalities to the forefront of political and public debate. In addition, the pandemic has had an undeniable impact on equality, diversity and inclusion in the workplace, with additional disruption and health risk for NHS staff disproportionately affecting some groups, such as those from minority ethnic backgrounds. However, the pandemic has also provided a lens to better explore the support that some staff need, an impetus for some to speak up and a renewed sense of compassion for colleagues’.

Ultimately, to ensure a sustainable workforce the NHS needs to ensure that it attracts, recruits and retains a diverse staff reflective of the local community it serves which can be better achieved via implementing the above suggestions.