Report shows BME nurses still stuck at bottom of career ladder

The Workplace Racial Equality Standard (WRES) report for 2018 showed nurses from BME backgrounds continued to face greater difficulty in climbing up the career ladder, compared to their white counterparts.

“Minority voices remain grossly underrepresented in senior management positions”

Dame Donna Kinnair 

While 21.3% of all nurses and health visitors in the NHS in England last year were from an ethnic minority background, just 3.4% of directors of nursing were BME.

At bands 8d and 9 – the highest two bands in the Agenda for Change pay scale – there were two more BME nurses, health visitors and midwives compared to 2017, and 61 more who were white.

The number of BME nurses, health visitors and midwives sitting at entry band 5 increased by 1,585 over the year, yet there was a 5,203 drop in their white colleagues. Out of the 72,183 BME nurses, health visitors and midwives in the workforce in 2018, 98% were in bands 5-7.

Overall, the number of nursing staff in England’s NHS increased by 6% from 2017 and 12% from 2013. This trend was reflected in other staff groups, with the number of BME people within the workforce rising year-on-year.

However, the WRES report painted a worrying picture about the experiences of BME staff within NHS trusts.

“Improving the experience of staff is good for them and leads to better outcomes for our patients”

Yvonne Coghill

The percentage of ethnic minority staff who reported suffering discrimination in the last 12 months went up from 13.8% in 2016 to 15.0% in 2017 – the latest data available through the NHS staff survey. In contrast, 6.6% of white staff reported the experience of discrimination at work in 2017.

Likewise, the percentage of BME workers who believed their trust provided equal opportunities for career progression, or promotion, fell from 75.5% in 2016 to 71.5% in 2017. The report stated that 86.6% of white staff held that belief in 2017.

However, the data showed year-on-year improvements in equality in the disciplinary process. The likelihood of BME workers entering the disciplinary process compared to white peers reduced from 1.56 in 2016, to 1.37 in 2017, and to 1.24 in 2018.

In addition, the likelihood of white staff being appointed from shortlisting compared to BME colleagues fell from 1.60 in 2017, to 1.45 in 2018.

However, white applicants were still more likely to get the job from a shortlist in a massive 91.7% of trusts last year.

“NHS leaders and trusts in London must once and for all demonstrate that they take the issue of race equality seriously”

Jude Diggins

There were 11 more executive BME board members across NHS trusts in 2018, compared to 2017.

However, BME people held just 7.4% of seats on boards last year – significantly lower than their 19.1% representation of the entire NHS workforce.

Reacting to the figures, Professor Dame Donna Kinnair, acting chief executive and general secretary of the Royal College of Nursing, said: “The rise in reported discrimination towards BME staff in the NHS in England is truly appalling, and shows just how far we have yet to go.

“It is a disgrace that black and minority ethnic staff experience racism, lower pay, harassment and limited career progression within our health service,” she said.

Dame Donna said it was up to employers and policymakers, working with trade unions and other organisations, to put an end to racial inequality in the NHS for good.

Donna Kinnair

Dame Donna Kinnair

Donna Kinnair

“A good start would be ensuring there are more BME voices at the top of the profession, yet despite modest gains highlighted since last year, minority voices remain grossly underrepresented in senior management positions,” she added.

Dame Donna said the RCN was willing to work with NHS employers to help them engage their staff in the process of resolving issues of “discrimination and systemic racism in their workplaces”.

She added that the government had no hope of tackling workforce shortages without the NHS embracing diversity at every level.

At the end of last year, London become the only region in England to have more BME nurses working in its NHS services than white.

However, the latest WRES report showed London was the worst performing region in the country for its racial equality.

For example, 30.4% of BME staff in the city reported to have experienced harassment, bullying or abuse from patients, relatives or public in last 12 months – the highest level in England.

Jude Diggins, regional director of RCN London, said the results were “hugely disappointing” and “questions the commitment to addressing these long known discriminatory practices”.

Royal College of Nursing London

Jude Diggins

Jude Diggins

She added: “NHS leaders and trusts in London must once and for all demonstrate that they take the issue of race equality seriously. That means engaging properly with [BME] staff and examining the cultures and processes that discriminate against them.” 

The WRES programme was introduced in 2015 and, through annual reports, reviews the treatment of BME staff in England’s NHS, as measured across nine key metrics, including representation, experience of discrimination and access to senior roles.

The initiative was initially due to last only two years but today NHS leaders have announced plans to expand the initiative. They have committed to funding the programme for the next seven years, supported by £1m of annual funding until at least 2025, as part of the NHS Long Term Plan.

In the long-term plan, NHS leaders have also pledged that “respect, equality and diversity” will be at the heart of a separate “workforce implementation plan” for the health service in England, which is set to be published later this year.

To support the drive, NHS England has appointed a team of 42 experts from within the existing workforce, who will work with senior staff to close the gaps between BME and white staff. They will join a network of more than 80 WRES expert ambassadors who are already championing the programme.



Yvonne Coghill

Yvonne Coghill, a nurse by background and director of WRES implementation at NHS England, said: “Improving the experience of staff is good for them and leads to better outcomes for our patients.

“As well as making the health service fit for the future of patient care, the NHS long-term plan commits to doing more for our staff by shining a light on areas where they aren’t always treated fairly,” she said.

“Investing in the WRES into the middle of the next decade, will help us make the changes in the NHS that our staff and patients need and deserve,” said Ms Coghill. 

Dr Habib Naqvi, WRES policy lead at NHS England, welcomed the improvements shown in the latest WRES report but said it was a “reminder of the challenges we still face”.