Intended for healthcare professionals


Promoting equality for ethnic minority NHS staff—what works?

BMJ 2015; 351 doi: (Published 08 July 2015) Cite this as: BMJ 2015;351:h3297
  1. Naomi Priest, senior research fellow12,
  2. Aneez Esmail, professor3,
  3. Roger Kline, research fellow4,
  4. Mala Rao, professor5,
  5. Yvonne Coghill, director, Workforce Race Equality Standard implementation6,
  6. David R Williams, Florence Sprague Norman and Laura Smart Norman professor of public health 789
  1. 1Alfred Deakin Institute for Citizenship and Globalisation, Deakin University, Melbourne, Australia
  2. 2Centre for Health Equity, Melbourne School of Population and Global Health, Faculty of Medicine, Dental and Health Services, University of Melbourne, Australia
  3. 3Institute of Population Health, University of Manchester, Manchester, UK
  4. 4Middlesex University Business School, London, UK
  5. 5Department of Primary Care and Public Health, Imperial College, London, UK
  6. 6NHS England, London, UK
  7. 7Department of Social and Behavioral Sciences, Harvard T H Chan School of Public Health, Harvard, USA
  8. 8Department of African and African American Studies and of Sociology, Harvard University, USA
  9. 9Department of Psychiatry and Mental Health, University of Cape Town, South Africa
  1. Correspondence to: D R Williams dwilliam{at}
  • Accepted 12 May 2015

NHS organisations are now being judged on indicators of ethnic diversity. Naomi Priest and colleagues look at the international evidence on how they should tackle discrimination

For decades research has shown that discrimination, harassment, and exclusion are pervasive experiences for staff from black and minority ethnic (BME) backgrounds in the National Health Service.1 2 3 4 5 6 In recognition of limited progress in achieving the goals of the now decade old NHS Race Equality Action Plan,7 the NHS has agreed a mandatory workforce race equality standard. The standard requires NHS organisations to collect baseline information from April 2015 on nine indicators of workforce equality for ethnic minority staff, including representation on boards, and to publish annual updates on these metrics (box). Organisations that fail to make progress on these metrics will be in breach of the NHS standard contract, and this will affect whether regulators judge them to be “well led.”8 9 We review the international evidence on the effectiveness of diversity initiatives to assess how best to achieve the standard’s intended outcomes.

Indicators for the workforce race equality standard

Workforce metrics
For each of these four workforce indicators, the standard compares the metrics for white and BME staff
  • Percentage of BME staff in bands 8-9 (very senior managers, including executive board members and senior medical staff) compared with the percentage of BME staff in the overall workforce

  • Relative likelihood of BME staff being appointed from shortlisting compared with that of white staff being appointed from shortlisting across all posts

  • Relative likelihood of BME staff entering the formal disciplinary process, compared with that of white staff entering the formal disciplinary process, as measured by entry into a formal disciplinary investigation. (Based on data from a two year rolling average of the current year and the previous year)

  • Relative likelihood of BME staff accessing non-mandatory training and continuous personal development compared with white staff

National NHS staff survey findings
For each of these five staff survey indicators, the standard compares the metrics for each survey question response for white and BME staff
  • Percentage of staff experiencing harassment, bullying, or abuse from …

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