'A long way to go': ethnic minority
NHS staff share their stories

An illustration of a group of NHS staff from ethnic minority backgrounds.

A long way to go': ethnic minority NHS staff share their stories

An illustration of a group of NHS staff from ethnic minority backgrounds.

This article explores people's experiences of racism and discrimination and may be distressing or triggering. If you've been affected by any of the issues raised in this article, we’ve put together a list of organisations that can offer advice, information and support.  

‘It’s been a journey… I’ve had to work ten times harder in order to have the opportunities everyone else [has].’ As part of our research exploring race inequalities in the NHS workforce, we spoke to Angela, who works in behavioural science. Back in 2019 we asked people from an ethnic minority background* to tell us about their experience of working in the NHS. Angela is one of the people who chose to share their story. 

Angela has worked in the health service for more than two decades. When we meet, we begin by discussing her career journey. Starting out, some branches of behavioural science seemed ‘pretty much an exclusive network of white middle-class people,’ she recalls.  

Fast-forward 20 years and as a Black Caribbean woman working in the NHS, what has shaped her experiences? ‘In our organisation currently, you know, Black staff are disproportionately disciplined… we don’t get access to training opportunities and promotions… and we’ve got a couple of initiatives to try and change that, but it’s still...’ she pauses, ‘...we’ve got a long way to go.’ 

‘A long way to go’ sums up the picture across the NHS. While there are examples of good practice, progress on making the NHS an inclusive environment for everyone has been stubbornly slow. Data from the 2019 NHS Workforce Race Equality Standard (WRES) shows that staff from an ethnic minority background have different and unequal experiences in the workplace compared to their white colleagues.  

In the 2019 NHS Staff Survey, 15.3 per cent of ethnic minority staff reported experiencing discrimination at work from a manager, team leader or other colleague in the past 12 months; more than double the proportion of white staff (see graph below).

A graph showing that in the 2019 NHS Staff Survey, 15.3 per cent of ethnic minority staff reported experiencing discrimination at work from a manager, team leader or other colleague in the past 12 months; more than double the proportion of White staff.

Source: NHS Workforce Race Equality Standard 2019

While the WRES data is an important indicator of what’s going on across the NHS, this only tells one part of the story. We wanted to understand how inequalities are experienced by staff in their working lives. What does it feel like? And what does it mean, personally and professionally, for those experiencing inequalities on a daily basis?  

*The term 'ethnic minority' refers to people belonging to ethnic groups that are in the minority in the context of the population of England.

'We're here and you're there':

unequal opportunities for career progression

Angela looks out at the reader. Behind her, two middle-aged white men in suits shake hands.

For Angela, it’s the lack of access to training and professional development opportunities that stands out. ‘I’ve got people who are managing me who are racist,’ she says. ‘My manager… holds me back, stops me getting opportunities that [are given] to my white counterparts who… [are] maybe not as experienced as me.’

Angela is not alone in this. According to the latest WRES data, white staff are 15 per cent more likely to access non-mandatory training than their colleagues from an ethnic minority background. Many of the people we spoke to described the experience of being bypassed for career development, requests for progression opportunities being blocked, and line managers failing to support their career aspirations. One individual described how staff from an ethnic minority background were not receiving the same access to specialist training as their white colleagues – training that was essential for their career progression. Another highlighted the rapid career trajectory of white staff and how opportunities for progression were often awarded behind closed doors: ‘Normally you get an email [if] there’s a secondment opportunity… we didn’t see any of that’.  

69.9 per cent of ethnic minority staff believed that the NHS trust they work for provides equal opportunities for career progression or promotion, compared to 86.3 per cent of white staff (see graph below)

A graph showing that 69.9 per cent of ethnic minority staff believed that the NHS trust they work for provides equal opportunities for career progression or promotion, compared to 86.3 per cent of White staff.

Source: NHS Workforce Race Equality Standard 2019

There was a commonly held view among the people we spoke to that recruitment practices and decision-making were not fully transparent and appeared biased in favour of white staff. As Anusha, an allied health professional, describes:  

[We’ve had] lots of more senior-level jobs coming up and lots of people promoted who you wouldn’t necessarily expect to be promoted in terms of their behaviour or their confidence. And those discussions are happening informally before the recruitment process has even happened… I am never involved in those conversations; I’m completely overlooked…

'We're here and you're there': unequal opportunities for career progression

For Angela, it’s the lack of access to training and professional development opportunities that stands out. ‘I’ve got people who are managing me who are racist,’ she says. ‘My manager… holds me back, stops me getting opportunities that [are given] to my white counterparts who… [are] maybe not as experienced as me.’

Angela is not alone in this. According to the latest WRES data, white staff are 15 per cent more likely to access non-mandatory training than their colleagues from an ethnic minority background. Many of the people we spoke to described the experience of being bypassed for career development, requests for progression opportunities being blocked, and line managers failing to support their career aspirations. One individual described how staff from an ethnic minority background were not receiving the same access to specialist training as their white colleagues – training that was essential for their career progression. Another highlighted the rapid career trajectory of white staff and how opportunities for progression were often awarded behind closed doors: ‘Normally you get an email [if] there’s a secondment opportunity… we didn’t see any of that’.  

69.9 per cent of ethnic minority staff believed that the NHS trust they work for provides equal opportunities for career progression or promotion, compared to 86.3 per cent white staff (see graph below)

Source: NHS Workforce Race Equality Standard 2019

There was a commonly held view among the people we spoke to that recruitment practices and decision-making were not fully transparent and appeared biased in favour of white staff. As Anusha, an allied health professional, describes:  

[We’ve had] lots of more senior level jobs coming up and lots of people promoted who you wouldn’t necessarily expect to be promoted in terms of their behaviour or their confidence. And those discussions are happening informally before the recruitment process has even happened… I am never involved in those conversations; I’m completely overlooked…

I am never involved in those conversations; I'm completely overlooked... 

- Anusha -

A pale purple pattern that forms the background to a quote from an NHS staff member on what it feels like to be marginalised.

Anusha worked in a range of jobs before deciding to go back into education and study for a Masters in one of the allied health professions. ‘What I most like about my job is developing people and improving people’s lives,’ she says. When we talk about her experience as an Indian woman working in the NHS, the lack of diversity within the allied health professions – in terms of both class and ethnicity  stands out for her: 'I think there’s the feeling that sometimes you’re not understood, or you’re treated maybe a bit differently; not part of 'in groups'. 

I think there’s the feeling that sometimes you’re not understood, or you’re treated maybe a bit differently; not part of 'in groups'. 
Anusha

This sense of ‘in groups’ (staff more likely to progress in their careers) and ‘out groups’ (staff who do not have close enough relationships with decision-makers but are just as – if not more – qualified for career progression) was a recurring theme in our conversations. For many individuals there was a sense that ‘progression was not going to be easy’, simply because they were from an ethnic minority background. For Anusha, this was a source of anger and frustration: ‘How much better do I have to be to prove that I’m good at what I do?’  

Many interviewees shared an internalised expectation that opportunities for career development would not be forthcoming and that promotion to the top jobs in the NHS would be improbable (if not impossible). This was consistently reinforced by the lack of representation at senior levels. ‘The managers above you are white, so again the role models are missing,’ explains Anusha. ‘You don’t see role models, any people of colour in higher positions, even within your own professional background.’  

6.5 per cent of staff at very senior manager pay band are from an ethnic minority background, compared to a 19.7 per cent representation in the workforce (see graph below). 

Source: NHS Workforce Race Equality Standard 2019

So, what is the cumulative impact of these messages about what is and is not possible for those from an ethnic minority background working in the NHS? Anusha’s response is revealing:  

We have staff that call it the plantation coming to work, so there’s some very deep-rooted stuff happening in the organisation… I think as the Black staff are generally [employed in] lower bands and the managers are all white, so it becomes like a slave–master type situation… There’s a lot of hurt and pain in that to say that you’re coming to the plantation but I know exactly why they’re saying it… you know, that constant reinforcement of we’re here and you’re there, we progress, you don’t. [You]’re more likely to go to disciplinaries, you’re more likely to get sacked, all those things, messages that are proven with data. They’re constant. 

How did Anusha feel when she first heard people talking about that? ‘It still gives me goose bumps,’ she says. ‘I felt shocked. I don’t know – it’s just… there’s a lot of hurt and pain in that.’ 

Anusha looks behind her at two white colleagues who are having a conversation. One of the women is holding a coffee cup, the other is reaching out her arms towards her white colleague and listening intently to what she is saying.
Anusha is in the foreground looking downwards. Her two colleagues continue their conversation behind her.
Anusha, in the foreground, looks out towards the viewer. The two women behind continue their conversation. One woman drinks from a coffee cup.

Visible and invisible:

the impact of micro-aggressions


Priya looks out at the reader. Behind her is a chest of drawers, a flip chart showing a graph, and a poster is stuck to the wall displaying a graph.

While structural inequalities have an important impact on how individuals experience their workplace, so too do micro-aggressions;  those ‘brief, everyday exchanges that send denigrating messages to people of colour because they belong to a minority group’. 

Priya began her career as a clinician but now works in a role focusing on workplace transformation. ‘Being on the forefront of change – I think it’s really exciting,’ she says. While she describes her experience as a clinician as ‘mostly positive’, the move into a non-clinical role brought particular challenges. ‘In a non-clinical setting, many of my thoughts in meetings have been dismissed, especially by older white men and women,’ she says. ‘It seems a young BAME [Black, Asian and minority ethnic] female doesn’t have something worth listening to in this environment… [It’s] really knocked my confidence…’  

At work Priya has been mistaken repeatedly for another Asian woman – something she has found increasingly frustrating: ‘It’s happened six times in two months, which I think is a lot… You’re not even recognising my talents or my hard work because you’re just lumping me in a category based on the colour of my skin.’ 

When Priya has raised this with colleagues, the response has been mixed. While one colleague was apologetic, another was defensive: ‘They started giving me this story about where they used to work and how all the other Black and Indian girls got mixed up with each other as well, which I found incredibly rude.’ 

Has she tried to raise this with management? Yes, she says. ‘But nothing ever happens. It’s just ignored, and I can only see it’s just not important for them.’ While the lack of action from management is infuriating, on a personal level this also has profound implications. ‘One thing I find quite difficult is the more I speak up the more my reputation becomes, oh troublemaker… in organisations where relationships and reputation [are] everything you can easily get pushed out. You’re just labelled difficult’.  

Visible and invisible: the impact of micro-aggressions

While structural inequalities have an important impact on how individuals experience their workplace, so too do micro-aggressions; those ‘brief, everyday exchanges that send denigrating messages to people of colour because they belong to a minority group’. 

Priya began her career as a clinician but now works in a role focusing on workplace transformation. ‘Being on the forefront of change – I think it’s really exciting,’ she says. While she describes her experience as a clinician as ‘mostly positive’, the move into a non-clinical role brought particular challenges. ‘In a non-clinical setting, many of my thoughts in meetings have been dismissed, especially by older white men and women,’ she says. ‘It seems a young BAME [Black, Asian and minority ethnic] female doesn’t have something worth listening to in this environment… [It’s] really knocked my confidence…’  

At work Priya has been mistaken repeatedly for another Asian woman – something she has found increasingly frustrating: ‘It’s happened six times in two months, which I think is a lot… You’re not even recognising my talents or my hard work because you’re just lumping me in a category based on the colour of my skin.’ 

When Priya has raised this with colleagues, the response has been mixed. While one colleague was apologetic, another was defensive: ‘They started giving me this story about where they used to work and how all the other Black and Indian girls got mixed up with each other as well, which I found incredibly rude.’ 

Has she tried to raise this with management? Yes, she says. ‘But nothing ever happens. It’s just ignored, and I can only see it’s just not important for them.’ While the lack of action from management is infuriating, on a personal level this also has profound implications. ‘One thing I find quite difficult is the more I speak up the more my reputation becomes, oh troublemaker… in organisations where relationships and reputation [are] everything you can easily get pushed out. You’re just labelled difficult’.  

You’re not even recognising my talents or my hard work... you’re just lumping me in a category based on the colour of my skin.

- Priya -

A dark purple pattern that forms the background to a quote from an NHS staff member on what it feels like to be mistaken for another colleague from an ethnic minority background..
An illustration of Minu, who is sat in front of a clock in an office and looks towards a ringing telephone.
Minu picks up the ringing telephone. The person on the phone says: 'Hi Minu, I just wanted to talk to you about that project.'
Minu speaks to a colleague on the phone. He says: 'Hi Julie, my colleague Sanj has been working with you on that.'
Minu is frustrated and looks at the phone. His colleague on the phone says: 'Oh, my mistake. I'll give Sanj a call.'

For Minu, who works in an information support role in the NHS, the experience of being mistaken for another colleague is all too familiar: 'They would talk to me about some project work… and then they would click, actually… I’m not the guy they want, it’s the other Indian guy in the far corner.'

They would talk to me about some project work… and then they would click, actually… I’m not the guy they want, it’s the other Indian guy in the far corner.
Minu

As one of the few individuals from a minority ethnic background in his workplace, the experience can be doubly frustrating. ‘Because like I’m the Indian guy there, it’s really obvious who this person is, you know,' he explains. 'It’s like… as a BAME guy, it’s really hard to get noticed but when something goes wrong, it’s so obvious it’s you.’ 

This sense of being at once visible and invisible was a recurring theme. While many people spoke about feeling invisible, for example, being bypassed for career development and progression opportunities, there was a feeling that this invisibility disappeared as soon as something went wrong. As one interviewee said: ‘You feel like you are treading on shards of glass, trying to make sure that you don’t let one of them stick to your foot.’ 

It is important to note that alongside these subtle, equally insidious forms of racism, interviewees also described more overt examples of racist or discriminatory behaviour. ‘Sometimes there could be comments made about your culture, your food, languages you might speak, or where you’ve lived, where you’ve grown up,’ describes Anusha.  

29.0 per cent of ethnic minority staff reported experiencing harassment, bullying or abuse from staff in the past 12 months, compared to 24.2 per cent of white staff (see graph below) .  

Source: NHS Workforce Race Equality Standard 2019

On one occasion, Anusha recalls overhearing a conversation where a colleague used a racial slur. Despite reporting this to management, no formal action was taken: ‘I was told that they’d decided not to do anything… because the language wasn’t aimed at me.’

What impact did this have? ‘It made me feel like I don’t actually have the support higher up when I’m reporting racist behaviour,’ she reflects. ‘I felt that my managers didn’t really understand what [that] word… meant in terms of actually how impactful that could be to a person of colour… And there was no sort of support for me, so that really gave me a feeling of what’s further up the chain.’  

Angela looks out at the reader.

Angela describes her experiences in the NHS.

Angela describes her experiences in the NHS:

Angela is depicted in profile, looking up at the media player on the right-hand side of the screen.

What could make a difference?

Of course, everyone’s experience is different – some readers may identify with these experiences, others won’t – and among the shocking and disheartening stories of prejudice and racism, some interviewees spoke very positively about their experiences in the NHS. One person described the consistent support he’d received from his line manager, who had encouraged him to participate in career development opportunities and acted as a ‘sort of mentor’. ‘I see the department as a fair and equal opportunities employer,’ he said. ‘We have a very… rewarding environment, and those that work hard, study hard, do progress.’    

Another interviewee described the impact of having a positive role model in her work and how she received the support of those in more senior roles to progress in her career; ‘[T]he sky’s the limit,’ she said. ‘What I feel really uncomfortable with is the echo chambers, is the people saying, "Well we’re a discriminated group".’ She explained: ‘I’m intersectional; I’m female, I’m brown, and all these are disadvantages that are working against me. I don’t want to think like that. I’m not going to thrive if somebody is constantly reminding me… these are all the things working against you.’ 

And for those staff we spoke to who had regularly experienced bias, racism and discrimination in their roles, what made a difference? For some, involvement in equality, diversity and inclusion initiatives at work offered a way to channel some of the frustration and sense of injustice they were feeling into something that could help drive positive cultural change.  

Others highlighted allyship as an important factor, as Anusha describes: ‘I would really want the majority of people in senior positions or middle management… to be allies, to say, you know, we know we have a problem… we want to change this.’ 

For Angela, part of this involves managers listening to and learning from the experiences of staff. ‘I think managers need to take responsibility for asking helpful questions about how… [staff’s] cultural identity is impacted within the organisation… We’re not all the same. We have… different experiences that we bring to the table.’ 

Priya agrees: ‘I think there needs to be some kind of training where people can feel the lived experiences of others… so they can really understand how other people have got to live when they come to work.’

Angela, Minu, Priya and a white colleague, are relaxing in a staff break-out room.
Minu, Priya, Angela and their colleague are talking to one another about their experiences in the workplace.
Minu gestures to his colleagues as he talks about his experiences.
The four colleagues share their different experiences of what it's like working in the NHS.

I think there needs to be some kind of training where people can feel the lived experiences of others… so they can really understand how other people have got to live when they come to work.

- Priya -

A pale purple pattern that forms the background to a quote from an NHS staff member on what could make a difference to their experience in the workplace.

Changing the story

There are reasons to be hopeful that NHS organisations can work towards inclusion for everyone. Our research in three NHS trusts shows that promising signs of change are discernible, however messy and non-linear that change might be.     

From the conversations we’ve had with NHS staff, it is striking how often the complex, challenging and often frustrating work of cultural change falls to those who are already experiencing injustice and marginalisation. It is impossible to overstate just how demanding and emotionally draining this work can be.   

Experiencing bias, discrimination or inequality, is not a choice. Tackling it is. Each member of staff, at every level, has an active role to play in making the NHS a more inclusive environment. It is the responsibility of the majority, not the minority, to make this change happen.  

Understanding the lived experience of staff is undoubtedly the starting point. Can you make time and space to reflect on the experiences shared here? How can you help to create safe spaces where colleagues can speak openly about their experiences? 

No one person has all the answers. But by seeing our workplace from a different perspective, perhaps we can begin to ask those important questions. As Anusha describes: ‘What can I do differently? What can we do differently to change your story in the future?’ 

>> If you've been affected by any of the issues raised in the article, we’ve put together a list of organisations that can offer advice, information and support.

>> Read our report exploring the work currently under way at three NHS trusts to tackle inequalities and promote inclusion.


The names of all the interviewees featured in this article have been changed to protect their identities.

All the illustrations for this digital storytelling project are drawn from the illustrator’s imagination. Any resemblance to real people or workplace environments is entirely coincidental. 

Please note that the interviews with ethnic minority NHS staff were carried out before the outbreak of the Covid-19 pandemic across the world and in the UK. 


Credits 

Thank you to the 12 people who were interviewed for this piece and who generously shared their experiences with us.  

Project team Shilpa Ross, Mandip Randhawa, Joni Jabbal, Siham Dahir, Ros West, Sarah Murphy, Jen Thorley, Helen Joubert.  

Illustrations Nadia Akingbule 

Published 7 July 2020 

The King's Fund is committed to tackling inequalities through the work we do and by using our voice to encourage change within the health and care system. We are also committed to becoming a more diverse and inclusive organisation, and recognise that we have much to learn and a long way to go to achieve this ambition. You can learn more about our experiences on this journey in this series of blogs.