A report from the NHS Alliance reveals significant challenges facing minority ethnic managers within England’s NHS system. The survey of 950 black, Asian and minority ethnic (BAME) managers found that nearly four-fifths have experienced racism, exclusion, or obstacles to career advancement. The findings indicate widespread institutional issues that have prompted one in five respondents to state they intend to leave the NHS over the next three years.
Managers reported multiple barriers to progression, including exclusion from informal professional networks, lack of diversity in senior leadership teams, and disparities in advancement opportunities compared with white colleagues. Several respondents highlighted feeling isolated and unsupported in their roles, with one senior manager describing being the only person of color in strategic and policy-level meetings. Others noted cultural obstacles to progression and questioned whether advancement was possible despite possessing necessary qualifications and experience.
While NHS leadership has become more diverse in recent years—with the proportion of BAME members on NHS boards increasing from 7.1% in 2016 to 17.3% in 2025—the alliance contends that these gains mask persistent systemic problems. The organization warned of a potential “haemorrhaging” of talented senior leaders from BAME backgrounds due to discouragement and demoralization.
The NHS Race and Health Observatory indicated it has received growing inquiries from BAME staff experiencing workplace racism, characterizing the findings as unsurprising given ongoing systemic issues. NHS England acknowledged that racism remains unacceptable and committed to requiring trusts to take sustained action against discrimination, with clear board-level accountability and efforts to ensure equitable recruitment and career progression.
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