The NHS in England is facing an exodus of minority ethnic managers who have suffered racism, exclusion and discrimination during their working lives, a report has found.
Almost four-fifths of managers from black, Asian and minority ethnic (BAME) backgrounds have experienced racism, exclusion and obstacles to progressing in their careers, according to a survey carried out by the NHS Alliance.
The problem is so widespread that one in five say they will quit the NHS in the next three years, amid renewed concern the service is doing too little to eradicate ingrained racism.
The NHS Alliance, which surveyed 950 BAME managers, said the findings are “further evidence of the corrosive and demoralising impact of racism in the NHS”. They risk a “haemorrhaging” of managers and senior leaders from BAME backgrounds, it warned.
Sir Ciarán Devane, the NHS Alliance’s chief executive, said “political and cultural polarisation” meant the diversity of the NHS’s leadership is more important than ever.
“Yet we now face a very real risk of senior minority ethnic colleagues walking away, discouraged, disheartened and disillusioned. This also represents a huge loss of talent from the NHS,” Devane added.
Survey participants described a lack of diversity in the senior leadership teams where they worked, being excluded from informal networks and “progression disparities” – not getting a fair chance to advance their careers compared with white colleagues. There is a worrying gap between BAME managers’ desire to rise through the ranks and their belief they will be able to do so.
“I am the only brown face at 99% of my meetings at strategic and policy level,” a black senior manager said. An Asian manager said: “There is a culture of nepotism. Although I believe I have the experiences, knowledge and ability to be promoted, the culture is too strong.”
A third manager, of African heritage, said: “There is a clear lack of diversity at senior levels and this absence makes it difficult to feel seen, supported or inspired to progress.”
The NHS’s leadership is more diverse than before. For example, the proportion of BAME members of NHS boards has risen from 7.1% in 2016 to 17.3% in 2025.
However, enduring institutional and structural racism means a series of initiatives it has undertaken to tackle discrimination have produced little meaningful change, a new report by the alliance said.
Too many BAME managers, including some who occupy very senior roles, face “continuing racism, exclusion and inequity in their everyday working lives” as well as “isolation and covert discrimination”, the alliance found.
Victor Adebowale, its chair, said: “The fact is the NHS is institutionally racist.”
In a plea to NHS bosses to do more, Lord Adebowale said: “If you are a competent leader, then you should be leading everyone everywhere all the time. In order to do that, you need to understand who you are employing; who they are. You need to raise the issue of race and racism not as a special thing, but as part of business as usual. This is what we do.”
The NHS Race and Health Observatory said it had seen a growing number of inquiries from BAME NHS staff who had experienced racism in their workplaces.
“These findings are alarming, but not surprising,” said Prof Habib Naqvi, its chief executive, responding to the NHS Alliance’s report.
“They expose a stark reality: too many black, Asian and minority ethnic NHS staff are still facing racism at work, with serious consequences for their mental and physical wellbeing, careers and willingness to stay in the service.
“Racism has become too normalised in parts of the system and NHS leaders must confront it with urgency, accountability and sustained action.”
An NHS England spokesperson said: “Racism and discrimination have no place in the NHS and it is completely unacceptable for any member of staff to experience them at work.
“While there has been progress in increasing minority ethnic representation in senior roles, we know there is much more to do to ensure equal representation and equal opportunities for all staff to progress and be treated fairly and with respect.
“That is why the new NHS staff standards require trusts to take sustained action to tackle racism, with clear board-level accountability and action to ensure equity in recruitment and career progression, with progress measured through the NHS oversight framework.”
