Partha Kar: NHS leaders must be honest about failures to confront racism in the workforce
BMJ 2025; 388 doi: https://doi.org/10.1136/bmj.r327 (Published 18 February 2025) Cite this as: BMJ 2025;388:r327Read more articles about racism in medicine
- Partha Kar, consultant in diabetes and endocrinology
- drparthakar{at}gmail.com
Follow Partha on Twitter @parthaskar
It’s remarkable how the narrative on tackling racism in the medical workforce has changed in recent years. In 2019-20 there seemed to be a genuine appetite to tackle the scourge of racism in the NHS workforce, with a new director for people and communities at NHS England1 and a specific lead for the Workforce Race Equality Standard (WRES). Datasets were made publicly available, and strategies were created to investigate why this protected characteristic always shows the worst outcomes in annual staff surveys.2 In 2020 The BMJ published a special issue focused on the culture of racism in the NHS workforce—but there’s been little, if any, progress.3
Five years on, there’s a feeling that racism is being dismissed. Race equality week came and went recently without a word from NHS leaders. Relevant social media accounts were mostly confined to reposting about problems related to policy, while disregarding the actual issue of racism. In the past five years we’ve seen a strategic organisational and leadership shift that has deprioritised tackling racism in the NHS.
The NHS’s equality, diversity, and inclusion improvement plan in 2023 encompassed all protected characteristics into one undifferentiated cohort.4 As expected, the strategy made no progress on its aims to reduce discrimination in behaviour, policies, practices, and cultures in the NHS workforce. WRES datasets get produced but are mostly not publicised and lack a dedicated lead to drive change, mainly passing without public scrutiny or discussion,5 and the WRES lead role has remained unfilled since 2023. The Medical Workforce Race Equality Standard (MWRES) was first published in 2021 and hasn’t been updated.6 A plan to reduce racism in the medical workforce was published in February 2023 by NHS England,7 but there are no signs of progress towards its objectives.
Shyness and reticence
Outcomes, however, continue to decline. Recent national staff surveys show deterioration, with staff experiencing record levels of discrimination.28 The NHS continues to focus on tackling health inequalities while shying away from confronting bias in the workforce that would improve these markers. Without sufficient intent to tackle this, racism and bias persist.
Independent think tanks and organisations such as the Race and Health Observatory have a responsibility to challenge national bodies about their neglect of this issue. A recent King’s Fund briefing on workforce9 avoided mentioning racism until there were calls to amend the document. The Race and Health Observatory continues to talk about racism and frequently voices its outrage over racial inequalities. Yet political expediency probably prevents any such organisations from highlighting the failure of strategies from NHS England’s Workforce, Training and Education team. The team has been unsuccessful in improving multiple markers in the workforce, such as morale, retention, implementation of the workforce plan, and challenging bias.89
There are questions around the new government’s position on challenging racism. Politicians appear caught between pandering to far right sentiment and committing to tackling inequalities for a fairer society. It would be unfair not to mention organisations such as the General Medical Council, NHS Resolution, and the royal colleges, which continue their work against racism, albeit within their silos. But health leaders must put aside their shyness or reticence to discuss this problem in public if they genuinely want meaningful change. Performative gestures such as soundbites and hashtags won’t change any outcomes.
Perhaps it would be better for the NHS to simply be honest about having no time or headspace to tackle racism in its workforce and not seeing it as a priority, rather than making half baked (or no) attempts to confront it. Most staff would probably respect a level of honesty more than a weak approach.
A strong approach would require relevant datasets to be published and reinstatement of tackling racism as a priority, with dedicated leads and workstreams. Ultimately, the responsibility for healthcare staff and their wellbeing sits with the health secretary, Wes Streeting. Whether that means improving the lives of everybody, irrespective of the colour of their skin, through progressive and revitalised NHS leadership, is his call to make. Change is seriously needed, as is leadership with the mettle to confront this heinous generational problem.
Footnotes
Competing interests: Partha Kar is type 1 diabetes and tech lead for NHS England and Getting It Right First Time (GIRFT), previous MWRES lead for NHS England, and author of the MWRES Call to Action report. He is the General Medical Council adviser for international medical graduates, a councillor at the Royal College of Physicians of London, and an honorary professor at the University of Leicester.
Provenance: Commissioned; not externally peer reviewed.