'Shocking' disparity seen in nursing workforce race equality

Overview of race equality data for nursing workforce sets out six tips on strategic approaches and operational interventions

Overview of race equality data for nursing workforce sets out six tips on strategic approaches and operational interventions

Picture: iStock

A new overview of workforce race equality data for the nursing profession in England should leave senior nurses ‘shocked to their core’, says one of the country’s highest-ranking nurse leaders.

Yvonne Coghill.
Picture: Barney Newman

NHS Workforce Race Equality Standard (WRES) implementation director Yvonne Coghill says the publication, in March, of the analysis should act as a wake-up call to senior nurses to act on race equality in their organisations.

About 20% of nurses and midwives are from a black, Asian or minority ethnic background, yet there is a huge gap in opportunity between them and their white colleagues.

Nowhere to hide

Nurses from black, Asian and minority ethnic (BAME) backgrounds are under-represented in senior Agenda for Change (AfC) pay bands across the NHS, and the situation worsens the higher the pay band.

Ms Coghill, who leads NHS England’s programme to improve the experience of BAME staff in NHS workplaces and tackle discrimination that blocks them from senior roles, says the report is essential reading.

‘It is robust data,’ says Ms Coghill, who wrote the foreword to the report jointly with chief nursing officer for England Ruth May.

‘This is not anecdotal about what is going on in our system. There is nowhere to hide.’

The overview shows:

  • There was a sharp fall in the number of white band 5 nurses in 2018 compared with 2017, while the number of BAME nurses increased in all bands, but particularly in bands 5 and 6.
  • There were 101 BAME nurses in pay bands 8c to 9 (6%), compared with 1,563 who are white (91%) and 53 whose backgrounds are unknown (3%).
  • There are now more BAME nurses (27,982) than white nurses (24,847) working in the NHS in London.

Happier staff


chief nurses (3.5%) in position at the 231 NHS trusts in England in January 2019 are from black, Asian and minority ethnic (BAME) backgrounds

Ms Coghill says organisations that take positive action to redress the balance will have fewer recruitment issues, happier staff and better finances.

Meanwhile, there is an NHS-wide commitment to ensure the leadership of organisations is representative of the overall BAME workforce by 2028.

‘We are haemorrhaging nurses left, right and centre. We are 40,000 nurses down. Do we really want to disenfranchise those nurses and midwives we have got?

‘Nurses are not going to be magicked out of thin air now the pipeline has dried up in Europe.

‘Treating the ones we have well must be a priority, and we need to bring those who have gone off to agencies back into the fold.'

Approaches and interventions

The latest overview of workforce data for nurses, midwives and health visitors in the NHS in England illustrates a gap in experience and opportunities for nurses, midwives and health visitors from black, Asian and minority ethnic (BAME) backgrounds.

Tips on strategic approaches and operational interventions include:

  • Use Workforce Race Equality Standard data to identify areas where there is a failure to recruit BAME staff
  • Set aspirational targets for BAME representation at leadership levels and across the workforce
  • Report progress in this area regularly to the trust board, and analyse data by directorate, service and occupation
  • Ensure robust processes and procedures for recruitment are in place to reduce bias
  • Provide ‘acting up’ secondment opportunities to enable career progression
  • Encourage access to mentoring, reverse mentoring and shadowing


Take responsibility

‘As a senior nurse, you have a lot of authority, power and clout. You need to take responsibility,’ says Ms Coghill.

Asking why we are in this situation and finding out answers to then do something about it are key.

In addition to being in equality legislation, race equality goals are expecetd to be written into the new NHS long-term workforce plan, and the Care Quality Commission (CQC) is inspecting for this in its ‘well led’ domain.


of the 348,678 nurses in NHS trusts and clinical commissioning groups (20.5%) are from BAME backgrounds

‘We expect this to be taken seriously. There is going to be more focus on race equality going forward. I suspect no one is going to want to be bottom,’ she adds.

‘We have to keep on’

Ms Coghill says recent racist rhetoric that has made its way into the news as political divisions widen in Britain in the face of Brexit ‘has always been there’, but she thinks more people now ‘have been given licence to say what they really genuinely feel’.

‘We don’t want to believe there are going to be some people who think and feel like that in the NHS system,’ says Ms Coghill, but she is realistic that, within the huge NHS workforce, there will be.

‘Some in senior level positions will be blocking others, using their power to disempower,’ she says.

‘Things are not going to mend it in four years or 40 years. We have to keep on at it for a long time, for the NHS, for the country and for the world.

Acknowledge the issue

‘More people must acknowledge there is a problem and issue – a lot of people are still in denial. Previous NHS systems we developed weren’t taking cognisance of that. We are only just now building and articulating this into the NHS.’

Arlene Wellman
Arlene Wellman

Epsom and St Helier University Hospitals NHS Trust chief nurse Arlene Wellman said her main message for senior nurses was to ask them to ‘really look’ for talent in the workforce and help to promote training and development opportunities.

Ms Wellman says: ‘Just because someone is born BAME they are at a disadvantage. Organisations need to support their BAME staff.

‘The talent is there and a lot of BAME staff are highly qualified, but what they need to know is how to navigate their way up, avoiding the pitfalls along the way.’


nurses in Agenda for Change bands 8c to 9 are from BAME backgrounds (5.9%)

An important agenda

Ms Wellman says she has been fortunate to have previously had the support of a chief nurse who understood the importance of the BAME agenda.

‘She was looking and supporting the person who could do the job, rather than asking “Does she or he look like me or sound like me?” So I had opportunities.’

Ms Wellman believes even very senior people in NHS organisations do not always understand what the BAME agenda means, but that WRES will help address this.

‘It is absolutely essential. A lot of trusts are failing in terms of staff satisfaction, and staff delivering better care is why it is important. Especially when a patient population is largely BAME. That is what makes this an important agenda.’

Stephanie Jones-Berry is a health journalist

Find out more

NHS England (2019) Workforce Race Equality Standard. An Overview of Workforce Data for Nurses, Midwives and Health Visitors in the NHS

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