Policy briefing

Resource update: toolkit tackling racism in the NHS

Trade union Unite has created a new toolkit to combat racism in the NHS.

Trade union Unite has issued a policy briefing on a new toolkit to combat racism in the NHS.

Career progression is more difficult for BME nurses. Picture: Daniel Mitchell

Unite developed the toolkit to help nurses and other staff tackle racial discrimination in health, with black and minority ethnic (BME) nurses often treated unequally compared with their white colleagues. 

Promotion prospects for the 250,000 BME workers in the 1.4 million-strong NHS workforce are often hampered by racism, according to the union.

Called Race Ahead in Health, the toolkit sets out steps to:

  • Tackle the pay gap for BME nurses.
  • Reduce bias during selection and recruitment processes.
  • Gain equal access to continuing professional development.
  • Deal with racial harassment and bullying. 

The toolkit also covers fairness for BME women working in health who can face double discrimination due to their gender and race.


The proportion of all acute trusts that reported a higher percentage of BME staff being harassed, bullied or abused by fellow staff

Data from the NHS Workforce Race Equality Standard (WRES), which was introduced in England in 2015, shows that more BME staff in the NHS are harassed, bullied or abused by colleagues than white counterparts, and in total, 75% of all acute trusts reported a higher percentage of BME staff being harassed, bullied or abused by fellow staff.

Effect on care 

In 86% of acute trusts, a higher percentage of BME staff do not believe their employers offer equal opportunities for career progression. More BME mental health staff say they are abused by members of the public than white staff.

Evidence suggests there is a link between a diverse workforce in which all staff members’ contributions are valued and good patient care. The greater the proportion of staff from a BME background who reported discrimination at work in the previous 12 months, the lower the levels of patient satisfaction. 

Roger Kline’s 2014 research, The Snowy White Peaks of the NHS, suggests that few BME staff were in senior NHS positions, and their number had declined from five years previously.

Expert comment

Obi Amadi, Unite lead professional officer for strategy, policy and equalities 


‘This toolkit is a refresh of the issues of racism and inequality, and is designed to help nurses and other healthcare professionals deal with these issues more confidently and competently.

‘Racial discrimination in the NHS is difficult to change. People say that they don’t see racism where they work, and it can be subtle and hard to spot.

‘While BME nursing and midwifery staff are well-represented at bands 5 and 6, few make it through to the most senior band 9 jobs.

‘This is partly because people like to recruit colleagues who look like them and, as senior managers tend to be white, they are less likely to recruit BME nurses.

‘All healthcare staff should know about the NHS Workforce race equality standards and the nine indicators that all employers should meet.’


Implications for nurses

Unite says that many nurses do not know that the WRES has started, but they can find out about it and see how their employers fared in the indicators measured. 

Staff can also take up opportunities for training to tackle bias and discrimination in the workplace.

Any colleagues who think they are being harassed, discriminated against or bullied should keep a diary of all incidents recording what happened, when, and who was there.

Unite recommends they contact their union representatives as soon as possible and decide what action they want to take. They can take their union representative with them to meetings for support and representation.

If things go further, they should be aware of the 3-month time limit for legal cases (6 months in Northern Ireland).  

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