"This also represents a huge loss of talent from the NHS."
The NHS in England faces a potential exodus of minority ethnic managers who have experienced racism, exclusion and discrimination during their careers, a new report has found.
Nearly four-fifths of managers from black, Asian and minority ethnic (BAME) backgrounds surveyed said they had experienced racism, exclusion or barriers to career progression.
The survey of 950 BAME NHS managers was carried out by the NHS Alliance, which warned the findings showed the “corrosive and demoralising impact of racism in the NHS”.
One in five respondents said they planned to leave the NHS within the next three years, raising concerns about the loss of experienced managers and senior leaders.
Sir Ciarán Devane, chief executive of the NHS Alliance, said “political and cultural polarisation” meant diversity in NHS leadership was more important than ever.
He added: “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.”
Managers described a lack of diversity within senior leadership teams, exclusion from informal workplace networks and “progression disparities” compared with white colleagues.
The findings also identified a gap between BAME managers wanting to progress into more senior positions and their confidence that they would have a fair opportunity to do so.
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.”
According to the reports, some BAME managers, including those in very senior positions, continued to experience “racism, exclusion and inequity in their everyday working lives”.
It also highlighted “isolation and covert discrimination”, despite efforts by the NHS to tackle discrimination and improve representation.
The proportion of BAME members on NHS boards has increased from 7.1% in 2016 to 17.3% in 2025.
However, the NHS Alliance said enduring institutional and structural racism meant previous initiatives had produced little meaningful change.
Victor Adebowale, chair of the NHS Alliance, said the issue required greater attention from NHS leaders.
In an upcoming episode of the NHS Alliance’s Health on the Line podcast, Lord Adebowale said:
“The fact is the NHS is institutionally racist.
“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.”
Professor Habib Naqvi, chief executive of the NHS Race and Health Observatory, said the findings were “alarming, but not surprising”.
“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.”
