Discrimination by Appointment: How black and ethnic applicants are disadvantaged in NHS recruitment


Discrimination against black and minority ethnic (BME) staff in the UK in access to employment, in opportunities once employed, and treatment in employment, is longstanding and well evidenced. Specific statutory changes, such as the Race Relations Amendment Act 2000, and a stream of policy initiatives have sought to encourage equality in the recruitment and treatment of BME staff by the NHS. Yet little has changed, and the time has come for the NHS to begin a serious conversation with itself about why not.

We decided to stimulate this conversation by carrying out a brief but informative survey of published selection data in 60 randomly selected NHS trusts in England. (Of those 60 trusts, it turned out that only 30 had data available in a form that enabled our analysis, and therefore the results in this report are drawn from those.) This was prompted not only by our awareness that the problem of discriminatory selection is continuing but also by two recent developments that could make the problem less visible: the radical changes ushered in by the Health and Social Care Act 2013; and the review, also this year, of the Public Sector Equality Duty.

Ten years on from a Prime Ministerial promise of an end to discrimination in the labour market seemed an appropriate time to consider what is happening in one very large employer over which the Government has significant influence, the NHS. Moreover, there is clear evidence of correlation between the treatment of BME staff in the NHS and the experience of patient care. So this is not only an issue of access to public service jobs but also of the quality of services.

The data we gathered indicated that in the 30 trusts for which usable published data were available the likelihood of white applicants being appointed is more than three times (3.48) greater than that of BME applicants, and the likelihood of white shortlisted applicants being appointed approaches twice (1.78) that of BME applicants. These are similar likelihoods of being appointed to those identified five years ago in a survey by Health Services Journal.

In a separate study we also looked at the recruitment of staff to the new institution set up to run the NHS by the Health and Social Care Action, NHS England (previously NHS Commissioning Board). As NHS England has started from scratch by recruiting its management and staff mainly from other parts of the NHS, and as it has a declared goal of promoting an ethnically representative NHS workforce, we might have expected to see that goal reflected in its own selection data. However, our analysis shows that the proportion of white applicants appointed to those new positions is between four and six times (depending on grade) greater than that of BME applicants.

The results suggest little or no improvement in the overall pattern of discrimination in NHS recruitment in recent years despite numerous initiatives, with adverse implications for both NHS patients and staff. We really do have to talk about this. We need to find out what is going on, why it is going on, and what can be done about it, so that the NHS workforce is as good as it can be and at all levels reflects the population it serves.

Click here to read the report in full