Attracting, supporting and retaining a diverse NHS workforce

The vital work of the NHS would be impossible without the contribution of a broad range of people, and a diverse and inclusive workforce ensures better care for patients. Yet despite considerable efforts and initiatives, it is clear that issues such as discrimination and harassment are present at every level of the health service. In this major new report commissioned by NHS Employers, we examine the representation of under-served groups and provide a set of recommendations for change as the NHS strives to become an exemplar of equality, diversity and inclusion.

The work that the NHS does would not be possible without the critical contribution of a broad diversity of people, covering different genders, ethnicities, disabilities, religions, national origins, sexual orientations, ages and other characteristics.

However, there appears to be scope for the NHS to become a more inclusive, diverse and equitable workforce at every level. Across an array of characteristics – including ethnicity, disability, gender and religion – some groups are under-represented in certain NHS careers. Despite efforts to improve equality and inclusion in the workforce and some improvements around diversity – such as in terms of minority ethnic representation in very senior roles – progress has been limited. 

This report builds on existing work to develop practical policy recommendations that can improve the current situation. While we have not attempted to cover the subject areas exhaustively, we did seek to keep the scope broad so as not to miss any key practical levers or mechanisms. We looked across the range of protected characteristics as well as other demographics such as socioeconomic status. We also considered barriers and opportunities across the career pathway, from education for and recruitment into the NHS, to promotion into senior roles. This report pays particular attention to representation and pathways into employment for underserved groups, and to combatting bullying and discrimination and improving staff experience once in post. 

This research was conducted at a unique time and our findings need to be interpreted in the landscape of a number of significant events that have brought inequalities and their root causes to the forefront of public and political debate. These include the Covid-19 pandemic, the murder of George Floyd and the prominence of the Black Lives Matter movement in the UK. The challenges and negative outcomes our interviewees encountered and the analyses highlighted in this report cannot be divorced from the wider structural discrimination and other systemic inequalities prevalent in society. This report was commissioned and supported by NHS Employers, a part of the NHS confederation. 

Key findings

  • The moral and legal cases for NHS trusts to increase the diversity and inclusivity of their workforce are indisputable. There is also a robust evidence base demonstrating the benefits, including: improved quality of care for patients; a more sustainable workforce supply; and increased efficiency of services
  • However, discrimination and other forms of unfair treatment are evident within the NHS – at every stage of the career pipeline – despite efforts to identify and eradicate them.
  • The Covid-19 pandemic has had a direct effect on equality in the workplace, and at no other time in recent history has the NHS’s duty of care to secure the health, safety and welfare of all its employees been as pressing.
  • Our research suggests that there are at least three conditions necessary to address these challenges but currently there is scope for the NHS to improve on them:
    • sufficient information and data to enable a more nuanced understanding of the challenges that staff experience, including within and across specific groups
    • clarity on ‘what works’ to address specific challenges, particularly in NHS settings
    • resources, skills and clear responsibilities within and across organisations to both implement and evaluate their intervention



Suggested citation

Hemmings N, Buckingham H, Oung C, Palmer W (2021) Attracting, supporting and retaining a diverse NHS workforce Research report, Nuffield Trust