Chart of the week: Black NHS staff are underrepresented in senior management roles

Each week, we present a chart that addresses a vital issue dominating global conversations around health care and society as a whole. This week, Lucina Rolewicz and Jonathan Spencer highlight the disproportionately low representation of black people working in senior positions in hospitals and community services in England.

Chart of the week

Published: 11/06/2020

The appalling recent events in the US and the inequalities revealed by Covid-19 have shone a light on racism and the treatment of black communities across the globe. 

Building on our work on ethnicity pay gaps, we investigated the proportion of people with black ethnicity across different NHS professions and compared this with the proportion of black people in senior grades within these groups.

We might expect the proportion of black people at senior levels in each group to match the overall proportion of people of a black background in that same group. However, the proportion of those in senior pay grades* is lower than the overall proportion, with midwifery the one exception. The difference is particularly stark for nurses, doctors and those working in hotel, property and estates.

The overall proportion of people of black ethnicity is very low for ambulance staff and ambulance support staff (0.6% and 2.2% respectively). Given that there is evidence of high levels of discrimination in the ambulance service, this may in part explain the low representation of black people in this profession.

While midwives of black background have comparatively high levels of representation in that staff group, there are other issues involving discrimination against BAME midwifery staff. For example, midwives from ethnic minority backgrounds in London are disproportionately more likely to face disciplinary proceedings and dismissal than their white counterparts.

Although promoting respect, equality and diversity is central to the NHS’s workforce plan, there is still much more to be done to make the NHS a model employer in this regard.

As a health policy think tank, we seek to play our own part in tackling racial discrimination by seeking out and promoting the evidence around ethnicity and health care, listening to and learning about the experiences of those affected by racism and improving our own record as both an employer and a policy research organisation.



  • * By senior grade we mean those on Agenda for Change Band 7 and above, or at Consultant level for doctors.
  • This data covers NHS staff working in hospital and community health services only. We have only counted staff from a black or black British background, rather than including all BAME groups.
  • Population estimates includes those from black, African, Caribbean or black British backgrounds. This data captures the percentage of these ethnicities in England across all age groups. Data for working age adults is available from the 2011 Census, but this covers England and Wales.