The case for race equality

07 November 2019

Yvonne Coghill, director of Workforce Race Equality Standard Implementation at NHS England, on the progress being made against race discrimination.

Since the inception of the NHS in 1948, race equality had never been mandated and built into contracts – until 2015, when the Workforce Race Equality Standard (WRES) was introduced into the NHS standard contract.

It was a bold and courageous move. Much energy and effort was made for the initiative to become a reality.

The standard made clear that all protected characteristics were important, but that for many years no focused attention had been paid to improving race equality in the NHS. As an organisation with 18% of the workforce from black and minority ethnic (BME) backgrounds (NHS, 2015), it was important that we looked more closely at this complex and highly sensitive issue.

I often hear questions about WRES: Is it fair? Is it the right thing to do? Yes and yes.

It is fair and right that all members of staff, regardless of background, are treated equitably. It is also right that we do something positive about the inequities in our system in order for patients to ultimately receive high-quality care.

Closing the inequality gap

WRES is designed to enable BME employees to receive equal access to career opportunities and fair treatment in the workplace. That might be through job appointments, career progression, or avoiding bullying and harassment.

The first WRES data return in 2016 showed clearly that BME staff had a poorer experience at work than their white counterparts (NHS Equality and Diversity Council, 2016). The challenge, then, was to close the gap on 
those experiences.

The change we are seeking in workforce race equality is backed up by moral, legal, financial and, most importantly, quality-of-care reasons. We must never forget that behind all our efforts, sacrifices and ambitions, the patients and service users are our ultimate priority. We have the evidence to show that a happy, well-respected, well-motivated workforce delivers high-quality care, a safer service and one which patients find more satisfying.

The root of the initiative lies in the NHS constitution, which states as one of its first principles that the NHS is for all people, regardless of background.

So after four years, where are we now with race equality in the NHS?

Green shoots of hope

Well, in the last few years, we have started seeing what could be referred to as ‘green shoots of hope’. Since WRES started reporting, the number of BME colleagues in the NHS has continued to grow, from around 18% to almost 20% as of March 2018 (NHS Digital, 2018).

The gap between BME colleagues and their white counterparts being appointed from shortlisting is reducing, and the numbers at the most senior posts in the NHS are slowly climbing, with an added 44 very senior manager roles filled by BME colleagues in 2018 (NHS Equality and Diversity Council, 2018). The number of NHS trusts with more than three BME board members is also increasing year on year – from 16 in 2016 to 29 in 2018 (NHS Equality and Diversity Council, 2018). Every year we continue to see more BME nurses moving into Band 6 and higher posts, and we hope to see more in the coming years.

This is all good news but there is more to be done.

The cultural indicators related to perceptions of bullying and harassment and discrimination among BME staff are not moving as quickly as we would like. Changing deep-rooted cultures takes time: it requires patience and determination, and as my colleague Habib Naqvi would say: ‘More Mo Farah than Usain Bolt... A marathon, not a sprint.’

The number of NHS trusts with more than three BME board members is increasing year on year – from 16 in 2016 to 29 in 2018

Do more than tick boxes

I believe the NHS is the best organisation in the world, delivering high-quality care to millions of people every day.

To thrive, it must be a forward, outward-looking organisation, one that attracts and retains staff from all backgrounds. The WRES is not a tick-box exercise. It is designed to enhance an organisation’s ability to attract and retain top talent, deliver high-quality patient care, improve patient satisfaction and patient safety. It aims to have a productive and positive workforce.  

The NHS Long-term plan published earlier this year set an ambitious national goal: that NHS leadership should be as diverse as the rest of the workforce within 10 years.

To this end, we developed the model employer policy. This was designed to ensure equity within our workforce by 2028. This work is reinforced by the newly developed NHS People Plan with its aim of making the NHS the best place to work.

The Long-term plan, the People Plan and WRES are inextricably linked and will ultimately improve staff experience in our NHS.

From my perspective, I believe we need to continue talking about race until we finally achieve equity in our NHS.    

Yvonne Coghill, CBE, is the director of WRES at NHS England. She has twice been voted by NHS colleagues as one of the top 50 most inspirational women, one of the top 50 most inspirational nurse leaders and one of the top 50 BME pioneers. 


  • NHS England and NHS Improvement’s A fair experience for all: closing the ethnicity gap in rates of disciplinary action across the NHS workforce: bit.ly/NHS_ethnicity_gap  
  • WRES’s data report for NHS trusts: bit.ly/WRES_data_analysis  
  • WRES leadership strategy, A model employer: increasing black and minority ethnic representation at senior levels across the NHS: bit.ly/WRES_leadership_strategy

Time to reflect

What are your ideas for reaching race equality in the NHS? What experiences have you had of race inequality? Join in the conversation on Twitter @CommPrac using the hashtag #NHSRaceEquality



NHS. (2015) Staff survey 2015. See: https://www.nhsstaffsurveys.com/Page/1062/Past-Results/Staff-Survey-2015-Detailed-spreadsheets (accessed 17 October 2019).

NHS Digital. (2018) NHS workforce statistics: March 2018. See: https://digital.nhs.uk/data-and-information/publications/statistical/nhs-workforce-statistics/nhs-workforce-statistics---march-2018-provisional-statistics (accessed 17 October 2019).

NHS Equality and Diversity Council. (2016) NHS workforce race equality standard: 2015 data analysis report for NHS trusts. See: https://www.england.nhs.uk/wp-content/uploads/2014/10/WRES-Data-Analysis-Report.pdf (accessed 17 October 2019).