Differential Attainment in Leadership Roles in the UK NHS Bridging the Gap - Thematic series on Tackling Differential Attainment in Medical Profession 2020

Main Article Content

Saif Sait
Vijay Nayar
Dev Chauhan
Sahana Rao
Geeta Menon


Aim – to review the evidence on differential attainment in leadership positions in the NHS and develop an expert consensus

In this review we will explore in-depth, the current data surrounding differential attainment in leadership roles in the UK NHS, possible reasons for these disparities, and what interventions may address this inequality. This scoping review forms part of the Alliance for Equality in Healthcare Professions project on DA chaired by the British Association of Physicians of Indian Origin (BAPIO) and will be integrated into the Bridging the Gap project undertaken by BAPIO Institute for Health Research (BIHR).

Article Details

How to Cite
Sait, S., Nayar, V., Chauhan, D., Rao, S., & Menon, G. (2020). Differential Attainment in Leadership Roles in the UK NHS: Bridging the Gap - Thematic series on Tackling Differential Attainment in Medical Profession 2020. Sushruta Journal of Health Policy & Opinion, 13(3), 1-12. https://doi.org/10.38192/13.3.22


1. Shah R, Ahluwalia S. The challenges of understanding differential attainment in postgraduate medical education. Br J Gen Pract. 2019 Aug 29;69(686):426-427. doi: 10.3399/bjgp19X705161
2. Mountford-Zimdars, A.K., Sanders, J., Jones, S., Sabri, D. and Moore, J., 2015. Causes of differences in student outcomes, Higher Education Funding Council for England. https://dera.ioe.ac.uk/23653/1/HEFCE2015_diffout.pdf
3. Milner A, Baker E, Jeraj S, et al. Race-ethnic and gender differences in representation within the English National Health Service: a quantitative analysisBMJ Open 2020;10:e034258. http://dx.doi.org/10.1136/bmjopen-2019-034258
4. West, M., Dawson, J. and Kaur, M., 2015. Making the difference: Diversity and inclusion in the NHS. The Kings Fund. https://www.kingsfund.org.uk/sites/default/files/media/Mandip_Kaur.pdf
5. Kline, R., 2014. The snowy white peaks of the NHS: a survey of discrimination in governance and leadership and the potential impact on patient care in London and England. https://doi.org/10.22023/mdx.12640421.v1
6. WRES Implementation Team (2020). NHS Workforce Race Equality Standard: 2019 data analysis report for NHS trusts [online]. NHS England website. Available at: https://www.england.nhs.uk/publication/ workforce-race-equality-standard-data-reporting-2019 (accessed on 27 February 2020).
7. Kmietowicz Zosia, Ladher Navjoyt, Rao Mala, Salway Sarah, Abbasi Kamran, Adebowale Victor et al. Ethnic minority staff and patients: a health service failure BMJ 2019; 365 :l2226 https://doi.org/10.1136/bmj.l2226
8. Moberly Tom. Doctors from ethnic minority backgrounds earn less than white colleagues BMJ 2018; 363 :k5089 doi: https://doi.org/10.1136/bmj.k5089
9. Sealy, R., NHS Women on Boards by 2020. NHS, 2017 https://www.nhsemployers.org/-/media/Employers/Publications/NHS-Women-on-Boards-report.pdf
10. Department of Health and Social Care (2019) ‘New data on gender pay gap in medicine.’ GOV.UK website. Available at: https://www.gov.uk/government/news/new-data-on-gender-pay-gap-in-medicine
11. Department of Health and Social Care (2015). ‘The NHS Constitution for England’. GOV.UK website. Available at: https://www.gov.uk/government/publications/the-nhs-constitution-for-england/ the-nhs-constitution-for-england
12. Rimmer Abi. NHS must do more to tackle white male dominance of leadership roles, Labour Party says BMJ 2016; 354 :i4610 doi: https://doi.org/10.1136/bmj.i4610
13. Medina, S., 2017. The diversity gap in the nonprofit Sector. https://philanthropynewsdigest.org/columns/the-sustainable-nonprofit/the-diversity-gap-in-the-nonprofit-sector
14. Confederation, N.H.S., 2019. Chairs and non-executives in the NHS: The need for diverse leadership. https://www.nhsconfed.org/-/media/Confederation/Files/Publications/Chairs-and-non-executives-in-the-NHS.pdf
15. Beech, J., Bottery, S., Charlesworth, A., Evans, H., Gershlick, B., Hemmings, N., Imison, C., Kahtan, P., McKenna, H., Murray, R. and Palmer, W., 2019. Closing the gap: key areas for action on the health and care workforce. London, UK: Kings Fund. https://www.nuffieldtrust.org.uk/research/closing-the-gap-key-areas-for-action-on-the-health-and-care-workforce
16. DEPARTMENT OF HEALTH. (2004). Race Equality Action Plan. Available: http://webarchive.nationalarchives.gov.uk/+/http://www. dh.gov.uk/en/Publicationsandstatistics/Bulletins/DH_4072494.
17. Bolden, R., Adelaine, A., Warren, S., Gulati, A., Conley, H. and Jarvis, C., 2020. Inclusion: The DNA of leadership and change. https://uwe-repository.worktribe.com/output/852067/inclusion-the-dna-of-leadership-and-change
18. Ross, S., Jabbal, J., Chauhan, K., Maguire, D., Randhawa, M., and Dahir, S., 2020. Workforce race inequalities and inclusion in NHS providers The King’s Fund website. Available at: https://www.kingsfund.org.uk/sites/default/files/2020-07/workforce-race-inequalities-inclusion-nhs-providers-july2020.pdf
19. Dawson J, Sampson F, Rimmer M, Buckley Woods H, West M, Nadeem S (2019). Evaluation of the NHS Workforce Race Equality Standard (WRES) [online]. NHS England website. Available at: https://www.england.nhs.uk/publication/evaluation-of-the-nhs-workforce-race-equality-standard-wres
20. NHS Equality and Diversity Council (2019b). Equality and Diversity Council: narrative and terms of reference [online]. NHS England website. Available at: www.england.nhs.uk/publication/equalityand- diversity-council-narrative-tor
21. NHS England (2020a). ‘NHS England chief pledges “head office” will match diversity of health service’. Press release, 5 March. Available at: https://www.england.nhs.uk/2020/03/nhs-chief-pledgeshq- will-match-diversity-of-health-service
22. Equality and Human Rights Commission (2011) Sex and Power. Equality and Human Rights Commission, London. https://www.equalityhumanrights.com/en/publication-download/sex-and-power-2011
23. Rosser SV, Barnard S, Carnes M, Munir F. Athena SWAN and ADVANCE: Effectiveness and lessons learned. Lancet 2019. 9;393(10171):604-608 DOI: https://doi.org/10.1016/S0140-6736(18)33213-6
24. NHS Digital 2019. NHS Workforce statistics September 2019 https://digital.nhs.uk/data-and-information/publications/statistical/nhs-workforce-statistics/september-2019
25. Advisory Committee on Clinical Excellence Awards. Annual report covering the 2018 awards round. 2019. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/867066/ACCEA_Annual_Report_2019.pdf
26. Bamrah J, Chand K. The best birthday present for the NHS? An end to its institutional racism [Internet]. the Guardian. 2020 [cited 19 July 2020]. Available from: https://www.theguardian.com/society/2020/jul/03/best-birthday-present-nhs-end-institutional-racism
27. Cook T, Kursumovic E, Lennane S. Exclusive: deaths of NHS staff from covid-19 analysed. Health Service Journal. 2020 Apr 22;22. https://www.hsj.co.uk/exclusive-deaths-of-nhs-staff-from-covid-19-analysed/7027471.article
28. Atewologun, D., Kline, R. and Ochieng, M., 2019. Fair to Refer. Reducing disproportionality in fitness to practise concerns reported to the GMC. https://www.gmc-uk.org/-/media/documents/fair-to-refer-report-pdf-79011677_pdf-79021583.pdf
29. Majid Aisha. What lies beneath: getting under the skin of GMC referrals BMJ 2020; 368 :m338 doi: https://doi.org/10.1136/bmj.m338
30. Jones Helen. Yvonne Coghill: cultural transformation through conversation BMJ 2020; 368 :m474 doi: https://doi.org/10.1136/bmj.m474
31. Rimmer Abi. White doctors are still over-represented in top NHS jobs, study finds BMJ 2020; 368 :m571 doi: https://doi.org/10.1136/bmj.m571
32. Linton Samara. Taking the difference out of attainment BMJ 2020; 368 :m438 doi: https://doi.org/10.1136/bmj.m438
33. Nath, V. Are opportunities still limited for black and minority staff in health care leadership? 2016. The King’s Fund website. Available at: https://www.kingsfund.org.uk/blog/2016/04/BME-staff-healthcare-leadership
34. NHS Improvement., 2019. A Model Employer: Increasing black and minority ethnic representation at senior levels across the NHS. Available at: https://www.england.nhs.uk/wp-content/uploads/2019/01/wres-leadership-strategy.pdf
35. McGregor-Smith R (2017). Race in the workplace: the McGregor-Smith review [online]. GOV.UK website. Available at: https://www.gov.uk/government/publications/race-in-the-workplace-the-mcgregorsmith- review
36. Chakravorty, I., Bamrah, J., & Mehta, R. (2020). A Rainbow Paper - Tackling inequalities, a neo-liberal order in a world after Corona. Sushruta Journal of Health Policy & Opinion, 13(3). DOI https://doi.org/10.38192/13.3.14
37. ENGLAND, N., 2017. Improving through inclusion Supporting staff networks for black and minority ethnic staff in the NHS. https://www.england.nhs.uk/publication/improving-through-inclusion-supporting-staff-networks-for-black-and-minority-ethnic-staff-in-the-nhs/
38. Atewologun, D., Cornish, T. and Tresh, F., 2018. Unconscious bias training: An assessment of the evidence for effectiveness. Equality and Human Rights Commission Research Report Series. https://www.equalityhumanrights.com/sites/default/files/research-report-113-unconcious-bais-training-an-assessment-of-the-evidence-for-effectiveness-pdf.pdf
39. Fuchs B (2019). ‘Talking leadership: Ben Fuchs on “advantage blindness”’. The King’s Fund website. Available at: https://www.kingsfund.org.uk/publications/talking-leadership-advantage-blindness
40. Coghill Y (2020). ‘“Our NHS people matter” – five years of the Workforce Race Equality Standard (WRES)’. Blog. Available at: https://www.kingsfund.org.uk/blog/2020/02/five-years-workforce-raceequality-standard-wres

Most read articles by the same author(s)