Your report (One in five black, Asian and minority ethnic NHS managers in England plan to quit amid racism, report finds, 15 September) rightly highlights racism, exclusion and blocked career progression in the NHS. But it also points to a wider risk: patient safety. Care mistakes already cost the NHS £14.7bn a year.
A March 2025 report by the NHS Race & Health Observatory notes that Black, Asian and minority ethnic (BAME) staff, who make up more than 40% of the medical and dental workforce, still face harassment and discrimination in promotion, everyday work and disciplinary processes. This fuels stress, burnout and poorer mental health. Bullying and harassment are estimated to cost NHS England £2bn a year through staff turnover, sickness and lost productivity. In such environments, BAME staff are less likely than white colleagues to speak up about patient safety, fearing that their concerns will not be understood or taken seriously.
In recent research funded by the National Institute for Health and Care Research, BAME NHS staff told us that racism, exclusion and barriers to progression affected not only their wellbeing but also whether they felt able to speak up when they saw patient safety issues. Staff in medical, nursing, midwifery, psychological therapy and patient safety roles described not being heard, unclear routes for raising concerns, fear of backlash, exclusion and bullying. Visa-dependent staff described particular anxieties. The result was reduced trust in organisations, diminished professional fulfilment and, in some cases, staff leaving.
NHS England’s pledge that new staff standards will require trusts to tackle racism and ensure equal representation, equal opportunities and fair treatment is welcome. But the standards must also require trusts to create psychological safety for BAME staff: workplaces where staff can raise concerns about safety and racism without fear of repercussions. This would support retention and progression, reduce avoidable costs and, most importantly, protect patients’ lives.
Dr Joy Spiliopoulos, Dr Jennifer Creese and Prof Carolyn Tarrant
University of Leicester
