During Oral Questions in the House of Lords on February 10th I asked how many nurse directors there were in the English NHS from black and minority ethnic backgrounds. The depressing reply was that there were only 5 – from 170 NHS organisations. This is about 2.5%, yet 20% of NHS nurses are of black or minority ethnic origin.

In 2004 I published a 10 point Race Equality Plan which was designed to improve the way the NHS cared for its patients from black and minority ethnic backgrounds. Today, Roger Kline, a Middlesex University Business School Research Fellow, publishes his review of the progress made in the 10 years since this Plan was published. The review, The Snowy White Peaks of the NHS, is even more depressing and shows that the situation is no better now and, in some cases, worse. He has examined executive directors, non executive directors, and senior managers of NHS Trusts, alongside the leadership of the national NHS regulators and commissioners. All in all, there is a smaller proportion of people from black and minority ethnic backgrounds at the top of the NHS than in 2004.

Why does this matter?

Leaving aside the very important questions of equal opportunities and legalities, this is fundamentally about health and the health of the population. I created the Plan because regular surveys showed that both patients and NHS staff from black and minority communities were less satisfied with the NHS than people from the majority community. I believe this is still true today.

Research shows that the lack of representation affects staff morale amongst this population because it shows that there is little scope for advancement and suggests that their contribution is not valued. As Professor Michael West and his academic colleagues have shown, poor morale is in turn one of the main factors in the quality of care and is directly related to successful outcomes for all patients. Similarly, the lack of visible leaders from these communities affects patients’ experiences and confidence in the service – and in whether they see it as understanding and meeting their needs.

This is why it matters – and why it concerns us all. Improvements in the NHS depend on a motivated and committed workforce where everyone is able to contribute their best,

The Department of Health and NHS England need urgently to examine these findings closely and decide how they are going to make improvements. Even more importantly, it is a challenge to all the leaders of a newly decentralised NHS. Clearly, the impact is different in different parts of the country but the issues are the same. Are they not making use of all the talents in their workforce and their communities? Is lack of representation leading to poor morale and poor care? What are they doing about it?

I asked the Minister in February to ensure there was regular independent monitoring of this position. He didn’t respond. This reports shows that there needs to be independent and public scrutiny and challenge of the way people from black and minority ethnic backgrounds are represented in the leadership of the NHS.