Originally published here.

Ethnic minorities have been a part of the NHS from not long after its inception in 1948 when health care was made free at the point of use (Brathwaite, 2018) in (Nuffield Trust, 2012). There is a long history of women working within the NHS, with BAME nurses being closely linked to British colonial history  (Simpson et al., 2010).Women  from the  Caribbean, India  and Africa were recruited as healthcare assistants, registered nurses and trained as registered and enrolled nurses (the author cites Baxter, 1988; Lee-Cunin, 1989; Kramer, 2006; McDowell, 2013). In 1964, 25% of the nurses in NHS hospitals were from black and minority ethnic backgrounds (the author cites Kramer, 2006).  

According to a 2005 report based on 2003 statistics, 29.4% of NHS doctors were born outside the UK and  for nurses recruited after 1999, the number was 43.5% (Simpson et al. 2010).    As highlighted by Brathwaite (2018) in  Pfeffer (1998), the NHS does not function in isolation from any historical, social or political influences and the power dynamic and racism that colonialism fostered which continues and reinforces the disadvantages BAMEs encounter. Other authors like Peterson and Rutherford (1986); Racine (2009a); Van Herk et al. (2011); Nobel (2016) and Hilario et al. (2018) explain that when you look at BAME women, they face a ‘double colonialism’ of racial disadvantage based on being both female and of a non-white ethnic background.

This gendered difference in organisational experiences, provides the need for research that considers women's workplace (Opara et al., 2020). The concept of the glass ceiling coined by the Wall Street Journal in 1986, is  used to explain why women fail to  achieve senior management roles in  numbers that reflect their  representation in the workforce (Anon, 2008).  Under- representation of BAME women in NHS In the UK, the NHS is the largest employer, and currently employs the largest number of people from BAME backgrounds approximately 20  per cent of NHS workforce. However, the distribution  of the workforce is concentrated mainly in the lower levels of the organisation, with only 1 per cent of Chief Executives from BAME groups (Naqvi and Kline, 2016).

Opara et al (2020) opined that when it comes to understanding BAME women in the workplace, their voices are all but absent in workplace equality and discrimination research, as it tends to feature experiences of white women.    Under-representation of BAME staff within the NHS at senior levels is a recurrent theme. Kilne (2014) notes that within English NHS bodies, ethnicity and gender diversity at senior level is poor, with BAME executives being entirely absent and women being disproportionately absent. Sprinks (2012) using the Freeedom of Information Act provisions surveyed 40 NHS organisations across the UK and found that eight of the 40 organisations have no BAME nurses in band 8 posts.  The Nursing and Midwifery Council report (2021) show that the mean ethnicity pay gap decreased from 28.7 percent in 2020 to 23.7 percent in 2021  and this  was not as  a   result of unequal  pay for  similar roles but  a result  of the under-representation of BAME staff in senior roles (NMC, 2021 Reports).

This pilot study explored the lived experiences of BAME female senior leaders working within the NHS. Two participants were interviewed using semi-structured interviews. The themes that emerged include interpersonal racism, learning training and development, intersectionality and working the system. The output from this work shows it has potential to contribute to the leadership body of knowledge from the perspectives of BAME Women, diversity  and organisational culture. It also  contribute to practice as this preliminary findings evidence endogeneous issues probably underpinned by unconscious bias within NHS top management towards BAME women. We are currently working on the main study and it will be interesting to see if its results will agree with that of this pilot study.

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