A troubling NHS narrative

A troubling NHS narrative is emerging in the National Health Service (NHS), according to Richard Powell, Ganesh Sathyamoorthy and Mala Rao of the Ethnicity and Health Unit.  At the very moment the NHS faces its most acute workforce pressures, ethnicity and migration are being deprioritised within strategic planning, creating blind spots that risk undermining both equity and system resilience.

With colleagues from Oxford, Glasgow, Portsmouth and Anglia Ruskin universities, they have co-authored three editorials for the Journal of the Royal Society of Medicine.  The 10-year NHS Plan speaks the language of scale, productivity and retention, and there have been welcome advances in the ethnic composition of its workforce and opportunities for career progression.  However, the authors contend that ethnicity is being deprioritised within planning circles, with limited thinking devoted to the lived realities of those from ethnic minority backgrounds, both in terms of workforce members and the research priorities of community members.  In doing so, it treats inequality as peripheral rather than structural.

The authors contend this matters most sharply for international medical graduates (IMGs).  The recent attempt by the Secretary of State for Health and Social Care, Wes Streeting, to appease striking resident doctors by prioritising them over IMGs in career opportunities, puts the latter as a professional crossroad.  Numerically essential to service delivery, yet unevenly supported, and under-represented in leadership roles, what does a future in the NHS hold for them?  

Workforce expansion strategies rely heavily on global recruitment, but without commensurate investment in induction, pastoral care, career progression and protection from bias, this reliance risks becoming extractive rather than sustainable. 

Collectively, these trends signal a strategic misalignment: a health service dependent on diversity, yet increasingly reluctant to value it.  Recentring ethnicity is not a moral add-on; it is a workforce necessity.  Without it, the NHS risks building its future on unresolved inequities, with consequences for staff wellbeing, patient care and its long-term sustainability.