A Study Reveals ‘Double Disadvantage’ for Overseas-Born Ethnic Minority NHS Staff
A new study published in JRSM Open has found that ethnic minority healthcare workers who were born overseas face a significant “double disadvantage” in career progression within the NHS, stemming from both their ethnicity and their migrant status.
The Core Finding
Overseas-born staff were significantly less likely to be placed in higher pay bands, even after accounting for education, job role, and years of experience.
Key Details of the Research
- Data Source: The study analyzed data from the UK-REACH cohort, focusing on over 5,700 healthcare workers employed under the NHS Agenda for Change (AfC) pay scale. This group includes nurses, midwives, and allied health professionals.
- The Disparity: Even when researchers adjusted for education, job role, and years of professional qualification, overseas-born staff were still significantly less likely to be in higher AfC pay bands.
- Specific Groups Affected: The disparity was most pronounced for Asian and Black healthcare workers born overseas, who were less likely to reach senior pay bands compared to their White, UK-born and trained colleagues.
Background: A Hidden Workforce Challenge
- Ethnic minority and migrant workers make up nearly a quarter of the NHS workforce, yet they are severely underrepresented in senior Agenda for Change positions.
- Migrant staff face barriers that go beyond those experienced by non-migrant ethnic colleagues. These include difficulties with international qualification recognition, limited professional networks, and restricted access to training.
- A major hurdle to solving this issue is the absence of routinely collected migration status data, which hinders research and efforts to address workforce inequality.
Statements from the Researchers
- Lead author Dr. Ji Soo Choi emphasized the critical, overlooked nature of the problem: “Migration status plays a critical role in career prospects but is not routinely recorded. Disparities cannot be addressed without recognition and recording.”
- Senior author Professor Manish Pareek highlighted the scale of the drop-off in seniority: “Ethnic minority staff represent over a third of the workforce at NHS pay band 5, but that number drops to just 10% in senior roles.” He noted this limits their influence over workplace decisions and could contribute to higher attrition rates.
Recommendations for Change
The authors recommend that NHS workforce policies must directly address the distinct barriers faced by migrant healthcare workers. Specific recommendations include:
- Improving access to training.
- Streamlining credential recognition.
- Expanding mentoring and leadership opportunities.