Race-ethnic and gender differences in representation within the English National Health Service: a quantitative analysis

• Main Authors: Adrienne Milner, Elizabeth Baker, Jabeer Butt
• Format: Article
• Language: English
• Published: BMJ Publishing Group 2020-02-01
• Series: BMJ Open
• Online Access: https://bmjopen.bmj.com/content/10/2/e034258.full

ObjectivesTo evaluate race-ethnic and gender disparities in National Health Service (NHS) England employment in position, prestige and pay.DesignNational study using data from NHS Digital.SettingTrusts and clinical commissioning groups in England.Participants1 105 390 NHS Hospital and Community Health Service staff.ResultsChinese people (42.9%, 95% CI 41.7% to 44.1%) are the most likely to be employed as doctors, followed by Asians (28.6%, 95% CI 28.3% to 28.8%) and people of mixed race/ethnicity (17.9%, 95% CI 17.3% to 18.4%); while white people (6.8%, 95% CI 6.7% to 6.8%) are less likely to be employed as doctors. However, white doctors are the most likely to be in the highest paid positions: 46.0% (95% CI 45.6% to 46.4%) of white doctors are consultants, whereas only 33.4% (95% CI 31.6% to 35.2%) of Chinese doctors are consultants. Black people are under-represented both among doctors and as consultants: 6.5% (95% CI 6.4% to 6.7%) of black employees are doctors and 30.6% (95% CI 29.2% to 32.0%) of black doctors are consultants. We found similar results for nurses and health visitors, where white people are over-represented in the higher pay bands. However, among support staff for doctors, nurses and midwives, we found that Chinese people were over-represented in the higher pay bands. These race-ethnic differences were similar for women and men. Additionally, we found that men were more likely to be employed in higher pay bands than women, and this gender disparity was apparent across race-ethnic groups.ConclusionsRace-ethnic and gender disparities exist in the NHS in position, prestige and pay. To begin to overcome such disparities, the NHS must collect data using consistent race-ethnic categories in order to examine differences over time.