Observatory commissions review into NHS Ethnicity Pay Gap

An independent review into ethnicity pay gaps in the NHS in England has been announced today by the NHS Race and Health Observatory.

Following an Invitation to Tender, the University of Surrey will work with the Observatory to undertake the first ever comprehensive review of an ethnicity pay gap across the National Health Service.

This 18 month project – spanning July 2025 to December 2026 – will focus on examining the differences in pay, career progression, pension contributions and potential impact on cumulative financial earning between staff from different ethnicities. It will also explore potential explanations for any differences and provide recommendations, and evidence-based solutions, to reduce and eliminate unwarranted inequities where they are found to exist.

The NHS is the biggest employer of Black, Asian and minority ethnic staff in Europe.  Despite becoming more ethnically diverse than ever before, staff from ethnic minority backgrounds in the NHS continue to be underrepresented in senior pay bands.

The Observatory will work with Professor Carol Woodhams (Professor of Human Resource Management at the University of Surrey), and Professor Doyin Atewologun (Professor (Hon.) at the University of Exeter and CEO of leadership and inclusion consultancy, Delta). Both will be key leads on the review.

In September 2024, 29.5% (449,127) of staff in NHS Trusts and Core Organisations were from an ethnic minority background. This represents a 136.0% (258,784) increase from September 2014 when just 16.8% (190,343) of staff in NHS Trusts and Core Organisation were from an ethnic minority background.

However, ethnic minority staff in the NHS continue to be significantly underrepresented in senior roles. In September 2024, staff from ethnic minority backgrounds made up only 7.9% of all staff in Very Senior Management (VSM) roles compared to 29.5% overall workforce representation. The gap between overall representation and representation at VSM roles has increased from 12.6% in 2014 to 21.6% in 2024.

Owen Chinembiri, Assistant Director, Workforce, NHS Race and Health Observatory, said:

“Black, Asian and ethnic minority staff continue to face hurdles when it comes to career progression in the NHS. Even though there have been some improvements over the past few years, this has been slow, patchy and frustrating for ethnic minority staff who have been impacted for far too long.

“Tackling these inequalities is now an urgent matter that requires our collective understanding and action. This research will identify areas where there are unwarranted gaps in pay and career progression, as well as come up with impactful recommendations that can be implemented by the NHS to reduce and, ultimately, eliminate these inequalities.”

Although some trusts voluntarily report on earnings, currently, ethnic pay gap reporting is not mandatory.

Professor Carol Woodhams, Professor of Human Resource Management, University of Surrey, said:

“We are proud to be leading this important work in collaboration with the RHO and national partners. We’ve researched workplace pay gaps for many years, so we’re pleased to support this vital review. It’s a chance to uncover the root causes of ethnic disparities in NHS pay and progression, and to help drive meaningful, evidence-based change.”

Professor Doyin Atewologun, CEO of leadership and inclusion consultancy Delta, said:

“Delta is pleased to collaborate with the University of Surrey, the RHO, and other partners on this important work. We will draw on our extensive experience in qualitative, intersectional research across health and other sectors, to contribute to providing a deeper understanding of ethnicity pay disparities and recommending sustainable, practical actions to help address them.”

The research follows the 2020 Mend the Gap: The Independent Review into Gender Pay Gaps in Medicine in England, commissioned by the Department of Health and Social Care, which highlighted significant pay inequalities by gender in the medical workforce and resulted in recommendations that have shaped a work programme to reduce the gap.

Within the NHS, each of the nine Agenda for Change (AfC) pay bands has a number of pay points with staff typically progressing to the next pay point annually until reaching the maximum pay band.

Current earnings, earnings over career timespans and roles using both quantitative and qualitative data and insight will be explored. Various aspects of established methodologies used to analyse statutory gender pay gap reporting will also be utilised.

Professor Habib Naqvi, chief executive, NHS Race and Health Observatory, said:

“This review is long-overdue and we’re delighted to be working with the University of Surrey and others on undertaking it. For too long, large proportions of Black, Asian and ethnic minority staff remain stuck, often stagnating for years, in lower pay bands within the NHS whilst other members of staff are supported to move swiftly through those same ranks. Tackling pay and progression gaps will help organisations across the NHS to create an inclusive environment for all staff – ensuring employees from different ethnic backgrounds have peace of mind that they are getting paid according to their skillset.

“Pay gaps are unjust, unfair and a public health challenge. We know a motivated, included and valued workforce delivers high quality patient care, increased patient satisfaction and better patient safety. When operating at equal levels, doing equal roles, staff must receive the equal pay to which they are entitled, and should have equal opportunities for progression.”

There are a limited number of comprehensive studies into ethnic pay disparities with some earlier reports highlighting no significant pay gap between average basic pay of White NHS staff in comparison to Black and ethnic minority staff.

Danny Mortimer, chief executive of NHS Employers, said:

“NHS Employers welcomes this much needed review by the NHS Race and Health Observatory and Carol Woodhams into ethnicity pay gaps and career progression for ethnic minority staff working across the NHS in England.

“The delivery of a better NHS and a healthier nation requires the best use of all the talents in our workforce: we cannot jeopardise this by the presence of inequalities and racism in our workplaces.

“The findings of this review will help us to work with our trade union colleagues to improve pay system and contract design, and will help us all to support NHS organisations across England to take action to address the issues identified by this crucial work.”

The Observatory’s approach will focus on in-depth, detailed variations of pay and grade related data, providing broader and clearer analyses. Where evidence is found of exiting pay gaps, the final report – due in December 2026 – will set out clear recommendations aimed at reducing salary disparities. It will also outline evidence-based interventions to tackle disparities in progression within the workplace.