Progression

While progress has been made in increasing representation within NHS leadership, many participants described continuing barriers to progression into leadership positions. Access to opportunities, sponsorship, organisational support and workplace culture were identified as important influences on leadership progression and career development. The findings suggest that progression is shaped not only by individual capability and ambition, but also by organisational systems and leadership behaviours. 

The findings are consistent with a substantial body of NHS literature which has repeatedly identified disparities in career progression and access to leadership opportunities for ethnic minority staff. Previous research suggests that ethnic minority employees are less likely to progress into senior roles despite comparable levels of aspiration, capability and experience. Studies have highlighted barriers including unequal access to professional networks, sponsorship, leadership development opportunities and influential decision-making environments (Archibong et al., 2015; Priest et al., 2015). More recent evidence from the Workforce Race Equality Standard (WRES, 2025) and the NHS Race and Health Observatory (2024) suggests that progression disparities continue to persist despite national efforts to improve race equality. The literature also highlights the importance of transparent recruitment processes, equitable access to development opportunities and active leadership advocacy in supporting progression into senior roles.

Survey findings 

The survey findings showed high levels of dissatisfaction with opportunities for promotion and career progression across all ethnicities and grades. Among respondents in bands 1 to 8, there was also a difference between aspirations for promotion and expectations of achieving it. While this does not in itself demonstrate inequity in progression, it provides important context for understanding participants’ wider experiences of career development. 

A total of 86 per cent of respondents who were in bands 1 to 8 reported some level of desire for promotion. However, only 33 per cent of those expressing a desire for promotion believed they had some likelihood of being promoted, with just 8 per cent stating that they would definitely achieve promotion. Most commonly, respondents reported that they did not expect to be promoted (44 per cent). 

Differences were also evident across ethnic groups within the survey sample. Respondents from Asian ethnic backgrounds reported lower expectations of promotion (27 per cent) compared with respondents from black (37 per cent) and mixed ethnic backgrounds (36 per cent). However, these differences should be interpreted cautiously, as the survey did not include a white comparator group and therefore cannot establish whether expectations of promotion differ between ethnic minority and white staff. 

National WRES data provides important additional context. In the 2025 NHS Staff Survey data reported through WRES, 59.1 per cent of white staff believed that their organisation acted fairly with regard to career progression or promotion, compared with 49.6 per cent of staff from all other ethnic groups. This national differential provides further evidence that perceptions of fairness in career progression continue to vary by ethnicity. 
The survey in this research also highlighted widespread dissatisfaction with promotion and career progression opportunities. More than half of respondents (56 per cent) reported negative experiences relating to promotion and career progression. Perceptions of fairness appeared particularly important. Not being treated fairly at work emerged as the strongest predictor of an individual’s intention to leave the NHS. Dissatisfaction with opportunities for promotion, training and career progression was also a strong predictor of intentions to leave. 

The qualitative survey responses provide further insight into how participants understood their experiences of progression. Respondents frequently described exclusion, limited opportunities and a lack of development or support. Progression was often perceived as being influenced by informal networks and access to influential individuals rather than transparent and equitable processes. These accounts are consistent with previous NHS research highlighting the role of professional networks, sponsorship and informal influence in shaping career progression opportunities for ethnic minority staff. 

Interview findings

The qualitative interviews provided additional insight into the factors influencing leadership progression. Across all interviews, participants consistently challenged the notion that progression barriers were primarily related to capability or ambition. Instead, progression was frequently described as being shaped by systemic factors embedded within organisational structures, leadership cultures and informal decision-making processes. 

A recurring theme was the importance of sponsorship and advocacy. While mentoring and leadership development programmes were viewed positively, participants repeatedly emphasised that sponsorship was often more influential in supporting progression. Career advancement was frequently linked to senior leaders who actively advocated for individuals within decision-making environments. 

The importance of sponsorship identified within the interviews reflects wider findings within the literature. Archibong et al. (2015) highlighted the role of professional networks, leadership advocacy and organisational support in enabling career progression for ethnic minority staff, while the NHS Leadership Academy’s Stepping Up programme has demonstrated the value of targeted leadership development and sponsorship in supporting progression into more senior positions. However, the literature suggests that access to sponsorship remains inconsistent across organisations and staff groups. 

Participants also described the emotional burden associated with leadership progression. Experiences of heightened scrutiny, underrepresentation and the need to continually demonstrate competence were frequently discussed. Some interviewees reflected on feeling required to work harder than their peers in order to achieve comparable opportunities. 

Others described progression pathways as less predictable and shaped by experiences of exclusion and rejection. 

The interviews also highlighted concerns regarding the effectiveness of existing interventions. While participants acknowledged the value of leadership programmes and positive action initiatives, several questioned whether these approaches were addressing the structural factors influencing progression or simply helping individuals navigate existing inequalities. 

Similar concerns are reflected within the literature. Kalra, Abel and Esmail (2009) argued that many interventions aimed at improving race equality focus primarily on supporting individuals rather than addressing the organisational and institutional barriers that create inequitable outcomes. Their review concluded that meaningful progress requires structural change alongside individual development initiatives.

Summary

Overall, the findings suggest that aspiration for leadership remains high among ethnic minority staff working within the NHS. Survey findings highlighted widespread dissatisfaction with progression opportunities and perceptions of unfairness, while national WRES data demonstrates that ethnic minority staff report lower perceptions of fairness in career progression than white staff. The qualitative findings provided further insight into these experiences, highlighting the importance of sponsorship, influential networks and organisational support in shaping progression. 

The findings therefore suggest that progression disparities are influenced not only by individual capability and ambition, but also by the structural and institutional factors that shape who is supported, recognised and promoted into leadership positions. Increasing representation alone is therefore unlikely to address progression disparities unless organisations also address the systems, leadership behaviours and informal processes that determine who is identified, supported and promoted into leadership positions.