Retention

While many participants expressed a strong commitment to the NHS and a desire to continue contributing to healthcare services, experiences of racism, exclusion, limited progression opportunities and organisational culture were influencing decisions about whether to remain within NHS organisations. Participants frequently described a tension between their commitment to the NHS and their experiences of working within it. 

Survey findings

A fifth of respondents reported that it was unlikely they would still be working within the NHS in three years’ time. While this indicates potential loss of ethnic minority staff from the NHS, the survey did not include a comparator group and therefore cannot establish whether ethnic minority staff are more likely to leave than other staff. The 2025 NHS Staff Survey also identified wider retention concerns across the NHS workforce, with 29.55 per cent of staff reporting that they often thought about leaving their organisation, 21.43 per cent indicating that they would probably look for a job at a new organisation within the next 12 months, and 16.75 per cent saying they would leave their organisation as soon as they could. 

The measures are not directly comparable, as the NHS Staff Survey asks about intentions to leave an individual organisation, whereas this survey asked respondents whether they expected to remain within the NHS. The findings should therefore be interpreted within this wider context rather than as evidence that ethnic minority staff are more likely than other staff to leave the NHS. 

Of greater significance within this research were the factors associated with respondents’ intentions to leave. Not being treated fairly at work emerged as the strongest predictor of whether an individual expected to leave the NHS. Dissatisfaction with promotion opportunities, career progression and training opportunities were also significant predictors of retention intentions. 

The qualitative responses provided further insight into these findings, particularly among long-serving and senior ethnic minority staff. Participants described how experiences of racism and inequity could accumulate over time and influence decisions about whether remaining within the NHS was sustainable. 

Among band 9 and VSM respondents, retention concerns were particularly significant where participants described the cumulative impact of their experiences over long NHS careers. Progression into senior leadership did not necessarily protect individuals from experiences that influenced their decisions about whether to remain.  

These findings suggest that retention challenges may be particularly significant where experiences of racism and inequity accumulate over extended periods.

Interview findings

The qualitative interviews provided additional insight into the factors influencing retention. While participants consistently expressed pride in working within the NHS and a commitment to improving outcomes for patients and communities, many described periods where they had considered leaving due to experiences of racism, exclusion or frustration with organisational responses. 

Interviewees also described the cumulative impact of repeated experiences of exclusion, bias and having to continually demonstrate competence. For some, the decision to remain within the NHS was influenced by personal resilience and commitment to service rather than confidence that organisational cultures would improve. 

A recurring theme was the importance of psychological safety and belonging. Participants frequently described wanting to remain within organisations where they felt valued, supported and able to contribute authentically. Conversely, experiences of isolation, lack of support and ineffective responses to racism were often linked to thoughts of leaving. 

The interviews also highlighted concerns regarding the loss of experienced ethnic minority talent. Several participants questioned whether NHS organisations fully recognised the impact that racism and inequity can have on retention, particularly among staff who have already progressed into leadership positions. 

This finding is reflected within the wider literature, which suggests that progression into senior positions does not necessarily remove experiences of exclusion, discrimination or isolation. Instead, some studies suggest that these experiences may become less visible but remain influential in shaping decisions regarding career sustainability and retention. 

Summary

Overall, the findings suggest that retention is closely linked to experiences of fairness, opportunity and inclusion. While many participants remained committed to the NHS and its values, a fifth indicated that they may not remain within the NHS over the coming years. Although this cannot be interpreted as evidence that ethnic minority staff are more likely to leave than other staff groups, the findings provide important insight into the factors influencing retention intentions among ethnic minority staff.

Experiences of racism, limited progression opportunities, inadequate support and ineffective organisational responses were frequently linked to intentions to leave. The qualitative findings particularly highlighted the cumulative impact of these experiences over time, including among long-serving staff and those who had progressed into senior leadership positions.   

The findings are consistent with a longstanding body of evidence demonstrating the relationship between workplace experiences and retention among ethnic minority staff.  From The Snowy White Peaks of the NHS (Kline, 2014) through to the Workforce Race Equality Standard (WRES), Shattered Hopes (NHS Confederation, 2022), the NHS Race and Health Observatory (2024) and the NHS Staff Survey (2026), evidence has consistently shown that experiences of discrimination, exclusion, limited progression opportunities and unequal access to support have cumulative effects on wellbeing, engagement and decisions to remain within the NHS. 

For many participants, the decision to remain within the NHS was influenced not only by their commitment to healthcare, but by whether they felt valued, supported and able to thrive within NHS leadership environments. 

The findings also suggest that retention should not be viewed solely as a workforce issue but as an indicator of organisational culture, inclusion and psychological safety.