Values to action: Embedding equality, diversity and inclusion in a changing NHS

When I joined London Ambulance Service NHS Trust, I found a workforce deeply committed to their roles but disconnected from the organisation itself. We made inclusion our foundation, our strategy, and not a side project, with leadership development, inclusive recruitment, active bystander training, and a renewed focus on values and behaviours.

The results were transformative:

• Sickness absence halved (from 14% to 7%).
• Retention and productivity improved.
• Staff survey scores rose in 90 of 97 areas and across all seven people promises, with our highest score in ‘We are compassionate and inclusive'.

The NHS is navigating a period of seismic transformation heralded by the publication of the 10-year health plan. Building on good work which is already taking place in many parts of England, it sets out a radical redesign to bring care closer to patients, a refreshed operating model, renewed freedoms for foundation trusts, and a bold commitment to modern, accountable leadership.

But amidst structural reform and financial constraints, one truth remains: our workforce is our greatest asset and key to making this change successful.

The case for inclusive leadership has never been stronger. This year’s staff survey results are a wake-up call. Reports of discrimination, from patients, the public, and colleagues, are at their highest since 2020 with one in four ethnic minority staff reporting experience of these behaviours. The Workforce Race Equality Standard (WRES) also shows a growing divergence in the experience between ethnic minority and white staff at work. White staff remain significantly more likely than ethnic minority applicants to be appointed from shortlisting, an indicator against which there has been no sustained improvement since 2016, and fewer than one in two ethnic minority staff say that their trust provides equal opportunities to career progression and promotion. We also continue to see an increasing gap between ethnic minority representation within the workforce (28.6%) and at board level (16.5%), particularly among executives (14.5%). These are not isolated data points, they are systemic signals.

We know the evidence: diverse teams are 30% more productive. Inclusive cultures are six times more innovative. A sense of belonging helps drive higher staff engagement which in turn leads to better patient care and outcomes. At a time when productivity, efficiency and addressing public satisfaction with the NHS are existential imperatives we cannot afford to side line equality, diversity and inclusion. It is not a 'nice to have', but mission critical.

NHS Providers was at the recent Seacole Group Annual Symposium, where trust leaders asked: What’s next for equality, diversity and inclusion (EDI)? In a climate of financial pressure and media scrutiny, the answer was clear: inclusive leadership leads to better decisions, better outcomes, and a fairer NHS.

Sir Julian Hartley, now chief executive of the CQC, offered a reminder that quality of care is inseparable from how we treat our people. The CQC’s own journey to embed an anti-racist, inclusive culture is rooted in a belief that psychological safety and trust in leadership are essential to effective regulation.

The event saw the launch of Roger Kline’s latest report, Not an Optional Extra, His case study on NHS England’s efforts to reduce disparities in disciplinary action shows that tackling racism benefits everyone, and targeted intervention to address the issue means fewer cases of both ethnic minority and white staff entering disciplinary processes, better overall staff experience, and significant resource savings.

With 45% of NHS budgets tied to workforce, we must continue to treat inclusion as a strategic investment, not a compliance exercise.

That means:

• Visible senior leadership support and commitment.
• A focus on translating values into evidence-based high impact actions.
• Clear board level accountability on progress.

If we want to build a resilient, high-performing NHS, we must lead with inclusion and continue to prioritise EDI as a strategic imperative. Not as a side agenda but as the core of how we deliver care, support our people, and earn the trust of the communities we serve.