The silence after the storm

Months have passed since the riots that many experienced as deeply Islamophobic. Yet for many NHS staff, the aftermath has been marked not by dialogue, but by silence. One colleague described arriving at work:

“I had to put on a smile for patients, but inside I felt invisible. No one asked how I was feeling. I was questioning my existence in this country.”

For ethnically diverse staff in the NHS, belonging cannot be assumed. When it is absent, the costs are profound: careers stall, confidence erodes, and patient care suffers.

Belonging is not a given

During Black History Month in October 2024, a small survey of staff network members revealed striking themes. While 81% reported a sense of belonging, nearly one in five did not. Half of Band 7–8 colleagues had experienced microaggressions. Those who felt unrecognised were also least supported when raising concerns. One participant put it bluntly:

“When my voice holds no value, I stop speaking. But I also stop dreaming of progressing.”

These voices are not isolated. The NHS Staff Survey consistently shows tens of thousands of colleagues report discrimination annually. Workforce Race Equality Standard (WRES) data confirm that Black and minority ethnic staff are less likely to be shortlisted for jobs and nearly twice as likely to face disciplinary action compared to white peers.

Cultural misunderstandings compound this. International and ethnically diverse colleagues are often subject to formal processes not out of malice, but misinterpretation. A direct tone shaped by dialect may be labelled “rude.” A pause before answering, rooted in cultural respect, may be seen as evasive. Instead of curiosity—“Is this how communication is expressed where you come from?”—the reflex is discipline. This isn’t just unfair; it tells staff their identity is a problem.

The weight of silence

As a Muslim member of staff, I have felt this silence keenly. After public Islamophobic incidents, which seem to be increasingly normalised, walking into work can feel like carrying grief alone. Colleagues often don’t know what to say—and too often, say nothing. But silence is not neutral. It communicates that our pain does not matter.

The consequences extend beyond morale. When staff do not feel safe, they step back. They stop applying for roles, hesitate to challenge unsafe practice, and retreat from leadership aspirations. For patients, this means empathy is replaced by task-driven care, questions go unasked, and development stalls.

Safety, silence, and patient care

The Improving Patient Safety Culture guide published by NHS England is clear:

“Team environments that promote inclusivity and psychological safety achieve the best patient safety outcomes.”

Research by West et al ( 2021) reinforces this link. Their analysis of NHS data shows that positive staff experience correlates with better patient satisfaction, lower infection rates, and even reduced mortality. Staff engagement—fostered through supportive management, inclusive teams, and meaningful appraisals—is a predictor of organisational performance.

Silence, then, is not just an HR issue. It is a patient safety risk.

We measure waiting times, infection rates, and hand hygiene because we know they matter. But what if we measured belonging with the same urgency? What if leaders were appraised not just on financial metrics, but on whether their teams felt safe, heard, and included?

Inclusion as a leadership imperative

Brimhall and Mor Barak (2018) found that fostering a climate of inclusion within health and social care organisations significantly enhances both innovation and job satisfaction. Their research demonstrated that inclusive leadership is directly linked to improved quality of care, highlighting the critical role leaders play in cultivating inclusive environments to support both staff and service outcomes.

Our survey showed that recognition, support, and progression are deeply connected. Those who felt unrecognised were least supported when raising concerns—and least likely to see a future for themselves.

“I see others promoted, but for me the door is always closed.”

Without cultures of belonging, career pathways narrow, diverse leadership pipelines dry up, and the NHS loses leaders whose lived experience reflects the communities we serve. Diverse leadership is not cosmetic—it improves cultural competence, patient trust, and outcomes.

Why do managers sometimes miss suffering in plain sight? Where is the compassion—the simple “are you OK?”—that signals value and belonging? Compassionate leadership is not a grand strategy; it is the everyday act of noticing, asking, and valuing.

Silence does not happen in a vacuum. It is sustained by leadership cultures that fails to see the everyday realities of minority staff. Removing a perpetrator may end an incident, but it does not heal the structure that allowed harm to persist.

Change begins when we rebuild connection. As Bevan and Fairman (2018/19) argue, leaders must build  “ bridging networks” through weak ties— the informal, cross-boundary ties that spark understanding and trust. When leaders reach beyond their familiar circles, invite difference, and amplify unheard voices, psychological safety has room to grow.

Roger Kline (2020) reminds us:

“Psychologically safe and inclusive teams are an antidote to the bullying rife in the NHS.”

His report,  Not an Optional Extra, makes the point plain: tackling workforce race discrimination is not a peripheral concern but a core patient-safety imperative. When belonging is treated as optional, safety itself is compromised.

From understanding to action

We know the subtleties of microaggressions matter. We know silence after racist or Islamophobic violence deepens trauma. We know exclusion harms staff and patients. The question is not whether we understand this. The question is whether we choose to act.

That means treating survey data as levers for change, not dashboards. It means making psychological safety and belonging as measurable as clinical outcomes. It means resourcing staff networks, creating safe spaces, and embedding accountability for inclusive behaviour. It also means challenging those who seek to divide us, rather than unite us.

So, the challenge for every leader is not only to listen, but to look honestly at their own teams and ask:

• If one in five of your team did not feel they belonged, would you even know?
• If you did, would you know what to do?
• And if you did, would you feel safe enough to act?

Author

Farheen Akhtar

Farheen is an Orthoptist and Project Facilitator in Greater Manchester, driven by a commitment to inclusive leadership, quality improvement, and anti-racism. As Deputy Chair of the Chief AHP Officer’s National BAME Strategic Advisory Group and Co-Chair of the Northwest AHP EDI Strategic Advisory Group, she works to amplify under-represented voices and build leadership cultures rooted in equity, compassion, and collaboration.

Declaration of interests

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.