There is a particular NHS conversation that is both familiar and unfinished. People say the right things, acknowledge inequity, speak of compassion—and yet something essential does not move. The language is there, but change is not.
Hosting Race and Health Matters, an eight-part series with the NHS Race and Health Observatory, left me thinking hard about that gap. Across conversations on pay, progression, bullying, governance and leadership, one message came through with striking consistency: the NHS is not short of awareness on workforce racism. It is short of consequence. That is, in fact, why the Observatory exists. Evidence does not implement itself, and the NHS has often been better at documenting inequity than interrupting it.
My conversation with Harvard professor David. R. Williams illuminated something crucial: these questions are about responsibility, not only injury. Workforce racism is too often discussed as individual prejudice or individual resilience. In reality, it sits at the junction of the personal and the structural. Iris Marion Young’s idea of structural responsibility is useful here—responsibility for unjust structures is shared, and people in different positions have different obligations to interrupt them. [1]
For me, this is not abstract. I grew up watching my father give forty years as an NHS surgeon, working harder and longer than white colleagues to be seen as legitimate, passed over for promotion while giving his life to the service. As a woman of colour myself, I know the quieter experience of entering a room fully qualified and feeling your authority weighed differently.
So what did the podcast teach me about leadership?
1. Listening alone is not action
Organisations can become very good at hearing painful truths while remaining poor at treating them as knowledge. Doyin Atewologun and Nabeela Kajee made this point sharply: lived experience is not merely testimony, but organisational intelligence. Miranda Fricker argues institutions wrong people not only through what they do, but by downgrading them as knowers causing epistemic injustice. [2] Some people are asked not only to endure inequality, but to prove its reality.
Listening can become an institutional comfort blanket. It signals care without requiring redesign. It acknowledges pain without redistributing opportunity. As I have argued elsewhere, listening without redistribution becomes institutional self-protection. The leadership question is not: have we heard this? It is: what will now be different?
2. Data matters—but only if it disrupts the system
Our episode on pay and progression with Carol Woodhams and John Appleby made clear that numbers are the residue of repeated decisions about who gets sponsored, developed, and recognised as leadership material.
The figures are stark. At 80% of NHS trusts, white applicants are significantly more likely to be appointed from shortlisting. Only 48.8% of BME staff felt their trust provided equal opportunities for progression, compared with 59.4% of white staff. BME board membership was 16.5%, while BME staff make up 28.6% of the workforce. NHS England’s mean ethnicity pay gap was 5.47%. [3,4] Yet these numbers become strangely inert. Deming and Berwick speak to this: measurement is meaningful only if it leads to redesign. [5] Otherwise, metrics become another language through which organisations appear serious without shifting power. A number becomes transformative only when someone is answerable for it.
3. Lived experience is organisational intelligence
Again and again, guests reminded me that lived experience is not anecdotal colour around “real” evidence. It is where the deepest truth about an institution becomes visible. People at the sharp end know which processes are formally available but informally unsafe. Sara Ahmed observes that organisations become skilled at receiving complaint, even sounding compassionate, while leaving arrangements untouched. [6]
My guests made this concrete. The medical resident praised as capable but never tapped for opportunity. The senior trainee asked to act up informally, without recognition that turns labour into progression. Behind every disparity is a sequence of missed recognitions—what sounds meritocratic is deeply patterned in practice.
4. Workforce equity is not separate from care quality
Workforce justice is not a side issue. Felicia Kwaku was especially clear: if the workforce is not highly valued, that will be reflected in care quality. A health service cannot ask people to practise care in environments that do not care for them.
If some staff are more likely to be overlooked, undermined, or blocked from progression, that affects morale, retention, psychological safety, and the moral atmosphere of work. The NHS cannot treat workforce racism as adjacent to performance. It is part of performance.
5. Future leaders are being shaped—or misshaped—today
Some of the most energising conversations were with younger voices. Students and early-career clinicians see institutions with unusual clarity because they have not yet naturalised their contradictions. Naabil Khan and Malone Mukwende made that vivid. Their interventions are about the hidden curriculum—what medicine centres, sidelines, and treats as normal. As bell hooks and Paulo Freire might put it, education can reproduce the world or help people change it. [7,8]
Future leaders are formed on placements, in teaching rooms, in handovers, in the everyday moral atmosphere of who gets interrupted, who gets encouraged, and what inequality is quietly normalised.
The Real Test
The question that stalks every conversation in this series is deceptively simple: what would a more historically honest, justice-oriented medical professionalism look like? One reflexive not only about patients, but about the institutions we work within and the hierarchies we reproduce? This podcast, at its best, felt like an example of that project in action.
This series is full of conversations NHS leaders need to hear. Not because they are easy, but because they are clarifying. Leadership on race inequity is not about saying the right things more eloquently. It is about making what we already know consequential. Perhaps that is the real test: not whether the NHS can hear the truth, but whether it is willing to be changed by it—refusing the comfort of pretending no one is answerable for patterns the institution keeps producing.
You can listen to Race and Health Matters on Apple Podcasts, Spotify or YouTube from June 23, 2026.
References
- Young IM. Responsibility for justice. Oxford: Oxford University Press; 2011.
- Fricker M. Epistemic injustice: power and the ethics of knowing. Oxford: Oxford University Press; 2007.
- NHS England. NHS Workforce Race Equality Standard (WRES) 2024 data analysis report for NHS trusts [Internet]. London: NHS England; 2025 [cited 2026 Jun 16]. Available from: NHS England website.
- NHS England. Diversity pay gap reporting 2024/25 for NHS England [Internet]. London: NHS England; 2026 Mar 24 [cited 2026 Jun 16]. Available from: https://www.england.nhs.uk/publication/diversity-pay-gap-reporting-2024-25-for-nhs-england/
- Deming WE. Out of the crisis. Cambridge (MA): MIT Press; 1986.
- Ahmed S. Complaint!. Durham (NC): Duke University Press; 2021.
- hooks b. Teaching to transgress: education as the practice of freedom. New York: Routledge; 1994.
- Freire P. Pedagogy of the oppressed. 30th anniversary ed. New York: Continuum; 2000.
Author
Guddi Singh
Guddi Singh is a consultant paediatrician and PhD candidate at King’s College London, researching leadership, health systems and justice. Her work focuses on how values, power and inequality shape care, and how clinicians can lead for more equitable, compassionate systems. She is co-founder of WHAM (the Wellbeing and Health Action Movement), which supports health professionals to act on the social determinants of health, and leads Powering Up, an HSJ Patient Safety Award finalist project. She was named a Global Top 30 Improver by the International Forum on Quality and Safety in Healthcare.
Declarations of Interest
I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: I am the host of Race and Health Matters.