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The Health Innovation Network (HIN) South London aims to be an anti-racist organisation, helping to drive racial equity through a range of internal and external projects and initiatives.

Many other NHS organisations within the NHS are also on their own anti-racist journey. In this blog, HIN Chief Executive Dr Rishi Das-Gupta reflects on the recent publication by Milton Keynes University Hospital NHS Foundation Trust of a report on career progression for global majority staff, and its potential to galvanise real progress through acknowledging the ‘hard truths’ around racism that persist within the NHS.

In healthcare, we often talk about compassion, fairness, and doing the right thing. But sometimes, doing the right thing means facing uncomfortable truths – and acting upon them. That’s exactly what Milton Keynes University Hospital NHS Foundation Trust (MKUH) has done by commissioning a powerful report from Roger Kline on the recruitment and career progression of staff from the global majority.

The report, which is published within MKUH’s recent board papers, doesn’t just highlight problems at one specific trust. It holds up a mirror to the wider NHS. And, crucially, it gives us a chance to do better – not just for staff from the global majority, but for everyone working in our health system.

What the report found

The report shows that while MKUH has a diverse workforce – 42.6% of staff are from global majority backgrounds – this diversity isn’t reflected in senior roles. Many global majority staff feel they are overlooked for promotions, face subtle (and sometimes not-so-subtle) discrimination, and don’t get the same support or encouragement as their white colleagues.

Some staff described a culture of ‘nepotism’, where jobs seem to go to people who are already known or favoured by senior leaders. Others said they had given up applying for promotions because they felt their efforts wouldn’t be recognised. There were also concerns about how safe it feels to speak up, especially for internationally trained staff or those from minoritised groups.

These are not easy things to hear, but they are important.

Why this matters

This isn’t just about fairness. It’s about making the NHS better for everyone. When people feel valued, supported, and treated fairly, they do their best work. That means better care for patients, stronger teams, and a more resilient workforce.

The report also reminds us that these issues are not unique to MKUH. Across the NHS, we see similar patterns. Global majority staff are underrepresented in leadership. They are more likely to face disciplinary action. And they are less likely to feel they have equal opportunities to progress.

A brave first step

I want to commend the MKUH Board for demanding this report, highlighting the role that non-executives can play influencing culture. I’d also praise Joe Harrison, the Chief Executive of MKUH, for commissioning this report. It’s not easy for a leader to invite scrutiny of their own organisation. But it’s the right thing to do. And I also want to thank Roger Kline for his clear, evidence-based findings and Yvonne Coghill for her work and report preceding this.

But now comes the hard part: turning findings into action.

What needs to happen next

The report includes many practical recommendations. These include:

• Making recruitment and promotion processes more transparent;

• Creating a dashboard to track progress on diversity and inclusion;

• Supporting managers to have honest conversations about bias and career development;

• Ensuring all roles are advertised and fairly assessed;

• Giving staff the confidence to speak up when things aren’t right.

These are not just ‘nice to haves’. They are essential if we want to build a fair and effective NHS with engaged staff. We know through our own journey towards being an anti-racist organisation that the scrutiny and changes needed can feel uncomfortable, but that ultimately result in a stronger organisation. I’d thank our own Board for the support that they have given us during this journey. I would highlight the need for prompt action calling out the problem. The January Board papers for MKUH highlighted that the issues had been extensively discussed by Board in a private session and that this would move to ‘Values based recruiting’, which misses the opportunity to inspire confidence in staff based on what outcomes we expect to change.

A call to action

I’d love to see MKUH lead the way. They can do this by sharing what works, what doesn’t, and what they learn along the way. I’d also like to see the Health Service Journal (HSJ) and other media platforms continue to follow this story, report on how the Board and senior team respond, and return to it in future. We need to keep the spotlight on this work.

There is a real opportunity here. The ‘hard truths’ in this report can be the foundation for positive change. But there’s also a risk. As the NHS goes through reorganisation, we must not fall back into old habits—like quietly finding roles for people with the right connections, in the name of cost-saving or avoiding redundancy.

We must make sure that:

• All roles are advertised;

• Selection is fair and open;

• We ask tough questions when certain groups are underrepresented.

• We use the answers to shape how we support and develop all our staff.

Final thoughts

This report is a wake-up call. But it’s also a roadmap. It shows us where we are falling short, and how we can do better.

Let’s not waste this moment. Let’s use it to build a more inclusive, supportive, and effective NHS. One where everyone – regardless of background – has the chance to thrive.

If you haven’t read the summary yet, I encourage you to do so. And if you’re in a leadership role, ask yourself: what can I do, today, to make things fairer for the people I lead?

Because change doesn’t start with a report. It starts with us.