Ethnic minority healthcare professionals who were born outside the United Kingdom encounter a compounded set of challenges that significantly hamper their career advancement within the National Health Service (NHS). This emerging insight arises from a rigorous analysis of data from the UK-REACH cohort study, a large-scale investigation dedicated to understanding the intersection of ethnicity, migration status, and professional outcomes among healthcare workers. Intriguingly, while ethnicity has long been considered a critical factor influencing workforce dynamics, the role of migration status—and its interaction with ethnicity—has seldom been examined with the granularity warranted by these findings.
The UK-REACH study comprises over 5,700 healthcare professionals employed across different NHS roles, all remunerated under the Agenda for Change (AfC) pay system. This pay scale uniformly governs the wages of a broad swath of clinical staff, including nurses, midwives, and allied health professionals. Importantly, the study employed sophisticated statistical adjustments to control for confounders such as educational attainment, professional role, and years since qualification. Even after these adjustments, overseas-born healthcare workers were demonstrably less likely to be appointed to higher AfC pay bands compared to their UK-born peers. This disparity was particularly pronounced among Asian and Black healthcare workers, whose pathway to senior pay grades was notably obstructed.
Such findings reveal that migration status is an underappreciated yet pivotal dimension influencing career trajectories within the NHS. Migration status data is typically not collected in routine HR databases, which leads to its underrepresentation in workforce analyses. The invisibility of this factor inherently limits the NHS’s capacity to identify and mitigate structural disadvantages experienced by overseas-born staff. As Dr. Ji Soo Choi, the lead author of the study, elucidates, acknowledging and recording migration status is foundational to any meaningful intervention aimed at redressing career disparities within healthcare professions.
Ethnic minority healthcare workers constitute nearly 25% of the entire NHS staff population, a testament to the NHS’s historically broad recruitment from diverse demographic pools. Despite their numbers, these workers remain conspicuously underrepresented in senior positions. The phenomenon impairs not just individual career satisfaction and economic reward but has wider implications for workforce diversity at decision-making levels. This systemic underrepresentation hints at entrenched barriers that extend beyond ethnicity alone, suggesting that factors linked to international migration exacerbate inequalities faced by minority staff.
Migrant healthcare workers confront several unique challenges that differentiate their professional experiences from non-migrant ethnic colleagues. Recognition of overseas qualifications poses a substantial obstacle, often resulting in protracted validation processes and, consequently, delayed career progression. Additionally, migrant workers frequently suffer from limited access to established professional networks within the NHS, which are crucial for mentorship opportunities, informal knowledge exchange, and visibility in promotion pathways. Compounding these issues is the restricted availability of tailored training and leadership development programs accessible to migrant staff, which further entrenches disparities in career advancement.
The study’s revelations underscore the critical importance of incorporating migration status data into routine workforce records. Without this dimension, research and policy expenditures risk foundational oversights, potentially perpetuating systemic inequities. Inclusion of migration data would empower more nuanced workforce analyses, facilitate targeted interventions, and support evidence-based policymaking designed to foster equity in career outcomes. The authors advocate for institutional reforms that will enable comprehensive tracking of migration-related variables alongside ethnicity and other demographic indicators.
Equally concerning is the precipitous decline in ethnic minority representation as NHS staff ascend the AfC pay bands. While they comprise over one-third of employees at the entry-level pay band 5, their proportion dwindles dramatically in senior roles to around 10%. Senior author Professor Manish Pareek highlights that this attrition in diversity at leadership levels constrains the influence minority professionals have over critical operational decisions involving compensation, scheduling, and workplace policy formulation. This power imbalance may, paradoxically, exacerbate challenges in cultivating a genuinely inclusive and supportive work environment.
The implications of limited diversity in leadership are profound. A leadership cadre that lacks adequate representation risks inadvertently perpetuating systemic biases and may be less responsive to the unique needs of ethnic minority and migrant staff. This dynamic could foster a workplace culture where disparities in pay, training access, and advancement are normalized or go unchallenged. The resultant dissatisfaction and marginalization contribute to elevated attrition rates among ethnic minorities, compounding the NHS’s existing staffing shortages and workforce instability.
Addressing these complex, multilayered challenges requires nuanced and multifaceted policy solutions. The research team urges NHS policymakers to devise workforce strategies that explicitly target the distinct barriers facing migrant healthcare workers. These strategies might include streamlined processes for international credential recognition, enhanced access to mentoring and leadership development programs tailored to migrant staff, and improved facilitation of professional networking opportunities. Such interventions would not only promote equity but also harness the full potential of a diverse healthcare workforce, thereby enhancing patient care outcomes.
The study also invites a broader reflection on the social and institutional determinants that shape career trajectories in the health sector. By spotlighting the intersectionality of ethnicity and migration status, it challenges the prevailing monolithic approaches to workforce equity. The research points to the necessity of adopting intersectional frameworks that more accurately capture the lived realities of minority healthcare workers, reflecting the confluence of race, nationality, and migration in shaping professional experiences.
From a methodological perspective, the robustness of the UK-REACH data and its comprehensive approach underscore the value of longitudinal, large-cohort studies in untangling complex socio-professional phenomena. Future research will benefit from integrating qualitative analyses, capturing lived experiences to complement the quantitative data and generate holistic insights into workplace disparities. It will also be imperative to extend analyses beyond career progression to explore how these inequities impact job satisfaction, mental health, and retention patterns among migrant healthcare workers.
Ultimately, this groundbreaking study serves as a clarion call for the NHS and allied healthcare systems worldwide to reevaluate workforce data collection practices, refine equity policies, and foster inclusive career development environments. By prioritizing the collection and analysis of migration status alongside ethnicity, the NHS can take critical steps toward dismantling barriers and cultivating a more equitable, effective, and representative healthcare workforce for the future.
Subject of Research:
The role of ethnicity and migration status in determining NHS healthcare workers’ career progression, specifically in relation to Agenda for Change pay bands.
Article Title:
The association of ethnicity and migration status with agenda for change pay band in National Health Service healthcare workers: Results from the United Kingdom Research study into Ethnicity and Coronavirus Disease 2019 (COVID-19) Outcomes in Healthcare workers (UK-REACH)
News Publication Date:
19-May-2025
Web References:
http://dx.doi.org/10.1177/20542704251330157
Keywords:
Caregivers, Medical economics, Nursing, Health equity, Health care costs
