Ethnic minority NHS staff who were born overseas face even greater discrimination than their UK-born colleagues, a new study reveals. This “double disadvantage” — shaped by both their ethnicity and migrant background — affects their pay and limits their chances for career growth.
The study, published in JRSM Open, utilized data from the UK-REACH project and analyzed the employment patterns of over 5,700 NHS healthcare workers under the Agenda for Change (AfC) pay scale. This scale includes a wide range of staff, such as nurses, midwives, and allied health professionals. Researchers found that even when adjusting for factors like education, role, and professional experience, overseas-born ethnic minority staff were less likely to reach the higher pay bands compared to white, UK-born workers.
Lead author Dr. Ji Soo Choi said this pattern is troubling, especially because the NHS does not routinely collect data on migration status. “Without acknowledging these differences, it’s impossible to address the inequality,” she warned.
The study also noted that although ethnic minority and migrant staff make up nearly 25% of the NHS workforce, they are severely underrepresented in higher-level roles. While over a third of ethnic minority staff are found in Band 5 roles, only about 10% are in leadership positions. This lack of diversity at the top means fewer people of migrant and ethnic minority backgrounds are influencing decisions about pay, work policies, and team leadership — factors that directly affect workplace satisfaction and retention.
Senior author Professor Manish Pareek added that migrant workers face challenges their non-migrant colleagues may not, including delays in recognizing international qualifications, fewer professional connections, and limited access to training. These hurdles compound inequality and make it harder for migrant staff to move up the career ladder.
The researchers are urging NHS policymakers to begin collecting migration data regularly and to design workforce policies that directly tackle the unique barriers faced by migrant healthcare workers. This could include easier recognition of overseas qualifications, more inclusive leadership development programs, and tailored support through mentoring.
As the NHS continues to struggle with staff shortages and burnout, the authors say that addressing inequality in the system is not just a matter of fairness — it’s key to keeping skilled workers in the system.
Why are migrant health workers less likely to get promoted in the NHS?
Migrant NHS workers often face challenges like unrecognized qualifications, lack of access to training, and smaller professional networks. These disadvantages, combined with existing ethnic biases, reduce their chances of reaching senior roles, despite having similar education and experience to UK-born staff.