Candid accounts of managers held back in their careers through prejudice and discrimination have been revealed in a confidential Department of Health investigation.

The study into barriers preventing NHS managers from gaining top leadership roles, carried out late last year, is based on interviews and group sessions with NHS staff in four regions: East Midlands, South Central, West Midlands and South East Coast.

One interviewee was asked by her senior manager during a heated discussion if she was “hormonal”

An overarching DH report says there has been some progress in improving access to top jobs but “real barriers exist with regards to progression at senior levels”.

Each region involved in the study published its own findings. NHS East Midlands reported “disturbing” evidence of prejudice faced by gay, lesbian and bisexual staff at one primary care trust.

Women at a hospital trust in the region said it was male dominated, particularly in medical management posts, with important informal discussions often taking place in men’s toilets.

One interviewee was asked by her senior manager during a heated discussion if she was “hormonal”.

NHS East Midlands assistant director of strategic leadership Peter Stewart said: “This report was always meant to be an open and candid exploration of the obstacles to equality and diversity in the region’s health economy.”

Like other SHAs, it is ensuring all NHS organisations have inclusive employment practices and behaviours.

In-depth interviews with 39 people working across the South East Coast region uncovered “barriers that had deep and enduring effects on some people’s work lives”, including an example of significant sexual harassment.

Another senior female manager said she had been encouraged by her male mentor to attend makeup classes and courses on how to dress well.

A spokeswoman said problems were being addressed in a new workforce strategy.

The sample was unrepresentative but provided “an honest reflection of their experiences throughout their careers”.

NHS South Central found many younger staff were enthusiastic about line managers and training opportunities but did not see the NHS as a long term career because it is “uncool” - bureaucratic, slow and old, with no perks.

SHA director of leadership Peter Lees said: “The recent NHS investment in the development of leadership is laudable and the benefits are increasingly being recognised.”

More than 3,000 alumni of an SHA-run leadership programme belong to “Generation Y”.

The recommendations of the final report, obtained using freedom of information legislation, include better data collection and the development of senior leadership talent pipelines.

They have been submitted to the National Leadership Council.

Talent and leadership plans were produced by each region in July this year, setting out how they intend to address diversity issues.