The first NHS targets for reducing the disproportionate share of black and minority ethnic staff being subject to disciplinary cases have been set by NHS England, which has also told trusts to reduce unnecessary disciplinary action overall.

The target was set in a document published by NHS England and Improvement today, A fair experience for all, alongside a letter to human resources directors from NHSE/I chief people officer Prerana Issar

She said: “I am sure you will agree that it is not acceptable that if you come from some backgrounds, you are more likely to enter the formal disciplinary process, stay in it longer and have more career limiting outcomes. We must change this and quickly.”

The document sets targets to reduce the gap in the likelihood of entry into the disciplinary process between BME and white staff across NHS trusts, clinical commissioning groups and NHS arm’s-length bodies.

In 2018, the ratio between the share of BME trust staff who were in disciplinary cases, and the share of white staff in disciplinary cases, was 1.24 – down from 1.56 in 2016, according to the document. 

Just 23.8 per cent of trusts fell within the recommended acceptable range of a ratio of 0.8–1.25, with BME staff at 135 trusts having a relative likelihood of more than 1.25, and having a relative likelihood less than 0.8 at 41 trusts. 

The targets, referred to as a “stretching and year achievable aspiration”, are for 51 per cent of trusts to fall within the “non-adverse” likelihood ratio in 2020, 76 per cent in 2021, and 90 per cent in 2022.

Calculations will be adjusted to account for trusts with very small numbers of disciplinaries.

The likelihood of entering formal disciplinaries is already a measure under the NHSE workforce race equality standard target, but this did not have specific targets attached to it.

Meanwhile, the document said each trust should pursue two goals: to reduce the likelihood ratio above; and “to reduce the overall likelihood and number of staff entering the formal disciplinary process for both white and BME staff”.

The document read: “We know that workforce race equality requires organisations to go beyond operational change because of compliance and regulation against processes and targets. Whilst these features are critical, the parallel challenge here is that of cultural and transformational change on this agenda.

“It is essential that every leader at every level of the organisation ensures they promote and model both compassion and inclusion in all their interactions. Only then will everyone who works in, and uses, health services see that these values are the lived genetic structure of the NHS.”


Figures in the document, covering trusts in 2018, show BME to white disciplinary likelihood ratios by sector as: Community providers - 2.7, ambulance - 1.74, mental health - 1.69, and acute - 1.14.

Regionally they were: London - 1.77, North - 1.36, Midlands and East - 1.18, and South - 1.12.

From the 2018 figures, these were the 10 trusts with the largest likelihood ratios: 

Org nameLikelihood of BME staff entering formal disciplinary process cf white staff:
North Staffordshire Combined Healthcare Trust 10.52
Hertfordshire Community Trust 7.25
Surrey and Borders Partnership Foundation Trust 5.13
Barnet, Enfield and Haringey Mental Health Trust 5.10
Hounslow and Richmond Community Healthcare Trust 4.58
Pennine Care Foundation Trust 4.52
Cornwall Partnership Foundation Trust 4.29
South West London and St George’s Mental Health Trust 3.84
South London and Maudsley Foundation Trust 3.79
Oxleas Foundation Trust 3.66

These were the 10 chiefly acute trusts with the largest ratios: 

Org nameLikelihood of BME staff entering formal disciplinary process cf white staff:
Hampshire Hospitals Foundation Trust 3.58
South Tees Hospitals Foundation Trust 3.19
University Hospitals Bristol Foundation Trust 3.16
Lewisham and Greenwich Trust 3.09
Queen Victoria Hospital Foundation Trust 3.05
Countess of Chester Hospital Foundation Trust 3.04
Wye Valley Trust 2.84
Great Ormond Street Hospital for Children Foundation Trust 2.77
The Christie Foundation Trust 2.73
East Suffolk and North Essex Foundation Trust 2.56