Beyond mandatory training: why Race and Health Matters should be required listening across the NHS

We have all sat through mandatory training that is formally correct but practically weightless. The slides are careful, the language current. Someone says ​“inclusion”, another says ​“belonging”. We tick the box. And yet nothing in the room feels rearranged.

I felt that deadness myself. Years ago, fidgeting in my seat, I realised that the diversity training I had signed up to was unlikely to help me become the kind of doctor – or person – I aspired to be. Too much EDI work remains anxious where it needs to be braver, bloodless where it needs to be more human, and individualised where it needs to be structural. 

I call this whitewashing diversity. Another box ticked. Another training completion rate to report upward. But who cares if 95% of staff have sat through training if little changes in the work itself?

That is why Race and Health Matters, the new podcast I host from the NHS Race and Health Observatory, feels so important. It does not offer a more polished version of the same script. It offers something rarer: a way of thinking and talking about race that is serious enough to help people act.

As I argued in the BMJ Leader[ref] Singh G. Five leadership lessons from hosting a podcast on race inequality in the NHS workforce. BMJ Leader, 2026 [/​ref], the NHS does not lack evidence – it lacks consequence.

The latest Workforce Race Equality Standard data are stark:[ref]NHS England. NHS Workforce Race Equality Standard (WRES) 2024 data analysis report for NHS trusts. London: NHS England; 2025. [/​ref] 

• At 80% of NHS trusts, white applicants were significantly more likely than Black and minority ethnic applicants to be appointed from shortlisting. 
• Only 48.8% of Black and minority ethnic staff felt their trust offered equal opportunities for progression, compared with 59.4% of white staff. 
• Black and minority ethnic staff make up 28.6% of the workforce, but only 16.5% of board members. 
• 27.8% reported harassment, bullying or abuse from patients or the public, compared with 24.1% of white staff.

Those are not marginal differences. They are a description of an institution still failing many of the people it relies on.

And yet this is precisely where so much NHS race work loses its force. We know it, note it and move on. We produce the report, the action plan. Repeated description of the problem starts to function as an institutional alibi. Awareness gets mistaken for progress. But the cost is not abstract; it is felt in eroded trust, lost talent, moral injury, and poorer cultures of care.

I have spent years trying to understand how race can be biologically empty and socially devastating at the same time. We have known for decades that race has no meaningful genetic basis.[ref]Duello TM, Rivedal S, Wickland C, Weller A. Race and genetics versus ​“race” in genetics: a systematic review of the use of African ancestry in genetic studies. BMC Med Ethics. 2021;22:129[/ref][ref]Collins FS, Mansoura MK. The Human Genome Project. Revealing the shared inheritance of all humankind. Cancer. 2001;91(1 Suppl):221–225[/ref] But it shapes housing, employment, exposure, opportunity, safety and health all the same.

During the pandemic, I helped write and appeared in Why Is Covid Killing People of Colour? with David Harewood.[ref]Why Is Covid Killing People of Colour? BBC One, 2021 [/​ref] It gave visibility to a truth that medicine still struggles to hold in view: race is not a biological essence, but racism has biological, social and institutional consequences. We can call race a fiction and still watch its effects take years off people’s lives.

This is also why the usual EDI script feels so thin. If race is still treated as peripheral to the serious business of healthcare, then we are still not understanding the institution we are working in.

A lot of NHS training still amounts to taught niceness: be respectful, be aware. But niceness is not enough to deal with the brutality that occurs in racism’s name every day. It is not enough for the doctor repeatedly mistaken for the nurse. The nurse repeatedly passed over for promotion. The trainee who learns that speaking up will cost more than staying silent.

The evidence on stand-alone anti-bias training is not reassuring. A widely cited review in Harvard Business Review, drawing on data from 829 firms over three decades, found that many standard diversity tools – especially when used as compliance mechanisms – do little to change behaviour and can even provoke backlash. [ref]Dobbin F, Kalev A. Why diversity programs fail. Harvard Business Review. 2016 Jul-Aug [/​ref] The Equality and Human Rights Commission’s review found the evidence for lasting effectiveness is limited and warned against treating it as a silver bullet.[ref]Atewologun D, Cornish T, Tresh F. Unconscious bias training: an assessment of the evidence for effectiveness. Manchester: Equality and Human Rights Commission; 2018 [/​ref] Mechanistic, tick-box training does not change culture simply by existing.

What does help is accountability, deterrence and HR policies with teeth. Complaint systems people actually trust. Leadership willing to hold up the light to difficult cases. The courage to absorb discomfort and let learning alter what is rewarded, tolerated and defended.[ref]US Equal Employment Opportunity Commission. Select Task Force on the Study of Harassment in the Workplace; Promising practices for preventing harassment. [/​ref]

In other words: not just talk, but consequence.

That is where Race and Health Matters comes in. The episode on lived experience and the ethnicity pay and progression gap, asks a question many institutions still avoid: what does the gap actually feel like from the inside? What does repeated under-reading do to confidence and aspiration? What happens when organisations favour metrics over meaning?

The series does not treat lived experience as anecdotal colour around the edges of ​“real” evidence. It treats it as knowledge, as organisational intelligence. A route into truths that the spreadsheet alone cannot reach. 

Statistics can tell us where inequalities exist, but not why they persist, how they are encountered, or which ordinary decisions keep feeding them. That is not a minor methodological point – it is a moral one. It raises the question of whose perspective gets treated as serious enough to disturb the institution’s sense of itself.

One of the things I value most about the series is that it helps hold a line many NHS race conversations still struggle with.

On the one hand, we reduce everything to individual behaviour: bad actors, bias, poor choices. On the other, we invoke ​“the system” in such abstract terms that nobody feels answerable. Both moves let us down. 

What we need instead is a way of thinking about responsibility that is shared, differentiated and practical. That, in part, is what my own PhD is trying to think through: what health professionals owe in the face of social injustice, and how to hold onto agency without collapsing into blame or fatalism.

Iris Marion Young’s writing on structural injustice has been especially helpful here.[ref]Young IM. Responsibility for justice. Oxford: Oxford University Press; 2011. [/​ref] The point is not to hunt for a single villain, nor to dissolve responsibility into fog. It is to recognise that unjust patterns are reproduced through ordinary actions and institutional habits, and that people in different positions have different responsibilities to interrupt them.

That is much more demanding than ​“be nicer”. But it is also much more useful.

For Q members, Race and Health Matters is essential listening because improvement is not only about tools and methods. It is about power, implementation, culture and consequence. 

The podcast connects race inequity to the questions people working in improvement already care about: how evidence becomes action, why change stalls, what accountability looks like, and what it means to redesign a system rather than merely describe it.

If a podcast is doing more than mandatory training does to help the NHS think honestly and act seriously on race, that should trouble us. It should also make us listen. Because these conversations should not remain optional extras for the already converted. They belong much closer to the centre of how the NHS learns, leads and improves.

The conditions in which people can feel safe at work do not appear by accident. We either create them or we fail to. If we already know enough to be alarmed, then the question is no longer whether we understand the problem. It is whether we are willing to act as though that understanding demands change.