Racism and sexism are “alarmingly normalised” within the structures and person-to-person interactions across the NHS, and the NHS has delayed acknowledging and learning from the evidence, says a report from the BMJ Commission on the Future of the NHS , published in The BMJ today.
There is an ethical imperative for the government and NHS institutions to act now, it concludes.
On a wider scale, discrimination and inequities related to protected characteristics, such as race and ethnicity, sex and gender, age, disability, sexuality, religion and belief have a major impact on the health of the public the NHS serves—and on staff wellbeing—says the report.
Discrimination and inequities contribute to increased risk of physical and mental health conditions, limit access to care, shape negative experiences of illness and encounters with services, and lead to worse overall health outcomes, including mortality, it highlights.
As well as having a major impact on population health, discrimination and inequity also have huge financial consequences for the UK economy. Every year health inequity leads to productivity losses of £31-£33bn, lost taxes, and increased welfare payments of £20-£32bn, as well as direct healthcare costs of at least £5.5bn, it points out.
After reviewing the evidence, the report makes recommendations for the UK government, healthcare leaders, the Care Quality Commission (CQC) and equivalent regulators, and the NHS on tackling discrimination and inequities across the NHS to enhance the experience of patients and staff and improve health outcomes.
For the UK government:
For the Care Quality Commission (CQC) and equivalent regulators :
For the NHS:
For healthcare leaders:
The six expert authors conclude: “NHS leaders and the public must recognise that prioritising health equity is a proved strategic investment that leads to good patient outcomes, and better retention and recruitment rates of staff. It is also an ethical and legal imperative.”
Equity in healthcare is about acknowledging that different needs require different responses with varying resources, and that inequity involves multiple characteristics in many cases. Services should be codesigned with those who struggle the most to access care and have the poorest outcomes to reduce inequality in health outcomes, they argue.
They add: “Inaction represents an unacceptable choice that increases harms to patients and costs in terms of increased staff absences, sickness, resignations, and reduced productivity.
“The evidence and policy options are abundantly clear. Political and institutional leaders must urgently choose to prioritise the elimination of these avoidable, unhealthy, and costly injustices, or face the consequences of a disaffected NHS workforce, and widening inequalities in health outcomes in the general population.
“The recommendations we make, if implemented, will go a long way to make the NHS a happier and healthier place.”
The BMJ
Commentary/editorial
People
NHS must tackle racism and sexism for the benefit of patients, staff, and society
1-Jul-2025
We have read and understood BMJ policy on declaration of interests and have the following interests to declare: CN and YC are board members of the Race and Health Observatory and JSB isco-chair of its mental health advisory group. KW receivesfunding from the Wellcome Trust.