Press release

Better appointment processes key to increasing diversity among NHS non-executive directors

A new report explores the steps needed to strengthen the diversity of NHS boards in England.

16 June 2021

An independent taskforce asked to examine the diversity of healthcare leadership has said that NHS organisations can create a "sustainable pipeline" of senior leaders that properly reflect the diversity of their staff and communities by refreshing their processes for appointing chairs and non-executive directors (NEDs).

The taskforce, commissioned by NHS England and Improvement and led by the NHS Confederation, has published its report, Strengthening NHS board diversity, as part of the membership body’s annual conference, to improve diversity of NHS chairs and other NEDs.

The report, based on the feedback of taskforce members including NHS chairs, NEDs and chief executives, found that while there are pockets of innovation, the current NHS appointment process for NEDs would benefit from a standard, more transparent procedure.

Other key recommendations from the taskforce include:

  • The requirement for NHS organisations to consider how to make board roles more attractive.
  • The suggestion of a new "compact" between the NHS and executive search firms (ESFs) setting out expectations on behaviours, data collection and a set targets for underrepresented groups who are shortlisted and appointed.
  • Improved succession planning for NHS boards and their ESFs to build links and seek alternative networks to help build up databases of candidates from underrepresented groups.

Figures published in 2020 in Professor Ruth Sealy’s report, Action for equality: The time is now, for the NHS Confederation’s Health and Care Women Leaders Network, show that the percentage of women holding NED and chair roles is 41 and 37 per cent respectively, and for people that disclose their ethnicity as BME, that figure drops to 10 and 5 per cent, respectively.

Figures from NHS England and NHS Improvement (NHSEI) published in May also show a lack of diversity on the boards of integrated care systems (ICSs), with just 14 women and five people from an ethnic minority background in chair positions. And according to the 2019 NHS Workforce Race Equality Standard report, there were 146 NEDs from ethnic minority backgrounds on NHS trust boards, although NHSEI signal that there have been improvements in this figure since then.


Commenting on the report, Joan Saddler, director of partnerships and equality at the NHS Confederation, said: “If COVID-19 has taught us anything about leadership, it is that it is key to have diverse leaders and we need many more of them. While there has already been progress in this area, more needs to be done to ensure that there is an independent process for the recruitment of NEDs and chairs onto the boards of NHS organisations.

“The recruitment process needs to be overhauled and a range of interventions are now required in order to fast-track the numbers of diverse NEDs and chairs working in the health service.”

In a foreword to the report, Prerana Issar, the NHS’s chief people officer, has confirmed that NHSEI will continue its work to ensure that NHS board recruitment and search strategies reach into the local communities they serve, and that the recruitment process will be more transparent.

Also, NHSEI has said guidance on succession planning will be introduced to help chairs review boards' skill and diversity mix and inform future recruitment. NHSEI will also provide NHS organisations with a common set of job descriptions and competencies for the recruitment and development of non-executives.


Commenting on the report findings, Prerana Issar, NHSEI chief people officer, said: “I fully support the task force’s recommendations and commissioned this report because I strongly believe that more representative healthcare leadership results in a better experience for both NHS staff and patients.


“To deliver on the ambition of fairness and equality in healthcare, set out in the NHS People Plan, we must continue to build on the excellent work already underway to ensure our recruitment strategies reach the communities we serve and are more inclusive and transparent, which will mean colleagues from more diverse backgrounds are fairly represented at all levels of our NHS.”

About us

The members we represent employ 1.5 million staff, care for more than 1 million patients a day and control £150 billion of public expenditure. We promote collaboration and partnership working as the key to improving population health, delivering high-quality care and reducing health inequalities.