Corporate publication

Commit, understand, act: our anti-racism strategy

Supporting healthcare organisations to eliminate racism and reduce health inequalities through commitment, understanding and action.

22 November 2022


Anti-racism is more than a statement for us at the NHS Confederation. Being an anti-racist organisation means that we actively target, challenge and remove systemic barriers that enable racism, recognising this as a corporate responsibility. For us, commitment, understanding and action to eliminate racism and reduce health inequalities really matters.

  • Commitment matters – because for years we have lacked concerted action to diversify the leadership needed to assist in creating anti-racist organisations.
  • Understanding matters – because evidence informs the personal and organisational leadership and accountability required to eliminate racism.
  • Action matters – because commitment and understanding are meaningless if we fail to act.

Our strategy, detailed in the pages that follow, will be implemented across the NHS Confederation. It will be targeted and regularly evaluated. Delivering the strategy will not be an easy process, but we can do no less if we are serious about healthcare leaders, and us as their membership body, being actively anti-racist.

In a time of increasing inequality, thrown into sharp focus by the unequal impact of COVID-19 on black and minority ethnic communities and the global Black Lives Matter protests, it is imperative that we as the NHS Confederation lead the agenda and support our members to tackle inequality and racism. Tackling racism - including institutional and systemic racism - is key to better governance, service transformation, workforce retention and delivering our Public Sector Equality Duty. Anti-racist practice improves conditions for all communities.

With a diverse and committed body of executive and non-executive healthcare leaders, we can tackle racism that facilitates health inequity. It’s time to commit, understand and act.

Matthew Taylor and Joan Saddler headshot

Matthew Taylor                                                         Joan Saddler OBE
Chief Executive                                                         
Director of Partnerships and Equality
NHS Confederation                                                  NHS Confederation

Our approach

We are committed to driving action to tackle racism and are working with organisations across our membership to confront these issues. We recognise, however, that commitment and action must start at home, with our staff empowered to speak up and tackle racism as core and central to their roles.

Our strategy - centred on commitment, understanding and action - applies equally to us as it does to our work on behalf of members and our support to them. Tackling racism systematically improves care quality and organisational cultures for all.

This document explores how we will support our members to be anti-racist organisations and systems.

Our strategy reflects an asset- and evidence-based approach, demystifying racism, tackling racism in the workforce and supporting members to focus on reducing health inequalities.

While acknowledging that racism has a personal dimension, our approach rejects the proposition that institutional racism can be addressed through individual solutions. Rather, our ‘commit, understand and act’ approach supports both us and our members to address structural change.

Our approach is consistent with the NHS Constitution’s principles of respect and dignity, and the Human Rights Act. It is aligned with the Marmot report’s analysis that, traditionally, government policies have focused resources only on some segments of society, whereas to improve health for all of us and to reduce unfair and unjust inequalities in health, action is needed across the social gradient.

Moreover, it is consistent with our member-led equality, diversity and inclusion (EDI) programme’s objectives of supporting improved diversity in NHS leadership, increased community engagement and improving robust accountability processes, ensuring that EDI counts. 

It also aligns with our commitment to tackle racism and broader inequality as intrinsic to all our work – from elective backlogs to mental health, to place working through to anchor institutions and beyond. The NHS plays a vital role in enabling social justice both as an employer and as a public service.

Being on the receiving end of racist behaviour or institutionally racist policies is hurtful and can have long-term damaging effects. [1] Research shows that poor morale and engagement among NHS staff have an impact on the quality of patient care. [2] This suggests that tackling equality and inclusion issues for staff will benefit patients too; it should improve patient care and help the NHS, at least in part, to address its workforce crisis. [3] 

"Race is a function of racism. Racism is an action."*

*Taken from our response to the Commission on Race and Ethnic Disparities' report into racial and ethnic disparities in the UK and Fields K & Fields B, (2014) Racecraft: The Soul of Inequality in American Life.

We are using the term BME/BAME as a political descriptor of the experiences of the range of people from racialised communities. The NHS Race and Health Observatory’s Power of Language report points to the need for an ongoing conversation on this issue.

Our support for members

We are currently using our three-stage approach to support members to commit, understand and act to tackle racism across the workforce and with people using services. We will continue to build on this approach as we develop our support to members further. 

Responsibility for actively driving anti-racism across the NHS Confederation does not only rest with our chief executive and chair. The chairs of our networks and directors all have a role in implementing and measuring the actions in the strategy, along with further member support. Communicating our work well will be an important step in turning our anti-racism commitment into tangible actions.

1. Commit

Commit to inclusive leaders leading anti-racist organisations focused on reducing health inequalities. Realise targeted increases in the number of black and minority ethnic leaders from racialised communities and target action towards tackling inequality in access, experience and outcomes.

    • Join our ICS diverse boards recruitment improvement programme for NHS chairs and chief executives. Delivering independent support for integrated care system (ICS) recruitment processes with our ICS Network. A programme shaped by members with particular emphasis on race equality and delivering Workforce Race Equality Standard (WRES) Model Employer outcomes.
    • For further information about this EDI programme support package, please contact Miranda Seed.
    • Access bespoke chief executive / chair 1-1 advisory support on approaches to tackling racism and developing organisational strategies.
    • For further information about this support package, please contact Carol Hill.
    • Join our Leadership Framework for Healthcare Inequalities Improvement programme (LFHII) offering members:
      • Health inequalities seminars supporting development of mandated health inequalities plans, also targeting work with black and minority ethnic communities.
      • Access to our leadership framework for health improvement resources platform.
    • Access our BME Leadership Network support for black and minority ethnic leaders, offering: 
      • Annual senior leaders roundtable, survey and publication.
      • Annual race equality report and Diverse Innovation Award with the Academic Health Science Network celebrating leadership of race equity initiatives.
      • Group peer mentoring programme.
      • Three national networking and profiling opportunities supporting system retention and network member development.
      • Peer platform and skills development for members leading local BME/BAME networks.  
      • Annual Black History Month Lecture and programme.
    • For further information about this support package, please contact Miranda Seed.
    • Access information about our tailormade ICS recruitment programme, targeting increases in black and minority ethnic leaders at board level and throughout the leadership pipeline. 
    • Find out about our BME Leadership Network coaching and bespoke organisational consulting service, supporting delivery of WRES outcomes.

2. Understand

Understand the personal and organisational leadership and accountability it will take to tackle racism, using data and insight to also help drive change.

    • Members can access seminal research, support and information from the independent NHS Race and Health Observatory (RHO), hosted by the NHS Confederation. Its global partnership with the US Centre for Disease Control offers members additional expert resources tackling racism and discrimination in health.
      • It supports, where appropriate, aspirations in these areas as outlined in national healthcare policies, including the NHS Long Term Plan. 
      • Since inception in 2021, the observatory already has proven experience as  a dynamic body providing evidence-based, actionable recommendations that can be adopted by policy makers and which will support and comment on the implications of those actions. 
      • Key areas of the observatory’s function are to: 1) Catalyse and facilitate high-quality, innovative evidence to develop meaningful insight; 2) Develop and embed evidence-based insight into actionable recommendations for change; 3) Support the implementation of recommendations and share good practice to facilitate change in the NHS.
    • Access support to understand and deliver the revised annual EDI accountability and reporting system, which is called the NHS Equality Delivery System 2022-23 – also linked to WRES reporting. Information is available for members and EDI leads through our BME Leadership Network and our Diversity in Health and Care Partners Programme, which is also supported by NHS Employers.
    • For further information about the NHS Equality Delivery System 2022-23 please contact Carol Hill.
    • Learn about population health as an approach that recognises racism as a public health issue and its negative impacts that increase systemic health inequalities. Health inequities are linked to structural racism reflecting poor outcomes for underserved communities. Access our population health case studies.
    • Access resources from our NHS England Chief Nursing Officer partnership project tackling anti-racist practice in nursing and midwifery. Register for the NHS Futures platform (CNO) to access: 
      • the first UK anti-racist nursing and midwifery practice guide for frontline staff and leaders
      • a seminal anti-racism literature review and summary led by our NHS Confederation partnership with King’s College, NHS England and the Nursing and Midwifery Council.
    • Access information about our BME Leadership Network bespoke organisational consulting and coaching service supporting adoption and roll-out of the anti-racism in nursing and midwifery practice guide.
    • For further information about this support package, please contact Carol Hill.

3. Act

Act by setting smart leadership led, engagement targets in partnership with racialised communities of NHS staff and patients to reform power structures and systems that enable racist practices, impacting communities. This supports our commitment to tackling racism and broader inequality as intrinsic to all our work supporting members, underpinning wider NHS transformation as detailed in the NHS Long Term Plan. 

    • Access our Leadership Framework for Healthcare Inequalities Improvement programme, supporting members to develop and achieve smart, leadership led, engagement targets with racialised communities, to change services at scale. Working with the NHSEI CORE20PLUS5 team to monitor and showcase progress.
    • Learn about our policy group of race equity leads working with our Mental Health Network . Also working with experts by experience to influence policy and practical change.
    • Access our Health and Care Women Leaders Network and Health and Care LGBTQ+ Leaders Network, supporting Black and Minority Ethnic networks and publications highlighting racism and intersectionality.
    • Learn about population health as an approach that aims to reduce health inequalities and promote physical and mental health and wellbeing. This is a priority area of focus for the NHS Confederation where we support members’ improvement as they plan and implement their own strategies tackling discrimination and racism across their workforce and communities.
    • Learn about the work of the Welsh NHS Confederation, supporting development and consequent member implementation of the Welsh Government’s Race Equality Action Plan that draws on lived experiences of racism and has been constructed with black, Asian and miinority ethnic researchers and communities. 
    • Connect with the Northern Ireland Confederation for Health and Social Care initiative supporting increased numbers of black and minority ethnic non-executive appointments. 
    • Access our Primary Care Network member hub featuring specific reports on anti-racism in primary care and help us develop our anti-racism member offer.
    • Find out about our enhanced community engagement offer for members that are ready to co-produce services at scale with and on behalf of local people and communities, particularly focusing on anchor institutions and combating racism through employment and wellbeing.
    • Email us to find out more.

Executive leadership of our anti-racism strategy is underpinned by our executive directors, accountable for the areas of work mentioned in this strategy, both corporately and for our members.

Our EDI programme is led by executive director Joan Saddler, who will develop a strategic action plan that sets clear deliverables, monitoring and evaluating ambitions, outcomes and impact. To find out more about the work of the EDI programme, please email us.


1. The Synergi Collaborative Centre. Nesta website. And Williams, D. R., & Mohammed, S. A. (2013). Racism and Health I: Pathways and Scientific Evidence. American Behavioral Scientist, 57(8), 1152–1173. And Clark, R., Anderson, N. B., Clark, V. R., & Williams, D. R. (1999). Racism as a Stressor for African Americans: A Biopsychosocial Model. American Psychologist , 54, 805-816.

2. Dawson, J (2018). Links between NHS staff experience and patient satisfaction: Analysis of surveys from 2014 and 2015. NHS England. And West, M & Dawson, J (2011). Employee engagement and NHS performance.

3. Beech et al (2019). Closing the gap: key areas for action on the health and care workforce. The King's Fund.