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Migrant status compounds inequality for ethnic minority NHS staff, study finds

Ethnic minority health care workers who are also born overseas face a double disadvantage due to the combined effects of ethnicity and migrant status, according to research in JRSM Open.

Using data from the nationwide UK-REACH cohort study, this is the first analysis to explore how migration status—often overlooked in Human Resources records—intersects with ethnicity to affect NHS career progression.

The cross-sectional study of over 5,700 health care workers employed under the NHS Agenda for Change (AfC) pay scale—which covers staff including nurses, midwives, and allied health professionals—found that overseas-born staff were significantly less likely to be placed in higher AfC pay bands, even after adjusting for education, job role, and years of professional qualification.

In particular, Asian and Black health care workers born overseas were less likely to reach higher pay bands compared to their white UK-born and trained counterparts.

Lead author Dr. Ji Soo Choi commented, "Our findings highlight that migration status plays a critical role in shaping health care professionals' career prospects, yet this data is not routinely collected. These disparities cannot be addressed without first being recognized and recorded."

Although ethnic minority and migrant health care workers make up nearly a quarter of the NHS workforce, they remain underrepresented in senior positions within the AfC framework.

Migrant workers may face additional challenges distinct from non-migrant ethnic colleagues, including difficulties with international qualification recognition, limited professional networks, and restricted access to training.

The absence of routinely collected migration status data means these issues are often overlooked in research, creating a gap that hinders efforts to address workforce inequality. The authors urge NHS policymakers to include migration status in routine data collection to enable more targeted and effective interventions.

"Ethnic minority health care workers represent over a third of staff at NHS pay band 5, but their presence drops sharply to just 10% in senior roles," said senior author Professor Manish Pareek.

"This lack of diversity in leadership limits influence over key workplace decisions such as pay, scheduling, and policy, which may contribute to a less supportive environment for ethnic minority staff. These inequalities risk driving higher attrition rates amid the NHS's ongoing staffing challenges."

The authors recommend that NHS workforce policies explicitly address the distinct barriers faced by migrant health care workers, including training access, credential recognition, and mentoring and leadership opportunities.