Workforce inequalities in health and adult social care

Key statistics 

• the employee voice survey received 832 responses, of which 646 were included in analysis after data cleaning 

• 41% of survey respondents reported personally experiencing and or observing race or ethnicity-related inequities, 32% reported sex or gender-related inequities, 22% physical disability or condition-related inequities, and 18% mental health condition or illness and nationality-related inequities 

• more than two-thirds of respondents reported experiencing and or observing two or more types of inequities 

• 77% of respondents identified attitudes of leaders or managers as a condition driving workforce inequities, 66% identified attitudes of staff or colleagues, and 62% identified organisational culture 

• more than 80% of respondents reported feeling upset or distressed due to experiencing inequities, and over half had considered leaving their job as a result 

• 54% of respondents said robust procedures to ensure complaints are acted on were effective, but only 31% said these were available in their organisation 

• 45% said senior leadership engagement was effective, but only 28% said it was present in their organisation 

Key messages 

• The report uses the term inequalities; however, many of the differences described reflect avoidable and unfair patterns, and can therefore be understood as inequities. 

• race and ethnicity-related workforce inequities were the most commonly reported form of unequal treatment across health and adult social care 

• combined or intersectional discrimination was common, with many staff reporting overlapping inequities linked to more than one protected characteristic 

• workforce inequities were linked to distress, anxiety, social exclusion, reduced career progression and intentions to leave work 

• inequities were shaped by both interpersonal factors, such as attitudes of managers and colleagues, and structural factors, such as organisational culture and systems 

• workforce inequities can affect care quality, staff willingness to speak up, and interactions with people using services 

• common EDI activity such as staff training and celebrating diversity was widespread but often seen as less effective than strong complaints procedures and visible senior leadership engagement 

Policy implications 

• set clear and measurable workforce EDI targets and link them to accountability and progress monitoring 

• expand collection and use of workforce EDI data across all providers, not only NHS trusts 

• strengthen complaints, grievance and speaking up systems so staff can report inequities safely and with confidence 

• make senior leaders clearly responsible for workforce equality and embed this into regulation and assessment 

• move beyond tick-box EDI activity and support more practical action on everyday discrimination, harassment and exclusion 

• strengthen the evidence base linking workforce inequities to care quality and outcomes for people using services 

Gaps 

• the report identifies a need for more research on disabled staff, sector differences, and the underlying causes of some reported experiences such as isolation and exclusion 

Commentary 
This report looks at workforce inequities across health and adult social care and shows that these are not only staff issues. They also affect how care is delivered. The report was commissioned by CQC and combines survey data, interviews, literature review and case studies to understand what workforce inequities look like, what drives them and what helps reduce them. 

A central finding is that race and ethnicity-related inequities were the most commonly reported. Staff also reported inequities linked to sex or gender, disability, mental health conditions and nationality. Many respondents described overlapping forms of discrimination, which matters because people do not experience these issues one at a time in real life. 

The report makes clear that workforce inequities are shaped by both workplace culture and wider systems. Staff most often pointed to managers’ attitudes, colleagues’ attitudes and organisational culture as key drivers. That matters for care equity because staff who are excluded, ignored or treated unfairly may be less able to progress, less likely to stay, and less likely to speak up when something is wrong. 

The findings also show a clear link between workforce inequities and the quality of care. The report says staff experiencing inequities reported negative effects on service quality, care quality and interactions with people using services. In particular, more than 40% of respondents experiencing or observing race or ethnicity-related inequities reported poor interactions with patients or people using services. 

From a care equity perspective, this is important because inequities affecting staff can feed through into inequities affecting people who use services. If some parts of the workforce are more exposed to bullying, poorer progression, low pay or unsafe speaking up cultures, that can affect continuity, trust and service quality. It can also be worse in parts of the system already under pressure, including adult social care, smaller providers and areas facing recruitment and funding problems. 

Another useful finding is that the most common EDI activity was not seen as the most effective. Staff training and celebrating diversity were common, but respondents were more likely to value strong complaints systems, transparent data and visible senior leadership action. This suggests that tackling workforce inequities needs practical follow-through, not just awareness activity. 

Overall, the report shows that workforce inequities are part of wider structural problems in health and adult social care. Improving care equity means paying attention to how staff are treated, who is heard, who progresses, and who feels safe at work. Without that, inequities in the workforce are likely to continue affecting inequities in care.