The NHS must do more to tackle "white privilege" and increase black and minority ethnic (BAME) representation among senior managers and directors, a leading hospital trust chief executive has told Sky News.

Sarah-Jane Marsh, chief executive of Birmingham Women's & Children's NHS Trust, says she will no longer sit on any interview board panel that does not include a BAME member, after figures for her own trust revealed ethnic minority candidates were less likely to succeed at interview.

Across NHS England as a whole, 18% of the 1.2 million staff are from a BAME background, but just 5% of very senior managers are non-white, compared to 27% of the lowest paid support staff.

Ms Marsh says the lack of representation at senior levels means the NHS is not as diverse as the communities it serves, and may not be getting the best possible staff.

"I know that in the NHS we have got a problem with ensuring that we have the right people in leadership positions to represent the diversity of our workforce," she said.


"The Workforce Race Equality Scheme data tells us that white people are more likely to be appointed at interview than black people, and in my own organisation they are twice as likely to be appointed.

"I do not believe that is because white people are twice as good as black people, there is something else going on.

Image: Ms Marsh says the NHS is not as diverse as the communities it serves

"I think there is white privilege, I think there are people having unconscious bias, there are people coming to interview and not performing because they see a panel in front of them that does not believe in diversity, and I want to do something to change that.

"I want anyone coming for interview to see that we are a diverse organisation and want the best people regardless of their background.

"It's clear white people have privilege because they make their way into positions of authority far more quickly."

Ms Marsh's decision is personal and while it will not apply to all interviews at her trust, she will apply it to any interviews she is asked to conduct in her national and regional roles.

"If you walk into an interview room and are met with a white wall you are going to think this organisation is not for me, or 'they are going to think I'm not for them'.

"If that happens initial performance can drop because of all these soft signals that the organisation does not value diversity.

:: Sky Views: What they haven't told you about the NHS

"There are only a handful of BAME chief executives in the NHS, then when you get to board and just below board level the figures drop away, certainly in comparison to the workforce. If we did not have BME staff we would not have an NHS."

The co-chair of the NHS Equality and Diversity Council, Joan Saddler, welcomed the Birmingham initiative and said change at senior levels is decades overdue.

"We do know of leaders who are taking a step on the position of a lack of BAME leaders at NHS board level.

"If you look at the BAME leaders who are chief executives or chairs, they have been clear about the need as leaders to ensure diversity.

Image: Ethnic minority candidates are less likely to succeed at interview

"What we want to see is more non-BAME leaders to do what Sarah-Jane Marsh is doing, and certainly there are some coming up.

"We have three or four BAME chief executives in NHS Trusts, so if we take that we don't have the representation of BAME staff at director or board level, and that has been a sustained picture for 30 years, while other stats have gone up but this one has stayed the same, whether we use the term institutionally racist is not something I would argue, but I would say we are not doing well."

Ms Sadler said further change would require a transformation in expectations and the way people view the potential of non-white communities.

"Morally of course it is the right thing to do. From a legal point of view we have to do this, and from a financial point of view it makes sense.

"Representation in the workforce is not only about numbers and colours it's about saying we can have a better quality of service if we have a more diverse service.

"There is something here about expectation.

"Where do we expect to see these people working, I'm using it in a negative way to highlight the problem, we know we have nurses and people who can give good care, but at the highest level we need to have the very best people and we can't have special measures.

"But I don't see myself as special measures."