The NHS in England is facing a growing concern as minority ethnic managers report experiencing racism, exclusion, and discrimination in their workplaces, according to a recent report by the NHS Alliance. The survey, which included 950 Black, Asian, and minority ethnic (BAME) managers, revealed that nearly four out of five participants had encountered these challenges during their careers. Alarmingly, one in five of those surveyed said they would leave the NHS within the next three years, sparking worries that the health service is failing to address deep-seated racial issues. Sir Ciarán Devane, the chief executive of the NHS Alliance, warned that the loss of BAME managers and senior leaders could be a "haemorrhaging" of talent. He emphasized that diversity in NHS leadership is more crucial than ever, especially in times of political and cultural division. Devane noted that many senior minority ethnic colleagues are leaving due to feelings of discouragement and disillusionment, which could weaken the NHS’s ability to serve a diverse population effectively. Participants in the survey shared experiences of being excluded from informal networks, facing progression disparities, and encountering a lack of diversity in senior leadership. One Black senior manager mentioned being the only person of color in nearly all strategic and policy meetings, while an Asian manager described a culture of favoritism that limited their chances of promotion despite their qualifications. An African heritage manager noted that the lack of diversity in senior roles made it difficult to feel supported or inspired to advance in their career. Although BAME representation on NHS boards has increased from 7.1% in 2016 to 17.3% in 2025, the report highlights that institutional and structural racism still persists. Efforts to combat discrimination have had limited success, with many BAME managers continuing to face daily challenges of racism and inequity. Victor Adebowale, chair of the NHS Alliance, stated that the NHS is institutionally racist and called for race and racism to be addressed as a regular part of business operations, rather than a special issue. The NHS Race and Health Observatory noted a rise in complaints from BAME staff, with experts urging urgent action to tackle the normalization of racism within the system. An NHS England spokesperson acknowledged that racism and discrimination have no place in the NHS and admitted more work is needed to ensure equal opportunities and fair treatment for all staff. New NHS staff standards now require trusts to take sustained action against racism, with clear accountability at the board level. Progress in this area will be monitored through the NHS oversight framework, aiming to create a more inclusive and equitable environment for all employees.