Formal support was broadly available to all, but for some groups it was peer support that proved hardest to access, and that gap matters more than we might think. 

When the COVID-19 pandemic hit, the NHS rolled out a range of support services for its staff: well-being hubs, rest rooms, free parking, and food parcels. By six months in, 83% of staff surveyed had used at least one of these services. On the face of it, the system was working. 

But formal support is only one part of what sustains people at work. The everyday experience of feeling backed up by the people around you, of a colleague checking in, a manager noticing, a team pulling together, is harder to engineer and, it turns out, far less equally distributed. 

We already knew that NHS staff from ethnic minority and migrant backgrounds are more likely to face discrimination, bullying, and harassment at work. The NHS Workforce Race Equality Standard consistently shows stark disparities: 17% of ethnic minority staff report discrimination from a manager or colleague, compared with 7% of White British staff. But we didn’t know whether these HCWs felt supported by their peers and managers, so we asked: did all staff feel equally supported, and by whom?  

We analysed survey data from 9,769 NHS staff across 18 Trusts in England, collected at the start of the pandemic and again six months later, controlling for age, sex, job role and mental health. 

What did the study find? 

KEY FINDINGS 

• No significant variation in formal support programme use by ethnicity or migration status 

• No significant variation in perceived support from managers by ethnicity or migration status 

• NHS staff from White Other and Asian ethnic groups were significantly less likely to feel supported by colleagues than White British NHS staff 

• NHS staff born outside the UK and EU were significantly less likely to feel supported by colleagues than UK-born NHS staff 

* Less likely than White British staff, adjusted for age, sex, role and psychological distress 

Why does colleague support matter? 

Informal peer support is not a luxury. It buffers stress, reduces isolation, and shapes day-to-day wellbeing in ways that formal services cannot easily replicate. For NHS staff working through a pandemic, the sense of being backed up by the people around you, of being noticed, checked in on, valued as part of the team, has real consequences for mental health and retention. 

The most recent NHS Workforce Race Equality Standard report found that 17% of ethnic minority staff reported discrimination from a manager or colleague, compared with 7% of White British staff. Migrant staff face additional pressures: cultural and language barriers, unfamiliarity with support systems, and greater job insecurity. What this study contributes is evidence that these inequalities extend beyond negative experiences. They also limit access to something positive and protective.

What needs to change? 

Improving staff wellbeing requires going beyond formal services. The conditions that determine whether informal support can function at all, including workload, team climate, psychological safety, and discrimination, need to be tackled directly. 

The pandemic did not create these conditions. It magnified them. Workforce shortages, retention difficulties, and racialised inequalities in the NHS long predate 2020. So, what would meaningful change look like? 

1. Address the structural conditions that determine whether peer support can function 

• Tackle workload and staffing levels as a prerequisite, not an afterthought, to wellbeing initiatives. 

• Invest in team climate and psychological safety, ensuring staff can raise concerns without fear of reprisal. 

• Take active steps to address discrimination and racial hostility, including clear reporting pathways and visible accountability for managers. 

2. Evaluate existing interventions rigorously and for all groups 

There is evidence that active listening training increases managers’ confidence to support staff. But the overall evidence base is thin, largely built on small case studies. Organisations and funders should: 

• Commission rigorous, independent evaluation of workplace inclusion and wellbeing interventions. 

• Ensure evaluations are designed to detect whether effects hold equally across ethnic groups, not just on average. 

3. Improve measurement, and rebuild trust in what measurement is for 

This study found disparities within White ethnic sub-groups that a simple White/non-White analysis would have missed entirely. Measurement needs to improve, but better data alone is not enough. For many ethnic minority staff, disparities have already been measured, reported, and recommended against, and nothing has changed. Years of WRES reporting have eroded trust in both the research process and the institutions behind it, and without rebuilding that trust, participation in future research will remain limited. Specifically: 

• Disaggregate ethnic sub-group data further in routine workforce monitoring. 

• Examine how ethnicity and migration status intersect, with studies powered to detect those effects. 

• Co-design research and monitoring processes with ethnic minority staff communities, with transparency about how findings are used. 

• Require NHS leaders and managers to act on WRES data, not just report it. 

What can I do with this? 

I work in policy and/or public health: These findings suggest workforce wellbeing policies need to go beyond formal support provision. Monitoring of peer support access by ethnicity and migration status, and stronger accountability mechanisms around WRES data, are both warranted. 

I work in service delivery: Consider whether all staff feel genuinely included and able to rely on colleagues, not just whether formal support services are available. Active steps to address discrimination and build inclusive team cultures are likely to matter more than additional wellbeing programmes alone. 

I am a researcher: Future work should examine the mechanisms driving these disparities, test whether targeted interventions can improve peer support equity, and ensure studies are powered to detect effects within ethnic groups, not just between them. 

I am a student: This paper is a useful example of how longitudinal survey data can be used to examine health inequalities in occupational settings and raises important methodological points about ethnic group disaggregation relevant to essays on health inequalities or workforce policy.