The report comes as the NHS prepares for one of the most significant periods of change in its history, driven by the Government’s 10-Year Health Plan and its ambition to shift services from hospital to community, analogue to digital, and sickness to prevention. 

Written by writer and researcher Arlen Pettitt, the report argues that diverse leadership will be critical to making those changes work for local communities. 

James Carss, CEO of Castle Peak Group, said: “There is no question that the health sector has made progress on inclusion. But progress has been too slow, and senior leadership remains less diverse than the communities the NHS serves. 

“If we continue recruiting in the same way, we will continue to get similar outcomes. We need to be prepared to do things differently if we want different results.” 

The research identifies several barriers to greater diversity, including traditional recruitment processes, expectations around previous NHS experience and the demanding nature of NHS board roles. 

Contributors said the complexity and public scrutiny surrounding NHS governance could discourage people from outside the sector from putting themselves forward, particularly for their first non-executive role. 

The report highlights approaches already being used successfully, including shadow boards, associate non-executive roles, mentoring, staff networks and targeted leadership development programmes. 

It also calls for recruitment firms to be tasked with producing diverse shortlists, greater use of diverse interview panels, reviews of job descriptions and recruitment processes, and action to make board roles more accessible. 

The research stresses representation alone is not enough. Boards must also understand the communities they serve, including the impact of deprivation, health inequalities and digital exclusion. 

This is particularly important in the North East, where the report highlights significant regional health and socio-economic challenges, including lower employment, higher child poverty and lower life expectancy than England as a whole. 

Harry Armstrong, Managing Director, Business Development at Opencast, said: “The NHS is entering a period of profound transformation. Technology and new models of care will only succeed if the people making decisions understand the communities those changes are intended to serve. 

“Diversity, inclusion and meaningful engagement with patients, staff and communities need to be at the heart of that transformation. 

“The conversations captured in Progress Under Pressure: Health, provide a valuable perspective on the leadership challenges facing the health sector as it navigates a period of real transformation. The report’s central message is that the NHS has made progress — but now needs to move faster.” 

The report concludes that NHS trusts are not simply healthcare providers but anchor institutions, with the potential to create opportunity and help shape the communities in which they operate.