Whereas senior management within NHS England was once so monocultural that it was dubbed the ‘snowy white peaks of the NHS’, recent data suggests that things have begun to change. However, Black staff in particular are still underrepresented. Interviews with Black and White NHS managers from four London trusts found that though the acronyms ‘BME’/‘BAME’ lack subtlety, management considered quantitative data important. The #BlackLivesMatter movement impacted NHS staff as a potential catalyst for change, though momentum fizzled out. Barriers to diversity and promotion have been seen to include microaggressions and negative stereotyping of Black staff. This article interrogates such underrepresentation, and uses the concept of ‘the afterlife of colonialism’ to suggest that NHS management hierarchies follow colonially-introduced hierarchies of ethnicity and discrimination, creating structural issues that are difficult to address. Taking a feminist framework of analysis, I will argue that diversity race work, including that of #BlackLivesMatter, is anti-hierarchical at its core, suggesting that it is difficult to assimilate within the hierarchically minded world of management. I will conclude that for ethnic diversity amongst staff to be realised, all staff must be committed to supporting this agenda, regardless of their race.