In July 2002 'Getting on against the Odds' was launched by the NHS Leadership Centre, the purpose of the document was to highlight the difficulties experienced by black and minority ethnic (BME) nurses in rising to positions of prominence in the NHS. The document stated that out of 400 director of nursing posts in the country only 3 were held by non white people. The launch of the document led to people in senior positions in the NHS taking the issue of lack of progression for BME staff in general seriously.

In the same year Sir Nigel Crisp, NHS CEO in the document 'Managing for Excellence in the NHS' stated his intention to establishing a national development programme to support BME staff into senior leadership roles.

It was clear to people in senior positions that there needed to be something done about the poor representation of BME people at senior levels in the NHS.

The breaking through programme a positive action programme, was officially launched on October 15th 2003. Over 500 delegates attended the launch.

In 2004, the Leadership Race Equality Action Plan was launched, the purpose of the initiative was to ensure BME patients had the same quality of and access to services as non BME people, in addition the paper highlighted the need for a focus on supporting BME staff through mentoring and support to reach senior positions in the service.

These initiatives along with the more recent push provided by David Nicholson with regards to importance of high quality leadership from a diverse group in the NHS has meant that the breaking through programme has risen in prominence and importance for delivering on the race and leadership objectives in the NHS. David Nicholson has said that he would like to see many more women, clinicians and BME staff in his top 200 managers. The newly designed breaking through will deliver on that objective with regards to BME staff and indeed BME clinicians and women.