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Gender equality in NHS leadership requires further progress

New research carried out by the University of Exeter, on behalf of NHS Confederation, has shown that more progress is still needed to achieve gender equality within NHS leadership and ensure women are more fairly represented in senior roles.

As part of their newly-released report, Action for Equality: The Time is Now, Professor Ruth Sealy, Associate Professor in Management at the University of Exeter, found that while progress had been made to increase the proportion of women in leadership roles across the NHS, there was still work remaining if the health service was to achieve it’s target of 50:50 this year, as set by the NHS regulator back in 2016.

The report found fewer than half of executive and non-executive roles across NHS trusts were held by women (44.7%).

It did represent a significant improvement from the 2017 measure of just 39% and showed progress towards that goal of gender parity – though, the researcher were keen to issue a caveat to the statistics, as their research also revealed significant variation in representation across individual organisations, ranging from as low as 15.4% through to 77.8%.

Commissioned by NHS Confederation’s Health and Care Women Leaders Network, the research also found variation in how women are represented in specific leadership roles. Only 1 in 4 chief financial officers were women – a figure which had fallen from 2017 – while nearly 1 in 3 medical director roles across the NHS were held by women.

To achieve the NHS’ target, and to remain squarely in line with the European Commission’s definition of gender balance (recorded as between 40% and 60%) an additional 150 executive and non-executive leadership roles would need filled by female candidates, including 40 medical director and 50 chief financial officer roles across NHS trusts and arm’s length bodies.

The research found that there has been the greatest progress with female representation in non-executive roles, where over two-fifths of these positions across the NHS are now held by women.


Professor Sealy said: “Our report includes analysis of board-level data on over 3,000 directors across NHS trust boards in England and arm’s length bodies, and over 70 in-depth interviews with board chairs, directors, and women aspiring to directorship positions.

“Comparing the data from the 2017 report, we can see that some progress has been made. But having detailed disaggregated board data allows us to see where the blockages remain.

“A unique contribution of this report is that it focuses on the behavioural responses required of senior individuals within the NHS boardrooms to ensure real progress: the why, what and how of achieving boardroom diversity.

“As well as case studies of how they implemented their action plans, chairs of the most diverse boards in terms of ethnicity and gender clearly articulate the benefits they are experiencing: board processes leading to better decision making and effectiveness, representation of community leading to greater legitimacy and better patient outcomes, and representation of staff leading to better talent management.”

Danny Mortimer, Deputy Chief Executive of the NHS Confederation and Chief Executive of NHS Employers, added: “If we compare the diversity of the NHS’s leadership in 2017 with the position now, we can see there has been some progress made in gender representation but we are not where we need to be. The challenge for race and ethnicity is even greater.

“It is vital we make full use of all the existing and emerging talent at our disposal. This report points to the action that national, professional and local leaders can take to improve the diversity of leadership in the NHS.”


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