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The NHS needs more senior women in leadership

The gender pay gap in the NHS remains a hotly debated topic, especially as the final report from the Gender Pay Gap in Medicine Review approaches. Andrea Hester, deputy director of employment relations and reward at NHS Employers, reports.

NHS Employers has collated and analysed the data from the latest round of reporting in the health service, comparing it with the previous year, and the figures paint a clear picture. Of the 253 NHS organisations that reported their gender pay gap figures for the snapshot date of 30 March 2018, all but 16 reported a median pay gap in favour of men, ranging from 0.6% of median hourly pay to 39.9%. Nine organisations reported zero difference, and seven a difference in favour of women. It is important to be clear that legally, employers must pay a female employee the same as a male employee for equal or very similar work. 

This is an equal pay issue rather than a gender pay gap issue as it compares the work of one person or more with another person of another gender. Based on NHS Employers’ analysis, this is down from a maximum gap of 52.5% in favour of men in 2017, but the upshot is the same: there is still work to be done before the gender pay gap closes within the NHS, where more than three-quarters of staff within the health service are women. 

When pulling the data together it is important to understand the narrative behind the individual figures, which can be masked when using percentages. For this reason, it is not helpful to provide an average for the NHS in England, given the variety of organisation types and reasons for the gender pay gaps. Taking types of organisation individually, acute trusts, for example, showed the widest gaps in gender pay, with the widest of all coming from a small acute organisation. 

The possible cause is clear: within acute trusts, there are more likely to be higher numbers of male consultants, earning clinical excellence awards. Among community trusts, 34 out of 38 organisations reported a gap of less than 20% and 23 had a gap of less than 10%. More than 50% had narrowed the gap from last year. Meanwhile, ambulance trusts all reported much narrower gaps, with 8 out of 10 reporting gaps in single figures, and only 20% reporting gaps of above 10%. So, what should the health service do next? 

NHS Employers encouraged organisations to publish a narrative and action plan on gender pay this year, and published proposed measures such as taking account of gender when providing leadership opportunities, raising awareness of shared parental leave entitlements and flexible working opportunities. Some organisations also considered introducing unconscious bias training for those involved in recruitment. 

This, however, is about more than just pay. There are issues in relation to recruitment, progression and flexibility in employment which contribute and encourage a systems approach that will be key to narrowing the gap. Furthermore, staff surveys show that employees believe having equal opportunities for career progress or promotion within their trust has an effect on how satisfied patients are with the care they receive. 

At a national level, NHS Employers is supporting the work of the University of Surrey, which has been commissioned by the Department of Health and Social Care to review the gender pay gap specifically in medicine, with the outcome expected in September 2019. NHS Employers itself will be considering further work to support organisations, including collaborating with external bodies such as the Government Equalities Office and the Behavioural Insights Team. 

Also under consideration will be further work to look at the relationship between narrowing the gender pay gap and improved patient care. Key factors to consider in this would be ensuring that all staff are treated equitably in pay and that they have equal opportunity for career progression. 

This is why the work of organisations such as the Health & Care Women Leaders Network, delivered by the NHS Confederation and NHS Employers, is so vital. Without greater representation of women at the highest levels of NHS leadership, it will be all but impossible to achieve true gender equality in the health service for people at all stages of their careers.