Sam Allen: Tear down structural barriers to close gender pay gap

Female hospital doctors are paid nearly 20 percent less than male hospital doctors. Not adjusted for contracted hours, that figure rises to 24.4 percent. For GPs, it’s as high as 33.5 percent. These are the headline findings from Mend the Gap: The Independent Review into Gender Pay Gaps in Medicine in England

Take a moment to let that sink in. The year is 2020—and women in medicine are still being paid far less than their male peers. 

This is not to lay the blame at any single door. I am yet to meet a colleague who doesn’t want to address this or who would (openly) say this is fair. We now need to address the structural barriers that cause this extraordinary imbalance and indeed, other inequalities that exist across the service.

The report makes for stark reading. It lays bare the injustice women can still face in the workplace in the NHS. Women are more likely to work less than full time and are unlikely to catch up with their peers that work full time if they return to full time working. Our system and structures are outdated and represent a bygone era in the delivery of healthcare.

This report flags issues for the whole NHS workforce, not just the medical workforce, and addressing the structural barriers should benefit all, not just women. This is an issue of fairness and sustainability. Our compassion and tolerance can only stretch so far and at some point, the women who make up 77 percent of the NHS workforce and our allies will say enough is enough.

The Health and Care Women Leaders Network report, Action for equality: The time is now, further shows how much work is yet to be done to make sure women are properly represented in the most senior roles in the health service.

Furthermore, race, religion, disability, and sexual orientation must also be factored into the equation alongside gender, so that issues of intersectionality can also be addressed, as Mend the Gap recommends. Startlingly, in our Action for Equality work, we found an overall representation of 8.9 percent BME directors, and that there were still 70 all-white NHS trust boards and six all-white ALB boards at the time of publication. 

At the Health and Care Women Leaders Network, which is delivered by the NHS Confederation, we know progress has been made to increase the proportion of women in leadership roles across the health service, but on average, fewer than half (44.7 percent) of executive and non-executive roles across NHS trusts are held by women.
But of course, no one wants to be a “token appointment”—our members want to see diversity, inclusion, and fairness represented across senior leadership and exhibited in behaviours and cultural change.  

The gender pay gap will start to close if we can tear down the barriers many face in progressing into more senior roles. We welcome the Government’s commitment to tackling pay gaps, but while these warm words provide some reassurance, we must now see the beginning of the real work to achieve pay equality for all, demonstrated by targeted and measured actions to achieve it.

No one would want their daughter or granddaughter to go into medicine knowing that these barriers may mean they will be undervalued compared with their male colleagues, or that they could be on the receiving end of discriminatory behaviour.

Roles must also be seen as doable alongside other responsibilities, and the ambitions of the People Plan to support flexible working for all must be met—that includes part-time, job shares, and a making sure a work/life balance can be maintained. 

Early career conversations must happen, in order to put the scaffolding in place for progress and development. Most importantly, women need to know they can progress to more senior roles and be supported to do so. Boards must make sure they understand and focus on what women bring to the workplace, especially as the benefits of greater diversity at a senior level to patient outcomes are well established. Data must be captured on an ongoing basis to measure improvement, and there must be board level accountability. That includes restarting gender pay gap reporting, which was paused at the beginning of the pandemic. This should be looked at alongside ethnicity pay gap reporting. Specific system and organisational responsibilities towards removing the pay gap must also be reinforced by setting clear goals and monitoring sustained actions towards achievement. 

2021 must be a year of action towards achieving gender equality in the sector. I love our NHS dearly but we need to be honest about its deficiencies and each take responsibility for making the change needed to make it inclusive, diverse, and fair. Everyone has a role to play—none more so than those working in and with the NHS—and effective change will be led from within, rather than imposed from the top.

Sam Allen, chair of the Health and Care Women Leaders Network, delivered by the NHS Confederation.

Competing interests: none.