Health and Care Women Leaders Network

More progress needed to achieve gender equality in NHS leadership

Sam Allen

NHS leadership that more fairly represents women in senior roles is “essential, overdue and needed now”, according to a new report out today (Wednesday 9 September) from the NHS Confederation.
In its report, Action for Equality: The Time is Now, the membership body’s Health and Care Women Leaders Network has found that while progress has been made to increase the proportion of women in leadership roles across the health service, there is much more to do to meet the NHS’s target for 50:50 representation this year, as set by the NHS regulator in 2016.
On average, fewer than half (44.7 per cent) of executive and non-executive roles across NHS trusts are held by women – an improvement from 39 per cent in 2017 – but there is significant variation in representation across individual organisations, ranging from as low as 15.4 per cent all the way up to 77.8 per cent.
Also, the research, which was carried out by the University of Exeter Business School on behalf of the NHS Confederation, found variation in how women are represented in specific roles.
For example, only 1 in 4 (25.3 per cent, down from 26.3 per cent in 2017) chief financial officers and nearly 1 in 3 (29 per cent, up from 25 per cent) of medical directors across the NHS are women.
Women would need to be in an additional 150 executive and non-executive directorships, including 40 medical director and 50 chief finance officer roles across NHS trusts and arm’s-length bodies, to achieve the European Commission’s definition of gender balance of 40 to 60 per cent. In 2017, this figure stood at 500.
The research finds that there has been the greatest progress with female representation in non-executive roles, where more than two fifths (40.9 per cent) are now women – an increase from 37 per cent in 2017.
The proportion of women in chief executive roles has increased in the same period from 42.6 per cent to 45.5 per cent.
Ambulance trusts were found to have the lowest proportion of women holding board-level positions with just 38.8 per cent, compared with community trusts and mental health trusts, which have 50.5 and 51.5 per cent, respectively.
Sam Allen, chair of the NHS Confederation’s Health and Care Women Leaders Network and chief executive of Sussex Partnership NHS Foundation Trust said: “It is well-established that boards that properly reflect the communities and staff they serve lead to stronger decision-making and better outcomes for patients.
“The NHS has made progress, but there remains much more for leaders to do in order to achieve consistent and meaningful gender balance.

“We must move away from the concept that gender balance is tokenistic or a ‘nice to have’, to something that is essential, overdue and needed now. This requires an inclusive and compassionate approach to leadership, with everyone in these vital positions held to account for their contributions.”
Professor Ruth Sealy, of University of Exeter Business School, who authored the report 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.”
The NHS Confederation’s Health and Care Women Leaders Network has made a number of recommendations in its report, including the need for chairs of NHS organisations to have explicit objectives to support diversity across their boards, and for clear succession plans to be set up to improve female representation, particularly in medical director and chief finance officer roles, with emerging leaders at mid and senior levels given the opportunity to experience board-level working.
To track progress, the network is calling for diversity data to be regularly reported to NHS boards and for the “well-led” framework, which the Care Quality Commission uses on its inspections of health and social care services in England, to cover specific reviews of board appointment processes, including whether chairs are proactively increasing diversity.
Danny Mortimer, deputy chief executive of the NHS Confederation and chief executive of NHS Employers, said: “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.
“The NHS is the largest employer in this country, with a workforce of 1.4 million people, of which more than 1 million are female. It is leading by example, but at a time when the NHS is experiencing the greatest challenge in its history, 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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