The gender pay gap and the NHS

07 August 2018

With national contracts in place for pay, it might be safe to assume that the NHS would report a smaller than average gender pay gap. In fact, at 25 percent, the disparity between male and female earnings in the NHS is almost half as big again as the ONS average of 17.4 percent. But it’s not a matter of unequal pay. As with many industries, it’s the domination of senior and better paid roles by men that creates the pay gap.

While the NHS has a predominantly female workforce (in many trusts in the region of 75 – 80 percent of workers are female) they tend to be concentrated in in roles at the lower end of the pay grades. The national contract, Agenda for Change, pays all NHS workers the same whether male or female. But it only covers bands 1-8. And after that, Band 9 and above covering dental and clinical staff, is where the pay gap really starts to expand.

It’s important to note that these consultant-level roles in band 9 and above have traditionally been male-dominated. So there is a clear historical factor at work here. In contrast, looking at junior doctors coming through now, there is a much more even split between male and female, with the proportions becoming more equal. Over time, that should help. I’ve also looked at the distribution of senior roles in the NHS in the south west of England, where most of the trusts CEOs are, in fact, women. Again, some indication that the more senior levels could start to show more even pay distribution in the years to come.

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But the other side of the equation remains a sticking point for more equal pay. Workers in the lowest bands are predominantly caring roles – registered and unregistered – and very much dominated by women. What’s more, as women are also more likely to take on roles outside work as carers and/or looking after children, there’s more part-time working here that further depresses their average pay relative to men.

For dental and clinical staff, the pay gap is increased by the bonus that’s awarded for clinical excellence. Those in band 9 and above receive a bonus according to their performance above and beyond the contractual expectations of their role. That bonus is decided and awarded with no reference to gender. But, here again, because people in these more senior clinical and dental roles tend to be male, the sheer weight of numbers means the distribution of bonuses skews the figures.

Nevertheless, the pay gap challenge for the NHS sits at both the top and bottom of the organisation. They need to attract men into the caring roles that have been traditionally dominated by women, making the lower bands especially roles 1-5 roles more attractive across the board. At the other end of the spectrum, women need to have the pathways through to the more senior clinical and dental roles.  

With a national pay contract, gender should make no difference. It is the composition of the NHS workforce that is largely responsible for the NHS’s gender pay gap today. The question is: what are trusts doing about it?

The NHSE report sets out a number of broad initiatives including new data-driven approaches to recruitment and remuneration, flexible working and coaching and mentoring as places to start. But each trust will need to create its own policies and actions to close the gender pay gap.

To learn more about the gender pay gap in health, visit our website.

Heather Ancient | Partner, PwC United Kingdom
Profile | Email | 07714 665144

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