As of this year, companies and public bodies with over 250 employees are required to report their gender pay gap to the Government Equalities Office, with the deadline of 4th April 2018. They must also include the proportion of men and women who receive bonuses and a breakdown of pay quartiles by gender.
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The gender pay gap is a measure of the difference between average hourly earnings of men and women. It is different from unequal pay, which is when men and women are paid different amounts for the same role – this has been illegal since 1970.
With over 1.6 million staff, the NHS is the largest single employer in the UK. One of the difficulties with interpreting data on the gender pay gap for the NHS is that each trust and organisation will report independently, so collating this information and drawing broad conclusions takes significant time and research.
According to the Guardian of 220 NHS organisations reporting their data, 201 (92%) report a pay gap in favour of men, ranging from 0.1% difference in median hourly pay at Lancashire Teaching Hospitals to 52.5% at Health Education England. 8 organisations reported no difference and 11 reported a difference in favour of women.
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How Many Women are Working in the NHS?
Women make up over 77% of the NHS workforce. There are more women working as nurses employed by NHS England than there are men in every category combined. However, there is a relatively greater number of women in lower pay grades than there are in higher, and women are routinely underrepresented in leadership positions (Appleby, 2018).
From FOI requests by the BBC we know that of the top 100 earning consultants in England, just five are women. In Scotland, 15 out of 100 of the highest-paid consultants are women. On average, full-time women consultants earned nearly £14,000 a year less than men – a pay gap of 12%.
Breaking down the type of pay explains the discrepancies a little. Men working as consultants only receive slightly more in basic pay than women, to the tune of £1,500 a year. The remaining difference is largely due to “additional pay”. This is most likely overtime, additional work and awards.
For clinical excellence awards in 2017, 318 successful applicants shared payments worth £14m. Only 20% of these were women. Women are just as likely to be successful if they apply, but for whatever reason, they apply in much lower numbers.
Structural societal problems: Men may be better at pushing for more money or more likely to put themselves forward and/or be nominated for awards. If this is part of a structural problem in society it may be difficult for the NHS to fix, but it can foster a culture where women are encouraged to put themselves forward and value their work, and where their work is valued by others.
Female-dominated professions: Research suggests that professions with more women tend to be undervalued, which contributes to poor morale and retention, and this is massively important when considering that the NHS is in many ways a women’s workforce – except for at the top.
Part-time work: One commonly provided explanation is that women tend to work part-time more than men do. Whilst this is true, this is taken into account by the gender pay gap counting hourly rather than annual wage. Others suggest that women working for the NHS miss opportunities to progress and improve because of the way career breaks and part-time working are treated. A system which better supports part-time workers, carers and parents would be beneficial to all.
Higher proportion of male doctors: Some believe it may be down to the fact that historically men have made up a higher proportion of doctors than women, and therefore with the number of women working as doctors increasing, we should see a decline in the gender pay gap. There is some evidence that this may be true, with women making up an increasingly larger proportion of middle-grade and registrar positions. There have been more women entering medical school than men since 2002/3, so if this theory holds out, we should expect to see this change imminently. I suspect however, this answer may be used to avoid looking more deeply at the gendered nature of work and reward in the NHS.
The difference in specialities: Another answer is that women tend towards practising in specialities which pay less such as psychiatry, paediatrics, obstetrics and gynaecology and general practice. The question here then is why these specialities are paid less than certain surgical specialities, and whether this is to do with the nature of the work or rather the way specialities in which more women work are undervalued.
In the future we can expect to see much deeper analysis of the NHS gender pay gap, especially as annual reporting comes into play. There is much left to be said both about doctors and about the broader health workforce, and research on this may prove relevant to future discussions on the culture of medicine and gendered inequality.
This article and NHS gender pay gap data discuss gender in binary terms. I acknowledge that these terms do not accurately describe all members of NHS staff, they have been used merely as a practicality.