The gender pay gap: what now?

National gender pay gap data has been collected for many years and shows the UK has made significant progress over half a century: moving from a median gap of 47.6 per cent in 1970 to 16.8 per cent in 2016. Against this benchmark, the health and care sector fares pretty well. Our analysis of the data shows a median pay gap of 9.5 per cent for NHS organisations1  and 3.2 per cent for a sample2  of the largest social care providers.

• 1Includes available data for NHS trusts, foundation trusts, clinical commissioning groups and national bodies.
• 2Major care home providers: http://nationalcareassociation.org.uk/content/images/uploads/area/Christie_NCA-May-2017-RJM_presntation.pdf, Major national home care providers: https://www.nhs.uk/conditions/social-care-and-support/national-homecare-providers/, data not available for all providers

However, progress at the national level in all sectors is slowing, with an improvement of just one percentage point over the past five years, suggesting the issues left to tackle are getting thornier. Researchers have tried to quantify what is causing the remaining pay gap, with several themes emerging.

Women and men do different jobs. For example, 90 per cent of engineers are male, while 83 per cent of primary-school teachers are female. The Office for National Statistics estimates that this is responsible for 36 per cent of the current gender pay gap.

Jobs done by women are undervalued. Both in terms of the value society places on the jobs and the wage people are paid. Jobs with a higher percentage of women tend to be lower paid, and if, over time, the proportion of women increases average pay goes down further. 

Men hold more of the most senior roles. Gender pay gap reporting showed 30 per cent of women are in the lowest paid quartile with 20 per cent in the highest paid, while for men these numbers are reversed.

Women pay a 'motherhood penalty'. Research in Denmark and the US has shown that while earnings for men and women keep pace until the birth of their first child for most women the pay gap generated at that point is never recovered.

The health and care sector is a good illustration of all of these factors at play. It is female dominated: 77 per cent of the NHS workforce and 82 per cent of the adult social care workforce are female. There is an increasing recognition, particularly within social care, that aspects of this work are undervalued: in a recent speech, the Scottish National Party’s health spokesperson, Dr Philippa Whitford MP, highlighted that 'Men who empty the bins are paid considerably more than the women caring for our grandparents'. The majority of the most senior non-medical roles in the NHS are held by men, with a similar pattern seen for medical grades. And in a 2013 survey of female leaders in health care half thought having children disadvantaged their career.

Jeremy Hunt recently announced Jane Dacre, President of the Royal College of Physicians, is leading a new review of the gender pay gap in medicine, aiming to eliminate the 15% pay gap that currently exists between male and female doctors. But what is the wider health and care sector currently doing, and what can it do in the future, to improve?

It is no secret that the health and care sector is short-staffed, so as the sector encourages more people to join, reaching out specifically to men for all roles could help start to create a better gender balance. The need for this approach has been recognised, particularly in social care, for some time. A 2010 Skills for Care report suggested awareness raising was key; currently, men simply don’t think of care work as a career option. Bringing examples of men in traditionally female careers into the mainstream, like this article showcasing male nurses, is something that all of us involved in health and social care, from local organisations to national bodies and think tanks, can do. 

The NHS is aware of the challenge it faces in supporting women into more senior roles, and has been set the task of NHS boards being ‘50/50 by 2020’. This still leaves some way to go to before it is representative of the wider workforce, but change is happening. The NHS Aspiring Chief Executives programme has a balanced representation of men and women. There are now more female role models than in the past, with the top three places in this year’s HSJ top trust chief executives list all held by women. And at The King’s Fund our longstanding Athena programme supports women to find, make and take up leadership roles.

And at the launch of Health Education England’s draft workforce strategy one of the key measures highlighted was the need to make the NHS a ‘family-friendly’ employer. As the strategy is finalised we need to ensure that what is communicated is gender neutral and doesn’t, by default, mean good maternity (but not paternity) leave and expectations of flexible working for women (but not men) with children. As this is the first NHS workforce strategy that will consider how the NHS integrates with social care, this should set the tone for wider change.

The factors driving the remaining gender pay gap are broad and challenge our societal norms. Making data transparent has a positive impact, but it is just the first step to thinking about what we can do, organisationally, professionally and personally, to move forward, as we have with education and the number of women in work. Now the media frenzy has died down we need to make sure we haven’t stopped talking about the numbers and entirely missed the point.

Our latest podcast episode delves into the gender pay gap and wider issues facing women in the NHS. Listen now.