Report highlights work still to do on women in senior management in the NHS

A new NHS Confederation report highlights where progress has been made in getting women into senior management positions and also where blockages still exist.

Women on boards - women at the head of a boardoom


Under a fifth of senior management in some NHS trusts are women, according to a new NHS Confederation report which says action is “essential, overdue and needed now”.

The Confederation’s Health and Care Women Leaders Network’s report, Action for Equality: The Time is Now,  finds that on average 44.7 per cent of executive and non-executive roles across NHS trusts are held by women  – up from 39 per cent in 2017 – and that 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, found challenges in particular roles. For example, only 25.3 per cent of chief financial officers and 29 per cent of medical directors across the NHS – the UK’s largest employer – are women. For CFOs that figure represents a decrease from 26.3 per cent in 2017.

The report says 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, as in other sectors, there has been the greatest progress with female representation in non-executive roles, where 40.9 per cent are now women – an increase from 37 per cent in 2017.

The proportion of women in chief executive roles has also 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.

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 report makes a number of recommendations, 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.

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