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Women still in the minority in NHS leadership roles

Women are still massively underrepresented in senior leadership positions in the NHS, a major analysis by HSJ has found.

Just 37 per cent of senior roles on clinical commissioning group governing bodies and NHS provider boards are held by women.

Despite the fact women make up 81 per cent of the non-medical workforce in the NHS, men constitute the majority in the leadership teams of all but 12 per cent of providers and 10 per cent of CCGs.

HSJ’s work forms one of the most comprehensive analyses of female representation in the NHS since the reforms set out in the Health and Social Care Act 2012 were implemented.

It found that where women hold executive level responsibilities these tend to be traditional female roles such as lead nurse or director of human resources. In contrast, three quarters of NHS finance directors are male.

Fifty two per cent of executives with a responsibility for workforce at providers are female.

Deputy managing director of the NHS Leadership Academy Karen Lynas told HSJ this division of labour was common in other industries. However, she said the “command and control” leadership style of the NHS was “unattractive to women” who, international studies suggested, tended to have a more inclusive approach.

“This emphasises the point that there isn’t a lot of room for people behaving differently [in the NHS],” she added.

HSJ’s analysis found the senior positions least likely to be held by a woman were those of CCG chair and medical director of providers. Meanwhile, CCGs are more than one and half times more likely to have a female finance director than providers.

Women's issue: Medical directors, CCG chairs, provider chairs stats

Source: HSJ research

Julie Wood, the commissioning development director of NHS Clinical Commissioners, said the lack of female clinical leaders was “of concern”. She suggested the fact that women tended not to be practice partners could be a cause and urged CCGs to consider creating a position on their boards for GPs working on a salaried or sessional basis.

She said the fact more women were likely to be in senior management roles at CCGs than at providers was the a continuation of a trend seen in primary care trusts.

Ms Lynas said there was “still a hierarchy of organisations in the NHS” and the higher proportion of women in senior leadership roles on CCGs reflected the fact the groups were “as yet unproven in terms of their power and influence”.

It is notable that of the 10 most prestigious teaching hospitals that form the Shelford group only one has a female chief executive - Dame Julie Moore at University Hospital Birmingham Foundation Trust.

Sixty four per cent of both South Tees Hospitals Foundation Trust and Lewisham Healthcare Trust’s leadership positions were held by women - the highest proportion.

South Tees is one of only 17 provider trusts to have a female chair and chief executive. Chief executive Tricia Hart said the “50 or 60” hour working week typical of executive positions could be more challenging for women but she felt positive about the future.

She said: “The fact that more people are having coaching and mentors can support them to look at the opportunities that are certainly out there.”

Readers' comments (10)

  • In this day and age why do we have this discussion. The NHS is completely open. All posts are advertised. If I feel I have not been selected or treated unfairly at interview I can appeal. So lets stop the moaning and get on and work hard and acheive each what we are capable of. In my experience of NHS interviewing, up to Board level, things could not be fairer. In fact it is the lack of women who want to apply that causes the lack of women at the top, not us being discriminated against.

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  • vicki diaz

    I would like to say that I work for Health Education England and feel we have a great representation of strong woman on our board. Nicki Latham Chief Operating Officer, Jo Lenaghan Director of Strategy and Planning, Wendy Reid Medical Director, Lisa Bayliss Pratt Director of Nursing and we also have three Non Executive Directors. Feels good to be working in an organisation that is flying their women as leaders flag so high.

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  • I am very, very non sexist.

    After 30 years comercial career and 10 years very close NHS working, I won't even mention my opinions on general NHS management.

    However one common factor across a lot of Trusts is that the most politically asperational nurses tend to progress to "Director of Nursing".

    Because they a politically aspirational they give the worst possible leadership to their reportees.

    I can't see the present pressure for culture change succeeding without traumatic management (clinical and administrative) changes.

    Doesn't matter whether you're male of female.

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  • I am a senior clinician in the NHS and sadly confirm there is institutional discrimination against women. When I was younger I thought surely not, we all have equal opportunities and everything is fair and open, it's just that women don't want to apply.

    We should ask ourselves what is operating to discourage them? We are wasting half our potential.

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  • There is an additional concern when you consider that women give birth, do more child care and live longer. All of this means women probably outnumber men as service users overall too. Many commercial industry boards have found they considerably improve productivity when their boards are reflective (in style as well as well as look) of both front line staff and service users. Leadership style at the top should reflect the style on the front line required. In other words. If you want a culture of service, empowerment and partnership between service providers and service users you need to see this "service culture" modelled down through the organisation. The NHS is not a military. We don't need a culture of command and control. We need servant leadership. The clue is in the title. It is a national health "service" .

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  • The data from this study is very similar to that which the HSJ recently published regarding the "difficulties" experienced by BME people in securing permanent roles in the NHS. The NHS has a moral and legal duty to do something these embarrassing data sets.

    Are women very able in caring for the sick, as nursing professionals, or for employees as HR Directors but less able to perform in other leadership positions?

    If the answer is yes - keep the status quo.
    If the answer is no - then what is the health system to do to make meaningful change in our lifetime?

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  • I am so proud to see HSJ taking keen interest on women in leadership and nice to see some hard evidence. It would be nice if HSJ publishes similar details for BME staff in leadership position and I am sure that that will also be interesting. But I rarely see any Journal, Trade Union or NHS Institution doing this because it is easy to talk about women but difficult to talk about race and ethnicity.
    Please do not take my comments in any negative sense. Leaders must always be appointed only on the basis of merit and any positive and negative discrimination is bad for the society. But FMLM, Royal Colleges, HSJ and many other great Institutions are quick and comfortable to talk about women in leadership but sadly I see there is always hesitation and reluctance to talk about BME in leadership position. In my vast experience on leadership it is a sad reality that only 10% of doctors have leadership skills, attitude, attributes, aptitudes or willingness to sacrifices needed to be a good leader. A good leader is the one who has all the great characters of being a great doctor. One who is clinically very competent but also has great communication skills, inter-personal skills, leadership skills, assertiveness skills and one who is honest, sincere, kind, caring and compassionate but one who always puts patients at the heart of everything he/she does. By not appointing good doctors as leaders from BME and women pool we miss out on appointing 10,000 good doctors as leaders and sadly in their place we appoint someone who is not so good as leaders and this is why in some places NHS is mediocre in his performance.

    Let us appoint leaders only on the basis of merit and not because they belong to a particular club, network, sex or ethnicity. We owe it to our patients, NHS and the profession to get the leadership right.

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  • Speaking as a woman in a senior role who also used to be a nurse, I am honoured to be in the HSJ list. And I admire Alastair, HSJ colleagues, the judges and the nominators for having the courage to do this, knowing that various Anons would be crying UNFAIR but not having the courage to put their names to their complaints.

    The facts are stark - 70% of the NHS workforce is female and 20 % BME. So let's see this reflected in jobs at all levels by filling each post through a truly open process, by encouraging those who have the skills but for whatever reason don't come forward for senior roles to do so, and by having great role models for people from all minority groups to aspire to.

    I spent most of yesterday evening talking to Sarah Amani, Molly Case and Helen Donnelly. We noticed that the room was much more diverse and inclusive than on other such occasions in age range, gender, sexuality, ethnicity and visible disabilities. It was lovely to be there.

    These 50 women represent over a million other women who all do amazing work in the NHS.

    Thank you to all of you x

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  • Tom  Bell

    There has been a wealth of great research done that shows women are "generally" more suited to providing balanced effective leadership than men.

    As a man I can honestly say that the best managers I have been managed by were women. This also applies to the worst manager I have had. The best was one who displayed attributes that I see as more prevalent in women; namely non-judgemental, sensitive to the needs of staff and able to see things from numerous perspectives whilst maintaining focus on the task in hand.

    My worst manager was a woman who tried to outman the men.

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  • Umesh is right, very few people are good at leadership.
    Maybe more Drs will be good leaders now that more women than men are becoming Drs, but I doubt it.
    If we accept that there a set of qualities that are predominantly held by women and a different set by men then there are likely to be opposite sets that make people poor leaders determined by their sex.
    Having been through two leadership courses over my 20 years as a GP I do not believe leadership can be taught. They certainly failed to teach me.
    I do believe leadership can be recognised and nurtured but that requires a whole different workforce development plan.
    Congratulations to the amazing women on the HSJ list, could we have a similar list for other groups please

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