A gender for change

This was a national initiative aimed at 'increasing the quality and quantity of women's participation in the workforce'. The NHS women's unit was the linchpin for the health service's campaign, and its goal was to increase the number of women in general management posts from 18 per cent to 30 per cent.1 The unit had an annual budget of pounds1.5m to spend on promoting opportunities for women, which it used to launch initiatives ranging from family-friendly working to career development and leadership programmes for female managers.

For a while it seemed that cracks were appearing in the glass ceiling. But in 1996, the women's unit was wound up and its role taken on by a new equal opportunities unit with a remit covering not only gender but race and disability too. While some were quietly glad to see the women's unit go, others saw its passing as a setback for the cause of women in the NHS, particularly those at a senior level.

Now latest figures suggest that female managers remain grossly under- represented in the higher echelons of the NHS. Income Data Services puts the number of women chief executives in trusts at just 17 per cent, while figures from the Institute of Health Services Management, which also include health authorities, show that out of a total of 699 chief

executives, just 133 - about 19 per cent - are women.2,3 There are marked geographical variations: in Scotland, for example, there are just three women chief executives out of a total of 47.

So was the disbanding of the women's unit premature, and has the push towards promoting female managers lost its momentum?

Caroline Langridge, former head of the women's unit and now an associate fellow at the King's Fund, believes it has and that women NHS managers now lack a champion in high places. She believes that the new NHS equal opportunities unit devotes much more of its energy to the issue of race discrimination than it does to gender.

'It's as if there's a feeling of 'we've done women now, they've had their push and it's time to move on to other things'. I think women are losing some of the ground they gained a few years ago.'

Ms Langridge says that at the NHS Executive she was conscious of a reaction from some men in the health service that 'enough was enough' when it came to trying to get more women to the top.

'The minute women started doing better, or at least as well, there were accusations of positive discrimination. But that was unfair. We never said women should be promoted on anything other than merit. But I'd get male managers saying to me in a joking but quite pointed way: 'I'll have to wear a skirt next time I go for a job interview.' I think there was starting to be a bit of a backlash and then Ken Jarrold came along and disbanded the unit.

'But he couldn't dispute the basic fact that women were almost 80 per cent of the NHS workforce yet they were seriously under-represented at the top.'

Mr Jarrold, former NHS human resources director and now chief executive of Durham HA, rejects the suggestion that his decision to scrap the women's unit was a response to any backlash: 'Absolute nonsense. It was a carefully thought out policy. We needed a structure that concerned itself with equal opportunities issues wherever they arose, whether that's gender, disability or any other kind of discrimination.

'I have always paid tribute to the work of the women's unit - it did a good job, but for a fairly limited number of people in one aspect of equal opportunities. It benefited a group of senior women managers and had a fairly narrow focus. I stand by my decision that what the NHS needed was a unit with a broader remit.'

Elisabeth Al-Khalifa, the head of the new unit, was formerly director of the women's leadership programme at the Local Government Management Board. She says: 'In my experience, when people are over-specific about women their thinking narrows down. The equality agenda has broadened and you must keep sight of that breadth and inter-relationships when you are considering issues relating to women.'

Ms Al-Khalifa is a member of the leadership team of Opportunity 2000. 'What is exercising our minds at the moment is how that campaign will proceed beyond the year 2000. Clearly, there is still much work to be done and there's no denying the glass ceiling still exists. What I feel we need to do is ask people in the service what they think matters and how they want us to proceed.'

The NHS Executive will be announcing the results of an evaluation of Opportunity 2000 in the autumn. Baroness Cumberlege, who was junior health minister when the goals were first set, describes the current figures on the number of female chief executives as 'pathetic'.

'It's very disappointing, though you have to take into account that it all started from a very low base and these things take time.'

Baroness Cumberlege believes that although women trying to get to the top did gain ground in the health service, they have reached a plateau. 'You can't sustain a continuous sharp rise, and you have to be careful of the backlash. It was always coming. We're on a plateau now, but another thrash should come soon. I hope so anyway, because what health service management badly needs is more diversity.'