What can be done to bring better representation of women at the top of the NHS finance function? Sue Lorimer discusses the HFMA’s recent rountable

It’s not in my nature to accept no for an answer or shy away from a challenge. It’s this determination that has driven me throughout my career and one of the main reasons I wanted, to investigate the gender imbalance at the top of NHS finance.

Stronger together

I’ve themed my presidency work on ‘stronger together’, and amongst other things this demonstrates what I, and many others like me, feel can be achieved if we have a better balanced boardroom.

As part of this quest, myself and a talented table of NHS, academic and sector professionals, both men and women, took this topic on at an industry roundtable event.

This was a joint Healthcare Financial Management Association and Future-Focused Finance venture. During the roundtable attendees discussed personal and professional experiences, both good and bad, as well as research and examples of where change has already been affected.

As part of this discussion, we attempted to shape ideas as to what might be done to bring better representation of women at the top of the NHS finance function.

For a multitude of reasons, women dominate the NHS workforce, representing more than 77 per cent of all staff. In finance, women are also in the majority with 62 per cent of those working in finance being female.

Some women, like some men, are not interested in progressing into the senior positions

At NHS chief executive level, women represent 41 per cent, which is a strong showing compared to other sectors. However, there is a sharp drop when the figures for finance directors are analysed, with only 26 per cent being female.

Somewhere between the 62 per cent and the 26 per cent, we lose talented women from finance.

Of course, some women, like some men, are not interested in progressing into the senior positions. I fully advocate individuals taking the career path they choose and one that works for their lifestyle and professional ambitions.

Yet, this needs to be an active choice and not rooted in a wider systemic problem. The statistics seem to indicate the latter.

In my view, as well as everyone around the table at the event, the NHS is missing out as a result.

There were five major themes we tackled during the roundtable: confidence, role models, sponsorship, flexibility and clear career paths.


Career success is often correlated with confidence as much as it is with competence, and this is where some women fall down – they don’t believe in themselves or their skills. The theme of confidence was discussed at length during the roundtable and the fact that active talent management is incredibly important.

We all need to take responsibility for nurturing those with potential to do particular jobs. There needs to be processes in place so this is done fairly, shows no bias towards a particular kind of person and does not just look for ‘mirror copies’ of a current senior team.

Talent is not about shouting the loudest or to do with what gender you are or background you come from, and those working in the system need to continuously remind themselves of this.

Role models and role transparency

The perception of particular roles needs to also be addressed and many of us felt this goes hand in hand with having more positive role models. We have a high proportion of female deputy finance directors, but this drops off at the finance director level.

One argument for this is that the title of finance director and what the job entails is sometimes seen negatively.

However in reality, the role of deputy director and director are incredibly different. Becoming a director is not about working harder or giving more, but instead focusing on other, less operational, priorities.


Sponsorship is something that was suggested in the session. Partnering senior colleagues with more junior ones to help support their progression and champion them through the organisation.

Where there are opportunities, good sponsors should be there to bang the drum for those they work with. For some lucky individuals, this can happen informally anyway, but as this is not always the case; structures should be set up to give everyone the framework for it.

It was decided that both men and women in NHS finance should be sponsors and be sponsored.


Flexible working is another sticking point. Organisations that say they are flexible, need to deliver on this.

Often the small things, an early morning or early evening senior leadership team meeting may alienate those with childcare responsibilities, setting a difficult precedent to break. It’s fair to say that some structures have not changed, even though the needs of the personnel working in organisations have done.

Furthermore, organisations need to accept that people’s personal commitments are as important as their work commitments, and treat them equally. Picking up a child from school or caring for an elderly parent does not make a person any less committed or talented in their job.

Language can have an impact too. We spend a lot of time talking about ‘staff’ and ‘resource’ meaning that there is a danger people are thought of as commodities rather than people.

A clear path

The NHS is flexible by nature and working in it means your career can take many positive twists and turns, allowing you to switch focus and gain other experience when needed. However, this portfolio approach and fragmented structure can sometimes blur the route to a clear path to senior promotion.

What ultimately is a benefit for the system we work in should not end up hindering us when trying to reach for the top, if we can’t quite see it. Perhaps some women working in NHS finance can’t see a direct path to a senior leadership team?

Until a more equal gender balance is achieved, the NHS is missing out on many of the right people to do the right jobs. There really is an opportunity to be stronger together on boards, in teams and across an organisation, but we need to grasp it.

The NHS finance community is renowned for its comradery and, even with current unprecedented financial pressures, there’s an overwhelming sense of pulling together. It’s my goal to see that same dedication and determination applied to delivering a better representation of women in our senior NHS Finance roles.

Sue Lorimer is president of the Healthcare Financial Management Association