Earlier this month we celebrated the 72^nd birthday of the NHS; our country’s greatest national treasure. 2020 has been the most challenging year in its history and we have rightly reaffirmed our gratitude and appreciation for this remarkable institution which is staffed by a dedicated and committed workforce. Women are overrepresented in the NHS, making up 77% of the total employees and 89% of nursing staff. With around 1 million women working for the NHS, it is one of the single biggest employers of women worldwide.

However despite women’s numerical dominance in the NHS the uncomfortable truth is that they are paid less, promoted less and systematically under-represented amongst the most senior jobs. According to official NHS data in 2018 women were found to be paid 23% less than men. The largest ever study of public sector pay last year found that female doctors in England typically earn £1,166 less a month than their male counterparts. And while half of all junior doctors are women, at consultant level the number falls sharply to around a third. Among senior non-clinical roles, only 12% are women.

Throughout its history, women have made an enormous contributions to the NHS. Yet these contributions were (and continue to be) undervalued and underappreciated, and women continue to face immense barriers to the profession.

Women’s access to the medical profession has been a hard fought battle. The first woman to openly qualify in Britain as a physician and surgeon was Elizabeth Garrett Anderson in 1865. Soon after this the Society of Apothecaries banned women from registering to study. In 1875, under pressure from the wider changes occurring as a result of first-wave feminism, Parliament passed legislation to allow women to study medicine. Yet, in reality, few institutions actually allowed women to enrol, or gave them equal treatment. For example, despite sitting the same exams, Sophia Jex Blake, a tenacious campaigner on this issue, was awarded a Certificate of Proficiency rather than the medical degree given to her male counterparts. She was forced to complete her medical education in Switzerland. It wasn’t until 1944 that the government provided funding to medical schools which admitted what it described as a “reasonable” amount of women - around one fifth.

There is no available data on women working in the NHS workforce when it was created. This wouldn’t be considered important and thus be collected for a further generation. What we do know is that women remained a minority and continued to occupy the lowest levels in the professional hierarchy.

Women can now be found in seniority across the medical profession with  Professor Dame Sally Davies, Dame Jane Dacre, Dame Marianne Griffiths, Fiona Godlee, Clare Panniker, Dr Navina Evans as some of the most impressive examples of female leadership. While these women’s successes should be welcomed, encouraged and replicated, we must not forget the majority of women working in the NHS remain underpaid and undervalued. Especially in the current climate we must keep discussing the particular risks women are exposed to. The women working on our frontline face the clear dangers of direct and sustained exposure to the COVID-19 virus. Shockingly, one analysis of COVID-19 related deaths indicate that young female NHS workers might have a mortality rate almost twice that of a matched non-NHS employed group.

One discussion that is especially worrying is the suggestion that women may being forced to put themselves further at risk with ill-fitting Personal Protective Equipment (PPE). Designed and procured in a “one size fits all”, unisex manner, this often translates to being inadequate for female facial and body shapes. Evidence on this is beginning to emerge with a study from Loughborough University finding that COVID PPE does not fit women as well as men, and the journal Anaesthesia publishing that female medics who have intubated COVID-19 patients are at higher risk than male medics of going on to contract COVID-19 themselves. Further research is urgently needed to establish the extent and significance of ill-fitting PPE and to ensure the adequate protection of women on our frontline from the dangers of coronavirus.

This year, as the NHS’ birthday passes us by, it is critical we do not forget those on the frontline, the specific dangers women face and the unique risks they undertake on a daily basis. During the last few months of the pandemic too many have made the ultimate sacrifice for their patients. I sincerely hope that one of the few positive legacies of the coronavirus is that NHS staff finally receive the recognition and appreciation that they deserve, something which is completely overdue and absolutely necessary.