Women make up the vast majority of NHS staff, both in clinical and non-clinical functions, and make up the majority of medical students and people entering the health professions. But they are still a minority in the senior ranks of the profession and in senior management. This under-representation of women has the potential to affect the priorities the NHS has in terms of service provision. It also demonstrates quite starkly how even in female-dominated organisations, women have been held back, either deliberately or structurally, from getting to the top.
Our Women in Leadership event, featuring Rachael Maskell MP, a former physiotherapist, Kirstie Stott, Programme Lead for the NHS Graduate Management Training Scheme, Jos Bell, Chair of the Socialist Health Association, and Rika Talukder, a junior doctor, discussed ideas about how to improve the situation.
It was apparent that the difficulties women face in advancing in the medical and associated professions start at university. While the hard professional skills are vital to learn, so-called “soft skills” such as leadership are also important for long term success. Women make up the majority of medical students and often achieve better academic results. It is incumbent on universities and professional trainers to ensure that women are mentored and encouraged to take on leadership roles and learn the importance of management alongside professional training.
In addition, it is the responsibility of educators to ensure that women do not have their horizons narrowed by preconceptions about what specialisms are better suited for men and women. We can tackle this problem in two ways. Firstly, there needs to be a focus on identifying and using positive role models in specialisms where women are under-represented. Secondly, and more importantly, there needs to be a cultural shift; a surgeon, for example, needs to have strong leadership skills, but she does not have to exhibit “traditionally male” traits in order to demonstrate that leadership.
The “soft skills” concept was a key theme of the evening. A major problem that was highlighted was the problem that medical professionals often face of being pushed into playing narrower roles and having narrow functions. While unproblematic in itself, it means that people can find it difficult to think of themselves as being able to take on leadership roles. Where women in particular are not encouraged to put themselves forward, often by male superiors, this issue creates a vicious circle for women. A concept of seniority reliant on longevity rather than achievement also makes it difficult to identify when someone is genuinely suited to take on responsibility.
Internal recruitment processes within the NHS came in for criticism. The recruitment process can often be excessively rigid, formal and process-driven. This can benefit those who see themselves as “natural” leaders and those who are of a similar social group to the assessors. The panel thought a better way of internally recruiting was to have a looser mechanism whereby top performers (identified by a holistic process rather than according to narrowly drawn criteria) could gradually be given more responsibility and prepared to enter management if they so choose. It was also felt to be important to ensure that people who want to maintain a strong clinical practice are enabled to do so alongside having management responsibilities. There are a wide range of types of “leadership” roles within the NHS, some which require more commitment than others and which would all benefit from greater gender parity.
Finally, external recruitment processes also suffer from problems. Where senior managers are brought in from industries or professions where gender equality is even worse, there can be a tendency to hire men rather than women. We need to make sure, using quotas or otherwise, that NHS recruiters are required to make the people they recruit externally look more like the NHS workforce rather than a FTSE 100 board of directors. The panel also highlighted that often this issue would not need to exist if sufficient steps are taken to encourage and promote women internally.
The NHS, and the medical and allied professions in particular, suffer quite considerably from the gendered effects of stereotyping, over-work and poorly defined career paths. To tackle them, and to make NHS management more representative, we are going to need to increase the levels of flexibility, support and mentoring available in the NHS, and concentrate on developing leadership skills from day one of training. Whether we can do this in the light of the NHS funding squeeze is doubtful. But when we waste talent and get our priorities wrong, and when we waste money on recruitment and on training women who drop out of the profession, we can’t afford not to put the changes in place to boost women and improve our health service for everyone.