Bridging the gender pay gap

What is the gender pay gap

In 2019, gender pay gap reporting was introduced as mandatory for organisations with over 250 employees. Additionally, under the NHS England EDI Improvement Plan published in June 2023, NHS organisations have a target to eliminate pay gaps for both ethnicity and gender. Disability and other protected characteristics will be introduced from 2026 and beyond. 

• Over the last five years, the UK gender pay gap has fallen by a fifth to 14.3 percent for all employees in 2023 and this includes the health and care sector. 
• However, the gender pay gap still persists, with male health professionals, on average, still paid 10.2 per cent more than their female counterparts in 2023.

Inequality continues to exist for many women working in the NHS and there are additional factors at play that should be acknowledged:

• A British Medical Association survey found that 91 per cent of women doctors had experienced sexism. 
• The 2024 NHS Staff Survey indicated that almost 9 per cent of staff have experienced sexual harassment, which increases to a quarter of staff working in the ambulance sector.
• A British Medical Journal report found that nearly a third of female surgeons had been sexually assaulted by a colleague. 

In addition, women are experiencing health inequalities, carry the majority of caring responsibilities at home and struggle to progress in the workplace in comparison to their male peers. Intersectionality must also be acknowledged as a factor, with BME, disabled and LGBTQ+ women all facing additional challenges.  

All of the above factors should not be seen in isolation from the persistent gender pay gap and should be considered when drafting your narrative and creating action plans. 

Understanding the difference between equal pay and gender pay

As set out in the Equality Act 2010, equal pay means that men and women in the same employment who are performing equal work or work of equal value, must receive equal pay. The gender pay gap is a measure that shows the difference in average earnings between men and women across an organisation or the labour market. It is expressed as a percentage of men’s earnings and includes bonus and additional pay supplements, such as clinical excellence awards.

Ensuring equal pay is a fundamental responsibility for employers and in the NHS, the job evaluation scheme is used to measure job value or job weight in a consistent, equality proof way. While it is different to gender pay gap, ensuring good job evaluation practice will give confidence that staff are being paid appropriately for the jobs they are doing. If there is pay inequality, the gender pay gap will be exacerbated.

Six steps to gender pay gap reporting

Addressing the challenges

Producing a narrative and explaining your figures 

The issues that surround the gender pay gap are complex and the causes are a mix of work, family and societal influences. The support provided by employers can influence all these factors and have wide-reaching implications on an employee’s wellbeing, personal life and even on wider society, as well as solely on those associated with their work. 

We strongly advise adding a supporting narrative to the gender pay gap information that you publish. This should be posted on both the government website and your organisation’s website. This narrative should explain the figures you have published and help anyone reading the statement understand the organisation’s view of why there is a gender pay gap (if one exists) and what the organisation intends to do to address it.

Publishing data without a narrative will not allow anyone looking at that data to fully understand the context and backdrop against which that data is being reported.

Examples of good practice from NHS organisations 

Take a look at these examples of gender pay gap reports published by four NHS organisations. They provide detail alongside good narratives to explain their gaps. You may wish to use these to guide you in developing your own narrative.

• North London Mental Health Partnership
• Lancashire and South Cumbria NHS Foundation Trust
• Pennine Care   
• Yorkshire Ambulance Service
   

Self assessment checklists and key actions

Our self-assessment checklists highlight some of the key considerations that may affect your organisations’ gender pay gap. Completing the checklist will enable you to assess your progress against different areas and understand those which require focus and should be addressed in your action plan. 

All organisations should also, in line with good practice, develop and publish a robust action plan that explains how it intends to tackle its gender pay gap. This plan should include targets and clear actions. This action plan should be reported to, discussed and endorsed by the board and be a vehicle for sending a strong signal of commitment to the workforce about their commitment to tackle gender equality in the workplace. 

Taking evidence from existing analysis and guidance in relation to gender pay gap reporting, we have identified six areas in which organisations might want to focus their attention in terms of addressing and redressing a gender pay gap. It must be stressed however that each organisation will use their own combination of approaches and strategies according to their own data and the issues that it reveals.

Checklist - Branding, communication and transparency

Actions

• Analyse your data to see who is applying for and being appointed to particular roles - especially those where there is a gender pay gap. See whether you can change that pattern through better communication, the language you use, gender neutral adverts and branding to attract a different audience. 
• Be transparent about processes, policies and criteria for decision making. Transparent promotion, pay and reward processes can help to reduce pay inequalities. 
• Remember that perceptions are formed early on and perhaps target schools and colleges to ensure that people understand the range of roles available in the NHS and that they are open to both men and women. 
• Make a bold, public commitment to reducing your gender pay gap, taking time to communicate and connect internally and externally. 

Checklist - Recruitment and promotion processes

Actions

• Regularly monitor and report on the gender profile for applicants, shortlisted candidates and appointments, at all levels and across all occupations and working patterns. 
• Ensure that every requirement listed is something that is necessary for the job and skills that can be acquired on the role are not included as a pre-requisite. 
• When shortlisting qualified candidates make sure more than one female applicant is considered. 
• Provide recruiting managers with training around good recruitment practices and interviewing techniques and skills. Use diverse interview panels with women throughout the process, to ensure a variety of perspectives are involved and scrutiny is applied at all stages.
• Review your recruitment practices to see if you could do things in a different way that allows candidates to better demonstrate their ability to do the job. For example, use skill-based assessment tasks and structured interviews in recruitment rather than relying on unstructured interviews. 
• Have clear and transparent job evaluation processes and procedures that allow staff to be appropriately paid for the work they do.

Checklist - Parental, adoption and carers leave policies

Actions

Checklist - Wellbeing and retention

Actions

• Flexible working is an excellent way to both recruit and retain staff and support them to create a better work-life balance and under the Employment Relations (Flexible Working Act) 2023, employees now have the right to request flexible working arrangements. This is also covered under section 33 of the NHS Terms and Conditions of Service Handbook.
• Ensure you fully consider the benefits of these arrangements when dealing with these requests. 
• Offer flexible working options for all staff. Encourage men to work flexibly, so that it isn’t seen as a female-only benefit and supports both men and women to undertake childcare and other caring responsibilities. 
• Where possible consider home or hybrid working patterns. This can be a permanent measure or as and when required by the staff member.
• Provide training and support for all staff on supporting women’s health. This should include the impact of the menopause, menstruation and conditions like endometriosis. 
• Develop a menopause and menstruation policy and be prepared to make changes to support women continuing to work through this period. 
• Encourage your senior leaders to role model working flexibly, taking time off work and, where possible, only working within working hours to allow for commitments outside of work.

Checklist - Supporting female staff

Actions

• Create female-led networks within your organisation or champion other similar networks that your female staff can be part of.
• Offer mentoring, coaching and sponsorship opportunities within your organisation that target women’s development. 
• Share and promote examples of senior female leaders and their career journeys. 
• Join and encourage female colleagues to join the Health and Care Women Leaders Network, a free network for women in the NHS and broader health and social care sector. The network is a diverse community of talented professional women who connect through events, networking and shared learning.

Checklist - Tackling sexism, misogyny and sexual misconduct in the workplace

Actions

• Develop a clear policy based on the NHS England national people sexual misconduct policy framework and encourage staff to complete the e-learning.
• Educate all staff on sexism and sexual misconduct including students, with a focus on responding to reports of sexual violence for managers, culture change, allyship and preventing sexual misconduct. 
• Create psychologically safe workspaces which create a culture where it is safe to speak up about inequity, harassment and misogyny and to ask questions and able to work without fear of retribution or retaliation.
• Sign up to the British Medical Association’s sexism in medicine pledge to tackle gender discrimination in the medical profession.

Checklist - Data analysis

Actions

• Scrutinise your data closely. Understanding the drivers of your gender pay gap will allow you to target your actions to achieve effective results. Identify those departments, services and occupations where the gaps are bigger, or where the number of female appointments is lowest, and investigate why. 
• Disaggregate your data in different ways, don’t just look at the data by gender. Also, consider the differences in terms of age, disability, race and other minority groups and see if this gives you any better insights. Consider the impact of intersectional identities and if one group of interacting identity categories has a larger pay gap than others. 
• Consider if there is a gap between part-time and full-time staff in rates of progression, promotion or within the organisation. This could indicate inadequate levels of support being provided to women with caring or childcare responsibilities.
• Analyse your NHS Staff Survey data, particularly focusing on the experience of women. 

Further resources

Blogs

• In this King’s Fund blog, Danielle Jefferies shares insights on Why there’s still work to be done to close the gender pay gap in the NHS and social care.

Guides

• Learn about the gender pay gap, find out which employers need to report and understand why it's important in this CIPD report Gender pay gap reporting: Understand what it is, if you need to report and why.
• Access the government’s Gender pay gap service for essential information on gender pay gap reporting. 
• Published by the Equality and Human Rights Commission, find out about Gender pay gap: enforcement and the action that will be taken against organisations don’t follow the rules.
• Visit NHS Employers’ page on pay gaps and learn about the different types and the significance of pay gap data.
• Read ACAS guidance on managing employees maternity leave, pay and other rights.
• Published by the government’s equalities office, Women’s Progression in the Workplace shares evidence-based actions employers can take to support women to progress, to help to close the gender pay gap and increase gender equality in the workplace. 

Reports

• Published by The Fawcett Society and the Runnymede Trust, Broken Ladders: The Myth of Meritocracy For Women of Colour in the Workplace is the first report of its kind to focus explicitly on the experiences and perspectives of women of colour in the workplace.
• Take a look at Mend the Gap: The Independent Review into Gender Pay Gaps in Medicine in England.
• Deloitte’s Women @ Work 2024: A Global Outlook examines some of the critical workplace and societal factors that can profoundly impact women’s careers.
• Published by Surviving in Scrubs, Surviving Healthcare: Sexism and Sexual Violence in the Healthcare Workforce provides analysis of 150 survivor stories. It contains recommendations for healthcare organisations to better support survivors and end these behaviours.
• The BMA’s Sexism in medicine report is based on a survey of nearly 2,500 doctors and highlights an issue of sexism in the medical profession.

Case studies

• Read how Dorset Healthcare is supporting working carers to stay in work.
• Learn about the Worker Protection Act 2023 and access new Equality and Human Rights Commission guidance around employers’ legal duty to prevent sexual harassment.