Susie Perks-Baker

Despite the advances of recent years, two recent reports, Women in finance and Women on boards: 50:50 by 2020, once again draw attention to the problems women still face in obtaining senior leadership positions within the NHS and outside it.

Women in finance is about fairness, equality and inclusion for women and men. It is predicated on a desire for gender parity and a balanced workforce because, as the evidence makes clear, this improves culture, behaviour, outcomes, profitability and productivity. However, the current situation in the financial services sector is quite different; more women than men start out in financial services but many women fail to move up the management scale. This leaves almost all the top jobs in the hands of men. The main reason for this, it appears, is organisational culture.

One study conducted in 2016 across a wide range of employment sectors found that unsupportive workplace cultures still present the most significant barrier to career progress for women. Amazingly this was the case for female respondents in the 20-29 age group as well as for older respondents. Gender inequality and discrimination were reported, as were difficult colleagues and managers, bullying, undervalued work, and women feeling that they have to over-perform simply because they are female. Recommendations following this study included building closer relationships between men and women in the workplace, and the provision of opportunities to discuss gender issues experienced within the organisational culture.

Organisational culture (including the drive for a more inclusive approach to leadership development) is something that is currently receiving considerable attention in the NHS. Michael West has led much of the work in this area, and his accounts of the impact of what – in some places – might be described as a macho culture, are deeply worrying. Given that the NHS is made up of a predominantly female workforce, the impact of such a culture is largely upon women. Obviously, in some cases, this includes women behaving less than supportively to other women.

Professor Ruth Sealy’s report on senior women in the NHS makes clear that, despite 77 per cent of the NHS workforce being female, there is still long way to go in terms of gender parity in senior leadership positions. If the NHS Improvement/NHS Employers target of 50:50 representation on NHS boards is to be achieved, 500 more women need to be appointed to board-level positions by 2020.

Despite these reports emanating from very different sectors, the issues they raise are remarkably similar and, not surprisingly, there is commonality across some of their suggestions for addressing the issue. For example, they each call for strong leadership (including positive male role models) or executive accountability for the gender parity agenda at senior leadership/board level, the use of agreed targets and, crucially, mandatory public reporting of progress against targets and gender balance on boards. As the saying goes: ‘What gets measured (usually) gets managed’.

The NHS report also advocates gender-specific learning in NHS training programmes, covering topics such as unconscious bias, management of flexible working practices and specific female coaching, mentoring and sponsorship.

Here at The King’s Fund we are already doing this in our Athena programme and, while Athena focuses specifically on issues facing women, we feel that progress on gender equality will be a catalyst for change in other under-represented groups and a step forward for working with diversity and difference beyond gender.

Our work ‘in the moment/in the classroom’ has involved experiential exercises around difference: in one such exercise we challenge people to consider various ‘labels’ – married, single, divorced, from an ethnic minority, born in the UK, not born in the UK and others – and then to explore what it feels like to be labelled in these ways, what it feels like to be in a majority and also a minority; noticing how it feels to be ‘different’. While this exercise is clearly relatively simplistic, it nonetheless acts as a gateway to a more profound discussion around ‘difference and diversity’ and the resource, as opposed to the threat, this offers for leaders.

Whilst attempts are being made to address the issue of unconscious bias generally in the NHS (see, for example, the work of The Royal College of Surgeons and this piece by head of diversity and inclusion at NHS Employers), in recruitment it remains an issue, despite the need for an inclusive workforce which reflects the diverse communities it serves. Unconscious bias (notably against women) continues to impact many senior leadership appointments both within and beyond the NHS.

Embracing difference forms part of our work on enabling women leaders to discover and use their own resources and talents to handle and transform the cultural challenges that remain in the workplace – and how hard taking on this challenge can be.

• Find out more about the Athena programme