Gender pay gap in England’s NHS: little progress since last yearBMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l2089 (Published 22 May 2019) Cite this as: BMJ 2019;365:l2089
All rapid responses
We know the arguments. We know how meaningless it is to compare the average of all male employee earnings in an organisation with the average earnings of all female employees in the same organisation unless these statistics are, at the very least, corrected for hours worked per week, or occupation, or position, or level of education.
And yet this broad brush approach persists and is now entrenched in law via an amendment to the Equalities Act. A statistic quoted in the BMJ report on GPG by Appleby from the Guardian attributing the cause of a 40% Gender Pay Gap in the Queen Victoria Hospital to the fact that 54 of its 72 highest earning consultants are men is not a pay gap, it’s a gender differential which is historical and likely to change with time as more female consultants filter through.
In this instance, as in most instances, the use of the term GPG is a complete misnomer. An ideological weapon which advocacy groups have delighted in using to browbeat organisations into action to address one of society's great ills—namely the conscious and unconscious bias against women.
The GPG is seen by some as the consequence of sexist stereotyping. The dark side of social conditioning leading to constrained choices and invisible barriers. But the key word in this statement is ‘choices’. And training and competition and appointment by meritocracy have to remain as the path —and barrier—to excellence. Anything other than that, any kind of affirmative action, is likely to undermine the basis on which the NHS thrives.
What the GPG isn’t is what it purports to be i.e. the underpayment of a woman doing the exact same job as a man where there is no other qualifying, hours worked or experiential difference.
If there is genuine evidence that any employee is paying an equally qualified and experienced female employee less than an equivalent male for the same work, that is illegal, is a punishable offence, and should be reported.
So isn’t it about time we changed the term GPG to something more meaningful and less insulting to our intelligence? Forget the pay, that's already written into law. Let's look instead at the numbers in equivalent jobs. How about caling it the Gender Differential Gap? Then, at least, we’ll find out what sub specialities and careers men and women, on an equal footing, will naturally gravitate to through choice (that keyword again) and we can hopefully quell the vociferous few with irrefutable data. That way we may well be able to finally compare apples with oranges, or doctors with bricklayers. Now wouldn't that be interesting...
Competing interests: No competing interests
In reading Appleby’s analysis of NHS gender pay gap (GPG) data, I am reminded of the quote:
“There are three kinds of lies: lies, damned lies and statistics”.
This is often attributed to Benjamin Disraeli, a 19th century British Prime Minister, among others.
It is a laudable aim that men and women should be paid the same if they do the same work. However, the kind of data analysis as presented in this BMJ article appears to lack granularity, which limits what can be learned from it. A key phrase is that large NHS organisations “…report data on overall differences in what their male and female employees earnt….”.
There is then scant detail, or at least scant discussion of any more detail than this. To utilise another well-known phrase, the Devil is in the detail. For example, a NHS Trust with a disproportionate number of junior nurses and allied healthcare professionals (who are often female) would have very different GPG results compared to a Trust with relatively fewer in this group.
Furthermore, a NHS Trust which happened to have a disproportionate number of older consultants approaching retirement, likely to be male, would have a different GPG profile compared to a Trust which had a disproportionate number of younger consultants, likely to be more mixed in terms of gender.
The nature and composition of any NHS Trust’s workforce is subject to many factors, some of which may be subtle, which cannot be captured in this kind of crude GPG analysis.
Thus, the details of the nature and structure of NHS Trusts’ workforces can have very dramatic effects on each organisations apparent GPG.
One should not compare apples with pears; it is inevitable this will lead to the conclusion that apples are not equal to pears.
I remain to be convinced of the value of statistical analyses which do not take all these complex factors into account. Broad-brush reviews of data like this only aggravate lobbyists for gender pay equality and certain sections of the media.
The case for improvement in GPG is not made by neglecting the extremely complicated variations in the NHS workforce and the reasons for those variations across the NHS in England. The NHS should not be homogenised into one amorphous mass & treated as a monolithic singularity.
The only thing this digestible but perhaps simplistic presentation of a complex body of data proves is the longevity and modern relevance of Disraeli’s famous quote.
1. Gender pay gap in England’s NHS: little progress since last year. Appleby J. BMJ 2019;365:l2089 https://www.bmj.com/content/365/bmj.l2089
2. Lies, damned lies and statistics. Wikipedia page https://en.wikipedia.org/wiki/Lies,_damned_lies,_and_statistics (accessed 3/6/19)
Competing interests: I am a male NHS consultant.
Without any prejudice against the author for an excellently presented article, I have to ask why are we still concerned about "The Gender Pay Gap" (GPG). In the most egalitarian countries in the world, namely Scandanavia, where they try and rid boys of their "toxic masculinity", encourage girls to play with Meccano, and believe preferences of the sexes are a "construct" (in spite of all the evidence to the contrary), in spite of their interventions, girls are choosing more traditionally female careers and boys, more traditionally male careers. So, the differences are natural, when equality of choice is maximal. In ophthalmology in the UK, I appointed far more females than males to senior positions. The opposite was true in orthopaedics. This is equality of opportunity and is a laudable aim. The opposite can be said of equality of outcome (to which the GPG applies), which is an ideological construct. What are we to do? Force women to do orthopaedics against their will? Make the women in ophthalmology do orthopaedics? The arguments just do not stack up because the whole GPG is an ideological construct of the left. Why do we not ever hear of equality of outcome in war deaths, in bricklaying, in construction, in farm labouring. Because, in this ideological construct, you have your cake and eat it - if you're a woman. There should be equality of opportunity for all and that should be our aim. Equality of outcome always leads to positive discrimination and in this case against men, in particular white men. In medicine we must oppose anything but promotion on merit, because that creates excellence, and that is how medicine has progressed to where we are today. We must also allow white males equality, and protect females, who in my experience want to be at work less for family reasons. That is quite simply their choice.
Competing interests: No competing interests
This continues to be a major stain and cause of shame for the NHS. It is not as simple as waiting for the old guard to retire, I am aware of continuing problems with female doctors being paid a lower sessional rate than their male counterparts for entirely the same role.
Almost 50 years since the Equal Pay Act in 1970 and this is still happening. More action must be taken to reduce the inherent but often entirely conscious bias against women in the NHS. More challenge must be made of poor decisions. It will be difficult as this is a very complex area. But it must happen. Additionally, the wider intersectional nature of this issue is less obvious unless you are already looking for it.
The NHS is a major employer in the UK and should be an exemplar of equality in the work-space for the rest of the economy.
Professor Dacre's work is of vital and continuing importance.
Competing interests: I am a white, middle-aged, straight, non-disabled male doctor.