Intended for healthcare professionals

Rapid Response:

Re: Gender pay gap in England’s NHS: "lies, damned lies and statistics"?

Sir,

In reading Appleby’s analysis of NHS gender pay gap (GPG) data[1], 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[2].

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.

References
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.

04 June 2019
Gee Yen Shin
Consultant Virologist
UCLH NHS Foundation Trust
UCLH NHS Foundation Trust, London