Gender issues in the workplace and in the NHS

1
Gender issues in the workplace and in the NHS

• Dr Natasha Mauthner
• Aberdeen University Business School

2
Aims of the session

• To understand
• The position of women in the labour market
  generally, and in the NHS more specifically
• The constraints on womens progression within the
  labour market and NHS
• How womens progression can be facilitated

3
Group work analysis of newspaper article

• Article The glass ceiling proves resilient
• Discuss your question with your group
• Nominate a time-keeper
• Nominate a note-taker
• Nominate a spokesperson
• Use overheads
• Feedback to the class/Class discussion

4
Question 1

• What have been the main changes in the position
  of women in the labour market over the last 20
  years?
• What do you know about the position of women in
  the NHS or health organisations within your own
  country?

5
Women in the labour market

• Increase in womens employment rates 41 of
  world labour force is female
• Decline in male employment over past 20 years
• Rise in womens employment mainly due to
• Increase in employment rates among mothers,
  particularly with children under 5
• Increase in part-time work
• Occupational segregation
• Gender pay gap

6
Women in the NHS

• The workforce is female dominated in September
  2005, three-quarters of NHS workforce was female
• NHS largest employer of women in Europe
• Women make up the majority of medical students
• Yet women are concentrated in certain
  occupational categories and at certain levels
• Occupational segregation vertical and horizontal

7
Example of horizontal segregation

• Women concentrated in less glamorous, less front
  line specialties e.g. public health,
  anaesthetics, pathology, radiology and geriatrics
• Women heavily concentrated in four occupational
  categories
• nursing and midwifery (90)
• allied health professionals (88)
• administrative and clerical workers (84)
• ancillary workers (74)

8
Gender pay gap
Gender differences in pay women getting paid
less than men for the same or equivalent work

• Pay gap in NHS is significant partly due to
  horizontal segregation, partly because male
  medical staff are in higher graded posts than
  their female counterparts

9
Question 2

• What progress have women made in the workplace in
  terms of management jobs and positions?

10
Womens progress in management

• Increase overall in women in management positions
  due to
• Greater numbers of women in education
• Economic growth
• Shift from manufacturing to service jobs
• Equal Opportunities legislation social
  policies
• Women at higher managerial levels

Numbers of women executives has doubled since
mid 90s Numbers of women company directors has
tripled since mid 90s
11
Women in management

• Women comprise less than 1 of company directors
• Under representation of women at the top even in
  traditionally female occupations e.g. nursing
• Women progress slower than men
• A report in October 2006 showed that Just three
  female CEOs in FTSE 350

• But the proportion of women in top management is
  still small

12
Vertical segregation in NHS

• Womens share of higher level jobs remains low
• Senior management 17 women
• Hospital medical staff 34 women
• Consultants 21 are women but just 5 of
  consultant surgeons
• GPs 34 are women

Women are heavily concentrated in lowest
managerial grades Women comprise 50 of managers
in NHS Women are under-represented in medical
staff, senior management and clinical grades
13
Vertical segregation within nursing

• Men comprise 10 of nurses
• Men dominate higher nursing grades
• Men occupy half of all nurse managers posts
• Men three times more likely to be in the top
  Director of Nursing grade than women

14
Question 3

• What are the barriers to womens progression in
  the workplace in general and in the NHS
  specifically?
• Why are there so few women in top management
  positions?

15
The glass ceiling
The invisible barriers women face in progressing
into senior management positions

• Why do women come up against a glass ceiling?
• Situation-centred explanations Organisational
  Culture
• Person-centred explanations Socialisation

16
Organisational Culture

• A male culture
• Networks
• Gender stereotypes
• Long hours culture
• Recruitment and selection
• Restricted opportunities for flexible working at
  senior levels
• Training, staff development and career
  development
• Mentoring

17
Socialisation

• Going for stereotypically female occupations
• Putting the family first
• Women holding back

18
Barriers to womens progression in the NHS

• Male attitudes and patronage
• An inflexible career structure and working
  practices
• Low status of part-time work
• Occupational downgrading for female returners
• The demands of having to be mobile
• Difficulties of combining career and domestic
  responsibilities
• Extremely long working hours
• Lack of time and opportunity for studying for a
  higher professional qualification

19
Question 4

• What can governments and organisations do to
  improve the situation of women in the labour
  market generally, and in middle/top management in
  particular?
• What policies and practices are you aware of to
  improve the situation of women in the NHS?

20
Facilitating womens progression

• State level national initiatives, policies and
  educational programmes
• Organisational level equal opportunities and/or
  managing diversity

21
State Level

• Legislation in Great Britain regarding
  discrimination on the grounds of sex
• Equal Pay Act 1970
• Sex Discrimination Act 1975
• Gender Equality Duty 2007
• Equal Opportunities Commission
• National Campaigns and Special Enquiries

22
Gender Equality Duty 2007

• As a result of GED all public sector bodies and
  private sector, voluntary or charity
  organisations providing public services, must
  take gender into consideration when providing
  employment services and service provision.

23
Examples of how the GED will work

• Men are less likely than women to visit their GP
  they often seek treatment late in an illness

• GED could see GPs improving provision of
• services to men by targeting men

24
Organisational level

• Equal Opportunities Policies
• Awareness raising
• Minority monitoring
• Selection training
• Recruitment, training, staff development and
  mentoring
• Positive discrimination/affirmative action

• Flexible working practices
• Managing diversity approach

25
Policies and practices within the NHS

• Opportunity 2000
• Career Development Register
• NHS Womens Unit (1991)
• Equal Opportunities Unit (1996)
• NHS Plan (2000)
• Improving Working Lives Initiative
• Flexible working initiatives in the NHS

26
Flexible working in the NHS Background and
Context

• Strategies adopted
• Increase in training places
• Recruitment from abroad
• Improved retention through improved career
  structures and flexible working
• Drawing back staff who have left NHS

July 2000 Launch of NHS Plan in order to address
staff shortages, recruitment and retention issues
27

• Improving Working Lives (IWL) Standard is an
  organisational change programme aimed at
  promoting flexible working and improve working
  conditions in the NHS

28
Why is the NHS introducing flexible working?

• Recruitment targets
• Retention of mostly female workforce
• Growing demand from staff for flexible working
• NHS as employer of choice
• Improving access to, and extending delivery of,
  health care services
• Increase functional flexible working

29
Flexible working initiatives in the NHS

• From 2003 all NHS employers were required to
  offer flexible working opportunities
• Flexible careers, training and development

30
Flexible Careers Scheme

• The Flexible Careers Scheme was developed in
  conjunction with the BMA to enable both hospital
  doctors and GPs to combine medical training and
  career development with periods of part time
  working and temporary career breaks.

31
Flexible working arrangements

• Self rostering shifts
• Annualised hours
• Reduced hours
• Job-sharing
• Career breaks
• Flexible retirement

32
Self rostering shifts

• Self rostering was introduced on Nathan House
  which is a Private Patients ward at the Christie
  Hospital in Manchester.Self rostering was
  introduced as there were several staff on the
  ward with children who found it difficult working
  shifts that were organised for them regarding
  childcare problems. Therefore by organising their
  own shifts staff could work around the needs for
  childcare.At the start of each month the off
  duty schedule for next month is put on the
  noticeboard for staff to fill in the shifts that
  they are able to work. The off duty is then
  completed by a senior member of staff.Staff
  find self rostering enables them to work their
  shifts around their home lives as opposed to the
  other way around. It had a positive effect on
  recruiting and retaining staff on the ward.

33
Job-sharing

• Tricia Fitzgerald (mother of three) job-shares
  her post as Head of Nursing, managing 76 nurses,
  reception staff and receptionists in a busy AE
  Department. She says
• When I returned to work after having had my
  third baby, I wanted a work arrangement that
  would accommodate my childcare responsibilities
  but still allow me to do a demanding job. So I
  talked to Lynne, who has similar qualifications
  and experience to me. We discussed the idea of
  job-sharing and our managers agreed. We started
  the job-share three months ago and it works very
  well. Our skills are complementary. Its
  important to be open and honest with each other
  and to give out the same messages as a united
  front. We both work 24 hours a week, overlapping
  on a Tuesday, when we arrange meetings. Its
  essential that we both attend, or wed end up
  wasting time communicating information
  second-hand. The great benefit for me is that I
  can do this very demanding job and run a family.
  I simply wouldnt be able to do it if I didnt
  job-share.

34
Flexible retirement

• Julie Brown will retire in January from a full
  time, managerial post in Occupational therapy.
  She wishes to remain at work, so has asked to
  return on a half time basis to a clinical post
  following her retirement. Management and the
  Trust has supported her in doing this.
• Gerald Scott wants to reduce his working
  commitments prior to retirement. By reallocating
  workloads the Trust were able to accommodate his
  needs. He has reduced in hours from full-time to
  25 per week, thus allowing the department to
  retain valuable nursing advice. Other staff
  members are now considering flexible retirement
  options.The Trust notes that It was possible
  that this person could have dreaded to retire
  early and we risked losing skills altogether.
  This has advantages to the organisation and the
  individual.

35
Practical help with childcare and other caring
responsibilities

• E.g. The NHS Childcare Strategy has made a
  commitment to provide NHS staff with high
  quality, affordable and accessible childcare,
  along with a range of family leave provision
  including leave for eldercare.

36
How effective have these initiatives been? And
what factors are limiting effectiveness?

37
Factors limiting effectiveness

• Provision?
• Awareness?
• Uptake?

38
Provision

• Provision of flexible working arrangements seems
  to be in place
• But this is not necessarily the solution
• E.g. recruitment and retention issues among
  doctors and nurses are more complex

39
Why are nurses leaving the NHS?

• Ageing workforce
• Stress
• Lack of flexible hours
• Pay
• Heavy workloads
• Erosion of skills, career structure and
  development
• Occupational downgrading among returners
• Inability to influence health care practice
• Increasing opportunities outside NHS

40
Why are doctors, particularly men, leaving the
NHS?

• Long hours
• Stress
• Patients expectations
• Increased opportunities outside the NHS

41
Awareness

• Due to
• Poor communication (e.g. word of mouth) within
  organisations regarding policies
• Some organisations actively choose not to
  promote such policies
• Lack of awareness and understanding among
  managers re family-friendly/flexible working
  policies

• Study of male medical clinicians in Northern
  Ireland in different specialties
• 75 did not know if there were any
  family-friendly policies in their organisation

42
Why the take up gap?

• The costs of flexible working occupational
  downgrading
• Organisational culture
• Long hours culture
• Perceived impact on career progression
• Heavy workloads
• Impact on earnings
• Perceived as a womans issue

43
Why the limited uptake among men?

• Structural issues
• Gender pay gap
• Social expectations
• Primacy of breadwinner role for men
• Primacy of carer role for women
• Organisational culture
• Emphasis on work vs family
• Long working hours culture
• Culture of presenteeism
• Full-time work commitment to job/organisation
• Preference among men for informal arrangements
• Work-family issues perceived as personal vs
  organisational
• Limited and/or targeted dissemination about
  flexible work policies

44
Male medical clinicians in Northern Ireland

• Among the 25 who were aware of family-friendly
  (FF) policies, uptake was minimal. Why?

• FF policies not applicable to medical profession
  and nature of the job
• Perception that there is no one to take over the
  workload
• Fear of letting down colleagues
• 94 feel it is more acceptable for women to use
  FF policies
• Perception that career advancement is
  jeopardised if work is modified because of family
  commitments

45
Conclusions

• Women now comprise nearly half the workforce and
  two thirds of NHS staff
• Yet vast inequalities remain
• Attempts to address gender equity at work at
  state and organisational levels
• Main barriers gender stereotypes
  organisational cultures mens (limited)
  involvement in the domestic sphere