The gender pay gap in the NHS: the story so far

With businesses all over Britain reporting on their gender pay gap this week, John Appleby looks at how the NHS has fared.

Blog post

Published: 05/04/2018

At the latest count, 9,406 businesses with more than 250 employees across Great Britain had reported details of the gender pay gap in their organisation, in keeping with the requirements of The Equality Act 2010 (Gender Pay Gap Information) regulations published last year. That addition to the 2010 Act stipulates some basic pay data for men: essentially the percentage difference between men and women’s average hourly mean/median basic pay, the same for bonus pay, and the gender split in the proportion of men and women in each quartile of an organisation’s pay range.

With over 1.5 million staff, the NHS is the largest single employer in Britain – three times the size of the largest private sector employer, Tesco. Most of its organisations (principally trusts) employ over 250 staff. So what does the data tell us about the gender pay gap in the NHS?  

The findings

220 NHS organisations – 214 trusts plus the Department of Health, NICE, Health Education England, Public Health Wales, NHS Resolution (formerly the NHS Litigation Authority) and NHS Digital – have published gender pay gap data. (Data for NHS organisations in Wales and Scotland has been published before and is not part of this new data set.)

201 of those 220 organisations (91%) report a pay gap in favour of men – ranging from 0.1% of median hourly pay (Lancashire Teaching Hospitals) to 52.5% (Health Education England). Eight organisations (4%) report a zero difference, and 11 (5%) a difference in favour of women.

Compared to all others, NHS organisations are (on the limited number of current reports) more concentrated in terms of their pay gap. For the 9,186 non-NHS organisations who have reported their details, the pay gap ranges from one company where women are paid 85% more than men, to the other extreme of one organisation paying men 85% more than women.

The pay gap and different quartiles

Another way of looking at the gender pay gap is through the proportion of men and women in each quartile of organisations’ pay distribution.

With women making up over 77% of the NHS workforce, it’s no surprise that there tends to be a higher proportion of women than men in every quartile. However, the proportion of women in the top pay quartile tends to be lower than in the bottom quartile for virtually all NHS organisations. And this under-representation of women in the top quartile is, to a degree, correlated with a pay gap favouring men, as this chart shows.

We need to know more

While the new gender pay gap reporting requirements are a step forward in understanding the scale of pay differences, on their own they say little about underlying causes and possible policy prescriptions, at least at a national level.

Locally NHS organisations – who will need to get to the heart of why they have a pay gap – will have much more detailed pay data, by staff group and including overtime payments, for example. So a next step will be to decompose the reasons for these pay gaps. Are higher paid occupations within NHS organisations dominated by men? Do men tend to dominate higher pay grades? To what extent does maternity leave affect women’s pay trajectory once they return to work?

But disentangling the reasons for the gender pay gap not only needs much more data (and local analysis) than currently being published, but a view about what may justify pay differences between men and women.

While pay gaps may exist even if a business pays equally for equal work, there may be wider societal inequalities (such as access to education) that account for pay differences and which need to be tackled.

Why it matters

But the gender pay gap isn’t just a matter of fairness. For the NHS, we know from staff surveys that employees believe that having equal opportunities for career progression or promotion within their trust has an effect on how satisfied patients are with the care provided.

Ensuring all staff are treated fairly in their pay and other factors, such as career progression, is likely therefore to not only be the right thing to do for staff, but for patients too.

*This blog includes gender pay gap data as reported at 4pm on 4 April.

Suggested citation

Appleby J (2018) "The gender pay gap in the NHS: the story so far", Nuffield Trust comment.


Appears in

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  • 16/02/2018