The gender pay gap in the English NHS: Analysis of some of the underlying causes

This briefing looks at differences in basic pay between men and women employed by the NHS in England, based on data from the NHS electronic staff record for one month. As well as drawing on previous analyses to describe the extent of overall pay differences by staff group, pay band, age and ethnicity, it also identifies factors that drive those differences.


Published: 13/05/2019

ISBN: 978-1-910953-63-1

Download the briefing [PDF 688.5KB]

From its adoption of the Whitley Council system to determine pay and terms of conditions of its staff in 1948, the NHS has come a long way in developing fairer and more appropriate ways of setting remuneration for its employees. An important goal of Agenda for Change was to ensure the NHS had a pay system that addressed unwarranted differences in the pay of men and women in the NHS. Around 88% of NHS staff in England are now included in the Agenda for Change system. The pay and terms of conditions of remaining staff – largely senior managers and doctors – are determined through other locally and nationally negotiated contracts.

Legislation has also developed to tackle discrimination and promote equality in the workplace. Most recently, in early 2018, came the requirement that all organisations employing more than 250 people should publish headline details of their gender pay gap – a requirement of the 2017 amendment to the 2010 Equality Act. This data revealed that around nine out of 10 NHS organisations in England had a median hourly pay gap that favoured men, ranging from 0.1% of median hourly pay to 52.5%. While these figures are useful in highlighting the extent of the problem, they say little about underlying causes and possible policy prescriptions.

In the light of these headline results and efforts to address unwarranted pay differences between men and women, this briefing brings findings from more detailed analyses of NHS staff level pay data, by factors such as staff group and age, in order to explore the reasons behind the current gender pay gap. It aims to establish overall pay differences between men and women and to identify how these differ by personal characteristics. It also reveals how much of the pay gap can be described by characteristics available in the data, and how much remains unanswered.

Suggested citation

Appleby J and Schlepper L (2019) “The gender pay gap in the English NHS: Analysis of some of the underlying causes”. Nuffield Trust