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Addressing the gender pay gap is a key issue for women leaders in the NHS

Addressing the gender pay gap is a key issue for women leaders in the NHS
By Victoria Vaughan, Editor
8 March 2024

On International Women’s Day chief executives of integrated care boards (ICBs) reflect on the progress of women leaders in the NHS since their careers began and the current challenges which need to be addressed. Leicester, Leicestershire and Rutland’s Dr Caroline Trevithick, Frimley’s Fiona Edwards, North East London’s Zina Etheridge, Gloucestershire’s Mary Hutton and Surrey Heartlands and Karen McDowell share their views

Gender pay gap

It is nearly six years since organisations with more than 250 employees, which of course includes the NHS, began to report their gender pay gap. Among all employees, the gender pay gap has fallen to 14.3% in 2023, from 14.4% in 2022, and is still below the levels seen in 2019 (17.4%). This includes falls across all health and social care roles. But if grouped together as health professionals, male workers are still paid 10.2% more than female workers.

Gloucestershire ICB chief executive Mary Hutton highlights the gender pay gap as one of her top concerns regarding the progress of women in the NHS.

‘There’s still a big gender pay gap, which is undoubtedly an issue. We need to think about how we actually encourage women. I think women tend to have more of an imposter syndrome and that needs to be addressed,’ she says.  

‘We’re all talking about the adjustments that need to be made for women in areas such as menopause, and how we can provide support. And how can we talk more openly about some of those issues that particularly impact women, probably at a particular stage in their career. So there’s lots of work to do in terms of adjustment and then to also enable women to get access to opportunities earlier in their career, identify talent, feedback to people, give them more support,’ she says.

Chief executive of Leicester, Leicestershire and Rutland (LLR) ICB, Dr Caroline Trevithick adds that there’s still the aspects of balancing work and home ‘you can’t get away from that’. ‘I’ve had colleagues say to me, “I don’t think I could ever be a director because I can’t work 24/7”. So there’s a perceived expectation that you have to, that it’s all or nothing. And I think we need to challenge that perception, we’ve got to get work life balance, right. Not just for women, but for men as well.’

Role models

When LLR’s Dr Caroline Trevithick, started out in the NHS as a nurse in 1987 all the leaders were women. But the leaders outside of the nursing profession ‘the chief exec roles, they were nearly all men’.

‘Did I ever think that I would become a chief exec? Ten years ago, I would have said ‘no’. But  five years ago, I could absolutely see that it was somewhere I wanted to be and there were people in that space and role models such as Amanda Sullivan, [chief executive of  Nottingham and Nottinghamshire ICB].

‘Seeing her in a senior nursing role, and then going into a chief exec role, was definitely a role model for me to look at locally and it demonstrated that women could do this. Now when I look around the chief execs across the ICBs there are a lot more women in leadership roles,’ she says.

And she adds that since being in post she’s been approached by a number of women who say ‘it’s so good to see a nurse and a woman’ in this leadership role.

‘It really brings in that sense of responsibility, that for future women leaders that I need to continue to pave the way as those leaders did for me, when I was coming up through the leadership ranks.’

North East London (NEL) ICB chief executive, Zina Etheridge, says, ‘There are loads of female leaders in the NHS. It’s great that Amanda Pritchard is the first female chief executive [of NHS England]. It’s a bit disappointing that it took until 2021 to get there.

‘But while there’s a lot of women role models in the NHS, that’s obviously less true in some clinical areas. I know,when I talk to female GPs, that the kind of challenges of being a partner and having a family are really great. There’s quite a lot more work to do.’

Frimley’s chief executive, Fiona Edwards, was involved in the early work, which was taken on by the NHS Confederation, on ensuring more gender balance in NHS Board rooms.

‘I have seen improvement in the numbers of women leaders in our board rooms, but this isn’t the whole story. We need to pay much more attention to the way we organise work and the cultures within our working environments. Our work on equality, diversity and inclusion within Frimley is vital to helping us to achieve this,’ she says.

Newly appointed Karen McDowell, chief executive of Surrey Heartlands ICB also highlights the importance of becoming a mentor.

‘The NHS is full of aspiring women in leadership positions and, having worked in the NHS for most of my career, it’s great to see more women represented in senior roles than there were when I first joined the NHS. Recently, we have also seen a real shift in the support available to women aspiring to be leaders, where there are now a range of mentoring and development programmes on offer – and that has been a really positive change and an area I have seen the benefits of firsthand, having become a mentor myself.’


NEL’s Zina Etheridge has been in post for two years and prior to that was chief executive of Haringey council. She says intersectionality should be an area of focus for progressing women leaders.

‘I think the most important areas to focus on is probably intersectionality. I know that for my black female colleagues, there’s a whole load of other barriers that they have to face that I and my white counterparts don’t,’ she says.

Dr Caroline Trevithick took away the notion ‘Empowered women, empower women’ from a panel she was on, discussing intersectionality. ‘I’ve taken that to heart as bit of a mantra. And so in all of the mentoring and championing that I do, and I’ve got six women that I informally mentor, I talk to them about their responsibility to empower other women as they’re coming along their leadership journey. I think there is still a challenge around ensuring that women understand that sense of responsibility for others.’

Leadership style

NEL’s Zina Etheridge says that a general point for public sector leadership is that there can be a tendency to want a hero leadership model. ‘Quite often, that’s not the model of women’s leadership. There are lots of men who are not that in that mold, either. But I think women are less likely than men to be in that mold.

‘I don’t think hero leadership is the right model for the complexity of the world that we’ve got around us. It certainly doesn’t get as many women into leadership positions as you would otherwise,’ she says.

LLR’s Dr Caroline Trevithick adds that she’s heard women leaders talk about the fact that the style of leadership seen the NHS at the moment doesn’t align to their personal style of leadership.

‘We need to understand that more. We don’t value or see compassionate leadership as being a driving trait. There’s a perception that it is sometimes seen as a bit of a weakness.’

Gloucestershire’s Mary Hutton says, ‘I do feel that women don’t put themselves forward as quickly or as early for opportunities. That’s another thing that I think needs to be addressed.’

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