Evidence submitted by the Equal Opportunities
Commission (WP 46)
1. The Equal Opportunities Commission was
set up by the Sex Discrimination Act 1975. Its duties are to work
towards the elimination of discrimination between men and women,
to promote equality of opportunity between men and women generally
and to keep under review the workings of the Sex Discrimination
and Equal Pay Acts. The Equal Opportunities Commission (EOC) welcomes
this opportunity to provide evidence to the Health Committee.
2. The EOC does not intend to address all
the issues set out within the terms of reference for the Committee
but does have some specific comments to make on how addressing
gender equality issues within the NHS will be critical to effective
workforce planning.
THE CENTRALITY
OF GENDER
EQUALITY TO
EFFECTIVE WORKFORCE
PLANNING TO
DATE
3. The EOC very much supports the work that
has already been done within the health service through Agenda
for Change. The biggest overhaul of NHS pay, terms and conditions
since its inception, Agenda for Change was introduced in response
to equal pay claims brought by women working for the NHS and is
designed to provide equal pay for work of equal value and has
begun to address the undervaluing of women's work within the NHS.
Agenda for Change also provides a better framework for training
and career development of health service staff.
4. Agenda for Change is an illustration
of how well a partnership between the medical colleges, the unions
and NHS employers can work and we would hope that any future workforce
changes would follow this model. It is also important to note
that Agenda for Change benefited from both political leadership
and funding which facilitated its implementation. Most importantly,
Agenda for Change was based upon a vision for the future—an
effective and efficient structure for pay and progression, which
sought to maximise the contribution each individual employee,
can make to the NHS. Future developments in workforce planning
need to be based upon a similar vision.
WHY GENDER
EQUALITY WILL
BE CRITICAL
TO EFFECTIVE
WORKPLACE PLANNING
IN THE
FUTURE
5. Workforce planning in the NHS is affected
by a number of factors. These include:
— The Gender Equality Duty.
— Policies and practice in relation
to procurement.
— Becoming and remaining an employer
of choice.
THE DEMOGRAPHICS
6. The population of the country as a whole
is both changing and ageing with consequences for the working
age population. By 2020 two-fifths of the population will be aged
over 50. [40]However,
some ethnic minority populations have relatively young populations
and it has been projected that ethnic minorities will account
for half of the growth in the working age population from 1999-2009.
[41]
7. Women's share of the labour market is
approaching half and we have one of the highest workforce participation
rate for women in Europe. Around three-quarters of women who have
children now return to work within less than a year. It is projected
that by 2010 only 20% of workforce will be white, male and non-disabled.
This demographic change means that the NHS will need to recruit
and retain an increasing proportion of female staff, many of whom
will be from black and minority ethnic communities.
8. The existing NHS workforce is also ageing.
One in four nurses, midwives and health visitors on the Nursing
and Midwifery Council (NMC) Register is aged 50 or over. In total
there are almost 100,000 nurses aged 55 or older on the Register.
The number of nurses likely to retire is set to double between
2005 and 2015—equivalent to a quarter of all nurses. [42]
AN AGEING
POPULATION
9. The ageing of our population will have
a significant impact on the provision of health care it is also
important to take account of the gendered aspect of this ageing
profile. An increasing number of health service staff, both male
and female, will be faced with the need to provide care for elderly
relatives which will increase the need for working practices within
the NHS to be fit for purpose in enabling staff to balance their
home and work lives.
10. An ageing population will also mean
increased need for both health and social care services. Currently
there is a dearth of social care provision which too often leads
to "bed blocking" where people who no longer need health
care within hospital are unable to leave, as they are unable to
source the care facilities they require. In considering future
demand on services it is essential, therefore, to consider both
the demand for both health and care services and develop wherever
possible an integrated approach to workforce planning.
11. The social care sector is also highly
gender segregated with women forming 92% of care assistants. Recruitment
and retention are already a problem within the sector due to the
low pay and low status of the work and these problems look set
to continue since a quarter of the current workforce is over 50.
12. The Health service also needs to develop
a range of strategies to retain/draw in older workers (50+) who
may well want flexible work (including part-time options) to help
increase the pool from which staff can be drawn. EOC research
last year suggested over a million older workers would re-enter
the workforce if conditions were flexible enough. [43]This
also has implications for the NHS's training formats and would
fit with the Government's broader agenda of extending working
lives.
THE GENDER
EQUALITY DUTY
13. From April 2005 the health service will
also have an obligation under the gender equality duty to eliminate
discrimination and harassment and to actively promote equality
of opportunity between women and men. Public bodies will also
have to consider their duty to promote equality in the procurement
of goods and services. The duty will also mean that the health
service will need to carry out gender impact assessments, in consultation
with key stakeholders, on any major developments in workforce
planning. The EOC's view is that this would include widespread
and ongoing use of agency staff.
PROCUREMENT
14. The duty to pay due regard to the need
to eliminate unlawful discrimination and harassment and to promote
equality between men and women means that the NHS will have to
build in relevant gender equality considerations into their procurement
processes. This encompasses the full range of public authority
contracts—including private finance initiative (PFI) projects
and public private partnerships (PPP).
15. It will be important to establish at
the earliest opportunity the relevance of gender equality considerations
to specific contracts so that they can be built into technical
specifications.
16. The weight given to gender equality
should be proportionate to its relevance to a particular procurement.
The EOC anticipates that a large number of areas of health service
procurement are likely to be affected including the contracting
out of ancillary services such as cleaning so that procuring authorities
promote good practice in diversity and equal pay matters.
BECOMING AND
REMAINING AN
EMPLOYER OF
CHOICE
Recruitment and Better retention
17. Research evidence suggests that nurses
have been leaving the NHS not just because of a lack of flexible
working arrangements but "because of a more complex dissatisfaction
with pay, the erosion of their skills and occupational downgrading,
heavy workloads and the inability to influence health care practice."
44[44]
Doctors are also leaving the NHS and the feminisation of medicine—women
now make up 60% of medical school places and 75% of GPs under[45]—means
that these issues must be addressed across the workforce as a
whole and not just amongst nursing staff.
18. Much has been done within the health
service to increase the amount of flexible working to enable staff
to balance their home and work responsibilities and the EOC welcomes
these developments but remains concerned that other key issues
need to be addressed.
19. The EOC's recent investigation into
flexible and part time working has found that four in five women
working part time do so below their potential—due to the
lack of available, high-quality part time opportunities. [46]These
findings resonant with an earlier study within the health service
found that 30% of nurses who returned to work part-time after
maternity leave suffered occupational downgrading and that the
prevalent view amongst NHS managers is that part-time working
is not compatible with nurse management. [47]Increasing
the access to high quality part time working within the health
service will, therefore, deliver efficiency gains through maximising
the potential of workers who want to work on a part time basis.
BME WOMEN
20. As already demographic change will mean
that the NHS will need to be an employer of choice for women from
black and minority ethnic communities. The EOC has recently launched
a major investigation into the labour market experiences of BME
women—the full interim findings from this project will be
available in June.
21. However, we have already identified
that young Pakistani, Bangladeshi and Black-Caribbean women are
almost three to four times more likely than white women to take
a job at a lower level than the one they are qualified for and
one in five Pakistani and Bangladeshi women, over 90% of whom
are Muslim, said they had experienced negative attitudes towards
religious dress at work. [48]
22. A long hours culture and lack of flexible
working arrangements has a more severe impact on ethnic minority
women since Pakistani and Bangladeshi women have four or more
children on average and a high proportion of Black Caribbean women
are single parents.
23. It will be important, therefore, for
workforce planning to take into account the experiences of BME
women within the NHS workforce. Monitoring BME women and by faith,
in terms of applications, interview, appointment, retention, promotion
and pay will be essential to that the NHS can identify any groups
of women who are missing out on opportunities or leaving and investigate
why.
24. Agenda for Change has made inroads into
some of these issues but it is important that any future workforce
planning gives due regard to these issues not only will this enable
the health service to comply with its obligation under the gender
equality and other equality duties but should help to recruit
staff, attract back staff who have left to return and retain them.
Equal Opportrunities Commission
16 March 2006
40 Government's Actuary Department 2004. Back
41
Cabinet Office 2003. Back
42
More Nurses, Working Differently: A review of the UK nursing
labour market in 2002, Royal College of Nursing. Back
43
Britain's hidden brain drain EOC September 2005. Back
44
Women and flexible working in the NHS Angela Coyle EOC 2003. Back
45
ibid. Back
46
Britain's hidden brain drain EOC Sept 2005. Back
47
Women and flexible working in the NHS Angela Coyle EOC 2003. Back
48
16-34 year olds. 2001 Census Commissioned Tables, Crown Copyright
2003. Crown copyright material is reproduced with the permission
of HMSO. Back
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