Has the ‘women’s work’ stereotype been holding down your pay?

A planned research project will investigate whether social attitudes to nursing have created a gender pay gap

A planned research project will investigate whether societal attitudes to nursing have created a pay lag for the profession

Image: Alamy

The RCN wants to examine what effect being an overwhelmingly female workforce has on nurses’ pay. 

Almost nine in ten nurses are women, and many in the profession consider gender-based stereotypes to be a factor holding back nurse pay.

The college is seeking tenders from researchers to investigate whether members’ concerns that nursing is pigeon-holed as ‘women’s work’ – and is therefore undervalued – are backed up by the evidence.

In general, men earn significantly more than women. The national hourly gender pay gap for workers in the UK is 18.4%, according to the Office for National Statistics (ONS).

NHS employers this week reported data showing female employees in England are paid 23% less than their male colleagues. On average, a woman working full-time in the NHS is paid £28,702 a year in basic salary, compared with £37,470 for a man, according to NHS trust figures reported to the government as part of a mandatory gender pay data collection.

Pay stagnation

Although plans are now afoot for a pay increase for NHS staff, nurses’ pay has stalled for years and those working in the health service have seen their pay shrink in real terms by 14% since 2010, the RCN says.

In its advertisement to researchers, the college says: ‘There is a broad feeling among nursing staff and their representatives that their treatment is related to a great extent to the high density of women in the nursing workforce, and the belief that they will carry on caring despite their working and economic situation.’

Many nurses do not feel their pay reflects their level of skills and responsibility, the college states.


The average gender pay gap in the UK

Source: ONS

The research project will focus on whether gender-based values are holding back pay for all nurses. It will also consider the policy actions the RCN could take to counter any gender pay gap and improve the working and economic situation of nurses.

The announcement of the study came as the RCN revealed last week it has a 14% median gap in men’s favour among its own staff.

Perception of low-status work

RCN associate director of employment relations Josie Irwin says the RCN will be testing the hypothesis that nurses, both female and male, have traditionally had low earnings because the profession is predominantly female, and therefore the role is perceived by policymakers to be lower-status ‘women’s work’. She hopes most of the research will be complete by the end of the year.

Nuffield Trust director of research and chief economist John Appleby says evidence suggests that when a workforce is predominantly female, individuals are paid less than when a workforce is mostly male.

Research on the undervaluing of supposed ‘women’s work’ suggests this is a key cause of women’s lower pay, says the Scottish Government-funded organisation Close the Gap.


of NHS trusts in England have a pay gap that favours men

Source: Nuffield Trust

This is reflected in the experience of public sector workers in Birmingham. In 2012, more than 170 people employed by Birmingham City Council in traditionally female roles such as cooks, cleaners and care home staff won an equal pay case in the Supreme Court after they were denied bonuses given to staff in traditionally male-dominated roles such as refuse collection and street cleaning. The authority said the claims would cost £750 million.

A study published in Journal of Women’s Health in 2014 found that in the Soviet Union, medicine became one of the lowest-paid of the professions at the same time as women grew to constitute the largest part of the workforce.

Complex societal factors

The reasons for the lag in women’s pay are complex and include: greater representation of women in part-time work, which generally attracts lower hourly rates; caring for children; occupation type; and underrepresentation of women in senior positions.

The question of pay disparity for equal work affects NHS nurses less than it does workers in many other professions, thanks to the national pay system in the NHS.

The ONS said in 2016 there was no pay gap in the hourly rate for male and female nurses. Interestingly, it found that female midwives were paid 62% more than their male counterparts, however the proportion of men in the profession is tiny.


of nurses are female

Source: Nuffield Trust

Data suggest that the NHS pay framework Agenda for Change, which was set up to provide fair pay based on the principle of ‘equal pay for work of equal value’, is delivering equitable hourly pay for both genders. It began in 2004 for one million members of staff to simplify complex and outdated local pay negotiations.

Male domination in senior roles

However, a report by HR services company Randstad in 2016 found a 14% pay gap between male and female nurses in men’s favour. The main cause of this was the disproportionately large number of men in senior positions.

While 77% of the NHS workforce are women, just 46% of the most senior manager roles are held by women, according to NHS Employers.

Unison head of health Sara Gorton says: ‘Any gap, no matter how small, is too large and there’s always more that can be done to ensure women are fairly represented at all levels of seniority in nursing and across the NHS.’ 

What the latest gender pay gap figures tell us about the NHS

All organisations in England, Scotland and Wales with more than 250 employees were required to publish their gender pay gap figures this week. 

The vast majority of NHS organisations reported a pay gap that favoured men.

Nuffield Trust director of research and chief economist John Appleby, who has studied data returns from 220 NHS employers in England, found that 91% reported a gender pay gap in favour of men. The remaining 9% had either none, or reported their pay gap favoured women.

Among the small number to report a bias for women was Liverpool Community Health NHS Trust, where median women’s pay is 17.3% higher than that for men.

Women make up 84% of higher-paid jobs at the organisation, which was acquired by the larger Mersey Care NHS Foundation Trust in March. Mersey Care reported a 10% pay gap in men’s favour.

While Professor Appleby says NHS figures reported to the Government Equality Office were too general to say if there was a gender pay gap for nurses, it is likely, given all the evidence, that there is. ‘Of course there will be one,’ he says.

The data could help nurses choose future employers, and also has a patient safety element, he says. The NHS staff survey finds that good staff experiences are associated with better clinical outcomes. ‘If there are issues with not feeling happy in terms of pay equality, then that could feed through into poorer patient care,’ he says.

Erin Dean is a freelance health journalist

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