We must create a more caring and inclusive culture for NHS staff

Matt Hancock spoke about tackling the gender pay gap in medicine at the Royal College of Physicians' annual conference

It’s great to be back in Manchester. I grew up just down the road in Chester, so coming to Manchester always feels like coming to the metropolis.

I went to my very first concert at the Manchester Arena, or the NYNEX Arena as it was then, to see… Meat Loaf. Yes, I really was that cool.

We came past the Manchester Arena this morning, and I was reminded of that, and of that horrific attack 2 years ago. Children. At a concert. A truly dark day for this city, and this country.

But I was also reminded of the incredible spirit, the incredible resilience, the love and compassion that the people of this city showed in that moment.

Not least the paramedics, the nurses, the doctors, every member of the NHS family, going above and beyond any description of duty, healing, uniting, giving us all hope that, together, we can get through this.

I know some of those NHS heroes are here today. And I want to say to all of you, on behalf of this city, and on behalf of our nation, thank you.

As that incredibly moving Tony Walsh poem says about Manchester: “This is a place where we stand strong together.”

And the NHS is a place where we stand strong together. And I tend to think of all of those who work for the NHS as something of a family.

But, truth be told, we haven’t always been there enough for every member of the NHS family. Or helped everyone realise their potential.

Too often, we’ve chosen confrontation when collaboration was the way to settle our differences.

And too often we’ve lost talented people because we haven’t done enough to convince them to stay.

Now, a big part of this is down to numbers and resources: I get that. I fully understand that we need more staff.

We’re putting in the longest and largest cash injection in the history of the NHS.

And we’re doing everything we can to recruit more staff, both in terms of training, and attracting the brightest and the best from abroad – as well as making them feel more at home in the UK.

I’ve listened to you, and tried to listen hard, about what you need to make your jobs easier: technology that frees up your time to focus on patients, not technology that slows you down with multiple log-ins and incompatible systems.

But technology is only a tool. The mission, our mission, is to help you care for people.

And what the whole NHS family needs to do more is care for each other.

Whether you’re a senior consultant, a midwife, a paramedic, a porter or a trainee just joining, I want the NHS to be a rewarding, compassionate, brilliant place to work for everyone.

Baroness Dido Harding is developing the first ever NHS People Plan to create that positive, inclusive, people-centred culture across the NHS.

So we can build the workforce of the future and meet the changing needs and expectations of the public.

Together, I want us to create an NHS working culture that reflects Britain in 2019, and how people expect to work and live now.

Because the most troubling statistic I’ve seen is this: one in 11 of our staff leave the NHS entirely every year. That’s more than 100,000 people each year. It’s something we must urgently address.

And I believe a large number of those people leave because we haven’t done enough to make the NHS a great place to work.

Yes, it’s about resources. Yes, it’s about terms and conditions. But bigger than that: the working culture, and how we treat each other.

So I want to talk to you today about how we modernise the working culture of the NHS and tackle gender, racial and other forms of inequality because those things are linked.

The NHS has 1.3 million employees, 77% of which – more than a million – are women.

So the NHS is one of the largest employers of women in the world.

You would expect one of the biggest employers of women to also be one of the best places for women to work.

Across society, women have transformed the working culture for the better: more collaborative, more compassionate.

Diversity brings diversity of thought. Every time I’m in a room with a more diverse group of people, better decisions are made because there’s a greater diversity of thought.

Some of the best leaders in the NHS are women:

• Sarah-Jane Marsh at Birmingham
• Amanda Pritchard at Guy’s and St Thomas’
• Lesley Watts at Chelsea and Westminster

Just to name 3. Brilliant women doing a brilliant job.

And yet, the NHS gender pay gap is still 23%.

Over half of junior doctors are women, but at consultant level it’s only a third. Women are under-represented as surgeons and over-represented in lower-paid specialties.

The gender gap is a good barometer of the health of the NHS. And it’s clear: things must change and I’m determined to change them.

Gender equality is the only way we can hope to build an NHS team fit for the future.

And it’s not just gender. 40% of hospital doctors and 20% of NHS nurses are from an ethnic minority background, but at board level that figure is only 6%.

Only by embracing equality of opportunity can we address staff shortages and get the people we need to create a sustainable NHS that’ll be there for all of us, for generations to come.

I’m hugely grateful to Professor Dame Jane Dacre and Professor Carol Woodhams for their review of the gender pay gap in medicine.

I agree with them: we need a culture of transparency in pay, promotion and reward if we’re going to close the gender pay gap.

And we need to create a working culture that puts flexible working at its heart, that encourages women to stay in the NHS family, that helps women move up the career ladder even when they have children and caring responsibilities.

So these are the 3 areas I want us to prioritise:

• more support and mentoring to get more women into senior leadership roles
• more flexible working
• ending discrimination and creating a compassionate culture

More female leaders in the NHS

At board level, we need to recruit 500 more women to reach gender balance across the NHS.

NHS Improvement and the NHS Leadership Academy are doing some great work to encourage more women into leadership roles.

And we’re going to work with the BMA, the Medical Women’s Federation and Health Education England to build on that, and step up the pace.

Raise the bar on aspiration with:

• tailor-made training programmes
• role models who can inspire and advise
• support networks throughout someone’s career

No specialty, no job should be off-limits to anyone because of who they are, or their background.

More flexible working

Becoming a parent is one of life’s greatest joys.

No mother, or father, should be made to feel their job is incompatible with their family.

I’m extremely pleased, and grateful, that we’ve worked with the NHS Trade Unions and the Junior Doctors Committee at the BMA to extend shared parental leave.

I want us to go much, much further on flexible working. More roles that allow part-time, term-time, home working and job-shares to make it easier for people to balance work and family life.

The NHS has committed to publishing rotas 6 weeks in advance for doctors.

I want to see smart digital rotas for all clinical staff in the NHS. Currently they’re available to only half, and less than one in 10 have access to the most sophisticated digital rotas that should be the norm across the NHS. That simply isn’t good enough.

All trusts must expand digital rotas and develop tech-enabled in-house staff banks. Better tech, across the board in the NHS, can help support more flexible, more modern working, and allow for a better work-life balance.

I know of a radiologist who was forced to leave her NHS job after she became a mother, to go and work for an agency providing the same service to the same NHS trust – so effectively doing the same job – just because that agency had the tech to let her work from home, when she wanted.

Costing the NHS more. Depriving her of job security and pension contributions. Forcing her to make a decision she didn’t want to and losing a valuable doctor in the process.

Of course, the NHS is a 24/7 operation – people don’t only get sick at a convenient time on a Wednesday afternoon – so we must have a 24/7 workforce.

But the reality of modern working is that people want the freedom to manage their own time.

They want greater choice and control over their working lives because their families, their friends, their independence is just as important to them.

Just look at this way: if you’re starting at medical school this September you were probably born in this century.

You’re a digital native. Technology has shaped every facet of your life from the way you shop, travel, eat, bank, socialise and even find love.

So of course, you’re going to expect that same flexibility and autonomy when it comes to your working life. And you’re going to become incredibly frustrated – and perhaps disillusioned – if your employer refuses to move with the times.

So the NHS must recognise and embrace the cultural change in society.

We’ve got to reflect modern Britain and look to the future, not hark back to an imagined past – a past that wasn’t always that rosy if you were a woman, or if you were black, or Asian, or disabled or dyslexic, or gay, or different in some way.

Creating a compassionate culture

And that brings me to my third and final point: ending discrimination, bullying and harassment and creating a compassionate culture.

This really hit home for me recently when Dr Zoe Norris and Dr Katie Bramall-Stainer spoke out about sexism and harassment by male colleagues. And they weren’t alone. Other women have had the courage to speak up.

I’m pleased the BMA is taking these allegations seriously and has promised a full and independent investigation. And for Clare Marx’s leadership on this subject at the General Medical Council.

Frankly, I’m disgusted and angry that anyone should have to experience bullying, harassment, sexism or any other form of discrimination as they try to do their job.

But it’s even more troubling in the NHS because the NHS is built on the principle of caring for people and treating everyone equally – and that absolutely must extend to our staff. And until we do that, we can’t create a more caring and more compassionate culture.

And this point really hit home for me when Dr Joanna Poole, of the Doctors Association, asked fellow doctors to share their stories on social media as part of the #NHSMeToo campaign.

There were stories about doctors who couldn’t get time off to attend a wedding or a funeral. I have doctors in my family who have often missed important family events because the rota says no. And there were stories about doctors who were told they had to work even when they were sick or had gone through a personal trauma.

But there was one story that really affected me, that has really stayed with me.

The doctor wrote:

"I needed early pregnancy scans every 48 hours because of a threatened miscarriage. I would go downstairs for my scans, be told they couldn’t see a viable baby and then have to return to the ward distraught and work.

"Everyone knew, but no one asked me how I was.

"I eventually had a ruptured ectopic pregnancy and ended up in emergency theatre. I was back at work within a week as we were short-staffed, having lost my baby. Still no one thought to ask how I was.

"I had to see a lady with a miscarriage when I returned to work. And I cried and cried in the toilets."

Just one story. One woman out of more than a million working in the NHS. So profoundly moving. So heart-breaking. In the NHS of all places.

The NHS: it’s meant to be a caring organisation. That’s what it does. And yet, sometimes it doesn’t care enough about its own.

So yes, we need more staff, more resources, better technology, and on my watch, we will have all of those.

But more than anything we need to create a more caring, a more compassionate culture. The way we talk to each other. The way we treat one another: it really matters.

Work should be something we look forward to, not something we have to endure. Everyone must feel valued and supported in the workplace. We must end bullying, harassment, sexism and discrimination.

Dido’s People Plan will have this at its heart, and our new Chief People Officer, Prerana Issar, will make this her mission. By creating a more diverse leadership that reflects and represents our diverse workforce. By modernising working practices so everyone with the ability to rise to top has the opportunity to rise to the top.

Being compassionate towards each other, whether you’re a trust or a trade union, a royal college or even a Health Secretary. We’re all on the same team. We all have the same goal.

Because I believe the NHS embodies the best of everything this country has to offer. I want us to live and breathe those values all of the time. I want us to care about each and every member of the NHS family.

And I commit to ensuring the NHS is a place where we always stand strong together. So let us make this change together.

Department of Health and Social Care
The Rt Hon Matt Hancock MP