Attitudes on cost-effectiveness and equity: viewpoints of medical professionals

The aim of this study is to determine the attitudes of physicians and trainees in regard to the roles of both cost-effectiveness and equity in clinical decision making | BMJ Open


Cost-effectiveness analysis does not accurately reflect the importance that medical professionals place on equity. Among medical professionals, practising physicians appear to be more egalitarian than residents-in-training, while medical students appear to be most utilitarian and cost-effective. Meanwhile, female respondents in all three cohorts favoured the more equitable option to a greater degree than their male counterparts. Healthcare policies that trade off equity in favour of cost-effectiveness may be unacceptable to many medical professionals, especially practising physicians and women.

Full reference: Li, D.G. et al. (2017) Attitudes on cost-effectiveness and equity: a cross-sectional study examining the viewpoints of medical professionals. BMJ Open 7:e017251.


Women and leadership – (still) more to do

Despite the advances of recent years, two recent reports, Women in finance and Women on boards: 50:50 by 2020, once again draw attention to the problems women still face in obtaining senior leadership positions within the NHS and outside it | The King’s Fund


Women in finance is about fairness, equality and inclusion for women and men. It is predicated on a desire for gender parity and a balanced workforce because, as the evidence makes clear, this improves culture, behaviour, outcomes, profitability and productivity. However, the current situation in the financial services sector is quite different; more women than men start out in financial services but many women fail to move up the management scale. This leaves almost all the top jobs in the hands of men. The main reason for this, it appears, is organisational culture.

One study conducted in 2016 across a wide range of employment sectors found that unsupportive workplace cultures still present the most significant barrier to career progress for women. Amazingly this was the case for female respondents in the 20-29 age group as well as for older respondents. Gender inequality and discrimination were reported, as were difficult colleagues and managers, bullying, undervalued work, and women feeling that they have to over-perform simply because they are female. Recommendations following this study included building closer relationships between men and women in the workplace, and the provision of opportunities to discuss gender issues experienced within the organisational culture.

How much progress is the NHS making on workforce diversity?

Overturning decades of discrimination will not happen overnight but there have been small yet significant improvements | The Guardian Healthcare Network


The NHS would grind to a standstill without the contribution of its black and minority ethnic (BME) staff. A fifth of nurses and midwives and a third of doctors are from BME backgrounds. Yet, by almost every measure, their treatment is poorer than that of their white colleagues. The latest report on the experience of these staff (pdf), drawn from nine workforce and staff survey metrics from all 236 trusts in England, makes sobering reading.

The more senior the pay grade, the less likely it will be filled by BME staff. Almost a quarter (24%) of nurses and midwives at entry grade 5 are from BME backgrounds, but this falls to 4% once senior management grades (8C and 8D) are reached.

Read the full news article here

NHS Women on Boards: 50:50 by 2020

Report finds that though representation of women on NHS boards has shown improvement, women are still not being sufficiently represented in key leadership roles. | University of Exeter Business School | NHS Employers | NHS Improvement.

This report, written by Professor Ruth Sealy of the University of Exeter Business School, examines the steps the NHS needs to take to reach the target of equal gender representation on boards by 2020.  It summarises demographic data from 452 organisations, including arms-length bodies, NHS trusts and clinical commissioning groups.

The report reveals that of 245 NHS trusts and arms-length bodies (ALB), the percentage of female chief executives was found to be encouraging at 42.6%. But the representation of women in other key roles within these organisations was disappointing, as only 26.3% of finance directors and 24.6% of medical directors are women.

The full report is available here

Related: OnMedica: Only a quarter of key NHS leadership roles held by women


What if NHS leaders were more representative of their patients?

Although the NHS is often held up as one of the most multi-cultural employers in England, the lack of diversity among its leaders is a barrier to the service achieving its full potential. In the latest essay from the Kings Fund’s ‘The NHS if…’ series, Vijaya Nath asks: what if leadership teams in the NHS were as diverse as the populations they serve?


Focus on transgender equality highlights poor experience of trans people in daily lives

By Will Huxter for NHS England Blog

‘The Chair of the NHS England Gender Identity Task and Finish Group reflects on a new top-level report on transgender issues:

Welcome to my latest blog on gender identity services.

I want to say something about the report of the Women and Equalities Select Committee on Transgender Equality, and to update on discussions with the adult Gender Identity Clinics about capacity and waiting times. I also want to talk about the work we are doing with Health Education England on developing the workforce of the future.

The Government will be making a formal response to the Women and Equalities Select Committee, including the recommendations in relation to health. Ahead of that, I thought it would be helpful to share some personal reflections, in my role as Chair of the NHS England Gender Identity Task and Finish Group.

Firstly, I very much welcome the initiative by the Women and Equalities Select Committee to focus on transgender equality for their first inquiry. This has brought a great deal of Parliamentary and media attention to the challenges which the trans community face in their daily lives, including huge difficulties in getting prompt access to supportive specialist and general health services.

The report lays bare the poor experience of many people, and rightly highlights the unacceptable delays in getting NHS treatment.

As part of my oral evidence to the inquiry, I acknowledged that the current waiting times are far too long, and confirmed that we are working with the gender identity clinics (GICs) and the surgical providers to build capacity and to reduce these waits’

Read the full blog via NHS England

NHS Women in Leadership report


women in leadership

Image source: NHS Employers

This report by Dr Penny Newman, medical director, Norfolk Community Health and Care NHS Trust sets out a clear model for NHS organisations to develop female leaders.

This report has been produced in collaboration with UN Women and is supported by NHS Employers and the HSJ Women Leaders Network.

Featuring interviews with 12 senior NHS stakeholders, the report:

  • outlines why gender equality is important in the NHS
  • draws upon the experience of the UN system
  • provides a series of actions organisations can take to enable change at an individual, organisational and system-wide level.

Recommended actions for the NHS include:

  • the creation of a guiding coalition
  • identifying a national champion
  • accurately measuring board membership by gender
  • setting aspirational targets
  • creating a framework for action including leadership development.

Read the full report pdf here

Read the full commentary via NHS Employers