Staffing is the issue keeping NHS leaders awake at night – and which consumes two-thirds of trusts’ spending. The fortnightly The Ward Round newsletter ensures you are tuned in to the daily pressures on staff, and the wider trends and policies shaping the workforce. This week’s column is by HSJ’s estates correspondent Zoe Tidman.
Few staff groups better illustrate the under-representation of women in senior roles in the NHS than estates and facilities management – an issue highlighted at a recent conference by an NHS England figure who is looking at ways to tackle the problem.
Lucy Rowe, who is the young persons and diversity manager within NHSE’s estates and facilities, commercial directorate, told a conference last month that women and minority ethnic groups were not only badly under-represented in higher bands compared to the overall NHS EFM workforce, but also compared to their counterparts in the private sector.
She said: “I’ve spent a lot of time with our suppliers looking at their workforce and… they are doing better than us. There is no reason EFM in the NHS shouldn’t be as equitable as the wider workforce and our supply chain.”
The EFM workforce is 57 per cent female overall, but just one quarter of its band 7 to 8 roles are held by women.
This is lowest out of all staff groups across the NHS for these bands (see chart below).
Only the ambulance sector – long viewed as problematically dominated by male managers – also had more men than women at bands 7 and 8 at the end of last year (around 35 per cent for ambulance staff and 40 per cent for support staff). There was no gender breakdown for band 9 estates and facilities roles.
‘Sometimes people can be quite shocked’
Following Ms Rowe’s comments, I’ve spoken to a number of women in senior estates and facilities roles about the issue. All spoke passionately about their jobs and did not feel held back as a woman. But they agreed more had to be done to address the gender imbalance at the top.
Some shared stories about people not realising they were the estates director. One female estates director said she has been walked straight past by someone looking for the manager.
Jane Longden from Walsall Healthcare Trust said: “I still think I get a few looks if I’m out there with my high-vis jacket on.”
The divisional director of estates and facilities says she has been in meetings where people say they need to speak to the estates director and she replies saying she has been listening. “Sometimes external contractors can be quite shocked.”
| Staff Group | Overall Headcount | % Female | % Male |
|---|---|---|---|
| Nurses & health visitors | 90,937 | 87% | 13% |
| Midwives | 6,157 | 99% | 1% |
| Ambulance staff | 3,767 | 34% | 66% |
| Scientific, therapeutic & technical staff | 86,469 | 77% | 23% |
| Support to doctors, nurses & midwives | 4,640 | 74% | 26% |
| Support to ambulance staff | 458 | 43% | 57% |
| Support to ST&T staff | 1,547 | 70% | 30% |
| Central functions | 23,087 | 62% | 38% |
| Hotel, property & estates | 1,646 | 25% | 75% |
| Senior managers | 8,830 | 61% | 39% |
| Managers | 23,149 | 62% | 38% |
| Unknown | 23 | 78% | 22% |
| Overall | 250,710 | 77% | 23% |
Michele McGee, associate director of estates and facilities at Mersey Care Foundation Trust, said the lack of women in senior roles was “100 per cent” noticeable across the NHS.
“People will often say, ‘Oh, you’re not the typical estates director, are you?’ and then you don’t really need to ask why, although sometimes I do just for the fun of it.”
Ms McGee said there had started to be a shift over the past few years with more females coming through the industry and going into senior positions. But she said: “I still think we have a way to go, particularly within the NHS estates industry.”
Different workforces
EFM represents a broad range of jobs. The technical side has traditionally attracted applicants from male-dominated trade backgrounds, such as engineering, while the strategic estates side and facilities has been less skewed towards men.
Charmaine Hope from Oxford University Hospitals FT said: “I think traditionally it’s been much more female-focused in facilities and male-dominated in the operational world.
The director of estates, facilities and capital development said: “That doesn’t mean it’s right. I think there is a lot more we can do and need to do to balance that out.”
Some EFM directors said they had noticed more women in strategic estates roles, for example leading schemes in the New Hospital Programme.
What can be done?
The EFM workforce plan, published last year, set out how diversity in senior leadership roles was lagging behind the rest of the NHS. It said there was “significant opportunity” to improve this.
It put forward four key actions, including for:
- Each EFM team to set a diversity target
- Ensure recruitment panels are diverse and reflect local demograhic
- Mention responsibility not to discriminate against colleagues and treat everyone with respect in job descriptions, as well as an accountability for this behaviour for managerial roles.
- Create national EFM working groups to embed workforce race and disability equality standards, as well as the staff and learner mental wellbeing programme.
Many estates directors I spoke to suggested more outreach and education could encourage a more diverse workforce to enter NHS estates and facilities.
Zara Hyde, director of estates and facilities management from Royal Devon University Healthcare FT, suggested a “slightly traditional” perception of what the role entails could be playing a role in the current lack of women in senior positions.
“It’s about being really honest about what the role is. I don’t go out there and prime pumps, I don’t go out there and lay bricks,” she says.
“However, I do have a way of thinking which is logical, the ability to communicate with people who want to share technical information for reassurance and an ability to assess what’s important and what’s not strategically to enable us to be successful as a hospital provider.”
NHSE was approached for comment.
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