Leaders from Edinburgh’s two medical Royal Colleges have called for action to close the gender pay gap in healthcare and address inequalities that make careers and opportunities for women and staff from ethnic minorities more difficult.

Last month the Royal College of Surgeons of Edinburgh (RCSEd) and Royal College of Physicians of Edinburgh (RSPE) hosted a first-of-its-kind conference on Women in Leadership, leading to a call for organisational change to support women in healthcare.

Speaking with healthandcare.scot, the Chair of the Equality, Diversity and Inclusivity (EDI) Committee at the RCPE, Dr Mary Ann Ferreux explained that there is a long way to go to effectively support women and minority groups working in healthcare.

She explained that it “makes financial sense” to support women in the workplace, particularly those with caring responsibilities – including access to conferences and paying for childcare to enable them to attend, adding:

“We’re just not doing enough for workers with caring responsibilities, and essentially most employers don’t have anything if you have to care for an older person – and again evidence shows that it often falls women to do those roles.

“That patriarchal structure makes things really difficult because it’s been built by white men for white men – and then we wonder if you don’t look like that, why doesn’t it fit for you? We’re constantly trying to retrofit ourselves into these structures that are just not supportive.”

In her presentation at the conference, Dr Ferreux laid out how women and people from ethnic minority groups are underrepresented at the top.

Speaking with healthandcare.scot, she said too little emphasis is being placed on structural reforms and an assumption that everyone will implement the Equality Act in a fair way.

Ingrained inequality

Dr Ferreux believes that structural reforms should include the processes around healthcare workers who have faced racism in the workplace. She said that while there may be a protocol for complaints, barriers to equality remain within this:

“Going to HR to raise the grievance or the complaint – but HR is 95% white.

“So how would somebody who is white be able to truly understand how it feels to have a racist microaggression against you?

“And therefore, the individual is dissatisfied with the investigation and then they often won’t report again.

“We have recruitment standards for every other job, we need to really be following through with those involved in the processes in the arms and elements of an organisation that make a real difference.”

Beyond looking to every level of healthcare organisations to engage with equality work, Dr Ferreux said there is a “huge amount” government can do.

But, she says, the problem lies in lack of diversity at the decision-making table leading to a “constant recycling of the same ideas”.

She added that while government tries to include lived experience perspectives around these decision-making tables “on paper”, this is not truly effective:

“The problem is it’s not authentic. They have lay members and advisers that sit on very high levels of boards. But the people chosen are often from a particular demographic or group – retired, white, male. It happens because they’re available, and unfortunately, they don’t speak for those most underrepresented.

“And if they do have people from a more diverse background, then it can be an incredibly intimidating experience to sit at that senior level and you need to make a really big effort, if you’re the chair, to include them in the decision-making.”

As a result, Dr Ferreux explained that a lot is done “with good intention” but does not deliver results because of the way it is being implemented.

This applies to co-design within innovation too, as work sometimes engages with patients too late in the process, rather than reaching out ahead of development. She shared the example of AI developments:

“In that innovation arm, we’re finding that the groups designing these digital and AI applications and products are from a certain demographic profile and they’ve inbuilt their bias into the products. So, we’ve got AI algorithms coming out that exclude people from ethnic minorities, Gypsy and Roma Travellers, or exclude LGBTQ+ communities.”

A poorer workplace

Dr Ferreux suggests that hospitals as a workplace are going backwards with a lot of support that used to make a particular difference for women in the past now having been rolled back, despite workers facing the cost-of-living crisis:

“What makes me sad is that 30 years ago we had creches at hospitals, we gave junior doctors free accommodation. Now all of those additional entitlements, they’re all gone – yet the cost-of-living has soared, house prices have gone up – and then we wonder why people are struggling.

“So I think for one, there is a huge amount of support that used to exist, that doesn’t. And the second element is we have feminisation of the workforce, so 60% of medical students are women, but the workforce planning doesn’t match how things are changing.”

Clare McNaught, Vice President of RCSEd, echoed this and urged decision-makers across Scotland and the UK to come together to tackle the workplace issues contributing to the staffing crisis:

“NHS employers, educational statuary bodies and all medical associations must work together in the coming months to address the poor workplace culture that exists in the NHS. Part of this is driven by the gaps in the nursing and medical workforce, which is creating impossible workloads for the staff who remain.”

Read more: Organisational change needed for women in healthcare; A pharmacist on the frontline; Scotland prioritises neuro-inclusion, says government; Scots women at the forefront of medical sciences; Inside Scotland’s widening health inequalities

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