NHS Case Study

National Health Service seeks culture change to address inequality and diversity disparities


Despite years of intense focus on diversity and inclusion and numerous initiatives, gender and racial disparities at senior levels persist. In 2019, the NHS reported a mean gender pay gap of over 30%. The purpose of this research was to provide NHS Trusts with actionable insights into the cultural factors contributing to inequality, pay gaps, and the under-representation of women and BAME employees at senior levels. The assessment used CultureQuest, a cultural assessment created by Psychologists at Conflux and delivered through Tivian, the leading employee feedback, and reporting platform provider. The CultureQuest Parity Assessment measures both the behavioral and cultural factors that influence decisions and ways of operating. Employees across 15 NHS Trusts were invited to respond to the online survey in February 2020 and the summary of results is based upon the 5,754 completed responses.


The assessment found that expectations regarding equality have not been met and that figures are significantly below those for other employment sectors. When asked to rate the level of commitment to equal opportunity for their current employer, 34% of men and 35% of women indicated NHS was “fully committed to equal opportunity for all staff” with 36% of men and 33% of women believing that people succeed on merit. Respondents identified the key leadership traits they felt were most valued and rewarded when it came to decisions regarding hiring, promotion, and performance management. When asked what traits should be most valued and rewarded to perform at the highest possible level, respondents placed a much greater emphasis on inclusive traits. These included traits such as open-mindedness, compassion, and empathy.

Demographic profiling of the respondents reinforces the view that the NHS gender pay gap is largely due to a lower proportion of women in the most senior and better-paid roles.


Before any action is taken, NHS needs to recognize and prioritize addressing the problems found in the CultureQuest assessment. Constant scrutiny of procedures and decisions around recruitment, performance management, and promotion is needed. Critical evaluation of the language and tone of all materials related to recruitment, competency frameworks, performance management, and career development will help to eliminate gender bias. Informal and unstructured recruitment and assessment procedures are a major source of bias. To drive lasting change, best practice processes need to be in place and enforced. All managers with responsibility for talent management should commit to following simple established best practices, such as providing feedback to unsuccessful applicants. This will support the creation of an open, meritocratic culture across NHS.

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