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A missed opportunity for women

The central fact to bear in mind amid all the talk of equal opportunities in the NHS is this: the NHS is staffed by women but run by men.

The latest Department of Health (DoH) equal opportunities initiative, part of the government’s Opportunity 2000 programme, sets out eight goals for health authorities and trusts to achieve.

These include increasing the number of women in certain job roles, such as consultant, general manager and accountancy posts; offering more flexible working practices to reduce the number of qualified nurses and midwives leaving the NHS; and ensuring that all women returning from maternity leave or from abreak in service for domestic reasons can return to work on the same grade and doing the same kind of work as before.

Health service trade unions have broadly welcomed these goals, though with a certain scepticism. The DoH has sent out innumerable press releases on equal opportunities for women, yet the response has remained patchy and unco-ordinated.

The unions see two main problems with the Opportunity 2000 initiative. First, the goals are limited in scope. They concentrate on improving the position of professionals - qualified nurses, doctors, accountants, managers. The thousands of women in lower scales - secretaries, records staff, catering and cleaning staff, nursing auxiliaries - risk being left out.

Second, implementation has not been addressed. The goals have been sent out to employers without any guidance or instruction on how they are to be put into effect. No extra funding is on offer, so key areas such as childcare facilities have not been included because they might be expensive.

Targets have been set for the appointment of women as managers and consultants but there is no indication of what kind of positive action would have to be taken to achieve these in the face of established male hierarchies. Nor has there been any mention of what will happen to authorities or trusts which do not take action to meet the goals.

Opportunity 2000 is difficult to implement in the NHS precisely because it flies in the face of the government’s introduction of trusts and the devolvement of employment decisions to local managers. The NHS Management Executive disparages the ideas of central direction or national bargaining - yet without these Opportunity 2000will fail.

But perhaps implementation was always less important than some positive publicity in the pre-election campaign?