IWD 2022: 'I was horrified to see young women medics lining up to kiss male Consultants'

HCSA President Dr Claudia Paoloni became the first woman to lead the association in its history.

To mark International Women's Day we talked to her as she prepares to hand over the presidency next month.

While the times are changing, there's still much left to do, she says.

How has the experience and situation facing women doctors changed during your career?

I qualified in 1991 from medical school. My first real insight into the culture of sexism that has pervaded the NHS was at our post-finals dinner.

I was horrified to see young women medics lining up in front of bay window recesses, where male Consultants sat, to take it in turns to kiss these Consultants and make their bids for a chance of an attachment with them as a houseman.

Suffice to say, I never witnessed lines of male final-years students waiting to kiss a female Consultant.

Throughout my training I experienced sexist remarks and innuendo portrayed as banter and, on placement in one centre, received numerous unwanted invitations for dinners out and experienced inappropriate sexualised comments and assault.

What I reflect on is that during that whole period, while the behaviour was recognised as being unpalatable, there was no belief that anything could be done about it and there was an acceptance that as a woman you had to put up with it or risk limiting your career choices.

Thankfully, the times do appear to be changing, exemplified by the recent media coverage around the #MeToo movement.

It is clear how unacceptable it is, and progress is being made as more doctors feel able to speak up and policies are modernised to address accusations of sexual harassment.

But this kind of culture has not yet been eliminated from the NHS. Surveys still provide continued evidence of sexual harassment and sexualised comments, especially towards trainees.

Female trainees still feel there is a game to play to succeed into Consultant posts and the Gender Pay Gap remains omnipresent within the medical workforce. Female Consultants struggle to gain placements in certain specialties, often those which score more favourably towards Clinical Excellence Awards, are less able to access additional payment opportunities or leadership roles. Often this is because there is no flex to accommodate caring needs and less-than-full-time contracts.

Thankfully, though, there has been recognition that changes are required and the recommendations contained in the 2020 Mend the Gap report were a good first step towards addressing the GPG. I hope though that this results in true action and not lip service to the issue. We cannot just rely on the increasing proportion of women in medicine to redress the gap slowly and indirectly.

What are the biggest barriers to progress for women in medicine?

Women still remain the main carers for children and elderly relatives which often requires more flexible hours to meet caring needs than full-time posts can offer. Often it is women who have to take LTFT contracts to accommodate this.

This in turn limits ability to succeed in obtaining leadership roles and placements in certain specialties, where absence from the workplace is deemed to demonstrate a lesser commitment to the role.

True work flexibility needs to be embraced for the future workforce with promotion of LTFT roles and increased opportunity for job sharing.

Do you think these barriers are now fully recognised?

I believe they are recognised but the appetite is not yet there to truly tackle the issues of inequality. This would require complex multimodal data collection, analysis and redress. Currently there remains a tendency to pay lip service to the issue rather than making decisions to significantly address inequality.

What impact do you feel you’ve been able to bring as HCSA’s first woman president?

Perhaps to be an inspiration for other women to take up a stakeholder leadership positions and to encourage other women to speak out and up for fairer and more equal working terms for women and other minority groups.

I was proud recently to get a Facebook message from a female doctor in Nigeria who had been a trainee in my department in 2005, when I was clinical director, before returning to Nigeria. She had seen me being interviewed on Sky News as President. She stated how inspired she was and has now come back to join us in our department!

I will however always wish I had been able to effect more noticeable change through my stakeholder activities. Change is slow in the NHS and I would have liked to have seen more progress on addressing the gender and ethnicity pay gaps and in addressing retention of our valuable staff.

One observation I have made when I compare the working culture within the NHS with my husband’s experience in industry is the tendency towards a demotivational leadership culture within our health service.

A lot of time is spent on describing limitations of projects and actions. Much is made of services and individuals not being productive enough or efficient enough or costing too much. Or we are told we are being obstructive or not doing enough, that the employer is not getting value for money out of the workforce. All this makes individuals feel undervalued.

In many other sectors there is more likely to be a positive culture of praise and reward to incentivise, morale boosting conversations, regular one-to-ones and two-way communication and support with less command and control management than the NHS. The result is a more motivated workforce.

I would love to see lessons of other sectors being learnt and applied within the NHS. Our management culture is in desperate need of change.