"It's not about legislative action or setting quotas," said Dr Karen Castille, associate director at the NHS Confederation, "but achieving a better balance of perspectives at NHS boards that more closely reflects the people and patients we serve." 

She made the comments as she opened a roundtable meeting of senior health service leaders on 5 November, convened by the Confederation to take action on the under-representation of women leaders in the NHS.

Sector-wide conversation

Attended by organisations including NHS England, Monitor, the Care Quality Commission as well as nursing and medical royal colleges, the meeting kick started a sector-wide conversation about what can be done to achieve more women on NHS boards and in senior leadership positions.

It aimed to secure pledges in support of the Confederation's goal to achieve 50 per cent more women on all NHS boards by the end of 2018.

'Flying blind'

Dr Castille argued that the NHS is "flying blind" and missing opportunities by drawing from a reduced talent pool.

"There is good evidence from the business world that gender-balanced boards significantly and consistently out-perform those with less female representation," she said.

'Economic issue'

Dr Castille is leading the campaign with chief medical officer, Dame Sally Davies, who said addressing the current imbalance is an "economic issue" not an "equity challenge".

With a workforce predominantly made up of females (around  80 per cent), "how can we not use half of our best brains?" she asked.

The meeting discussed what practical and system-wide actions can be taken to encourage more women to apply for and gain leadership roles.

'No silver bullet'

The group acknowledged that there is no 'silver bullet' to achieving the goal, but said that gaining system-level backing from the NHS's top leaders was a key step in the right direction.

Addressing recruitment processes, creating system-level interventions and considering the views of the next generation of leaders were put forward as areas for action.

The group agreed to meet again in spring 2014 to review progress.

Lever for change

It follows calls in the Francis report – echoed in reviews by Professor Don Berwick and Sir Bruce Keogh – for culture change in the NHS. Having more balanced boards could be one of the levers to achieve this, said Dr Castille.

She added that now is the time to consider, act on and harness the contribution women can bring to add value.

Women on boards

The meeting came ahead of a Government call (7 November) to businesses to do more for gender equality in the workplace, and publication of Women on boards by Cranfield University.

The report monitors progress towards achieving the Lord Davies's target for 25 per cent of FTSE 100 directors to be female by 2015. He set the target in 2011, following a Government commissioned review.

Women on boards co-author, Ruth Sealy, also attended the Confederation roundtable. 

Influential women

The meeting was informed by an NHS Confederation meeting with the Health Service Journal's 50 most inspirational women in healthcare, in October, which explored how the health service can better support and encourage more women leaders.

It was felt that with more support, women would be more likely to step up and take on senior roles.

The group developed several suggested actions that national bodies can take to tackle the issue at both  individual and system-level to break down barriers and keep the focus on achieving balanced boards.