Pay inequality within NHS England has come under renewed scrutiny after the organisation’s latest workforce data revealed a widening gap not only between men and women, but also for ethnic minority and disabled staff.

The findings, based on the 2023–24 diversity pay gap report published in 2025 and representing the most recent dataset available in 2026, highlight persistent structural inequalities across the NHS workforce. Despite years of policy focus on equality, the figures suggest that meaningful progress remains limited, raising questions about the effectiveness of current strategies.

Gender pay gap remains entrenched

NHS England’s gender pay gap continues to sit in double digits, with the mean gap recorded at approximately 11.4% in 2023–24. While this marks a marginal improvement from the previous year, when it stood at 11.8%, it still indicates that women earn significantly less on average than their male counterparts across the organisation.

This disparity is not attributed to unequal pay for the same roles, but rather to differences in workforce composition. Women are disproportionately represented in lower-paid roles and remain underrepresented in senior and executive positions. Although initiatives such as flexible working policies and leadership development programmes have been introduced, their impact has so far been incremental rather than transformative.

Ethnicity and disability gaps show worrying trends

More concerning for NHS leaders is the evidence that pay gaps related to ethnicity and disability have widened. The diversity pay gap report confirms that staff from ethnic minority backgrounds and those with disabilities continue to earn less on average than their peers, with disparities closely linked to representation at higher pay bands.

These findings are consistent with broader workforce data, which shows that ethnic minority and disabled staff are less likely to occupy senior leadership roles or specialist positions. As a result, average earnings across these groups remain lower, reflecting systemic barriers to progression rather than differences in pay for equivalent work. The persistence of these gaps suggests that existing equality targets have not been met, despite commitments to eliminate disparities within set timeframes. This has intensified debate about whether current interventions are sufficiently robust to address deeply embedded inequalities.

Structural challenges underpin disparities

The ongoing pay gaps reflect wider structural issues within the NHS workforce. Patterns of occupational segregation, where certain groups are concentrated in specific roles or grades, continue to shape pay outcomes. Career progression pathways also appear uneven, with some staff groups facing greater barriers to advancement than others.

These dynamics are influenced by a range of factors, including access to training, mentorship opportunities and organisational culture. While NHS England has made efforts to address these issues, the scale and persistence of disparities indicate that change is occurring slowly. Importantly, these challenges are not unique to the NHS but mirror trends seen across the wider public sector. However, given the NHS’s size and its role as a major employer, progress within the organisation is seen as particularly significant.

Data and digital systems shaping accountability

From a health technology perspective, the increasing availability of workforce data has been instrumental in highlighting these inequalities. Digital systems such as the Electronic Staff Record enable detailed analysis of pay and representation, allowing organisations to identify where disparities exist and track progress over time.

NHS England has expanded its reporting to include multiple dimensions of diversity, reflecting a broader commitment to transparency. However, the effectiveness of this approach depends on the quality and completeness of the data. Information on ethnicity and disability is based on voluntary disclosure, meaning that gaps in reporting can affect the accuracy of the analysis. There is growing interest in using advanced analytics to identify critical points in career progression where inequalities are most pronounced. Such insights could help target interventions more effectively, although translating data into action remains a significant challenge.

Policy ambitions under scrutiny

The latest figures come despite ambitious targets set out in national equality strategies, including commitments to eliminate ethnicity and disability pay gaps within defined timelines. The persistence of these gaps suggests that these goals have not been achieved, prompting calls for more decisive action. Workforce experts and representative bodies have argued that addressing pay inequality requires stronger accountability and a more systematic approach to change. This includes improving transparency in recruitment and promotion processes, as well as ensuring that leadership development opportunities are accessible to all staff.

At the same time, there is increasing recognition that cultural change is essential. Without addressing underlying attitudes and behaviours within organisations, technical interventions alone are unlikely to deliver lasting improvements.

A critical issue for workforce sustainability

Pay inequality is not only a matter of fairness but also has implications for workforce sustainability. Disparities in pay and progression can contribute to dissatisfaction, affecting staff morale and retention at a time when the NHS is already facing significant workforce pressures. As the organisation continues to navigate challenges such as staffing shortages and rising demand, ensuring a fair and inclusive working environment will be critical to maintaining a stable workforce.

Outlook: from transparency to tangible change

While NHS England has made progress in measuring and reporting pay gaps, the latest data underscores the difficulty of translating transparency into meaningful outcomes. The persistence of disparities across gender, ethnicity and disability highlights the need for a more effective and sustained approach.

The focus now is likely to shift towards delivery, with increased emphasis on demonstrating real improvements rather than simply reporting data. For NHS England, the challenge will be to ensure that its equality commitments are reflected in tangible changes to workforce composition and career progression. As scrutiny intensifies, the organisation’s ability to close these gaps will be seen as a key test of its broader commitment to equity and inclusion within the NHS.

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