The government has just released its Equality Analysis of the contract it intends to impose on junior doctors. Its ‘tortured logic’ reveals much about what the government really thinks about gender equality and work and family life issues, argues Jill Rubery.
If you delve into the 38-page document from the Department of Health, and work your way down to paragraph 95, you will see its stark conclusion; that the new contract ‘is fair and justified as good for both staff and patients. We consider that the new contract will advance equality of opportunity and further good relations between different groups’.
The outcome is hardly surprising; the last thing a government wants to concede is that they got it wrong. Impact assessment should ideally be done at a much earlier stage to help decide between competing proposals. When the policy has already been decided, these assessments should be done externally by people with credibility on equality issues.
Yet the tortured logic the report uses to reach its conclusion is more surprising for what it reveals about what the government really thinks about gender equality and work and family life issues – and also about the redundancy of impact assessments when policy goals are already determined.
This latter point is summarised in the following statement: ‘Any indirect adverse effect on women is a proportionate means of achieving a legitimate aim.’
The purpose of equality impact assessments is to identify the risks of collateral damage to equality objectives to decide if the ends justify the means. But this statement implies that any impact can be disregarded if the aim is legitimate.
It is probable they meant to say that the specific indirect effects they identified were proportionate. But if this is the case, they not only need to express themselves more precisely but also do a better job at explaining what constitutes a legitimate aim. Far from exploring whether their aim is legitimate, the report wraps up the objective in a form of management speak;
‘to enable employers to roster Doctors when needed across seven days including evenings and weekends more affordably to support the delivery of a 7 Day NHS for patients in accordance with the clinical standards developed by the Seven Days a Week Forum’.
What this means is the aim is to reduce the costs (the pay) of doctors rostered to work unsocial hours in order to require them to work more unsocial hours at lower costs.
Few would query the legitimacy of seeking to improve patient care, although the jury is definitely still out on whether staff weekend ratios are the top priority. What is not clear is if it is legitimate to do this at the expense of doctors’ pay or work life balance. Some upper limits to unsocial hours working are to be set but the report is silent on what would constitute a reasonable amount of unsocial hours working, or how that would compare to current rotas.
If no more unsocial working is required, this would reveal the aim to be simply pay cuts and the seven day care agenda to be a pretext. The assessment in the report of additional childcare costs implies they do expect doctors to work more. But how much more is a legitimate aim?
It is in discussing childcare costs that the government reveals its very partial understanding of gender equality and work life balance issues. It latches on to the tendency among some couples for some women to go to work at times when their partner can take on childcare, to reduce costs and also improve the quality of care,
It then makes the absurd suggestion that working more in the evenings and weekends can be considered a benefit or some women in couples. No reference is made to evidence that parents working non-standard shifts can harm the development of children – nor to the fact that these non-standard hours come on top of day shifts, so more unsocial hours working equate to more days when they don’t get to see their kids at all.
It is also absurd, as this ‘benefit’ should apply to men as well. The presumed benefit to women in couples is mentioned to offset the accepted higher childcare costs for lone parents who are mainly women. There may be no clear gender impact for couples as both men and women will suffer. But that of course does not mean it is fair or equitable.
I have long advocated looking at the impact of employers’ working time arrangements on the interests of children, rather than treating childcare adjustments as a privilege for women or even parents. If this was added to the equality impact assessment, then the government would be justifying the adverse impact on children, a much harder political sell than arguing that women’s sacrifice is worth it for the greater good of patients.
The report treats childcare as a matter of costs – and not as an issue of the quality of life for children, as well as parents, nor an issue of availability. There is a big gap in provision of childcare for those working non-standard hours – and the government has no plans to mandate nurseries to open over the weekends and evenings so that childcare may simply not be available, whatever the price.
One outcome of more enforced unsocial hours working may be more women and men opting to work part-time as the only way to see their families – but this will reduce, not expand, the number of doctors available for shifts involving unsocial hours.
The government, in its determination not to allow part-timers or those on maternity leave to progress up the pay scale, may have anticipated this outcome. This change in pay policy will widen the gender pay gap, as the impact assessment report recognises. But the British Medical Association seems to have made a sensible response in negotiating higher pay for middle grade junior doctors to mitigate the impact on salaries.
This equality impact assessment was undoubtedly intended as one further step towards the successful imposition of the new contract. But its ill-judged comments and ill-considered methods may yet see the plan unravelling, following the precedence set by the recent budget.
