The NHS has missed its own target of ensuring that half of its top jobs be filled by women by 2020. Although it has made progress it is still falling short with just 44.7% on NHS trusts’ boards in England being female. In some trusts the percentage is just 15.4% of the most senior roles in women’s hands, though in others it is as high as 77.8%. The failure by the service to achieve 50:50 gender equality is revealed in a report published this Tuesday by the NHS Confederation, which represents providers of care. The report is based on analysis of 3,000 board directors at NHS trusts and other bodies, undertaken by Prof Ruth Sealy, of Exeter University business school. In 2017 the regulator NHS Improvement told the service to ensure that by this year half the members of trust boards were female, after it was found that the level stood at just 39%. Such roles include chief executives, medical directors and chief financial officers, and the chairs and non-executive directors who sit on the boards overseeing the trusts’ operation and performance. Sam Allen, chair of the confederation’s Health and Care Women Leaders Network, and also chief executive of the Sussex Partnership NHS mental health trust, said: “The NHS has made progress but there remains much more for leaders to do in order to achieve consistent and meaningful gender balance. “We must move away from the concept that gender balance is tokenistic or ‘nice to have’, to something which is essential, overdue and needed now.” Overall, 77% of the NHS’s 1.4m-strong workforce are female. In all, 115 of the 213 trusts studied met the European commission’s definition of gender balance – which is that 40%-60% of key roles are held by either sex. While the proportion of female chief executives has risen since 2017 to 45.5% – women now run 97 trusts – the number of female chief financial officers has fallen to 25.3% and the percentage of medical directors who are women is still only 29%. Before the 50:50 target was set, the NHS had to put an additional 500 women into top jobs to ensure gender parity; it still needed 150 more to gain board-level positions to achieve that aim, Allen pointed out. Amanda Pritchard, NHS Improvement’s chief operating officer, said: “We know that the experiences and opportunities that women, black and minority ethnic staff face today are not always positive.” In the report Gillian Norton, chair of St George’s University Hospitals NHS foundation trust, in London, said: “If you are a woman even now I would say you have to work harder, be more on the ball, be more persistent to get to senior levels than men have had to be in the past.” A properly diverse board led to better decisions, she added. Her own trust had achieved the 50:50 split after she told headhunters to focus on identifying well-qualified candidates who would represent more diversity in terms of gender, age, ethnicity, and physicality. Danny Mortimer, the confederation’s deputy chief executive, said: “There has been some progress made in gender representation but we are not where we need to be.” NHS ambulance trusts have the lowest proportion of women in key roles (38.9%) while mental health trusts have the highest (51.5%).