Lottie Moore, Policy and Partnerships Analyst, Public Policy Projects, calls upon Government to address the stark underrepresentation of the working class in our medical workforce.

NHS doctors are the most ethnically diverse workforce in the public sector, according to Government statistics. And yet, the small proportion of people from working-class backgrounds that makes up our doctors makes them remarkably unrepresentative of the people they serve.[1] If the Government does not address this issue, academics predict huge impediments to UK’s progress in science, medicine and technology (STEM).

There is an inherent structural disadvantage within Britain’s labour market is disproportionately affecting our STEM progress.[2] In 2016, the Social Mobility Commission predicted that nine million low-skilled people would be chasing four million jobs with a shortage of three million workers to fill 15 million high-skilled jobs by 2022. According to STEM Learning, 89 per cent of businesses in the sector admit they are struggling to recruit. A combination of inflated salaries, longer recruitment processes, additional training and temporary staffing is costing businesses £1.5 billion a year. [3]  

The problem begins within education

The STEM shortage within the labour market is largely reflective of the situation within education. First in Family (FIF) students are 28 per cent less likely to study medicine and dentistry than those whose parents completed an undergraduate degree.[4] “Not for people like me” was the apt title for a report from WISE in 2014 that showed that class disparities within higher education have resulted in the UK having one of the lowest shares of students pursuing STEM in Europe.[5] There are wide disparities in medical school admission by social class.

A study conducted by the British Medical Journal measuring pupils’ perceptions towards medical school found there to be striking differences by socio-economic status.[6] Whereas pupils from affluent backgrounds perceived medicine as a high-risk and high-reward choice, their poorer counterparts could not comprehend that the financial risk could be worth the reward. Not only did the poorer pupils partaking in this study perceive medicine as a culturally alien career path, but these pupils also saw the financial risk of five years of study as entirely prohibitive towards their chances of success.

Perceptions from the student perspective are compounded by the fact that poorer pupils are statistically much less likely to receive an offer for medicine than their wealthier counterparts. The BMC found that 80 per cent of medical students come from professional households and more than a quarter from private schools.[7] While it is a well-known tale that ‘doctors make doctors’, there is truth to it: children of doctors are nearly 14 per cent more likely to be admitted on to a medical course.[8]

…And continues within the workforce

This insight into how socio-economic status affects uptake of STEM at education level of course paints a bigger picture. As a result of class underrepresentation within STEM higher education, social diversity within the medical workforce is poor.

The 2018 twitter hashtag #mypathtomedicine was promoted to disrupt the idea that doctors only come from wealthier socio-economic backgrounds. The hashtag was used to highlight the stories of those from difficult circumstances in the hope of inspiring those from similar backgrounds.

In 2019, the Sutton Trust found that only six per cent of UK doctors are from working-class backgrounds, although they make up 33 per cent of the workforce as a whole.[9] On average, these doctors will earn about ten per cent less a year than their wealthier counterparts. This is due to the ‘class ceiling’: unpaid internships, nepotism and soft skills have become more important in securing a job in an increasingly competitive market, further disadvantaging those without.

“The NHS falls particularly short on social mobility and commitment to the real Living Wage”: this was the headline from the Centre for Progressive Policy’s 2020 report ‘Simply the best? Making the NHS a leader in good employment’. The report ranked all 223 NHS trusts using its Good Employer Index to assess how well the NHS is ‘levelling up’ across the UK. While it found the NHS as a middle-ranking employer in comparison to other large organisations, it argued that commitment to the Living Wage and focus on social mobility must be prioritised further.

What can be done?

The commitment to increasing social diversity within STEM begins at education level and, while much is being done to rectify the problem, stakeholders throughout the process must be supported to play their part. The Government must consider substantially increasing resources for teachers and widening participation teams to support FIF students in pursuing their ambitions and talents and offering substantial and reliable bursaries for FIF students wishing to pursue STEM.[10]

At a time when NHS resources have been haemorrhaged by the pandemic, overcoming socio-economic barriers to the medical profession is of utmost importance. The next generation of NHS patients depends upon it.

The issues covered in this article tap into wider questions around inequality that PPP is focusing on in its State of the Nation report: ‘Addressing the National Syndemic’ chaired by Sir Michael Marmot. For more information please contact Lottie Moore (lottie.moore@publicpolicyprojects.com)

[1]https://www.ethnicity-facts-figures.service.gov.uk/summaries/public-sector-workforces

[2]https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/569410/Social_Mobility_Commission_2016_REPORT_WEB__1__.pdf

[3]https://www.stem.org.uk/news-and-views/news/skills-shortage-costing-stem-sector-15bn

[4]https://www.tandfonline.com/doi/full/10.1080/03054985.2020.1784714

[5]https://www.wisecampaign.org.uk/wp-content/uploads/2018/06/not_for_people_like_me-full-report.pdf

[6]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC437148/

[7]https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-016-0536-1

[8] https://www.jstor.org/stable/145820?seq=1

[9] https://image-src.bcg.com/Images/BCGSocial-Mobility-report_tcm38-165914.PDF

[10] https://blogs.soas.ac.uk/cop/wp-content/uploads/2021/02/Working-Class-Students-are-missing-out-FINAL-briefing.pdf