Why we need to see more women in healthcare leadership roles

The need to strengthen leadership in nursing at all levels is well recognised. International cancer nursing position statements, including those from International Society of Nurses Cancer Care (ISNCC) and All-Party Parliamentary Group (APPG), consistently highlight the importance of strong nursing leadership in delivering person-centred, culturally safe and evidence-based care. 

However, these statements rarely address who progresses into leadership roles, or how the persistent under-representation of women, particularly in senior posts, should be tackled. If leadership is critical to high-quality cancer care, then equity in leadership must be treated as a core workforce issue, not an optional aspiration.

Women make up the majority of the nursing profession, yet they remain under-represented at a senior level. Meanwhile, men continue to be over-represented in nursing leadership roles across the UK. A pattern that has remained largely unchanged for the last 30 years.

Workforce data from 2017 showed that while men represented only 11% of the nursing profession, they held almost one in five of the top jobs (Punshon et al, 2019). In Northern Ireland, men made up just 6.6% of the workforce but held 27.5% of the highest paid “very senior manager” grade jobs. Similar trends were seen across all four UK countries with male nurses appearing to be over-represented at higher pay bands within the UK NHS compared to the population average.

For healthcare professionals working in cancer services, these figures raise important questions about progression, visibility and access to opportunity within the system.

Barriers and intersectional inequality

Evidence suggests that women’s under-representation in leadership is driven by multiple, interacting factors. These include gender stereotyping, organisational culture, and structural barriers such as access to development opportunities and informal networks.(Surangi et al, 2024).

In cancer care specifically, a workforce report suggests women face gender-based discrimination (Lancet, 2023). This is particularly important for women from ethnically diverse backgrounds who often face compounded disadvantage at the intersection of gender and ethnicity.

A survey carried out by the Royal College of Nursing of more than 10,000 nursing staff from across the UK reported that white nursing staff and those of mixed ethnic background across all age groups were more likely than Black and Asian colleagues to have received at least one promotion since starting their nursing career (RCN, 2021).

To better understand what leadership progression looks like in practice, I spoke with Fungi Motsi, Macmillan Lead Cancer Nurse at the George Eliot Hospital in Nuneaton. Fungi has been a nurse for 22 years – and has spent 14 of these as a Macmillan Professional, including seven in her current role. 

Fungi has been ambitious from the outset of her career, leaving Zimbabwe at the age of 18 to come to England to study nursing. As a Project 2000 graduate (a preparation for practice for nurses), she finished her 3 years with a diploma alongside a registered nurse qualification. Soon after this, she completed further qualifications in cancer care which enabled her to progress from staff nurse to ward sister and then into management. She is now studying for an MBA.

Seeking opportunity, building confidence

“On the ward, when opportunities to progress - or to learn and develop, like getting involved in research - came up, I would always put myself forward. I’m grateful to the people in my career who saw my potential and encouraged me – this includes my first ward manager in the earlier days of my career, but also more senior colleagues who I admired and felt I could identify with later down the line. Now I’m in a position where I feel I can seek advice at Chief Executive level.”

“There were times when I felt nursing was quite a lonely experience, so I was driven to create networks of support which have helped me to define my own career prospects. I was fuelled by my curiosity, as well as my desire to take on new projects and stretch myself, so this has helped me to make connections and allow opportunities for development relatively quickly.

I was then able to look for promotion opportunities and I really had my sights set on a leadership role. However, that part wasn’t quite as easy as I had hoped. On one occasion, I was given feedback that I had interviewed well, but then found out that I didn’t get the post with no clear rationale why. It was disappointing, but I did later succeed and secure this role in another Trust and over the years I’ve learned to look at things that are within my control and focus on looking forward”.

I really admire Fungi’s commitment to continuing to strive to progress in her career, especially in the face of cultural and structural barriers. Her expertise, skill set and ability to deliver across systems in what is a complex and multi-faceted role is testament to her grit and determination.

The Lead Cancer nursing role is a role that many cancer nurses aspire to - and now, through her coaching and mentoring, Fungi is generously helping develop many other nurses’ careers enabling them to step up into their next role.

Supporting women to progress into leadership roles requires action at both individual and system level. Clear, structured leadership pathways must be developed, embedded and consistently supported across organisations.

Macmillan is co-delivering the ACCEND programme,referenced in the NHS Long-term Workforce Plan (2023), to support aspiring cancer nurses and allied health professionals. ACCEND focuses on increasing their knowledge, skills and capability across four pillars of practice – including leadership (NHSE, 2024). It provides the existing cancer workforce with access to the education and training that is needed to match the competencies required for their role across all levels of practice, including the most senior leadership roles.

What needs to happen next

While programmes like ACCEND are an important step forward, they are not enough on their own. Inequalities remain embedded within social, organisational and professional systems. One of the most influential factors in addressing gender inequity is improving representation, ensuring women are visible, supported and present in leadership roles at every level.

For healthcare professionals, seeing leaders who reflect their background and experience matters. Role models create belief, aspiration and momentum. To build a cancer workforce that truly reflects the communities it serves, we must continue to invest in leadership development, challenge inequity, and actively empower people from marginalised groups to progress.

This is not only about fairness, it is about strengthening leadership, improving workforce sustainability, and delivering better care for people living with cancer.

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