Concerns about childcare brought Helena McKeown into medical politics – and now she is chair of the BMA representative body, it is still an issue which drives her.

As a GP and single parent, she struggled to keep her own career on track, and knows that many other parents, particularly women, face the same problem today.

‘I think we’re very foolish as a society not to sort this out,’ she says. ‘We’ve got some of the most expensive childcare in Europe and a desperate shortage of doctors. It makes no sense that we can’t get it heavily subsidised or a tax concession. It doesn’t make economic sense and it doesn’t help doctors to have a well-rounded life.’

Late last year, the UK Government published its report into the medical gender pay gap.

Mend the Gap found that, despite growing numbers of women entering the profession, there remains a ‘significant and substantial’ gender pay gap, out of line with other professions, and significantly wider than for other healthcare groups.

The report cites support with childcare – or the lack of it – as a crucial factor in individuals’ ability to remain and thrive in a medical career.

It also points out that women’s disproportionate responsibility for caring (whether for children or older relatives) makes ‘a major contribution to the pay gap between men and women’.

For Dr McKeown, it all sounded depressingly familiar. Although her interest in the topic was sparked by her personal experience, talking to doctors around the country has convinced her that, while some progress has been made, there remains much to do.

‘I was a new GP partner when I became a single parent,’ she explains. ‘That was in 1998, when we still did our own on-call, prior to the 2004 GP contract which allowed us to opt out.

‘My children were under five, and when you added up the fees for pre-school, nursery, wraparound care, care in the school holidays and care overnight when I was on-call, it was almost as much as I was earning; I nearly gave up general practice.’

Responsibility for childcare is shared more equally between parents than it was in the 1990s, she says, but the cost is still prohibitively high.

‘I think there’s been a culture change – it’s more common for dads to be very involved with their children, including when their children are sick. For example, my experience is that it’s much more common now for male GPs to work less than full time and to spend one or two days with their children, being the one who looks after them at home.

'It’s become accepted – even encouraged – now. But childcare is still very expensive. I would look to the Scandinavian model and have heavily subsidised childcare. I think it’s good for the economy not to lose doctors’ working hours and I also think it’s humane for people who are parents.

'It would let parents continue in their profession, and be parents, rather than making it a choice between one or the other. As tax payers, we spend so much money to train doctors to be experts, but then we lose so many GPs in their late 30s – they leave the profession. That’s a terrible waste to the individual and a terrible waste to the economy.’

The BMA has set up an implementation group for the medical gender pay gap report and its first meeting will be held soon.

Childcare will very much be on the agenda, says Dr McKeown.

‘What’s important is that we’ve got doctors from all branches of the profession, and I want to have some input from dads as well, because this isn’t just a mums’ issue or a woman’s issue; it’s important for everyone.’

According to the Mend the Gap report, some employers have taken the step of employing a care coordinator to assist staff with caring responsibilities for children and, in some cases, for older relatives. While these posts are far from universal, and their impact can be variable, they have been a huge boon for some doctors.

Myra Herbert is a paediatric emergency medicine consultant at Sunderland Royal Hospital, part of South Tyneside and Sunderland NHS Foundation Trust.

She is also a single mother to a five-year-old. She confesses that until she had a child herself, she hadn’t particularly thought about the need for a care coordinator – but since then, she has found her services invaluable, particularly during the pandemic.

‘I had seen the coordinator’s name on trust emails, but I didn’t really pay much attention until I was on maternity leave. I had been naïve – I had assumed that all hospitals had nurseries attached to the premises – but it was only when I looked into it that I realised that wasn’t the case.

'I contacted the coordinator and she was really helpful, sending me details of nurseries, and also giving me information about childcare vouchers and other advice too.’

This support came into its own when COVID hit, bringing with it pressures on health services and changes to the availability of childcare.

‘My childcare arrangement was all working very well until lockdown,’ explains Dr Herbert. ‘That was a very emotional time. At first the Government said that nobody could look after your children, I couldn’t have a friend in the house – so what was I to do?’

Dr Herbert was fortunate in that her mother, who usually lives in London, was staying with her at the start of lockdown and didn’t go home – meaning there was someone at home with her son overnight to cover on-call. But additional childcare was needed to cover the evenings when Dr Herbert was at work.

‘The nursery was open so the daytime was no problem. I was also able to coordinate with a colleague who needed time off during the day for home-schooling, so she did my late shifts and I took on a lot of daytime hours, then returned to hospital after my son was in bed – which was OK, as Grandma was in the house. But I was working crazy hours, and was really struggling with the whole thing.’

She called the care coordinator ‘in despair’, she says, because she simply couldn’t put in the required time at work with the childcare she had in place. At that point, the trust had said it would cover the cost of extra childcare for staff and the coordinator managed to arrange for home care for her son from workers he was already familiar with from his nurseries.

‘I spoke to the coordinator when I was really struggling and she said, “hang on, let me make a few calls”,’ says Dr Herbert. ‘When she said that some of the nursery staff were happy to come and babysit, I just cried. It really, really helped me at that time.’

The availability of a care coordinator is something that her employer mentions upfront when advertising job vacancies, and it has proved popular, says Kath Griffin, the trust’s director of human resources and organisational development.

‘As an employer, we know the pressure that staff can be put under when they suddenly lose childcare or unexpectedly become a carer for a loved one,’ she says.

‘Our care coordinator can support staff by helping them to identify alternative childcare, as well as helping carers to access additional levels of support like flexible working and in some cases, additional time off. 

‘Our staff are the most important part of our organisation and we know that juggling work commitments with caring responsibilities can be stressful and demanding. That’s why it’s so important that we make sure these members of staff are supported.’

Despite the availability of this support, however, Dr Herbert believes that she might well have changed tack in her career in paediatric emergency medicine had she become a parent before she was a consultant.

‘I love my job, but if I’d had my child earlier in my career, when I was a junior doctor or middle grade, I probably would have changed course a bit, if the truth be told.

'I might have looked at general paediatrics because it would have been easier for childcare – they do on-call, but it’s from home.

'Obviously, you still have to have someone in the house because you might be called in, but I would be able to be at home with my child rather than on-site all the time.

‘I’m very lucky – I have a job that I love, which is a blessing that not everybody has. But I’m a mum as well, and it’s important to get that balance.’