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LGBTQ+ staff and patients deserve better from the NHS


recent survey by the British Medical Association (BMA) and the Association of LGBTQ+ Doctors and Dentists (GLADD) highlighted the difficulties faced by LGBTQ+ NHS staff. More than a quarter (29 per cent) of lesbian, gay, bisexual and queer respondents, and three in five trans respondents (59 per cent) considered their experiences serious enough to amount to unlawful discrimination, abuse or harassment. For our trans colleagues, the survey showed that transphobia is widespread – 49 per cent of trans colleagues surveyed have experienced transphobia in the past two years.

This is occurring alongside the increasingly polarising rhetoric around trans rights. Meanwhile the 2021 NHS Staff Survey reported that 24 per cent of bisexual NHS staff and 22.7 per cent of gay and lesbian staff surveyed have personally experienced harassment, bullying or abuse from other colleagues.

The survey from the BMA and GLADD also highlighted cis heterosexual colleagues are not recognising the scale of the problem too – only 1 in 20 think there is a problem with homophobia in their workplace compared with nearly 1 in 3 of LGBTQ+ colleagues. It’s clear that there is much that needs to happen to improve the experiences of LGBTQ+ staff in the NHS. As Dr Michael Alexander wrote in April 2021, there are likely tens of thousands of LGBTQ+ people working within the NHS. The personal impact of the poor experiences of LGBTQ+ staff is morally unacceptable, not to mention the risks of losing talent from the NHS in the midst of a workforce crisis.

'The personal impact of the poor experiences of LGBTQ+ staff is morally unacceptable, not to mention the risks of losing talent from the NHS in the midst of a workforce crisis.'

The discrimination that LGBTQ+ staff face also effects the patients we treat. A recent survey by Stonewall found 23 per cent of LGBTQ+ people have ‘witnessed discriminatory or negative remarks against LGBTQ+ people by health care staff’ and one in seven LGBT staff have avoided treatment for fear of discrimination. A third of trans patients have experienced unequal treatment. We also know LGBTQ+ people face health inequalities, including higher rates of mental illness and poorer experiences when accessing health care.

LGBTQ+ staff and patients have been leading the way in tackling the discrimination and health inequalities faced by the community. GLADD has been growing a LGBTQ+ medical and dental community through social and networking events, delivering teaching and funding research. In recent years, we have seen the growing success of the NHS rainbow badge initiative, started by Dr Michael Farquhar at Evelina London. By wearing the badge, staff are visibly showing patients and colleagues they can be trusted to provide inclusive, safe health care and they are informed about LGBTQ+ healthcare issues. More attention is being drawn to the long waits patients face to access gender dysphoria clinics and some areas are starting initiatives to integrate trans health care with primary care. More than three quarters of medical schools have signed the charter on ‘So-Called LGBTQ+ ‘Conversion Therapy’’ – thereby supporting the ban and ensuring ‘curricula include authentic and joyful representation of LGBTQ+ people, to challenge stigma and stereotyping’. After several u-turns, culture secretary Michelle Donelan has confirmed a new draft law will include a ban on trans ‘Conversion Therapy’. As Stonewall and many NHS bodies have explained, these practices are ‘unethical land harmful’ and have a devastating impact on people’s mental health.

I work in A&E, and in this context specifically there are several ways we could improve the situation for LGBTQ+ patients and colleagues. Across the NHS, we should all work to undo our biases – to not make assumptions when taking people’s histories and examining patients. There should be clear signage in wards, departments, clinics and offices outlining that we are an inclusive environment and discrimination will not be tolerated. NHS leadership should empower people – staff and patients – to speak up if they see discrimination at play. For NHS staff, we should ensure facilities are inclusive – for example, many A&E departments have insufficient and inadequate changing room options. NHS leaders must ensure that LGBTQ+ staff are supported to progress successfully through their careers by well-informed and inclusive senior management. And when NHS staff face discrimination, they must know how to raise these issues and trust that they will be listened to and acted upon.

'The onus now needs to be on allies within the NHS to step up and help to improve the situation for both LGBTQ+ staff and patients alike.'

These changes can be brought about in a multitude of ways. Over the past two years, I have worked with colleagues to celebrate Pride within our A&E. We have delivered teaching regarding LGBTQ+ health care and the history of Pride, signed colleagues up to the rainbow badge scheme (ensuring they understand the responsibilities involved in doing so), raised money to improve the diversity of books available in paediatric A&E, provided pronoun stickers for colleagues and raised money for local LGBTQ+ charities.

The onus now needs to be on allies within the NHS to step up and help to improve the situation for both LGBTQ+ staff and patients alike. From the data above it is clear not all cis heterosexual colleagues appreciate the scale of the problem. NHS staff, particularly allies, must encourage open reflection of our own prejudices and biases in order to start to address them. We need to improve the teaching about LGBTQ+ health care and rights within medical schools as laid out in The UK Medical Schools Charter on ‘Conversion Therapy’. This charter then gives people grounds to hold medical schools accountable to deliver high quality LGBTQ+ health teaching.

Within the workplace the NHS needs to foster inclusive safe environments for LGBTQ+ staff. This involves leading by example, colleagues must call out both micro and macroaggressions that we witness. LGBTQ+ networks in NHS trusts must be supported and empowered – they themselves should be diverse and those leading them should be given formal time allocation to do this work.

As health care professionals, we must loudly advocate for our LGBTQ+ patients. We should improve our knowledge regarding LGBTQ+ health and avoid making any assumptions based on biases and prejudices. Most importantly LGBTQ+ voices need to be centred and the experiences of both staff and patients should be heard and acted upon while we work towards improving the inclusivity of the NHS.