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Around 1.6 million people in the UK work for the NHS and many more, including staff in general practice and dentistry and large numbers of outsourced support staff, help to provide NHS services. Taking a ballpark estimate for LGBTQ+ prevalence, let’s say 2–3 per cent, would mean tens of thousands of people who identify as LGBTQ+ work in the NHS – a number that seems likely to increase in the near future, as younger individuals appear more likely to identify with part of the LGBTQ+ community, or at least to be willing to report that to researchers and pollsters.
Members of a sexual orientation or gender identity minority group, or indeed both, are more likely to be bullied or harassed at work. This treatment is likely to be at the hands of their colleagues, rather than customers or clients – 78 per cent of respondents to the Government Equalities Office LGBT survey ascribed the most serious incidents of inappropriate workplace treatment to colleagues or superiors. In health and social care specifically, Stonewall found that more than a quarter of lesbian, gay or bisexual staff reported experiencing bullying or poor treatment, related to their sexual orientation, from colleagues in the preceding five years. Almost one in ten were aware of colleagues experiencing discrimination as a result of being trans.
'Members of a sexual orientation or gender identity minority group, or indeed both, are more likely to be bullied or harassed at work. This treatment is likely to be at the hands of their colleagues, rather than customers or clients...'
In 2016 GLADD (The Association of LGBTQ+ Doctors and Dentists) and the BMA surveyed more than 800 lesbian, gay and bisexual doctors and medical students. Of this group, 12 per cent had experienced bullying or harassment in the preceding two years, and the same percentage felt that they had suffered some form of discrimination at work. That discrimination can take many forms, some much harder to demonstrate conclusively. Anecdotally, most of the senior LGBTQ+ doctors that I know at least suspect that they have been passed over for jobs and promotions during their careers. Plenty of doctors who are still working can recall explicit and legal discrimination.
More recently, the 2020 NHS staff survey found that 13.7 per cent of gay or lesbian staff reported discrimination from patients or the public, and 11.8 per cent from their colleagues. More than half (61.5 per cent) ascribed this to their sexuality. In every category of experience of harassment, abuse, bullying and physical violence, whether from patients and service users, colleagues, or managers, heterosexual staff members reported the lowest incidences. No data was published on trans status or gender identity.
This brings us to a familiar question: how do you change a culture? I think we have all reached the point of accepting that desultory box-ticking equality and discrimination training delivered by ‘e-learning’ is not the answer. Many trusts, or other NHS organisations, have LGBTQ+ staff networks. For those organisations that already have such networks, members of those networks will have all the expertise and ideas about what is needed, if management is willing to listen. Employers should be seeking to encourage LGBTQ+ staff to organise themselves, and the prerequisite for that is a degree of visibility. Once some members of staff feel comfortable being themselves at work, they will encourage others to do so, and organisation can follow.
How does an employer encourage visibility? First, they must acknowledge that diversity of sexuality and gender identity is a fact, and not one that is best ignored. Wherever they are in the country, whatever community they serve, they will have LGBTQ+ staff members and patients. From there, they can take steps to make those workers and patients feel accepted and welcome. LGBTQ+ people cannot make the presumption that we will be welcomed wherever we go. That presumption lies behind the now widely used, if not always so widely accepted, concept of privilege. Fostering a supportive environment can be as simple as putting up a poster on LGBTQ+ health, or using inclusive language. These things may be simple, but they are not always uncontroversial, as seen recently in the laudable efforts of Brighton and Sussex University Hospitals Trust to introduce gender inclusive language into its maternity services.
There are also more formalised schemes that should be mentioned. The LGBT Foundation runs a programme called Pride in Practice that provides accreditation for GP practices, dental surgeries, pharmacies and optometrists for excellence in LGBT health care provision. Dr Michael Farquhar’s NHS Rainbow Badge project, originally developed with his team at the Evelina in London, has now partnered with many NHS trusts and other organisations, including GLADD. Participants sign up to pledges to support LGBTQ+ patients and colleagues, and wear the badge to show that support. These programmes are signs of progress.
'The pandemic has made very clear the importance of providing support to NHS workers so that they can do their work. Part of that support is making it possible for them to come to work as themselves, without fear of harassment or discrimination.'
Recent legislative change has also made an impact. NHS workers now have greater rights to refuse non-critical treatment to patients who subject them to various forms of bigoted harassment. Although I do not expect these powers to be used frequently, and it has to be clear that no one will be refused treatment based on their opinions, no matter how unpalatable, the message being sent is a positive one.
Stonewall’s list of Top 100 employers for 2020 contains five NHS bodies. Shouldn’t the NHS be dominating that list? After all, everyone in the NHS works to provide care to people in need, whomever they are, and so acceptance and inclusivity should be things with which they are familiar. I have made it this far without referencing the Covid-19 pandemic, so you had to know it was coming. The pandemic has made very clear the importance of providing support to NHS workers so that they can do their work. Part of that support is making it possible for them to come to work as themselves, without fear of harassment or discrimination.