Everyone should have a positive experience at work, so they can thrive at the work they do and feel included, valued and respected, regardless of background circumstances or identity.
The most recent NHS survey in 2020 reported that 13.7% of gay or lesbian staff reported discrimination from patients and public, more than 61% attributed this to their sexuality and many feel this has affected career opportunities. It also only reported on lesbian or gay staff, implying that either they failed to include the transgender staff or there was simply no data as people have no confidence in the reporting system.
The COVID-19 pandemic has highlighted the importance of staff being able to work without fear of harassment or discrimination and yet the NHS, one of the biggest employers in the UK (albeit made up of numerous organisations), doesn’t dominate LGBTQ+ rights charity Stonewall’s Top 100 Employers list. If we are to be a truly representative service for the population we serve, this needs to change.
Culture plays a large part in the recognition and celebration of diversity, and what was a closed door not too many years ago is now opening. The younger population are more confident in reporting that they identify as LGBTQ+ and I hope these individuals will be well represented in the NHS workforce of the future, but there remains some work to if we are to enable them to be confident and valued.
The importance of inclusion
Embracing LGBTQ+ staff isn’t just the right thing to do – it’s essential to providing a better healthcare service. If staff cannot be open about who they are or feel they need to hide part of what makes them them, they may feel isolated, feel an uncomfortable need to ‘act straight’ or feel they can’t speak up about any signs of heterosexual, cisgender privileges and assumptions in the workplace. It may affect their mental health and their ability to reach their potential or perform to their best abilities. Even more importantly, we miss out on an incredible asset as we design health and care services.
At Eastern AHSN we are strong advocates of co-production in health services, acknowledging that people with lived experience are often best placed to advise on what support and services will make a positive difference to their lives. Healthcare for the LGBTQ+ community needs input from service users but needs to make better use of the experiences of staff who are also part of that community. If NHS staff can’t be open and celebrated for the contribution they can make, we are missing out on an amazing opportunity to learn from their experiences.
So what can we do?
I’m proud that the AHSN Network has made three diversity pledges to underpin our work and last year partnered with the LGBT Foundation to launch a nationwide call for innovations to help address health inequalities facing LGBT+ people which I hope will identify best practice and have an impact.
The NHS is making progress, but in an organisation this big the cogs are slow to turn; e-learning initially became a route to get information out, but evidence of it being effective is light and prescribed training risks becoming a tick-box exercise that fails to engage staff in a positive light, leaving the LGBTQ+ people again at the mercy of the majority.
Many trusts have now established networks of members with expertise and ideas as to what is needed, but requires a management team that is willing to listen. Fostering a culture that is visible must first acknowledge the diversity of the workforce, from there grow to be all inclusive and move away from labels. This needs to be underpinned by a commitment to addressing prejudice and having clear channels for people to report inappropriate or harmful behaviour towards LGBTQ+ people backed up by confidence that something will be done. The pandemic has brought mental wellbeing to the forefront of people’s mind both within and outside of the NHS. Now more than ever these networks need the support to succeed, become part of the norm and enable these walls of discrimination and bias to be broken down and rebuilt better together.
Celebrating LGBTQ+ heroes
One thing we should be doing more of is celebrating those people who have achieved great things, broken stereotypes, led the way in LGBTQ+ rights and excelled despite societal prejudices. I don’t just mean household names like Alan Turing or Florence Nightingale, but also people like Lord Cashman, a former actor and member of the House of Lords who founded Stonewall. Within healthcare and the NHS, leaders like Professor Tracy Myhill OBE have encouraged and inspired people to discuss LGBTQ+ issues with their local health board to ensure the inclusion of voices or LGBTQ+ people within the decision-making process.
This may sound controversial given where we are now, as a nurse we act as the patients advocate, but we are also at times the patients. For me this is the starting point: people. We are all the same really – we arrive, live and then we die. What we do in the middle is our legacy, how we do that is driven by culture, one we should continually assess, look back and reassess, change and improve.
At times this is not always the easiest path, we need to work to be all inclusive, to walk the path together, the more people there are the richer the conversation is.
This starts with recognising the road we have already travelled, which is why LGBT+ History Month is so important.
I am the clinical lead for deterioration within the Eastern Patient Safety Collaborative, working to embed the Managing Deterioration Safety Improvement Programme (ManDetSIP) within care homes across the region as part of the national managing deterioration QI programme. I hold a Master’s degree in Patient Safety Management from Loughborough University and have a plethora of clinical experience in critical and intensive care nursing, specialising in the deteriorating patient, escalation and response. I have worked in general, tertiary referral and teaching hospitals across the UK managing both critical care outreach and out of hours teams. I was influential in the design and implementation of electronic observations in a large teaching hospital in the midlands, and I also introduced medical safety handovers using a task management system and SBAR to support efficient team working at the trust, completing QI projects on device management and workforce utilisation out of hours through utilising live data feeds.
I have a special interest in clinical human factors and am a member of Loughborough’s alumni, CHIFE and Q.