The NHS is often seen as a caring and accepting environment for LGBT+ staff – but it still has a long way to go to be fully inclusive place to work. There’s no doubt that there have been enormous steps forward in how LGBT+ staff are treated at work over the last 20 years or so. Anthony Nichols, longstanding MiP national committee member recalls that when he set up the first LGBT+ network in 1995, one senior manager asked him why he was bothering to bring gay men together “as they will only moan about the wallpaper”.
Carola Towle, senior national officer in UNISON’s equality unit, points out that 30 years ago many employers would not have regarded sexual orientation as an issue to be raised at work. But this has changed, along with the legal position – sexual orientation is now a protected characteristic – and the higher profile of LGBT+ people in popular culture and the media. “The NHS has made strides to be a good employer. We have worked a lot over the years with NHS employers,” she says.
But this progress masks some major problems in the NHS and workplaces in general. “There are still very high levels of discrimination – that should not surprise us,” says Towle, pointing out that racism has been recognised as a workplace issue for much longer but has still not been eradicated.
The TUC reported survey results in 2019 showing that 70% of LGBT+ people had been sexually harassed at work, but two-thirds of those people didn’t report it because they didn’t want to be outed at work.
Not everyone is out
UNISON's senior equality officer Carola Towle: “The role of the manager is crucial. Creating an inclusive culture still depends very much on local managers.”
It’s not clear – because only the most basic data is collected – how many people working in the NHS define their sexuality as LGBT+. While it is more common for people to be out at work than in the past, many people aren’t – and this may lead colleagues and managers to believe that there are few non-straight people in the workplace. “Just because a few people are out does not mean there is not a problem,” explains Towle.
Many older LGBT+ people will have lived through the years when there were high numbers of deaths from AIDS – and the resulting discrimination against gay men, in particular – and the state’s opposition to gay lifestyles, expressed through the notorious Section 28. This may mean they need assurance before they can be out at work, says Nichols.
He believes more senior leaders should “walk the walk” about bringing their whole selves to work and be out in the workplace. “I would ask people who are LGBT+ to come out and be their authentic selves,” he adds.
Outright and visible discrimination may be rarer than in the past but it can still happen. Nichols, who is head of diversity and inclusion in NHS England’s North West region, cites the case of a recently married gay couple some of whose colleagues refused to contribute to a wedding present because they did not agree with marriage between two men.
Visible leadership and role models
But just because such examples are not as commonplace as in the past, that does not mean that there are not still problems and barriers to LGBT+ people advancing in their careers.
Towle says there can be a lack of understanding in HR departments about the law. The TUC often sees first drafts of employment policies where the quality is really shocking and may reflect a misunderstanding of the law, she says.
And LGBT+ people can still find workplaces uncomfortable. It may be hard to talk about what they have been doing Nicholls says. Like many staff with protected characteristics, they may experience micro-aggressions or simply ignorance in the workplace – Nichols recalls one case where an NHS worker could not understand how a gay couple could have children, for instance.
What’s missing, he says, is visible leadership and role models from all protected characteristics and ‘intersectionalities’ (combinations of protected characteristics) at very senior levels.
It’s managers who need to take the lead on this, creating a culture which is inclusive and makes clear what is acceptable and what is not – for example, by making sure office banter does not overstep the mark or that trans people are not deliberately misgendered. “It can still be very dependent on the local managers. The role of the manager is absolutely crucial,” says Towle.
This extends to questions such as whether recruitment processes and adverts state a commitment to LGBT+ equality, whether images of LGBT+ people are represented in NHS literature and whether organisations mark LGBT+ History month.
Challenges at work
Anthony Nichols: “I would ask senior leaders who are LGBT+ to come out and be their authentic selves at work."
The pandemic may also have had a disproportionate impact on LGBT+ employees who were already at risk of mental health problems and may have felt particularly isolated, Nichols warns. Towle says it’s particularly important that staff can access mental health support services which are LGBT+ inclusive.
Trans people can face particular challenges at work, such as being asked to produce a gender recognition certificate if they want to change their gender in the HR records. “But that’s like being asked to produce your full driving licences to apply for a provisional licence,” says Towle. “You can’t apply for a GRC until you have lived in that gender for two years.”
And the issue of trans people having access to facilities such as changing rooms and toilets which match their gender is still controversial – but it is a manager’s job to find a way through, says Towle. “I think managers are used to dealing with difficult conversions in the workplace. This is no different to any other workplace issue. It is the manager’s role to ensure that everyone’s dignity is preserved. In this situation, it is trans people who are the most vulnerable,” she explains.
LGBT+ networks are important in representing the community and raising issues which concern them – and senior leaders may rely heavily on them for input. How representative they are may be variable but Nichols points to other issues – the lack of protected time for learning and getting involved in co-production for those involved in running networks. “Until we build in something that protects that role and that time, we are not going to authenticate it,” he says.
But there is also more which could be done by the centre. Towle highlights the use of unnecessarily gendered language in areas such as Agenda for Change and the need to ensure that all national policies are LGBT+ friendly.
And Nichols points out there are good reasons why managers should address these issues. As well as the moral case for treating people equally, better treatment of LGBT+ people could benefit the NHS by helping it attract the best talent, regardless of sexual orientation. “If you look at the business case around employing people who are LGBT+, there is an enormous amount of talent there,” he says.
- Hear Carola and Anthony speak at MiP’s webinar “Creating LGBT+ inclusive workplaces” at lunchtime on 3 September 2021. Details and joining insructions will be sent to all members by email, or contact us for further information and book your place.