The Stonewall effect: the positive difference an inclusive employer can make
Attitudes towards LGBT people have changed. Now health employers are catching up
Attitudes towards LGBT people have changed. Now health employers are catching up
Brian Dalgleish decided in his early twenties to train to be a nurse. He had been working in a bank since leaving school, but wanted a job in which he was making a direct and positive difference to people’s lives.
He started his nurse training in Lanarkshire in 1983, just three years after sex ‘in private’ between two men aged over 21 was decriminalised in Scotland – and the same year that men who had sex with men were asked not to donate to UK blood banks because of the AIDS crisis.
He was in his first role as a qualified nurse when, in 1988, the then prime minister Margaret Thatcher introduced Clause 28 of the Local Government Act (called 2a in Scotland), which sought to prevent local authorities ‘promoting’ homosexuality or promoting the ‘acceptability of homosexuality as a pretended family relationship’.
‘Able to be myself’
Perhaps it is not surprising, then, that Mr Dalgleish was not at that stage completely ‘out’ at work. ‘I was out to some people as a nursing student, then to some people when I was working,’ he says, adding that he did not disclose he was gay when he spent a short time working in the United States.
It was only when he joined his current organisation in 1994 that he was completely open about his sexuality.
Now a senior charge nurse in intensive care at the Golden Jubilee Hospital in Clydebank, near Glasgow (previously a private hospital called HCI), he says: ‘I had come from the health service into the private sector, which had a very flat structure, not the nursing hierarchy that there was in the NHS. I felt I was able to be myself.’
In 2015, research showed that a quarter of lesbian, gay and bisexual health and social care staff had been victims of bullying or abuse in the previous five years
Since then the environment for LGBT people has undoubtedly transformed, with landmark changes such as the legalisation of gay marriage across most of the UK. But not all workplaces, including health services, have kept up.
In 2015, the charity Stonewall published research showing that a quarter of lesbian, gay and bisexual health and social care staff had been victims of bullying or abuse in the previous five years, and that a fifth of all staff had witnessed negative remarks being made about trans people in the workplace.
One in ten health and social care staff involved in patient care had witnessed colleagues expressing the belief that people could be ‘cured’ of being lesbian, gay or bisexual, and almost six in ten did not believe that sexual orientation was relevant to healthcare.
How nurses (LGBT or not) can make a difference in the workplace
- Find a support network. It might be that one exists in your trust or other organisation – for example, an LGBT staff forum in which you can get involved
- If there isn’t an obvious network in your own organisation, contact neighbouring trusts to find out what they are doing, building relationships and communities on the basis of shared objectives
- Contact your organisation’s diversity and inclusion leads and ask what is being done in relation to LGBT policies. Positive action includes having written and well-publicised policies that promote inclusivity, taking an active role in events such as Pride and promoting visibility of senior LGBT staff
- Encourage your employer to access the many resources available from organisations such as Stonewall and the RCN’s LGBT network
- It can be easy to feel alone and isolated, but there are lots of people out there with the same objectives. This includes allies, that is, people who do not identify as LGBT but who also want to make their organisation more inclusive and welcoming
Same barriers still exist
The research report, called Unhealthy Attitudes, also said that a quarter of all staff reported not having received any equality and diversity training, and that 16% said they wouldn’t feel confident challenging colleagues who made negative remarks about LGB people.
‘Some of the findings were quite horrendous,’ says Stonewall’s head of public sector membership programmes, Pete Mercer, who believes the situation has not changed significantly since the research was carried out. ‘If we repeated it today, I think we’d probably find similar stories,’ he says.
‘While there have been improvements, there are still barriers that need to be overcome.’
Stonewall, which works with around 80 organisations in the health and care sector (some of which feature in the charity’s annual Top 100 Employers list) provides a range of tools and information to help them to become welcoming and inclusive workplaces for LGBT people.
But there remain challenges across the public sector, not least the pressures on time and resources, which make it difficult for staff to leave the wards to work on improvements to diversity.
Lack of visible role models
There can also be management issues. ‘Sometimes there’s a lack of strong and positive leadership – some trusts are very good, but it’s patchy,’ says Mr Mercer. ‘Even where there’s strong and positive leadership at the top, it can get lost at the middle management level; it needs to cascade down,’ he says. ‘There can also be a lack of visible LGBT role models.'
That is something that is close to the heart of Carole Anderson. She is head of strategy and performance at the Golden Jubilee Foundation, the national NHS board that runs the Golden Jubilee Hospital, where she leads on LGBT equality. She is also a Stonewall Scotland role model and chair of the Scottish Workplace LGBT Networking Charity (SWAN).
‘When you begin a new job you worry about standing out – that it will negatively affect your career’
Carole Anderson, head of strategy and performance and LGBT equality lead, the Golden Jubilee Foundation
The openness she enjoys at work today would have been unthinkable to her back in the late 1990s when she started her career in healthcare. ‘When I trained as a physiotherapist I was mostly out to colleagues and some lecturers, but when I started work I went back into the closet,’ she says.
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‘When you begin a new job you worry about standing out – that it will negatively affect your career. I would avoid talking to colleagues about personal things – even simple things like what I’d been doing at the weekend. I became adept at holding whole conversations [about my partner] without using any personal pronouns, and even making up stories about a male other half. It was exhausting, trying to remember “his” name from one week to the next,’ she laughs.
‘Banter’ about LGBT people
Although she makes light of it now, this does not detract from her passionate belief that everyone should feel able to be themselves at work.
Her early experience of working in the NHS was isolating, she says. There was no ‘messaging’ from her employers to indicate that the workplace was inclusive for LGBT staff, for example. There was also ‘banter’ and inappropriate jokes about LGBT people that went unchallenged.
‘I was very open and said that colleagues could ask me what they wanted to know. I learned that talking about my authentic experience could have a wider impact’
When she started working at the Golden Jubilee, she made the decision to be out to her colleagues and, almost to her surprise, it began to have a ripple effect.
‘I was very open and said that colleagues could ask me what they wanted to know,’ she says. Lesbian and gay nurses within the organisation reported to her that physiotherapists had become more ‘relaxed’ working with them. ‘I learned that talking about my authentic experience could have a wider impact,’ she adds.
Since then, the Golden Jubilee has taken steps to ensure it is an inclusive and welcoming employer for LGBT staff, including engaging with Stonewall’s Workplace Equality Index. It frequently appears in the charity’s Top 100 Employers.
In the past decade the organisation has made its policies more inclusive, developed values based on dignity and respect, appointed diversity champions and ensured there are visible role models in senior positions.
‘Every time I tried to move up, I would get knocked back’
As a young nurse working the in the NHS, Watty Gaffney was ambitious and keen for advancement. But when he was turned down for promotion several times, he wondered what was going on.
‘Every time I went for a band 6 post I would get knocked back. There wasn’t much feedback – I felt they were palming me off. I was a confident nurse who was constantly being praised by patients, but I was being turned down and much more junior nurses were being appointed.’
Mr Gaffney is convinced that he was being bullied and victimised because he is gay.
His situation at work, along with some personal issues, led to what he today calls a nervous breakdown, and a suicide attempt. ‘It was very unpleasant,’ he says with devastating understatement.
A mixed picture
That was eight years ago. Today, Mr Gaffney is working to ensure that healthcare staff are treated fairly, regardless of their sexual orientation or identity. As a Unison union steward and LGBT co-convenor, based at the Queen Elizabeth Hospital in Glasgow, he has an impressive overview of the issues facing nursing staff in the UK. And he says it’s a mixed picture.
‘From a gay man’s perspective, there is still some way to go,’ he says. He points to positive developments, including high profile involvement of health boards and their staff in Pride events, and the proliferation of rainbow lanyards in healthcare settings.
Equally, he cites areas that are less developed, such as a recognition of the specific needs of trans and non-binary people, and help and support for nurses who are transitioning. ‘We also need more visibility of our bi colleagues,’ he says.
Spreading positive employment practice should also apply beyond the big NHS organisations, he says, for example in small care homes.
He is optimistic that the workplace will become a more welcoming place for all, not least because the way has, to an extent, been ‘paved’ by the fight for LGBT acceptance.
Steps that create an inclusive workplace
The Golden Jubilee also offers training to nursing students on improving the healthcare experience of LGBT patients. Key elements include understanding the historical legal context and that older gay people, in particular, might have felt persecuted for much of their lives.
Northumbria Healthcare NHS Foundation Trust is another healthcare organisation that has made frequent appearances in Stonewall’s top employers list – last year it was named as the best hospital trust employer for LGB staff.
Patrick Price, equality and diversity lead for both the trust and Northumberland County Council, says there is a drive for constant improvement. Part of it is about inclusive policies – for example, ensuring people are aware that they can apply for carer’s leave to look after an ill same-sex partner, and that trans people aren’t ‘dead-named’ (that is, calling them by the name they had before they transitioned).
But it’s also about creating a positive and inclusive culture, he says. Initiatives include providing equality and diversity training for all staff as part of their induction, and taking part in events such as Northern Pride Festival and a Trans Lives Matter regional conference.
Good for business
The success of these steps is translating into tangible benefits – for example, staff satisfaction has risen, and a relatively high proportion of staff are happy to declare their sexual orientation. Mr Price believes it’s also positive for the ‘business’ of the trust. ‘We want to attract the best talent and be seen as a good place to work,’ he says. ‘We want to recruit locally and have a workforce that is as diverse as the local population,’ he adds.
For Matt Starr, a critical care nurse at the Golden Jubilee, the health service and nursing in general have felt like positive places to be a gay man.
That doesn’t mean he has never suffered discrimination or stigma. ‘School was a bad time for me. I was bullied for being gay and was being called all these names at a time when I was confused about myself and who I was,’ he says.
He believes, however, that the efforts his employer makes to promote and support the rights of all staff make a real difference. ‘I feel that organisations should do all they can to help LGBT employees and make the work environment more inclusive,’ he says. ‘In return, happy staff will lead to employee retention.’
‘People do worry about getting it wrong and yes, terms are changing, it can be confusing. But there’s lots of information out there’
Pete Mercer, Stonewall head of public sector membership programmes
At Stonewall, Mr Mercer believes everyone, whatever their gender identity or sexual orientation, can make a difference at their workplace, including becoming a formal ‘ally’. He says that some people might hold back because they are worried about causing unwitting offence. ‘People do worry about getting it wrong and yes, terms are changing, identities are changing, it can be confusing. But there’s lots of information out there,’ he says.
‘People often ask us what they can do – they say: “tell us to do one thing”. The answer is to do some research, to educate yourself. The health sector is an incredibly important place, and we need to get it right.’
Jennifer Trueland is a health journalist
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