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Zero tolerance for unhealthy attitudes

A report published last year by Stonewall revealed the persistence of negative attitudes to LGBT people in health and social care services, with a significant problem existing between staff. Managers’ failure to support employees and challenge remarks, however subtle, are part of the problem.

A major survey has uncovered shocking accounts of homophobia and transphobia in health and social care settings – with staff often targeted by their colleagues

‘Dyke’, ‘poof’ and ‘she-male’ are among the derogatory terms that nurses hear colleagues use about lesbian, gay, bisexual and transsexual people, according to a survey of 3,000 health and social care staff published last year.

Picture credit: Chris Keegan

The YouGov survey, conducted for the charity Stonewall, found discrimination towards LGBT staff from patients, and from staff towards LGBT patients and service users. But it also identified a significant problem between staff. A quarter (26%) of lesbian, gay and bisexual staff who responded to the survey reported being bullied as a result of their sexual orientation. One in six respondents – including doctors, nurses, counsellors, carers and managers – were aware of lesbian, gay and bisexual colleagues experiencing discrimination or poorer treatment at work.

Almost a quarter (24%) of all respondents in patient-facing roles had heard colleagues use derogatory language to describe gay, lesbian and bisexual people, and 20% had heard such comments about trans people. One in ten had witnessed colleagues expressing the opinion that someone can be ‘cured’ of being lesbian, gay or bisexual. One in 14 respondents (7%) said they would not feel comfortable working alongside a trans colleague.

The report, Unhealthy Attitudes – which can be viewed here – provides some startling examples. One nurse reported that a nursing colleague with strong religious beliefs told him he ‘should be hanging from a tree’ due to his sexual orientation. He added that some colleagues didn’t want to use the same mug as him in case he had AIDS. Another nurse said colleagues described same-sex parents as obscene and unnatural. A doctor said that LGBT people are ‘not the norm’, and their needs should not be forced on others.

Nurses reveal their negative experiences

‘I was told I should be hanging from a tree by a nurse from Nigeria with strong religious beliefs. People refused to drink from a mug I had used in case I had AIDS.’


‘A consultant... was very friendly and very good with me until somebody told him I was gay... then he turned nasty, rude, and said: “He can run the pink team.” More importantly, I was placed on a lower level in the social ladder within the unit. If I was trying to talk about professional, work related things when he was there, he would turn and shout: “We are talking.” All this has affected my career.’


‘My workplace let aggressive and abusive behaviour by family members go by all the time.’


‘A transgender nurse is often referred to as “he-she-it” by other staff and service users. Some service users have complained about being cared for by this nurse based on her being trans and not based on the quality of care.’


‘Managers tend to say: “Oh, it’s only banter.”’

Source: Stonewall’s Unhealthy Attitudes report

Stonewall Scotland campaign, policy and research manager Catherine Somerville says patients suffer when staff express negative and homophobic attitudes.

‘The overwhelming sense from the report is how prevalent such bullying is in our health services,’ she says. ‘That’s completely unacceptable as far as we are concerned.’

The report found that 16% of health and social care staff would not feel confident challenging colleagues who make disparaging remarks.

‘If attitudes are going unchallenged, it has a direct impact on the individual staff member, on their confidence in themselves and their ability to perform. But it also has a knock-on effect on the experience of the patient, particularly a LGBT patient,’ says Ms Somerville.

‘What we are seeing is that not only are staff not challenging homophobic and transphobic remarks, but they are also not challenging those made directly towards patients who are receiving services.’

Culture of care

Research using the NHS Staff Survey has shown that bullying, harassment, abuse and discrimination leads to poorer outcomes. It has an impact on staff turnover, absenteeism and patient satisfaction, according to the 2011 study by Lancaster University and Aston Business School.

The report on NHS staff management and health service quality concluded that a culture of ‘respect for all’ – staff, patients and public – provides the ‘ideal’ care environment.

Ms Somerville says that while homophobia is less pronounced in the NHS than it used to be, concerns remain that some negative attitudes are being expressed in subtler ways – which can be harder to tackle than overtly homophobic statements.

Community nurse Drew Payne says he is comfortable being out with his colleagues at Whittington Health in London, and they are all supportive. But he knows of other nurses who still experience homophobia from those they work alongside. ‘When I was training in the 1980s, I heard a student nurse say that Freddie Mercury deserved to die,’ he recalls.

‘Things are improving, but I think it is becoming more subtle and underhand. A big thing now is that homophobia is being justified by religious beliefs. Someone will say that they are stating things from the Bible or that God says this, and some people find that awkward to challenge.’

While most staff told Stonewall they had received equality and diversity training, its quality was variable. In one case it was reported that the trainer ‘kept giggling about trans people’. Almost three quarters of patient-facing staff said they had not received any training on the health needs of LGBT people, the rights of same-sex partners and parents, or the use of inclusive language.

The Stonewall report stresses the importance of embedding best practice in caring for LGBT patients and services users across all pre-registration courses.

Challenging discriminatory remarks

Be brave Support the person being targeted. Instead of leaving or ignoring the situation, monitor what is happening so you can intervene, if it is safe to do so.

Be heard Confront the perpetrator by using a statement such as ‘That’s not okay’, and explain why. Try to keep calm and explain why it matters. Whatever happens, stay safe and do not put yourself in danger. If you are being targeted, report the abuse to your manager or HR department.

Be kind Create the world you want to see with your own actions and words. Approach the person who was targeted and check if they are okay. If the victim is a patient, suggest they talk to a family member, a friend or the police, and report what has happened to your employer. If the victim is an employee, encourage them to report the abuse. Don’t forget to be kind to yourself – it is not always possible to intervene, but offering support can go a long way.

Source: Stonewall

Brendan McCormack, head of the division of nursing at Queen Margaret University, Edinburgh, says its undergraduate nursing course encourages students to tackle homophobia in the workplace. Principles of equality are prominent in the professional practice module in the first year of the course.

‘As a member of the LGBT community, I haven’t experienced homophobia much, but I have been in more senior positions, so have had the power and authority to make it clear I am not happy with such comments,’ says Professor McCormack. ‘But among staff there can be an issue with jokey homophobic comments that I know colleagues and students can find difficult to challenge.

‘We try to equip students to question homophobia and make it clear they are uncomfortable with it.We are explicit in terms of what nursing students need to be doing in terms of questioning appropriately to challenge the sense of threat they feel.’

In her 30-year career Janet Lee, a paediatric critical care practitioner at Brighton and Sussex University Hospitals NHS Trust, has seen attitudes at work change gradually in line with an increasingly tolerant society. However, problems persist – such as when she shared some photos of her civil partnership and one colleague refused to touch them.

‘I am concerned at the impact the financial pressures on the NHS will have on progress,’ Ms Lee adds.

‘Up and down the country, LGBT forums are failing and training is being reduced because staff cannot be let go from their posts to attend. If LGBT staff are invested in, it reduces their sickness rates, increases their confidence and leads to better services for patients. There is a risk we will go backwards because of the financial pinch’.

Hospital’s training challenges stereotypes and encourages respect

Equality and diversity have been at the heart of a culture change for staff and patients at Golden Jubilee National Hospital at Clydebank, near Glasgow.

This work has been recognised by Stonewall, who recently named the hospital Top Health and Social Care Provider in the UK in its Workplace Equality Index 2016.

Jane Christie-Flight, a perfusionist, equality lead and employee director, says that equality and diversity training is an important part of the induction process and is threaded throughout other training carried out in the hospital, which is a specialist centre for heart, lung, orthopaedics and some elective services.

Thirty diversity champions have had extra training on issues such as how to challenge inappropriate behaviour. There are also staff who act as confidential contacts for nurses to approach if they feel they need to raise an issue like bullying.

‘We are trying to mainstream equality throughout the organisation,’ Ms Christie-Flight says. ‘The training during induction challenges a lot of stereotypes and recognises that everyone has bias, and how to overcome that. We interweave equality and diversity through other sessions, such as those on caring behaviours.

‘We try to get staff to think about people as a whole, and within the organisation there is a huge focus on person-centredness, not just for patients but for staff too. If we treat staff with dignity and respect, then we get a better patient experience.’

Ms Christie-Flight adds: ‘I have found Golden Jubilee to be supportive of me [as a lesbian] and that comes from the top down within the organisation.’

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