01 / 12 / 2014 10am
There are many types of discrimination which can hamper NHS Staff, the bias based on sexuality does not attract the attention it should. It is great that the lack of representation of women and BME leaders is receiving the attention it deserves (still not enough), but what about LGBT staff?
The discrimination felt by lesbian, gay, bisexual and trans healthcare leaders and staff receives sparse attention.
This might be because there is an assumption that the NHS is a workplace in which LGBT people feel comfortable - or that perhaps because sexuality is not always obvious in the way that gender or race is and that somehow discrimination will be less prevalent.
I am aware that there are a number of NHS organisations that have earned the right to feel proud of their record in making LGBT people welcome, but there are many others - and particularly those organisations who are away from the big towns and cities in which LGBT issues and the LBGT staff are silent. In my own organisation we are beginning to explore how we move this agenda forward.
How has it been for me?
I began my NHS career in 1981, 33 years ago and for many many years worked hard to keep my sexuality under wraps. When I think about this now, being an out lesbian woman in the early eighties was most definitely much harder. I grew up in a town and had to go to the nearest city to be part of a scene where I was welcomed and made to feel part of the troop. I was aware of a handful of LGBT staff in the hospital I trained in. The rumour mill was rife and many staff I heard referring to these staff did so in a derogatory way. No incentive then to come out of the closet.
As I progressed in my career, it seemed to get tougher. Expectations of people who reached the boardroom were pretty stereotypical. I was aware that it was difficult for young women to prove their worth (I made my first board post at 29) but it was even tougher as a gay woman. I remember joining a male dominated team of, (as far as I know) straight men. It was so stressful being constantly quizzed about my personal life. There was (and still is) an assumption that I was married and in a heterosexual relationship.
At this point in my career I certainly wasn't openly gay, but as I became more experienced at this level and grew in confidence I felt able to share my sexual orientation. I was never sure about the impact though and was once given the feedback that I hadn't been appointed for a bigger job due to the fact the chairman knew I was a lesbian.
I remember how much easier life was when I worked in Trent - with a regional office with more LGBT staff than any previous organisation I had ever known. The thing that made things easier was that being gay was openly discussed. It was the sort of workplace where LGBT staff had photos of their partners on their desks or pinned up on their notice boards. LGBT issues were discussed at all levels and right from the top of the organisation.
Feeling discomfort and feeling different
During the times in my career where I haven't felt I could be open about my sexuality, I therefore haven't felt comfortable. Anyone who has experienced this knows how it feels. I am ashamed to say that I have at times pretended to have a boyfriend and on more occasions that I would want to admit have changed the name of my partner from a girls name to that of a boys, just so that I could join in a conversation and talk about what I did during my holiday or the weekend.
I am certain this did nothing for my self-esteem and confidence. Having to pretend is never comfortable - living a lie is hard work!
This impacts on everything from confidence to dress sense, which is a big part of identity. At the time I began my career lesbian sexuality didn't seem anywhere near as fluid in terms of identity. Trying to decide what uniform was the correct one in the boardroom was a nightmare. Many of the people surrounding me were dressed in pin stripes of either blue or grey. I followed suit (pardon the pun!) for a while - which I don't think I do any longer.
The difference now
I have been in the health service now for 33 years. I have been a chief executive for the last 12. The experience and longevity at a senior level in the NHS definitely give me a sense of comfort and confidence in who I am. Today I talk about my partner - we have been together 15 years and had our civil partnership five years ago. She also works at senior level in the NHS and I am really pleased to say that we are both able to be openly gay at work. I haven't experienced outward discrimination for some time now. I have however at times experienced the discomfort of others. I wonder what this would have felt like if I was a more junior member of staff? I wonder if sensing this discomfort other LGBT staff may have felt uncomfortable and not felt able to share their sexual identity.
A LGBT friendly NHS
The statistics are revealing. The campaign group Stonewall has calculated that approximately 3.3 million people who identify as lesbian, gay and bisexual in the UK provide through their taxes funding for the NHS amounting to £6bn. To this add in the estimated 300,000 – 500,000 trans community in the UK. Also, it is estimated around 100,000 staff currently identify as lesbian, gay or bisexual (this figure is very likely to be underestimated!).
If we turn to LGBT people on the receiving end of healthcare it makes for depressing reading. For example, lesbian and bisexual women are on average twice as likely never to have a smear test compared with women in general. Half of lesbian and bisexual women are not out to their GP. Some 3% of gay and bisexual men have attempted to take their own life in the last year compared to 0.4% of men in general. People who identify as trans also have specific health care needs and people who are trans generally at greater risk of depression, self-harm and suicide.
Parts of the NHS are achieving great things in terms of attitudes, initiatives and support for the LGBT community. A recent HSJ survey (19 September 2014) painted a much more positive picture than I imagined. To some extent this reflects broader societal changes - we should remember that homosexuality was only declassified as a mental illness by the world Health Organisation as recently as 1992.
For me the decision to come out was a very personal decision. However, I know how uncomfortable I felt hiding my sexual orientation and how important this was and is as an element of who I am. As a chief executive, I want to create an environment where staff can really flourish and give their very best to our patients. Being able to feel comfortable, respected and valued for who you are is surely a key component of that. For the NHS, which is not only one of the largest employers in the work but also holds the responsibility for the healthcare provision of each one of us - creating the right environment is a pressing concern.
Importance of positive role models
Positive role models have been influential for me throughout my life. I hope that I am providing this for staff in my own organisation, the people I coach and mentor and also through my work as a PFD ambassador for NHS Employers. I want to encourage NHS organisations to provide a positive environment for LGBT staff to flourish and grow, and in turn build their esteem and confidence to support their own network of colleagues.
Jackie Daniel is chief executive at Morecombe Bay University Hospitals NHS Foundation Trust
The Trans Research Review, a review of evidence on inequalities conducted for the Commission (Mitchell and Howarth 2009) (1)