The illusion of inclusion? LGBTQ+ staff experience in healthcare

Introduction

LGBTQ+ staff represent one in 20 of the NHS workforce, yet successive NHS staff surveys have shown that there is persistent inequity in staff experience. 

The Health and Care LGBTQ+ Leaders Network conducted its largest ever survey with its members in August 2024 – with a remit to delve deeper and capture specific insight to better understand the trends exposed in the NHS Staff Survey. The survey aimed to:

• understand the realities of LGBTQ+ experience, from the perspective of LGBTQ+ staff and allies
• benchmark progress towards inclusion 
• uncover the day-to-day challenges facing LGBTQ+ staff and how the network can use its collective power to tackle them.

Read a snapshot of the main findings below, alongside our news story with reflections from our network chairs.

Survey snapshot

Over 540 network members responded, working at all levels and representing the breadth and depth of health and care. 78 per cent of respondents identified as LGBTQ+, with the remaining 22 per cent responding as allies.

The survey focused on five key areas:

1. Benchmarking progress related to organisational inclusion
2. Personal and witnessed experiences of being LGBTQ+ at work
3. Efforts to support meaningful LGBTQ+ inclusion and allyship
4. Insights into the challenges that LGBTQ+ staff would like to see addressed
5. Specific support that the network can provide for its members.

Progress with organisational inclusion

We asked members to rate their organisations based on the following seven Gartner Inclusion Index categories: fair treatment, integrating differences, decision-making, psychological safety, trust, belonging, and diversity. 

The findings were compared to results from our 2021 survey to capture key trends. 

What we found

• The Gartner Inclusion Index categories that saw the most improvement were fair treatment (+13 per cent), psychological safety (+6 per cent); and belonging (+6 per cent). 
• The perception of diversity improved by 18 per cent, but is still the worst measurement overall (only 38 per cent responded positively) – highlighting the need to increase LGBTQ+ visibility and representation at more senior levels.
• Categories that worsened since 2021 were decision-making (-5 per cent); trust (-2 per cent) and integrating differences (-1 per cent).
• Allies had a slightly more positive view of inclusion overall – but in the main, their experience of organisational inclusion often aligned with that of LGBTQ+ staff.

Personal experience of LGBTQ+ staff

We asked network members about their personal experience of being LGBTQ+ or an ally – and whether they had experienced, or witnessed, homophobia, biphobia and transphobia in their organisations.

What we found

Network members disclosed higher rates of direct or indirect homophobia, slightly higher rates of transphobia, and less biphobia compared to the NHS Staff Survey results. Crucially, across the board, concerns were raised about organisations’ ability to respond to incidents swiftly and appropriately. 

• 25 per cent of survey respondents said they have experienced direct or indirect homophobia (compared to 13 per cent in the NHS Staff Survey).
• 9 per cent of survey respondents have experienced direct or indirect biphobia (compared to 12 per cent in the NHS Staff Survey).
• 20 per cent of survey respondents have experienced direct or indirect transphobia (compared to 18 per cent in the NHS Staff Survey).

Where these instances occurred, on average only 14 per cent of respondents felt their organisation responded swiftly and appropriately. This figure increased for allies suggesting a disparity in lived experience and experience that was witnessed. This highlights an urgent need for NHS leaders to fully embed LGBTQ+ inclusion within their workplaces – and ensure that policies are acted on and fully communicated to all staff. 

LGBTQ+ inclusion at work

We asked network members to share positive examples of meaningful LGBTQ+ inclusion work within their organisations, alongside allyship from both colleagues and senior leaders.

What we found

• 39 per cent of LGBTQ+ staff believe their organisation has implemented meaningful inclusion work – however, a significant 37 per cent believe their organisations have not.
• Survey respondents shared many positive examples of LGBTQ+ inclusion work, ranging from visible support for awareness days to training; staff belonging and inclusion strategies; and senior leadership buy-in.
  
  “Training within leadership meetings available to all staff, messages in all communications to mark significant days and to promote the LGBTQIA+ staff network, zero tolerance messages from senior leads. The safety of LGBTQIA+ people, both staff and patients, their inclusion and care is palpably cared about and the message is clear that bigotry will not be tolerated.”
• However, personal experiences of inclusion that were shared in the qualitative feedback were generally more negative in tone. 
  
  “Sometimes it’s difficult to know, for example, if a refusal to attend the organisation’s trans training is a genuine case of not being available or is a not wanting to.”
  
  “I regularly witness and experience micro-aggressions that seem normalised within the organisation. This has often been from senior managers. Their behaviour is not called out or challenged in any way."
• 73 per cent of LGBTQ+ survey respondents experienced visible allyship from their colleagues. This compares to 43 per cent from their senior leaders, highlighting the need to ensure that senior leadership are informed, active and visible allies for their LGBTQ+ staff.

Key challenges to address

We asked network members to rank the key priorities they would like the Health and Care LGBTQ+ Network to focus on.

Top priority areas LGBTQ+ members would like the network to focus on:

• Creating inclusive cultures – 65 per cent
• Trans workforce inclusion and equality – 62 per cent 
• Encouraging allyship in senior leadership – 61 per cent 
• Improving LGBTQ+ visibility – 55 per cent 
• Supporting career development – 31 per cent 

Top priority areas ally members would like the network to focus on: 

• Creating inclusive cultures – 64 per cent 
• Advice and guidance for allyship – 56 per cent 
• Encouraging allyship in senior leadership – 58 per cent 
• Trans workforce inclusion and equality – 49 per cent 
• Improving LGBTQ+ visibility – 40 per cent 
• Supporting career development – 17 per cent 

Other areas suggested by network members included: LGBTQ+ awareness training; inclusive data recording; a focus on how organisations respond to reports of bullying, harassment and discrimination; introducing LGBTQ+ equality standards; and supporting LGBTQ+ staff networks to thrive.

Support from the network

The final question focused on what support members would like to see from the Health and Care LGBTQ+ Leaders Network.

The top three areas identified by network members were resources to support LGBTQ+ inclusion (73 per cent); the opportunity to learn from LGBTQ+ leaders and aspiring leaders (69 per cent); and peer support in a safe space (54 per cent).

For ally members, the top three areas of support were the opportunity to learn from LGBTQ+ leaders and aspiring leaders (65 per cent); resources to support LGBTQ+ inclusion (63 per cent); and regular news and updates (42 per cent).

Other areas of support mentioned focused on the need for support in tackling discrimination and securing senior support and buy-in for internal networks. 

Conclusion and next steps

The Health and Care LGBTQ+ Leaders Network would like to thank all members who took the time to share their thoughts, experiences and feedback. In the three years since we last surveyed members, we had expected to see greater progress in improvements around LGBTQ+ workforce experience in healthcare. 

It is unacceptable that staff continue to be discriminated against and that they do not consistently see their organisations taking meaningful action to address and prevent it. There is a clear need for organisation leaders, and central decision-makers, to take more affirmative action to remedy this disparity.   

As a network, we want to work collaboratively to help address these challenges, drive progress and ensure that all LGBTQ+ staff working across health and care can thrive. Watch this space for further details on our upcoming network priorities, resources and programmes of work.