Health Policy September 3, 2019
A badge of pride: How the NHS is championing LGBT issues

By Daniel Male - Accountable Care Journal

Fifty years on from the Stonewall uprising in New York and this year’s Pride celebrations were bigger and more popular than ever. This is unsurprising as LGBT+ awareness continues to grow with public sector organisations and private companies increasingly showing public their support for the campaign and taking part in addressing LGBT-related issues. The NHS is one of them.

Staff from Guy’s and St ThomasNHS Foundation Trust were some of the most notable participants in this year’s parade in London, leading a giant rainbow NHS balloon through the streets of the capital. So what is the NHS doing to address LGBT+ patient issues? We spoke to Dr Michael Farquhar, creator of the NHS Rainbow Badge, about how it is boosting patient outcomes.

Issues Facing the LGBT Community

According to the Stonewall Unhealthy Attitudes Survey (2015), almost a quarter of patient-facing staff in the NHS have heard a colleague make negative remarks about LGBT people. This, says Dr Farquhar, results in a reluctance amongst the LGBT+ community to engage with the health service. “One in seven say that they would not choose to access healthcare because they are worried about the reception they might receive in terms of discrimination,” says Dr Farquhar, referencing data published by Stonewall in 2018.


In his work as a paediatrician, Dr Farquhar is aware that children and young people can have questions relating to their sexuality or gender identity, which can often go unrecognised. Without the confidence to speak to an understanding and accepting person, they risk internalising those feelings. This can then present a further risk as the individuals may experience greater anxiety, and even depression, in later life.

“Almost a quarter of patient-facing staff in the NHS have heard a colleague make negative remarks about LGBT+ people” 

The broad risk within the NHS is that those who would benefit from receiving care are prevented from doing so because of concerns surrounding their sexuality or gender identity. The first step is gathering data on the extent of the issue, suggests Dr Farquhar. The required data spans social attitudes at the population level, to information about existing initiatives within trusts and NHS service providers. While data is beginning to emerge, there remains a lack of diverse datasets providing real-time metrics on the health impacts on the LGBT+ community.

Taking a lead on LGBT+

There are over 200 projects across the NHS focusing on inclusivity and support for LGBT+ patients and staff. While many of the trailblazing projects have spawned on the frontline, the Government has appointed Dr Michael Brady as NHS National LGBT+ Health Advisor to drive changes on a broader scale and support localised schemes.

The Rainbow Badge, one of the more recognisable projects, falls among these local schemes. Developed at the Evelina London Children’s Hospital, part of Guy’s and St Thomas’, where over a quarter of the 16,000 staff are now wearing the badge, it has become a popular symbol across the entire health service. There are now over 150,000 badges being worn by staff in trusts across the NHS, a number that continues to grow.

The concept is simple, explains Dr Farquhar: “If someone's wearing the badge, then you can be confident that person is actually going to understand if you've got questions or concerns relating to sexuality or gender identity. ” While it should be accepted that all NHS staff are decent, understanding individuals, this proactive approach seeks to signal to patients that the wearer is receptive and has received training and support in LGBT issues.

However, it is not just signalling that is important. The model that sits behind the badge is crucial to achieving cultural change within the NHS and ensuring the positive attitudes of staff. In order to make it as adaptable as possible, the NHS Rainbow Badge comes with a supporting toolkit, designed to “let anybody put this into practice”. The toolkit is available on request by senior staff or trusted Equality/Diversity/Inclusion officers.

The toolkit contains a multitude of resources, including guidelines for best practice, guidance on where badges can be printed and an adaptable framework for the implementation of the programme, which is designed to be tailored to the needs of individual trusts. At Guy’s and St Thomas’, staff are asked to read through a series of online resources before wearing the badge. In other trusts, staff must attend a one-hour training session or an online training module to ensure they are briefed on LGBT+ matters.

The project officially launched in London in October 2018 and was rolled out more widely from February 2019. The toolkit has now been sent to over 80 per cent of NHS trusts in England. At present, over half of all NHS Trusts in England have launched the badge project or are about to do so. In many instances, this sits alongside wider work including staff LGBT+ support groups and specialist events.

“We anticipated we would see some negative pushback to the project but overall, we’ve been hugely impressed by how positively they have been received” 

Across trusts where the scheme has been rolled out, it has not received any resistance at boardroom level. However, there has been some pushback from mid-level management where questions have been raised about why it is necessary to take extra steps when these attitudes should be in place “as standard”. “This is generally quite easily tackled because what these people don't understand is the data that lies behind the problem,” says Dr Farquhar. “I am more worried about the silent people that are potentially in the 25 per cent and who hold these views. These people present more of a challenge. ”


Wider impact

The NHS is a trailblazer in terms of LGBT+ action with many other sectors showing an interest in the Rainbow Badge scheme and the impact it is having. Given its perceived special status in Britain, the NHS is a powerful symbol and the example it sets cannot be understated. As a paediatrician first and foremost, Dr Farquhar finds much of his inspiration and drive in knowing the importance of sending a clear message to children and young people. “If we don't get this right for children and young people, the consequences will last their lifetimes,” he says.

Dr Farquhar is keen the workforce within the healthcare sector fosters an open approach, starting by taking ownership and recognising issues within the health service. The point that this is not just for LGBT+ NHS staff couldn’t be clearer. “We're not expecting the people wearing the badges to be experts in LGBT+ healthcare issues,” says Dr Farquhar, “all we’re asking is for staff to be receptive, open and non-judgemental. ” Patients can then be signposted on, if needed, to other resources both within and outside the NHS that can help provide support.

50 years on, what’s next?

Not only have LGBT+ issues become a focus at the trust level, action has also been seen within clinical commissioning groups (CCGs), the NHS Leadership Academy, NHS Improvement and within primary care providers. Professor Helen Stokes-Lampard, Chair of the Royal College of General Practitioners, has supported the project and there are discussions underway with the Pride in Practice team.

At Guy’s and St Thomas’, development and implementation of the Rainbow Badge project has been fully supported and funded by the GSTT Charity. While many other trusts have taken a similar approach, Dr Farquhar suspects that the cost to the NHS of increased healthcare problems experienced by LGBT+ people means that investing in strategies to improve care and access earlier would result in an overall cost saving. However, he confesses he’s no healthcare economics expert.

Moving forward, Dr Farquhar is looking at how to take the project to the next level, and to use the hugely enthusiastic and positive response that the badges have been met with to help support badge-wearers to be even better allies to LGBT+ people. He is keen to see central training resources developed to further support the project, and to integrate with work being done as part of the NHS England LGBT+ Action Plan.

While there is lots of interest from people who don’t directly work for the NHS to wear the badge in support, Dr Farquhar is keen that the badge’s core signal to LGBT+ people - “I work for the NHS and I’m here to listen to you and help you if you need it” - isn’t diluted. “Preserving the integrity of the model that underpins the project is really important to us, because we know that the badges can only ever be a small part of a bigger solution to the challenges we know LGBT+ people face when accessing NHS healthcare today. ”

Since the Stonewall riots 50 years ago, a lot has changed for gay, lesbian and bisexual people. However, there is still a long way to go to weed out bigotry and discrimination, foster more positive attitudes and deliver meaningful cultural change. In healthcare, the badge is just the beginning.

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