The LGBTQ+ staff experience gap

The annual NHS Staff Survey is one of the biggest staff surveys in the world. The most recent results were released in March 2024 and provide a picture of staff experience for the 1.4 million people who work within the NHS in England.

Overall, it tells us that over the past year, staff experience has largely improved. But it is possible to interrogate the results further. For the third year in a row, we are able to look specifically at the experience of LGBTQ+ staff working across the NHS, and the results are fascinating.  

What does the data tell us?  

Of the NHS Staff Survey respondents, 2.6 per cent reported that they are lesbian or gay, 2.3 per cent bisexual, 0.4 per cent transgender, and 6 per cent preferred not to say. Their survey responses reveal that not only are LGBTQ+ staff still having a disproportionately poor experience working in the NHS, but that the experience gap between LGBTQ+ staff and their colleagues is getting worse, particularly for transgender staff.  

LGBTQ+ staff comprise a significant proportion of the NHS workforce – at least one in every twenty staff. 

The results show that in the past year, while the experience of gay, lesbian, bisexual and transgender staff improved in ten out of the twelve staff survey themes, the experience of their colleagues in the NHS improved substantially more. Perhaps surprisingly, 61 per cent of gay and lesbian staff were confident about all staff being treated fairly by their employer compared to 57 per cent of straight staff; the level of confidence went down to 46 per cent for transgender staff.  

This past year has been notable for high rates of sexual orientation and gender rhetoric in politics and the media, and a substantial national rise in hate crime against trans people. Against this backdrop, the NHS Staff Survey finds little improvement in bullying and harassment of its LGBTQ+ staff, and a drop in how many LGBTQ+ NHS staff would now recommend the NHS as a place to work.

Below are some of the key findings, which you can also access in our infographic:

• In 2022, 57 per cent of heterosexual staff said their employer took effective action on health and wellbeing. This rose to 59 per cent in 2023. Gay staff members’ experience improved too, but only from 54 to 55 per cent.  
• In 2022, 25 per cent of heterosexual staff reported bullying and harassment at work; this fell to 23 per cent in 2023. For gay staff the figures fell from 34 to 32 per cent. It’s still up at 35 per cent for transgender staff.  
• 8 per cent of heterosexual staff reported discrimination from patients, relatives and visitors, compared to 14 per cent of gay staff and 18 per cent of trans staff.  
• 3.4 per cent of heterosexual staff described unwanted sexual behaviour from other colleagues at work, compared to 7 per cent of gay and lesbian and 15 per cent of transgender staff. As for unwanted sexual behaviour from patients, relatives and visitors, this affected 8 per cent of heterosexual staff, 12 per cent of gay and lesbian staff and 15 per cent of transgender staff.
• Around one in five LGBTQ+ NHS Staff reported personally experiencing physical violence at work. This is significantly higher than for heterosexual staff. 

This data echoes discussions taking place within our Health and Care LGBTQ+ Leaders Network, where LGBTQ+ staff in the NHS have described their personal experiences of recognising what sometimes feels like a regression in inclusion and belonging for LGBTQ+ people at work.  

The experience gap between LGBTQ+ staff and their colleagues is getting worse, particularly for transgender staff.  

They described experiences from colleagues, patients and relatives of homophobia, biphobia and transphobia hitting particularly hard at work due to the increased prejudice and discrimination they have been experiencing in other parts of life, including barriers to accessing their own NHS healthcare.

Enabling LGBTQ+ NHS staff to feel safe and thrive as well as their peers  

For the NHS to function, it must achieve excellent recruitment and retention of staff, including ensuring staff wellbeing. The NHS is the most diverse employer in the country. LGBTQ+ staff comprise a significant proportion of the NHS workforce – at least one in every twenty staff. 

The most recent staff survey results find that the growing LGBTQ+ staff experience gap is a recruitment and retention risk for the NHS. At a time when the NHS is seeking to retain as many staff as possible, LGBTQ+ staff are more likely than their colleagues to be thinking of leaving and less likely to be willing to recommend the NHS as an employer.

The growing LGBTQ+ staff experience gap is a recruitment and retention risk for the NHS.

The data tells us that based on staff experience this year, only 58 per cent of gay staff and 56 per cent of trans staff would recommend the NHS as a place to work compared to 63 per cent of heterosexual staff. A fifth of gay, lesbian and bisexual staff (20 per cent) and a quarter of transgender staff (24 per cent) said they are thinking about leaving the NHS, compared to just 14 per cent of heterosexual staff and 15 per cent of cisgender staff. 

Quite apart from the ethical and policy concerns associated with certain staff groups having a worse experience at work, and the financial costs of bullying, discrimination and harassment, we cannot afford to lose skilled and dedicated staff from the NHS.

The NHS does not systematically record the sexual orientation or gender identity of those leaving. But the gap in the willingness of LGBTQ+ people to recommend the NHS as an employer and the rising rate of those thinking of leaving may be the canary in a coal mine. NHS leaders seeking to mitigate the risk and increase a sense of inclusion and belonging for the LGBTQ+ workforce may wish to make use of the resources developed by the Health and Care LGBTQ+ Leaders Network. 

If the NHS aspires to remain an employer of choice, fulfil its People Promise and achieve the ambitions of the Long Term Workforce Plan, this latest staff survey reveals that one area where improvement is essential is the experience of its LGBTQ+ staff.

Dr Layla McCay is director of policy at the NHS Confederation and executive lead of the Health and Care LGBTQ+ Leaders Network. 

Her new book Breaking the Rainbow Ceiling: How LGBTQ+ people can thrive and succeed at work (published by Bloomsbury Business) comes out on 23 May 2024.  

You can follow Layla on Twitter @LaylaMcCay.