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Do Unhealthy Attitudes Ever Change? (August 2015) During my first year of nurse training (twenty-five years ago) I ran into a wall of homophobia. I was told by some of my vocal colleagues that I only wanted to be a nurse to see naked men, that all gay men deserved AIDS, that I was a danger to children, and that God could heal me and make me “normal”. I endured it because it was 1990 and homophobia was what I expected as a gay man. It's now 2015 and our society has changed so much since my student nurse days. We are so much more open, we have so many legal protections now against homophobia; last year my partner and I got married. I thought we had come so far and then I was brought down to earth with a crash. This month, Stonewall (the LGTB campaigning organisation) published Unhealthy Attitudes (1), their report on the treatment of LGBT health and social care staff, and it was a shocking read. It felt as if I was right back there twenty-five years ago, like nothing had changed. The report, written following a YouGov survey of health and social care staff, found that one in four people had heard a colleague make negative or homophobic statements about LGBT people and one in five had heard negative statements about trans people. A quarter of them had been the victims of homophobic bullying from patients and service users. 10% had heard colleagues make claims that LGBT people can be “cured”. These statistics may sound cold and not greatly impressive but the report also carries the realities behind them, it is full of personal quotes. The nurse who was told by another nurse that he should be hung for being gay. The nurse whose manager told her that homophobic comments were “only banter”. The nurse who was ostracised by his whole staff team, at work and socially, when it came out he's gay. And many comments where trans people were called “it” or “she-male”. Then there were the comments that were themselves homophobic. A healthcare assistant (HCA) who said people are not born LGBT but “choose” this “lifestyle”. A doctor referring to anyone he doesn't consider “normal” as “deviants” whose needs shouldn't be “forced” on the majority. Yet this report has created little outrage or even comment from our nursing leaders or the wider community. If this report was highlighting racism or sexism surely there would have been an outcry about it, articles in our newspapers or items on the television news. Yet this report barely caused a ripple. Homophobia still seems to be the prejudice that we most easily accept, it's just “banter”, it's just someone's personal belief or personal views, and any challenge to it is seen as “political correctness gone too far”. But it's none of these; it’s prejudice and it can damage or even destroy people's lives. Why, as nurses, are we tolerating this? There have been several reports previously from Stonewall highlighting the poor treatment experienced by LGBT people from the NHS and how reluctant they are to be out to healthcare workers. The results of Unhealthy Attitudes only reinforce these earlier findings. How can we offer patients open and non-judgmental care when we can't offer non-judgmental support to our own colleagues? We have spoken a lot about “person-centred care”, but it seems that if the person is LBGT then a large part of their personality and needs are ignored, at best. LGBT people have their own healthcare needs, more than just using the gender-natural term “partner”, but the evidence is that they are still being ignored. How have we got to this point? Unhealthy Attitudes has a clear recommendation, staff training in LGBT issues. It found that three in four people haven’t received any training in the needs of LGBT people and only one in four have been provided with any equality and diversity training. Yet the NHS has a legal responsibility to eliminate discrimination. In the last three years my own equality and diversity training has consisted of one fifteen-minute, online presentation that covered the needs of disabled people, black and ethnic minorities people and LGBT people, but in no depth at all for any of them. How can we say we focus on person-centred care when LGBT staff’s safety is so bluntly ignored by the NHS? (This was originally published as a comment piece in Nursing Standard magazine) Drew Payne Find out more about this short blog series here

A Safe Place for All? (January 2015) Freddie Mercury died from AIDS in November 1991. I was a student nurse at the time. One of my colleagues told me that he “deserved it” because of his “lifestyle”. I exploded faced with her homophobia, but I was turned on by others who supported her, saying their views were right because they wanted to be parents and any parent would want to protect their sons from the likes of Freddie Mercury. And I was wrong, they said, because I was defending someone like Freddie Mercury. Their homophobia cut me deeply that day. Last year, my partner Martin and I got married. When I returned to work, my colleague Wendy wanted to see our wedding pictures. When I got them up online, the whole office gathered around to look at them. Nobody made any homophobic or prejudiced remarks; nobody said they didn't “agree” with same sex marriage, though I was asked a lot of questions about our guests. I have been out as a gay man throughout my entire career, at first I regularly came up against blunt homophobia from many colleagues, but as the years passed society has changed, homophobia is declining (I do work in London, one of the most metropolitan of all our cities). We now have openly gay MPs, police officers, soldiers and military personnel, and no longer is it “career suicide” when an actor comes out. This year, Nottinghamshire Healthcare NHS Trust was named to be the most lesbian and gay-friendly employer in Britain (1). Every year Stonewall, the LGBT campaigning organisation, name their Top 100 Employers and this year the top one was an NHS trust, the first time an NHS trust has achieved this. So life is rosy and we have achieved all we need to? No, far from it. I have also experienced the NHS from the other side of the nurses’ station. I have asthma and have been an NHS patient for years as an in-patient, out-patient and GP patient. I am an out gay man, but when I'm a patient I suddenly rush back into the closet, it's the only time I do, but I have good reason to. I always fear that if a clinician finds out I'm gay they will give me prejudiced treatment because it has happened in the past. I have had clinicians try to force me to have a HIV test, wear two pairs of gloves when treating me, and make comments suggesting that it is my fault I am ill because I’m gay. As a patient I am so vulnerable, I rely on good relationships with the people treating me. The fear of homophobia hangs over this, if they know I'm gay will their homophobia come out and suddenly the quality of care I receive fall? I can't take that risk. There have been a lot of high-profile cases where people have gone to court for the “right” to discriminate against lesbians and gay men. Registrars not wanting to marry same-sex couples, counsellors not wanting to see same-sex couples, therapists wanting to “cure” gay people. How do I know the clinician treating me doesn’t have these views too? In the past I have met enough nurses who have had these attitudes. This is not paranoia but an all too real fear for many. Stonewall found a third of gay men and a half of lesbians have received negative experiences from healthcare professionals because of their sexuality and a third of gay men and half of lesbians aren't out to their GPs (2). These statistics are nothing to be proud of. The picture for lesbian and gay staff is equally as patchy. Nottinghamshire Healthcare NHS Trust might be the most lesbian and gay-friendly employer in Britain but there were only eight other NHS organisations in the Stonewall Top 100 Employers. We have come a long way, but we still have a long way to go. We can’t sit back and say the job is done. Yes, we have marriage equality and gay characters on our soap operas, but the NHS still isn’t a safe place for all people, and how can we rest until it is? (This was originally published as a comment piece in Nursing Standard magazine) Drew Payne Find out more about this short blog series here

Marching with Pride (July 2008) On Saturday (5th July 2008) it was London LGBT Pride and, with bright sunny weather, my partner and I had a wonderful day there. The highlight, as always, was the Pride March. People were laughing and smiling, enjoying walking through central London together and openly. The march was headed by groups representing many of our uniformed and emergency services. First came lesbian, gay and bisexual members of the navy, army and RAF, all in their uniforms. Next followed the police and British transport police, again in uniform. Members of the fire service, complete with a bright red fire engine, followed them. Finally came members of the ambulance service and St John’s Ambulance service. It was a very impressive sight and the crowds cheered and clapped as they passed. But I was left with one thought, where are the nurses? True, there was an NHS float, much later in the march, but it was a general float. It didn’t have the impact of a group of nurses or healthcare professionals marching with the others at the head of the march. But why do nurses need to march at Pride? Still so many lesbians and gay men have little trust in healthcare. A recently published survey, from Stonewall, on lesbians’ experiences of healthcare, found that half of the women taking part had had negative experiences of healthcare in the last year (1). An earlier study found that 50% of gay men were too uncomfortable to come out to their GPs (2). We have a long way to go, but nurses marching at Pride will help along that path. Previously the police had a very poor relationship with the lesbian and gay community, there was no love lost on either side. Now, while still far from perfect, there has been a great improvement in police attitudes and an increased trust in the police in recent years. This has been achieved through a lot of different activities but not least of these has been the presence of police officers marching at Pride (not just “policing” it). The presence of those police officers has given confidence in the police. Nurses marching at pride could give so many lesbians and gay men far more confidence in healthcare and nursing as a profession. Nurses may not be able to march in uniform, with the duty of care that a nurse’s uniform carries, but the presence of nurses marching at Pride, even not in uniform, will go towards building up lesbians’ and gay men’s confidence in healthcare. Who will march though? Well, people like me. (This was originally published as a comment piece in Nursing Standard magazine) Drew Payne Find out more about this short blog series here

The next six blogs form a short series, which I have called “With Pride” because they were all originally comments pieces, on LGBT rights and healthcare, published in the Nursing Standard magazine, and I am proud of having written them. For nearly fifteen years, on and off, I have written comment pieces for Nursing Standard and a lot of them were on LGBT healthcare. These pieces chart changes in attitudes, but they also had recurring themes and one was responding to a very disturbing piece of research, reading which just left me frustrated and angry, I felt nothing had changed. The first and last pieces here almost become companion pieces though they were written eleven years apart. The first one asks a question and the last answers it. I am posting here the original versions, with their original titles and all the links to their source material; they were edited for publication but mostly this involved reducing their word count. The last one was written in 2019, we had every intension of following that one up the next year, but history had other ideas. There were no London Pride marches in 2020 and 2021 due to the COVID pandemic. This year was the first one since then and fate has intervened again for me. I want to say “happy reading”, but some of these pieces are on uncomfortable subjects. I am very grateful to the Nursing Standard for giving me the opportunity to write these pieces and to be able to shout above the crowd. Find out more about London Pride here. Drew Links to the other With Pride blogs: With Pride July 2008 With Pride January 2015 With Pride August 2015 With Pride January 2017 With Pride July 2019