With Pride, August 2015

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

The 6.5% Problem

Last week the Royal College of Nursing (RCN) members voted to accept the government’s pay offer of 6.5%, phased in over three years (1). The vast majority of NHS unions have voted to accept this pay rise (2). The only one to have voted to reject it was the GMB union (3). In the RCN ballot, 77% of members who took part voted for the pay deal, though the ballot only had an 18.5% turnout (1) – anyone who has organised an online or postal survey knows this is a pretty high response rate.

I have blogged previously why I feel this is a bad deal, read the blog here, but basically it’s a bad deal because:

• This 6.5% pay rise will be phased in over three years, 3.0 this year, 1.7% next year and 1.6% in 2020 (4a). This will mean that only one of these pay rises will be above inflation, this year’s one, and only by 0.5% (4b). A pay rise below inflation is a pay cut in real terms.  
•  There will be a “re-structuring” of the Agenda for Change pay points (the yearly pay increments staff receive for professional development). These will be reduced, the pay bands will be reduced to three points for Bands 5 to 9, with only two pay points for Bands 2 to 4, and they will not be awarded yearly (4a). So staff will not be rewarded for yearly professional development.
• This pay rise will do little to recruit nurses into the 40,000 empty nursing posts in the NHS (4c). 
• Last year, for the first time, we saw more nurses leaving the NMC register of nurses then joined it (4d). You cannot work as a Registered Nurse unless you are registered with the NMC. 
• Since 2010, when the Conservatives returned to power and NHS pay restraint started, nurses’ pay has fallen by over 14% in real terms (4e), this pay rise will do nothing to correct this.
•  Since the scrapping of student nurse bursaries, UCAS has seen a 14% fall in people applying for nurse training (4f). People training as nurses now will be saddled with £35,000 to £40,000 of student load debt before they have worked their first shift as a Registered Nurse (4g). How will this pay deal help them pay that debt off?
  
• The NHS is haemorrhaging nurses, many are leaving because of the stressful working conditions, shortage of staff and the fall in pay, in real terms. How will this “jam tomorrow” pay offer change this?

GMB general secretary Tim Roache denounced this pay deal, saying, “After a nearly a decade of pay-pinching the prospect of a further three years of cuts to wages is unacceptable.” (5) I agree with him but it seems I am in the minority in nurses.

If this deal is so bad then why did so many nurses vote for it?

Eights years of no pay rises or less than inflation pay rises have worn down many nurses to the point were people will take any deal for the chance of a pay rise. The government’s chronically poor management of the NHS has left so many nurses so demoralised that they readily excepted this poor pay deal. I cannot blame nurses for doing this, nurses’ moral is at rock bottom and stress is at record levels, but I do blame this government for running down the NHS with eight years of under resourcing it and then pushing this bad pay deal upon us.

We should have been forewarned that this pay deal was going to be bad. Jeremy Hunt has previously been talking about wanting to “change” our yearly increments, pay points, calling for a “more professional pay structure” in the NHS (6). But this just shows how little he understands the NHS. The increments were brought in to reward professionalism and professional development, but Hunt has not seemed to very interested in professional development of NHS staff. He has been very silent as nurses lose continuing professional development (CPD) time (7). A third of nurses (34%) told the NMC during the revalidation process in 2016 that they achieved ten or fewer hours of CPD training each year (7). But is that Hunt’s definition of “professional”? Or does he mean a pay structure that is cheaper and forces staff to work harder for any pay rises, as if we aren’t working hard enough.

Well Hunt has got his wish, our increments structure has been butchered. What next will he want us to accept?

As for me, I voted against accepting the pay deal. In my blog about it, I had said I’d be voting to accept it for the chance of a pay rise and because I feared that the government wouldn’t offer us a better deal and would try forcing this deal on us. But in the end I just couldn’t accept such a bad deal, a deal that gives so little and takes away so much.

On the other hand.

Nurses on the island of Guernsey will get a 4.25% pay rise this year with the promise of further pay reform, pay increases, to come (8). I guess for nurses the way to get a decent pay rise is to work in a tax haven, now there’s a thought for post-Brexit Britain…

Drew Payne

Just More Number Crunching

We’ve had the Equality Act since 2010 (1) and for many LGBT people it has been a game changer. It requires that anyone providing a service for the general public, including healthcare providers, does not discriminate who they provide that service to, no more “We don’t serve your sort in here, this is a family establishment.” In October 2017, NHS England has only just waken up to the fact the Equality Act also applies to the NHS, and in response they have released their latest initiative.

They announced that they want all patients’ sexuality recorded, with their other demographic details (2). So at every face to face encounter with a patient with doctors and nurses and all healthcare professionals have to ask patients what their sexuality is, if it does not already state so on their demographies. Patients do have the opinion to decline to answer.

But this is NHS England’s only response to the Equality Act, to gather data on patients’ sexuality, nothing more. We’ve had several studies, in recent years, about the poor treatment LGBT patients have received from the NHS, there have also been studies into what an unfriendly working environment for LGBT staff the NHS is.

Back in 2007, Stonewall published their study Being the Gay One (3), on the homophobia faced by staff working in health and social care, it was more than an uncomfortable read. Since then they have published four different studies on the experience of LGBT patients in the NHS (4, 5, 6, 7) and all of them have highlighted the negative and homophobic experiences they have received, with many LGBT patients unwilling to be open about their sexuality for fear of homophobic treatment from healthcare professionals.

In 2015 Stonewall published Unhealthy Attitudes (8), their report into a survey of LGBT healthcare staff. The findings of this report showed so little had changed since 2007, and Stonewall’s first report (3). Unhealthy Attitudes found that 25% people surveyed had been the victims of homophobic abuse at work. Last year a BMA study found that 70% of LGBT doctors had experienced homophobia at work, and three quarters of them had never reported it out of fear of reprisals (9). Last year we had the unpleasant sight of NHS England itself going to the High Court to win the right not to fund the HIV preventative drug PrEP (10).

Yet we also have areas of good practice and there are resources out there for NHS Trusts that want to turn around this situation. In 2012 Stonewall published Sexual Orientation, A guide for the NHS (11), which is full of practical advice for combatting homophobia in healthcare. Back in 2009, the Department of Health produced Sexual Orientation: A practical guide for the NHS (12), which was designed to help reduce the healthcare inequalities faced by LGBT people.

We already have a lot of evidence about the homophobic treatment many LBGT people have received at the hands of the NHS, NHS Choices acknowledged the problem back in 2012 (13), there is also guidance on how to reverse this, and yet all NHS England can think to do to combat healthcare homophobia is to ask patients what their sexuality is. A third of gay and bisexual men are not open about their sexuality to their GPs (7) and half of Lesbians and bisexual women (5). Why isn’t NHS England launching a high profile initiative to tackle homophobia in the NHS and to make it a welcoming place to LGBT people? Why isn’t NHS England ensuring that the NHS complies with the Equality Act? Instead all they can do is collect data on LGBT people. So typical of NHS England, too little and much so late.

But why should nurses, be concerned about this? How can we say we are providing open and non-judgemental nursing care when so many LGBT people are afraid of being open about themselves in front of us?

(This was originally written for the Nursing Standard)

Drew Payne