7 October 2022 – NED webinar – NHS Confederation LGBTQ+ inclusion framework

This week’s session opened in conversation with Peter Molyneux, chair of the NHS Confederation’s LGBTQ+ Leaders Network, chair of Sussex NHS Foundation Trust and the London Mental Health Employment Partnership, and a non-executive director at the Richmond Fellowship and a Stonewall Ambassador.

Peter said: “The network was born out of a belief that equitable and inclusive organisations are more innovative and creative. We know that about 80% of millennials say that an employer’s approach to diversity, equality and inclusion is an important factor in deciding whether to apply to that employer or not. We also know that about 25% of people who were out at university go back into the closet when they enter the workforce, so there’s something of a gap between the aspiration and the reality – and also a bit of a gap in terms of how inclusive we all say we want to be in order to get that creativity and innovation and the reality that people are experiencing.

“We did a survey of our members late last year. They said they didn’t see themselves reflected in senior leadership levels in organisations across health and care. They felt there was a veneer of inclusive language but that underneath there was often very little real action and that many of the old prejudices still survive beneath the surface. And they felt there was very little understanding of the challenges facing LGBTQ+ staff and I think that particularly came through for those who are LGBTQ+ and who possess other identities as well – so if they were black or Asian or disabled. So there’s a real leadership challenge there.

“This year as part of Pride season we also interviewed ten leaders from across health and social care who identify as LGBTQ+. They were from really quite diverse backgrounds, but we wanted them to talk about their experience and I really commend those interviews to you if you have 20 minutes to spare – they’re really rich and interesting. What they were reflecting is that as leaders too often they had to hide parts of themselves in order to fit in, and that they spent a long time making decisions about how much to share, but also that there was a real challenge now about how to communicate that to leaders across your organisation and to what extent have their expectations changed in terms of the extent to which we’re expected to fit in. Many of the current leaders in health and care grew up in an environment where silencing was commonplace, so we need to learn, to be honest, curious and compassionate in terms of making sure we’re creating the right environment. There’s also a recognition as leaders that orgs can be blind to their cultures – we need to be willing to challenge the status quo and create psychologically safe environments in which potentially difficult conversations can take place.

“That’s why we created the Health & Care LGBTQ+ Inclusion Framework. It was born out of a roundtable in early 2020 when we brought healthcare leaders together to think through how we might learn some of the lessons from Covid and some of the impacts there had been on patients and staff who were LGBTQ+. From that we brought together 13 pilot sites across mainly the NHS but also some care organisations where the ask was ‘how do we address Covid recovery?’. What they came up with together was this inclusion framework, which is based on six pillars. I think it speaks to where we are as leaders within health and care and to what would be true for inclusion generally.

“They felt we need to have much more visible leadership and confident staff, that quite often we are made to feel invisible so it’s our task to make ourselves visible. We need to develop a much stronger knowledge base to understand more about who is in our organisation. We need to think about how heteronormative and cisnormative our cultures are and that this does need challenging. We need to take much more responsibility for collecting and reporting data. We need to listen to our service users and ask if we’re hearing from service users who are LGBTQ+ themselves. And we need to think when we’re redesigning care pathways are we bringing in partners to those pathways who can bring with them the lived experience of different communities?

“We didn’t want to recreate some of the harm reduction approaches that have been used elsewhere in inclusion and diversity. We wanted to focus much more on leadership accountability: how are we accountable as leaders, how do we hold ourselves to account? And start to think about the behaviours that would drive that. What we’re hoping is that organisations will adopt the framework, then there will be a need for a further iteration. I just want to credit Chris Truscott as the person who pulled all of that work together.

“We’ve already learned a lot about ourselves as leaders and what people are now asking of us. And also what we need to hold ourselves to account for in creating the psychologically safe environment in which potentially difficult conversations can take place.

“All of us will have strong opinions but this is about how we place those in a professional context and make sure that we’re seeing people in the context that their identity, their family, their community, and that we’re being compassionate and respectful.”

Also overheard:

“Absolutely agree that the EDI agenda is central to our delivery of high-quality services and developing an engaged workforce. All our executive directors have an explicit objective around EDI as one of their annual objectives.”

“I think the challenge to the board is the right one about psychological safe environment. The reality is that our data capture reflects a deficit and our staff's fear to identify themselves. I think the challenge to the boards is what support do we provide to our staff so that they feel safe in recognising their diversity?”

“My experience is that a number of people will respond (and feel safe to make disclosures about themselves our family) when, but only when, as a leader, I self-disclose (as a cis gay man – but often done obliquely, e.g. talking about my husband and our sons). That itself carries a psychological cost for me. Having said that, I also negotiate faith spaces as a hospice chaplain, and that feels much less safe than the NHS.”

“We're a high-performing and well recognised trust for EDI, with a positive culture and visible LGBTQ+ leaders. And yet our LGBTQ+ network is the smallest and least active. Our other networks are much more representative of our workforce. How can we, as leaders, increase the psychological safety?”

These meetings are by invitation and are open to all NHS non-executives directors, chairs and associate non-executive directors of NHS providers. Others may attend by special invitation.

If you have any comments, questions or suggestions about these webinars, please contact: events@good-governance.org.uk