Sexual Orientation and Gender Identity Equality Report 2024

This paper provides data relating to representation and experiences of LSCft colleagues who identify as lesbian, gay and bisexual. The report also includes national data on transgender NHS staff.

Report provided for:

• Assurance
• Information

Report to: Trust Board

Date of meeting: 03.10.2024

Presented by: Rob Cragg

Prepared by: Joanna Harrison, Diversity and Inclusion Manager

Link to Quadruple Aim	All quadruple aims
Aligned to Board Assurance Framework Risk	PR9 - Failure to provide employment opportunities proportionate to the diverse communities we serve, caused by poor staff experience impacting on the continuity of care delivery.
Executive summary	This paper provides data relating to representation and experiences of LSCft colleagues who identify as disabled. It is mandated by NHS England and used to measure progress, benchmark against national data and create actions to drive change.
Recommendation/required action	The Board is asked to read this report for approval and take into account any escalations.

Contents

• Introduction and background
  • Scope
  • Definitions
  • Key findings
• Table of indicators
• Metric 1 – Percentage of staff who identify as LGBO 
• Metric 2 – Relative likelihood of LGBO candidates being appointed from shortlisting
• Metric 3 – Relative likelihood of LGBO candidates being in a formal disciplinary process
• Metric 4a - Percentage of staff experiencing harassment, bullying or abuse from patients, relatives or the public in last 12 months
• Metric 4b – Percentage of staff experiencing harassment, bullying or abuse from managers in last 12 months
• Metric 4c – Percentage of staff experiencing harassment, bullying or abuse from colleagues in last 12 months
• Metric 5 - Percentage of staff who believe that organisation provides equal opportunities for career progression / promotion
• Metric 6 – Percentage of staff who have experienced discrimination at work from the public
• Metric 7 – Percentage of staff who have experienced discrimination at work from colleagues
• Metric 8a - Percentage of staff experiencing unwanted sexual behaviour at work from the public 
• Metric 8b – Percentage of staff experiencing unwanted sexual behaviour at work from colleagues
• Metric 9 – Board and Executive Team who identify as LGBT
• Conclusion 
• Recommendations

Introduction and background

This is the second year Lancashire and South Cumbria NHS Foundation Trust (LSCft) has reported on the representation and experience of lesbian, gay, bisexual staff and other sexual identities (LGBO) staff. The report also incorporates national data for trans staff. Whilst not having a national mandate to report on this data the Trust recognises the importance of reliable data to inform, monitor and measure progress.

Following the approach of the NHS Workforce Disability Equality Standard and Workforce Race Equality Standard, nine metrics have been identified focussing on representation, recruitment, disciplinary, staff experience and Board representation. An additional metric this year added to report on unwanted sexual behaviour in the workplace.

Currently Electronic Staff Records (ESR) does not have the ability to record gender other than male and female, or if a person’s gender is the same they were assigned at birth, meaning it is not possible to measure other gender identities or if someone has transitioned gender. Staff who have transitioned gender are able to self-identify when completing the NHS staff survey and although the number of responses is below the reporting threshold at LSCft responses data contribute to the national data set which is included in this report.

Last year’s Sexual Orientation & Gender Identity Equality Report was socialised within the organisation and it initiated conversations to better understand disparities in the data with the LGBTQ+ staff network, the Recruitment team and HR. Importantly key findings were included in LSCft’s inaugural Inclusion & Belonging Report and an objective was included in relation to developing the monitoring of sexual orientation as a standard. 

LSCft’s aspiration is to create a sense of belonging and inclusion for our all staff and this report reflects the importance the Trust places on recognising sexual and gender minority staff. The Trust is proud to include this data as part of a wider suite of data that will measure, report and deliver on actions to improve the experience of minority staff.

Scope

The parameters for sexual orientation metrics in this report have been developed by the Trust in collaboration with the LGBTQ+ staff network and follow examples of good practice from organisations already collecting this data.

The data included in this report was obtained on 31 March 2024 from the following sources:

• ESR
• Human Resource team records
• Organisational Development records

The 2023 NHS Staff Survey is used for metrics relating to staff experience.

The data included in this report relating the experiences of trans and non-binary staff has been obtained from ‘Exploring LGBTQ+ staff experience in the NHS’, LGBTQ+ Leaders Network and NHS Confederation.

Definitions

The definitions below are taken from LSCft’s Supporting Trans and Non-Binary Service User Policy.

LGBTQ+: The acronym for lesbian, gay, bi, trans, and queer (or questioning). The ‘+’ includes anyone who doesn’t specifically identify with any of those terms to ensure that all of the Trust’s diverse staff and service users feel included.

Cisgender: Cisgender is a term used to describe those whose experiences of their own gender matches the sex they were assigned at birth. It is the opposite of transgender.

Gender: often expressed in terms of masculinity and femininity, gender is largely culturally determined and is assumed from the sex assigned at birth.

Gender identity: how a person sees themselves/feels in terms of social constructions of what it means to be a man/woman and sometimes, their own feelings about what being a man/woman actually relates to.

Gender queer: An umbrella term for identities that are not solely male or female—identities that are outside the gender binary.

Non-binary: Not identifying with the man or woman approach to gender. A non-binary or gender queer person may say they are neither man nor woman, or have some other sense of gender – for example, pan-gender, poly-gender, third gender.

Trans (transgender): An umbrella term to describe people whose gender is not the same as, or does not sit comfortably with, the sex they were assigned at birth. Trans people may describe themselves using a variety of terms including: transgender; transsexual; gender-fluid; gender-queer; gender-variant; third gender; bi-gender, non-binary; trans woman or man; trans masculine or feminine.

Key Findings

• 0.4% increase in LGBO employees reporting on ESR (total 3.9%)
• 0.54 increase in likelihood of LGBO candidates being appointed from shortlisting (from 1.54 to 1.0)
• 0.86 increase likelihood of LGBO employees being in a formal disciplinary process (from 1.67 to 2.53)
• Improvements on metrics of LGBO staff experiencing harassment, bullying and abuse from public (9.3%) and colleagues (3.6%)
• 2.2% increase in LGBO staff experiencing harassment, bullying and abuse from their manager 
• 3.3% decrease in LGBO staff reporting that they have equal opportunities for career progression or promotion 
• 3% decrease in LGBO staff experiencing discrimination at work from the public 
• 2.1% decrease in LGBO staff experiencing discrimination at work from colleagues  
• 17% of LGBO staff experience unwanted sexual behaviour from the public compared to 10.3% of heterosexual staff 
• 3.2% of LGBO staff experience unwanted sexual behaviour from colleagues compared to 2.4% of heterosexual staff 
• 5.5% increase of LGBO employees on the Board  

For each metric there is a percentage of staff whose sexual orientation is unknown. This fluctuates significantly between each metric but is particularly high in the overall organisation representation (12.5%) and in disciplinary (14.8%)

Table of indicators 

Metric	Label		2022	2023	2024
1	Declaration rate	LGBO*		3.50%	3.90%
2	Recruitment	LGBO		1.54%	1%
3	Disciplinary	LGBO		1.67%	2.53%
4a	Public Harassment, bullying or abuse	LGBO	37.70%	42.30%	33%
		Heterosexual	27.40%	27%	24%
4b	Managers Harassment, bullying or abuse	LGBO	15.60%	9.50%	11.70%
		Heterosexual	7.30%	7.30%	8.00%
4c	Colleagues Harassment, bullying or abuse	LGBO	16.60%	14.10%	10.50%
		Heterosexual	13.20%	14.10%	7.00%
5	Career development	LGBO	54.10%	65.30%	62.00%
		Heterosexual	59.20%	59.90%	64.00%
6	Public Discrimination at work	LGBO	16.40%	12.40%	9.40%
		Heterosexual	5.60%	6.40%	6.70%
7	Colleagues Discrimination at work	LGBO	13.10%	8.20%	6.10%
		Heterosexual	5.90%	6.10%	6.10%
8a	Public Target of unwanted sexual behaviour	LGBO			17.00%
		Heterosexual			10.30%
8b	Colleagues Target of unwanted sexual behaviour	LGBO			3.20%
		Heterosexual			2.40%
9	Board membership	LGBO		13.30%	18.80%

*LGBO - lesbian, gay, bisexual, other

Metric 1 – Percentage of staff who identify as LGBO 

At LSCft 3.9 % of staff identify as LGBO an increase of 0.4% from 2023. 1.7% identify as bisexual, 2.0% as gay or lesbian and 0.2% as other sexual orientation not listed. This is higher than the UK 2021/22 census data which estimated 2.2% of the UK population aged 16 and over identified as LGB.

The 2023 NHS staff survey staff national and local sexual orientation and gender identity demographics are comparable:

	LSCft	National
Lesbian or gay	2.5%	2.6%
Bisexual	2.2%	2.3%
Transgender	0.5%	0.4%
Preferred not to say	4.9%	6%

The tables below have grouped the LGBO workforce data into pay band clusters and clinical and non-clinical. The clusters cover multiple pay bands as the numbers of LGBO staff are relatively low in some pay bands, meaning that a small shift in data can appear as a significant change, however they provide a useful barometer to see spread of LGBO staff. It is important to note that there is a much larger population of LGBO staff in clinical roles compared to non-clinical roles (234 compared to 51).

The data show a large representation of LGBO staff in clinical roles and a drop in clusters 3
and 4 in the non-clinical workforce.

 

 

Metric 2 – Relative likelihood of LGBO candidates being appointed from shortlisting

This metric saw a significant improvement from last year’s data which saw heterosexual candidates being 1.54 times more likely to be appointed to 1 which is parity for both groups. The numbers for this metric are have a large enough size to make this data relatively robust (249 LGBO candidates and 57 appointed).

Metric 3 – Relative likelihood of LGBO candidates being in a formal disciplinary process

This data has worsened since last year which found that LGBO staff were 1.67 times more likely to be in a disciplinary process compared to 2.53 this year. Numbers are relatively low for this metric meaning that the data is likely to significantly fluctuate (81 colleagues of whom 7 identified as LGB).

National LGBTQ+ NHS Staff experience

	Bullying and harassment at work	Discrimination from public (LSCft LGBO 9.45)	Unwanted sexual behaviour from colleagues (LSCft LGBO 3.25)	Unwanted sexual behaviour from public (LSCft LGBO 17%)
Gay and lesbian	32%	14%	7%	12%
Bisexual staff	34%	12%	9%	19%
Transgender	35%	18%	15%	15%
Heterosexual	23%	8%	3.4%	8%

LSCft LGBTQ+ staff experience

The data set out in the Table of Indicators and below highlights that LGBO staff at LSCft have a different experience than heterosexual staff, particularly relating to harassment, bullying and abuse, discrimination at work and unwanted sexual behaviour from the public.

In terms of bullying and harassment of minority staff the development and implementation of policy has been a focus for 23/24 alongside processes for early intervention. LSCft now have a clear Bullying and Harassment policy in place with clear expectations in regards to zero tolerance to all forms of discrimination. There is also an in-house mediation service with diversity amongst the trained mediators to support complex conversations.

LSCft continues to raise awareness and train staff on LGBTQ+ issues and history. Lancashire LGBT+ have been commissioned for a second year to deliver training (available to all staff) and the LGBTQ+ staff network delivered a varied programme of events for LGBTQ+ History Month. This year the Trust is represented at multiple Pride events across Lancashire & South Cumbria.

A survey was carried out in 2023 to assess staff engagement with the NHS Progress Badge that is widely used in LSCft. The subsequent report noted that the badge has been largely positively received, however a few respondents noted negative responses from the public or colleagues, highlighting the importance of education, awareness and Allyship.

Metric 4a - Percentage of staff experiencing harassment, bullying or abuse from patients, relatives or the public in last 12 months

33% of LGBO staff reported harassment, bullying or abuse from patients, relatives of public compared to 24% of heterosexual staff. This data has improved since last year (42.3%) and whilst the gap between the two groups are significant it has narrowed since last year (15.3% to 9%).

Metric 4b – Percentage of staff experiencing harassment, bullying or abuse from managers in last 12 months

11.7% of LGBO staff reported harassment, bullying or abuse from managers compared to 8% of heterosexual staff. This data has worsened since last year (9.5%) and the gap between the two groups has slightly widened.

Metric 4c – Percentage of staff experiencing harassment, bullying or abuse from colleagues in last 12 months

10.5% of LGBO staff reported harassment, bullying or abuse from colleagues compared to 7% of heterosexual staff. This data has improved since last year (14.1%) and the gap between the two groups has widened.

Metric 5 - Percentage of staff who believe that organisation provides equal opportunities for career progression / promotion

62% of LGBO staff believe that organisation provides equal opportunities for career progression / promotion compared to 64% of heterosexual staff. This has worsened slightly since last year (65.3%) and the gap has narrowed.

Metric 6 – Percentage of staff who have experienced discrimination at work from the public.

9.4% of LGBO staff have experienced discrimination at work from the public compared to 6.7% of heterosexual staff. This has improved since last year (12.4%) and the gap between the two groups has narrowed.

Metric 7 – Percentage of staff who have experienced discrimination at work from colleagues.

6.1% of LGBO and heterosexual staff have experienced discrimination at work from the colleagues. This has improved since last year and there is parity between both groups.
 

Metric 8a- Percentage of staff experiencing unwanted sexual behaviour at work from the public

17% of LGBO staff report experiencing unwanted sexual behaviour at work from the public compared to 10.3% of heterosexual staff.

Metric 8b – Percentage of staff experiencing unwanted sexual behaviour at work from colleagues

3.2% of LGBO staff report experiencing unwanted sexual behaviour at work from colleagues compared to 2.4% of heterosexual staff.
 

Metric 9 – Board and Executive Team who identify as LGBO

18.8% of the Board identify as LGBO which is an increase on last year’s data (13.3%).

Sexual orientation unknown

Some metrics report high numbers of staff who do not declare their sexual orientation which will be reported each year to note any trends.

Metric	Unknown	Total	Unknown %
Overall organisation	967	7759	12.5%
Recruitment	145	3113	4.7%
Disciplinary	12	81	14.8%
NHS Staff survey	-	-	4.9%
National UK census  2021	-	-	7.5%

Intersectionality

This year intersectional data was collected to better understand the representation of LGBO staff in the context of ethnicity, gender and organisational network. Over the coming year engagement will take place with the LGBTQ+ staff network to understand how to best use these data sets whilst being mindful of protecting sexually minoritised staff. 

Risks

The indicators that will form the priorities of 24/25 based on detriment, aligned to national plans are as follows:

High risk:

No	Description	Alignment
4a	Harassment, bullying and abuse from public	High Impact Action 6 NHS Long-term workforce plan- Retain
8a	Target of unwanted sexual behaviour from public	High Impact Action 6 NHS Long-term workforce plan - Retain