What is the indelible mark left by the NHS Rainbow Badge scheme?

The organisers of the NHS Rainbow Badge scheme have announced that it has come to an end due to lack of funding. But project lead Alex Matheson says that “the project has left an indelible mark” on NHS trusts. 

The scheme was created in a London hospital in 2018 and adopted by NHS England for national rollout. Dr Michael Brady, the national advisor for LGBT Health, NHS England and NHS Improvement, said that over 90% of NHS trusts in England were participating after phase one. NHS Scotland has a scheme called the NHS Scotland Pride Badge which is essentially the same thing and which is continuing.

Badges were just the start

The badges were given to NHS staff who pledged to “reduce inequalities and provide support and signposting to LGBT+ people”. This is a laudable aim. NHS services should be inclusive for everyone. But the problem with this scheme is that, in focusing on the demands of one group, it demanded changes that lead to confusion and which could be harmful to patients. 

Phase two of the scheme started in 2021, when Stonewall and the LGBT Consortium were appointed by NHS England to benchmark and award NHS organisations for their work on ”LGBT+ inclusion”. Behind the brightly coloured badges was a small army of staff providing briefings, filling in feedback forms and reporting back to the assessors. Clinical and administrative staff were expected to attend webinars to prove their allyship. 

NHS Trusts pay to implement “Stonewall law”

Under the scheme, Stonewall or the LGBT Consortium assessed the policies and procedures of participating NHS Trusts and gave them marks for compliance – not with the law, but with what Stonewall wanted.

Through freedom-of-information requests, the reports made by NHS Trusts to the assessors and the feedback they received have been obtained. These reveal how the scheme has caused chaos in the health service.

Trusts score well on the scheme by taking actions such as:

• removing the words “mother” and “woman” from maternity policies for staff
• changing the names of departments and medical procedures to avoid references to women or the word “female”
• replacing legally correct legal terms with concepts like “non-binary” that do not exist in UK law and listing the protected characteristics of the Equality Act incorrectly
• requiring staff to ask patients their preferred pronouns, and checking with patients that staff have done so
• adopting policies on transitioning at work in line with Stonewall recommendations.

There does not appear to be the same focus on replacing male biological and medical terms with “gender-neutral” terms. 

In feedback given to NHS Trusts, unnamed assessors from Stonewall or the LGBT Consortium tell them:

“We highly recommend replacing the term ‘gender reassignment’ with ‘trans status’, as this is a more inclusive of non-binary people as well as being more commonly used and less medicalised.”

“If making reference to the protected characteristics, we advise listing them as they are mentioned in the Equality Act 2010, as well as going above and beyond this to also include a commitment to supporting non-binary people.”

“Non-binary” has no status in UK law, and no relevance to healthcare needs. Nor does there appear to be any actual training on healthcare issues relating to LGBT+ people – perhaps because they are quite different, depending on whether you’re male or female, gay or transsexual.

Unclear language harms women’s health 

One NHS Trust was told: “Instead of saying ‘women’s health’, name the department according to its purpose, such as colposcopy [cervical examination]”. But how many people know what a colposcopy is? The charity Jo’s Trust has reported that half of women do not know what a cervix is. The NHS reports that women with learning difficulties and women from ethnic minorities are less likely to attend cervical screening. Among the factors in women not attending cervical screening are “cultural or language barriers” and “no female sample takers being available”. 

Erasing female-specific language in healthcare to accommodate the sensitivities of those females who do not want to be women, or those males who do, comes at a considerable cost to the many women who do not understand the new language.

NHS staff have concerns

It’s not just service users who find the language confusing. One NHS Trust reported in its Rainbow Badge audit that its maternity services is undertaking a comprehensive assessment of all patients, covering “cis-gendered, trans women and non-binary persons”. The audit report said: “When thinking about perinatal service provision the patient cohort would be trans men not trans women. A trans woman is someone who was assigned male at birth but identifies and lives as a woman.”

A staff member reported:

“I have experience of a patient changing genders on a daily basis – it would be completely impractical to move this person between a male  and female ward on an ongoing basis.”

Another said:

“Birth sex is an essential to provide healthcare to assess risk of pregnancy and other sex-based conditions. Pretending sex doesn’t exist doesn’t help anyone, including trans people. For example, the risk that a trans man is not assessed for pregnancy out of politeness.”

One-sided policies for transitioning staff

The assessment survey asks NHS trusts to submit their policies for allowing employees to change their “gender marker” on workplace systems. There is nothing in the assessments to suggest that NHS Trusts should consider the rights of other staff and of patients when they do this. 

A male doctor or nurse who changes his name and “gender marker” has not changed sex, and this remains relevant to other staff (such as in changing rooms and showers) and to patients being examined.

Staff are unhappy

It’s clear from staff comments that many find this scheme distracting and unhelpful. Some resent what they see as a disproportionate use of resources. Others feel it is divisive and irrelevant to focus on one aspect of some people’s identities. In fact, the scheme is sowing division among staff.

“What is discriminatory is to impose LGBT badges on religious staff (Jewish, Muslim, Christians etc.) whose religious beliefs directly contradict celebration of transhumanism and same sex relationships. This is direct discrimination on religious grounds.”

“I do not feel it is appropriate for a person’s sexual preference to be discussed and / or celebrated by the workplace? This should be a deeply personal matter and no one should have to feel uncomfortable.” 

“Spend money and resources on more pressing needs.”

“I think Stonewall are creating imaginary problems where there are none in order to keep their massive funding coming.”

“I don’t think it is necessary to provide any further training, it is entirely possible to deliver high quality care to our patients with no knowledge of their sexual orientation or gender identification. This is another example of virtue signalling by the NHS and our Trust and is contributing to dissatisfaction of our staff. This is evidenced by our poor staff survey results.” 

“Why would they need extra support? Being lgbt does not make them mentally ill or disabled, does it?”

“I’d like to see the hospital operate as a hospital and not a rainbow flag waving sex-obsessed nuthouse.”

“We should stop saying birthing people in maternity policies. We are educated people who can adjust our wording for the minority that are trans. I think it is devaluing women and mothers.”

Oncologist Professor Angus Dalgleish, quoted in the Daily Mail, said:

“The edict is Orwellian. Patients are even being handed questionnaires to check up on us, with questions such as: ‘Have you been asked by staff, or on a form, if you have a trans history, or if your gender is not the same as the gender you were given at birth?’” 

Staff comments like these are flagged as “problematic” by the Rainbow Badge assessors.

The cost to healthcare

We’re paying hundreds of thousands of pounds for this. Freedom-of-information requests have revealed that NHS England spent £220,000 on the Rainbow Badge scheme in 2021 to 2022, when there were 50 trusts taking part. Since then it’s been reported by the Daily Mail that 77 trusts are involved – and this does not include the NHS in Scotland, Wales or Northern Ireland. Then there are staff costs. The time spent by clinical and administrative staff in every participating NHS trust is unknown.

Announcing the extension of the scheme in a statement put out by Stonewall in 2021, Dr Michael Brady said: “I am delighted that we’re able to build on this success by investing in Phase 2 of the project, to support delivery of wider objectives to improve the care and reduce inequalities for LGBT patients, as well as improving experience for LGBT staff.” 

But there is no evidence from the audit reports of any focus on healthcare or outcomes. There is, however, evidence that this costly scheme has left a legacy of division and confusion for NHS staff and patients. And although the scheme has come to an end in England, the policies it supported have now been widely adopted across the NHS. 

The scheme encouraged NHS trusts to review their policies, communication and language to pay attention to one group, rather than all. This is not inclusion.