A recent study has shown that although measures are in place to prevent discrimination on the basis of sexuality, it is still being demonstrated throughout the NHS. Stuart Shepherd reports on why many are choosing to hide their sexual orientation from colleagues

Discrimination, victimisation and harassment of staff on the basis of sexual orientation are unlawful. They are also detrimental to patient care and to business. Which is why, surely, the NHS, employer to more than 150,000 lesbian, gay and bisexual staff and with a strong track record on employment and equality issues, will not and cannot afford to tolerate it.

The experiences of 21 lesbian, gay and bisexual people working in health and social care, however, as told in the Department of Health's Equality and Human Rights Group-commissioned report Being the Gay One, suggest discriminatory practices and homophobic bullying are being displayed towards staff at all levels, within a variety of professions and across a range of sectors and organisations.

In such an atmosphere, fear of disclosure of sexual orientation exerts undue stress on staff, limits performance and careers and in some cases drives people from the sector. Respondents to the survey, published in June, also share concerns that the quality of patient care is reduced where a pervasive homophobia exists in the workplace.

'We were shocked by some of the stories,' says Ruth Hunt, head of policy and research at Stonewall, the organisation completing the study into the nature and long-term implications of discrimination and the barriers to prevention.

'We expected some low-level stuff but some episodes - for instance when the consultant told [the respondent] she was glad she didn't know of her sexuality before supporting her application for promotion - portrayed a level of blatant discrimination we have not seen for a long time.'

Several other accounts of direct harassment on the basis of sexual orientation come to light in the pages of the report. One that stands out comes from Joan, who as a student nurse was forced to read passages from the bible because her workplace supervisor thought she was sick.

Further to these very personal experiences, the study also describes circumstances where it became apparent to staff that their place of work was homophobic.

Nancy, a podiatrist, remembers her manager failing to challenge a clerk describing a woman who lived with another woman as 'disgusting'. Homophobic comments overheard by pharmacist Sharon made her feel afraid to disclose her sexuality.

As the report notes, while not always on the receiving end themselves, 'the participants in this study all acknowledged that general discriminatory attitudes have an impact on their comfort and attitudes to work'.

'What we encounter in the health sector is a lack of understanding that sexual orientation is an equality strand with robust legislation for the purpose of protecting staff,' says Ruth.

She adds: 'This is not filtering down either at an employment level or, as the interviews show, to the employees.'

The study shows the lengths to which people go to hide their orientation and shows what, in the absence of management support or awareness, are the consequences of not doing so. David, a specialist registrar in oncology, describes the nervous energy he puts in to maintaining the deceit that he is heterosexual. 'One false move in the wrong direction can flaw your career for life,' he says.

A successful challenge to discrimination by a senior operating theatre sister also comes under the spotlight. In contrast to much of the study's content, it demonstrates just how effective anti-harassment and homophobia procedures can be when they work well. And the confidence to act that comes from knowing colleagues and employers are backing you up.

Identifying barriers

Participants identify a number of barriers to preventing discrimination and these are mirrored in many of the recommendations for action they make to the DoH. They include investigating training about sexual orientation, an unequivocal lead from the DoH on the condemnation of homophobia and discrimination, empowerment of lesbian, gay and bisexual employees through rights awareness, support for their staff network groups, raising the profile of lesbian, gay and bisexual staff in the workforce, supporting a Single Equality Act and identifying and promoting good practice.

Better Employment workstream chair Justin Varney is part of the DoH advisory group on sexual orientation and gender identity and an adviser for the commissioning of the study.

The stream was set up two years ago and this latest research was prompted by the findings of its first commissioned study Harassment and Sexual Orientation in the Health Service.

'[The study] illustrated some stark findings about human resource managers in the NHS who don't understand what homophobia is,' says Justin, 'and staff either being unaware of or having no trust in any of the systems designed to protect them from discrimination'.

There is a strong commitment in the highest levels of health to addressing discrimination, he suggests, including chief medical officers and board-level champion for sexual orientation Sir Liam Donaldson.

'This latest and shocking report makes clear that what needs to happen now is to get that message to both the front line and to managers,' says Justin.

'But there is a huge challenge with the performance management of equality and diversity, and what came from our meeting with NHS Employers was that there seems to be the need for a separate business case to be made for tackling homophobia and discrimination - or it will not be funded.'

He continues that, as with racism, this 'is about dignity, respect and an NHS that welcomes and empowers diversity'.

Discussions between the DoH's equality group and NHS Employers are looking at work on strengthening training and resources.

'Clearly the legislation has come in later than the other diversity strands,' says deputy director of NHS Employers Sian Thomas, 'so I suspect this is the one where we are a bit behind the curve.'

'We have to get better at describing the clear links between the diversity agenda and delivering on the bottom line, and promoting best practice,' she continues.

'Compliance is not enough. We need to explain how this, as it does in successful finance companies and organisations like the police, improves on quality, reputation and delivering services.'