LGBT+ History Month: In conversation with Dr Michael Farquhar

Dr Michael Farquhar profile picture

28 February 2024

Dr Michael Farquhar
Consultant Paediatric Sleep Medicine
Guy's and St Thomas' NHS Foundation Trust

What motivated you to create the NHS Rainbow Badge Scheme? 

We know that LGBTQ+ people have worse outcomes in general when it comes to health, and many can feel nervous or scared being open about their sexuality or gender identity with healthcare staff, which can delay the care they need. The Pride flag has served as a beacon for generations of LGBTQ+ people, emphasising places where they can feel confident and safe to be open about who they are. The badge was intended to bring that into a healthcare environment.

It's difficult to describe to a non-LGBTQ+ person the sense of relief when you get the signal that this is an okay place – you can relax and be yourself. I wanted us to send that signal more strongly. I'm also a paediatrician who had the experience of growing up in the closet, so I know how important visibility can be for LGBTQ+ young people especially, who are often just starting to think through their sexuality or gender identity. Being able to find someone they can talk to about these issues can make a huge difference. 

What were the key enablers in creating the scheme?  

At the beginning, Twitter, the power of social media and word of mouth! I had 100 badges made and gave them to people who I thought would be supportive. It created a lot of buzz – it was great to see people immediately "got" it, and that something so simple could have such a big impact. The biggest enabler was simply the power of stories: people wearing the badges shared details of their encounters with patients and colleagues that they otherwise wouldn't have had.

As interest grew, and it was clear there was a lot of potential in the project, I had support from the executive team at Evelina London Children's Hospital, with funding from our fabulous Evelina London Children's Charity, to develop the project. I did this with the remarkable Jess Law, Evelina's senior comms manager, without whom the project as we know it would not exist. We then got support from more senior people within the NHS, including Dr Michael Brady, NHS England's LGBT+ Advisor, who was instrumental in shepherding the project onwards. The project has always been about more than just the badge itself, and I hope we've lived up to that. 

What progress do you think has been made since the scheme started?  

I think the badges helped create better awareness of the challenges and difficulties that LGBTQ+ people still face when accessing healthcare. For people who aren't LGBTQ+, there has been a perception that "things are much better than they were, so everything's OK". While lots of things have improved for LGBTQ+ people in the UK in my lifetime, there are still stark disparities for LGBTQ+ people when it comes to health that are even worse for some people within our community, particularly trans and gender-diverse people. I think that was – and still is – a surprise to many.

Phase two of the project, under the leadership of Dr Brady and his team, saw it become part of a process where individual trusts can assess the care they deliver for LGBTQ+ patients and staff and suggest improvements. I think this made a real difference. Even in the best performing trusts, there's still lots to improve. The project helped give structure and guidance to trusts looking to do better and it's therefore disappointing that funding for this aspect of the project has been discontinued [this month]. On a smaller scale, again, it comes down to stories – of the patients who have come to their doctor or nurse; the colleague who feels able to put a photo of her wife on her desk for the first time; the people who felt just that little bit more confident revealing their whole selves. 

What are the key challenges or obstacles that still need to be addressed to further enhance LGBTQ+ visibility and inclusivity in the NHS?   

I grew up in the 80s, my school years very much affected by the long shadow created by the passing of Section 28 by the then government, which made it illegal for schools to talk positively about gay people, and reinforced toxic attitudes and false beliefs towards LGBTQ+ people. We have been fortunate to see some things change hugely for the better – the repeal of Section 28, same sex partnerships, equal marriage, apologies for historic wrongs committed by the state against LGBTQ+ people – but we're now starting to see things fall backwards again. Promises made for further change – such as a ban on conversion therapy – continually fall by the wayside.

The current rhetoric feels increasingly hostile and scary, and it's not uncommon now to see projects like the Rainbow NHS Badge described as "woke nonsense" or "a waste of money". The NHS doesn't exist in isolation, and the biggest challenge to enhancing LGBTQ+ visibility and inclusivity is the increasingly toxic and hostile environment in which our organisation sits. Government needs to continue to address this and pursue further changes that recognise the right of LGBTQ+ people to exist as they are, and protect those rights in law, such as with a meaningful ban on conversion therapy.

What improvements are needed in terms of LGBTQ+ representation and support within the NHS?  

Trans and gender-diverse people, and in particular young trans and gender-diverse people, have been put in a position where their very existence is a political football, a talking point in the so-called culture wars. Senior politicians suggest policies that are popular with certain groups, but which continue to marginalise and harm. The NHS has a responsibility to put the needs of the patients it is here to serve before politics, and I think we need much clearer policies and services for trans and gender-diverse people in particular. The re-development of the gender identity development service (GIDS) for trans and gender-diverse young people is something we absolutely have to get right. These young people have been let down by under-funded and under-resourced services for too long, with astronomical waiting times to get the assessment, help and support they need. We must do better. 

What other initiatives or strategies do you believe could help promote sustained and meaningful progress in LGBTQ+ visibility and inclusivity across various levels of the NHS?  

Creating a culture where every NHS staff member feels able to bring their whole selves to work is really important. The indomitable Dr Ronx has a motto: "You cannot be what you do not see" and I think they are absolutely right. For every group who has historically not seen themselves represented, seeing examples of people like them succeeding – while being open about who they are – makes a huge difference. On a more practical level, we need to be better about gathering data about LGBTQ+ people accessing healthcare so NHS services can be better tailored to meet their needs – but we also have to create the environment where they feel comfortable sharing that information in the first place. Simple things like being able to readily change names and pronouns on NHS IT systems so letters are addressed correctly can sometimes take a surprising amount of effort. It should be much easier. 

Do you think equality, diversity and inclusion (EDI) lead roles in the NHS are important?   

Absolutely. Institutionalised prejudices relating to race, sex, sexuality, gender identity and more remain a major problem within British society as a whole. The NHS is not immune to that. Those embedded view and beliefs, often relatively unrecognised, harm both individuals and the service. Everyone, whether patient or staff, has to feel they are seen and supported to ensure the delivery of high-quality care. Acknowledging that these imbalances exist, and actively putting in place strategies to counter them, allow the NHS to better reflect the population it serves and support talented individuals to achieve their potential. EDI leads highlight this and educate those who may find it hard to see there is a problem in the first place and putting solutions in place – but the key is they have to have the power to effect meaningful change.  

About the author

Dr Michael Farquhar profile picture

Dr Michael Farquhar
Consultant Paediatric Sleep Medicine

Dr Michael Farquhar is a consultant in sleep medicine at Evelina London Children’s Hospital. He trained in general paediatrics, respiratory paediatrics and sleep medicine in Glasgow, Nottingham, Sydney and London, and took up his current post in 2012.

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