The problem with ‘allyship’ schemes at NHS hospitals - The case of the royal free

[IwantToRetire]

A new research note published by Policy Exchange exposes serious issues with ‘allyship schemes’ which have become commonplace across the NHS – with materials promoting gender ideology on display in multiple prominent locations at the Royal Free Hospital – a major NHS teaching hospital in London.
https://policyexchange.org.uk/publication/the-problem-with-allyship-schemes-at-nhs-hospitals/

Key Issues
• Materials seen by Policy Exchange – which have been on public display at The Royal Free hospital in London in recent months – including a pop-up banner and posters, act as a case study revealing a variety of issues associated with the activities of staff networks and ‘allyship’ schemes – often influenced by external organisations – which have become commonplace across the NHS in recent years.
• A publicly-accessible noticeboard in the hospital has a document entitled ‘7 Ways to be a good Trans Friend’ (Fig. 4) which tells staff that basic questions such as asking a patient “what is your name?” are inappropriate, posing challenges for staff to conduct routine tasks with patients, such as bringing up their patient records. It also contravenes General Medical Council guidance.
• A banner, seen in a photograph (Fig. 1) which has stood at the entrance of The Royal Free, makes the troubling suggestion that certain members of staff may be ‘safe’ ‘for LGBTQ+ patients to speak to’ on the basis of whether they wear an ‘LGBTQ+ Ally’ badge, setting a damaging precedent in creating a divide between staff who could be deemed ‘safe’/unsafe in providing care for LGBTQ+ patients.
• The wording of the banner is also suggestive of a hierarchy of protected characteristics. Other individuals with protected characteristics may feel that they too should be seen by staff ‘badged’ as culturally sensitive and ‘safe’ for ‘who they are and how they feel’ as a result.
• The lower half of the banner shows staff have made an anti-racist pledge under the ‘See ME First’ scheme which was established at a neighbouring London trust. Yet pledges – that staff should provide quality care regardless of a patient’s background and that fellow staff should be treated with respect – are already enshrined in both equality law and the NHS Constitution for England.
• Both the ‘LGBTQ+ Ally’ and ‘See ME First’ schemes have operated on the basis of staff either making a ‘pledge’ to obtain a badge or lanyard or participating in ‘Allyship Training’ via the staff intranet. No additional qualifications or ongoing assessment are required.
• Another notice (Fig 5) cites a 2018 survey conducted by Stonewall which claims that “1 in 5 LGBT+ people are not out to any healthcare professionals regarding the [sic] sexual orientation when seeking medical attention”. It is not clear why – in almost all cases – it would be appropriate to disclose sexual orientation to a medical professional when seeking ‘general medical care’ unless it was your express personal choice to do so or if it was of clinical relevance.
• Previous Policy Exchange reports have highlighted similar activity throughout the public sector, emerging through staff networks within the police force, and relating to same-sex provision within the NHS
https://policyexchange.org.uk/wp-content/uploads/The-Problem-with-Allyship-Schemes-at-NHS-Hospitals.pdf

How is asking someone their name rude, intrusive and insensitive?

It says you wouldn't ask such a question to a cis (their word, not mine) person... errmm, yes I would.

outside of my obgyn, I don't think I've ever been asked my sexual orientation in a doctor's appointment - and then it was obliquely. Why is it relevant to my mammogram or my blood pressure whether I am having sex with a man or a woman?

The name thing is weird. How can you record appointments if you don't know someone's name? It's not like people turn up with photo ID so you know the patient's name.? is it problematic that people's names are called when it's their turn? How does the receptionist know which appointment you've turned up for if names shouldn't be used?

Surely there's a typo in there somewhere and they mean something else? I notice there is a word missing later on so I'm really hoping it's that and not that they are really saying don't ask someone's name. That would just be bonkers

Poster
First paragraph heading - use their chosen name and pronouns at all times.

Paragraph opposite - inappropriate questions - What is your name?

How exactly does that work - telepathy?

i think it is likely copied from an American site as I’m not convinced that ‘bathrooms’ are a common feature in most hospitals.

Have just seen this and it seems the hospital is implying it isn't an official notice(?)

If that is the case then Policy Exchange should have thought to find out if it was official or not.

Although if not official it does indicate that members of staff (or outsiders) are able to use hospital notice boards to promote unofficial policies is an underhand way.

https://www.thisislocallondon.co.uk/news/23755370.royal-free-hospital-defends-trans-policy-amid-woke-poster-claim/

I had just viewed this - the ‘it’s transphobic to ask someone’s name’ and the demand to rename a cervical cancer clinic/pap smear appointment to ‘colposcopy appointment’ is just delusional nonsense.

https://m.youtube.com/watch?v=cR7yisduTkk

How the holy fuck can patients be treated without correctly identifying the patient? We have 3 point ID - name address & dob as standard ! Tbf we generally call out the patients name & they come forward then we check dob & address in the room.

Funnily enough I had a patient this evening who told me they were transgender and told us to call them a different first name than the one we were using! Patient wasn’t insulted or upset! This ideology is just loooking for problems!

There has long been debate re: lesbians possibly being at increased risk of certain types of cancer but it’s still pretty inconclusive (more data required), worth paying attention though, and asking about it at breast screening services, just in case it is a thing:

https://epgn.com/2020/10/07/lesbians-and-bisexual-women-at-higher-risk-for-breast-cancer/?amp

https://cancer-network.org/cancer-information/lesbians-and-cancer/lesbians-and-breast-cancer-risk/

shoving the T on makes accurate data collection nigh on impossible (because obvs transbians don’t have female bodies/female organs and transmen take exogenous testosterone which changes their risk profile so both TW and TM need to considered as a category and not just chucked in with lesbians and bisexual women)

As Dennis Kavanagh is wont to say ‘LGBTQ-WTF-LOL’.

Surely hospital staff are supposed to ask all patients/service users their names? Isn’t that just standard/polite conversation (and also a health and safety necessity to ensure the right person is getting the right meds/correct diagnostic tests/being discharged, whatever?)

When you're an inpatient, they constantly ask your name. They have to before any intervention because they might give the antibiotics, blood transfusion whatever to the wrong person if they don't.

How do these idiots imagine this will play out?

"Sorry, we amputated your left leg by mistake because we didn't like to ask your name in case you got upset".

JFC.

I work in the nhs. For 20 years I have asked ever adult I meet “what should I call you?” (Cuts the Robbie’s from the roberts and allows someone to prefer Mr Smith to first names). How else am I supposed to find out?

Also completely standard to ask someone’s name (often in a slightly jokey way “are you still chrissie?”) As you check their inpatient bracelet with their name on it as you CANNOT administer meds unless you have checked they are the right patient.

so perfectly normal to ask all “cis” and otherwise patients their names.

so presumably you march up to someone, assume they are who you are looking for and amuptate their leg, because you didn't ask their name and you lopped off John Smith's perfectly good leg and Dave Jones is dying of sepsis? that kind of inappropriate questioning?

FFS this is getting ridiculous isn’t it. No one is suggesting we change the name of prostate checks!

The hospital doesn't imply that it's not official.

The quote in the media story is (my bolding)

"But the Royal Free Hospital says the guidance was incorrectly worded and that there is no policy that says staff should not ask a patient’s name.

The hospital says the poster should actually have told staff not to ask trans people what their “real” name is.

It claims that it cannot be verified who created the poster but that that [sic] the wording appears to have been taken from a Health Education England document."

The hospital evidently knows what the poster should say, then.

And when it says "it cannot be verified who created the poster", I would hazard a guess that it simply can't get any member of its EDI, LGBTQ+ or other internal pressure groups or external consultants / advisors to fess up.

Not to mention trying to throw the blame on Health Education England.

OMG. That ally training. THREE HOURS. What on earth can they be talking about for all that time? That's more time than we get for our annual resuscitation training. Even an anaesthetics workshop on conscious sedation was only 2 1/2 hours.
It's just mad.

Also whilst not asking the patient's name I'm pretty sure you aren't meant to ask about their trans status either.

And yet this hospital that failed the rainbow badge assessment was marked down because staff don't routinely ask people their trans status or sexuality. 🤷‍♀️ If anyone asks me if I'm trans I shall feel no shame in telling them to fuck right off.

Funnily enough even my routine greeting "Hello, I'm Fanny, can I just check you are (whatever name is in the notes) and what do you like to be called?" was met with an eye roll and a sharp "My name obviously" by one older lady. I doubt asking her her trans status/sexuality would have gone well.

Have any of these schemes done any good? Are the looking into huger maternal / baby death rates in black mothers? Older people being having DNRs on file without their knowledge? women not having diagnosis for heart attacks because they have different symptoms/are thought to be hysterical, women getting no painkillers for intimate procedures… what? What are these people doing 9-5???

I understand why the term "real name" will annoy patients but there are other patients who change name (adoption, marriage, deed poll...) so I assume that the term "real name" wouldn't be used anyway.
Or are they referring to the point when paperwork is changed to the new name and while the GP may have the new name, the hospital may not because of slow IT systems. That's not the fault of the person who accidentally dead names the patient because they can't possibly know what hasn't been updated digitally

I was at the Royal Free recently taking DH to an appointment and I noticed the "allyship" display at the main entrance. It's very prominent.

I was at the Moorfields eye hospital recently and there is an old portrait in the lobby (looks like 1920s maybe?) of some noteworthy doctor or other.

His portrait is bedecked with progress flags and ribbons. I thought - poor guy, he may not have been gay, or particularly wanted to have a flipping ribbon parade focussed on his sexuality and not his actual achievements.

Indeed. Yet in a recent NHS meeting (not Royal Free) we were told we would have to complete this question as part of the new Datix/ LFPSE incident reporting tool. Appreciate there are times when this info may be useful as mentioned by a PP but I fail to see how it's relevant in this tool. Incidentally 'Self identified Ethnicity' was also a new question ????

Think there has been a mix up somewhere from the design team in the rush to adopt terms or exclude language - woman - without just and proper consideration.

How is it that so many of these institutions go along with this without seeming to ask why this massive push for publicly declared "allyship" and special treatment just for "LGBTQ+" - and specifically trans - people, and not any other minority or oppressed groups? It's so bonkers.

People get upset and annoyed all the time by things that happen in the NHS. Some reasonably, some less so. All kinds of assumptions can be made by busy staff who might then have to be put right. If you're a Ms you'll get called Mrs. You might have to explain you have a disability or special requirement many times as people forget. And if you're a worried mum of an ill child you will almost certainly be treated like a clueless overprotective moron by someone. So what? It's going to happen, we can talk about it and deal with it without the world ending.

Setting one group up as super-special snowflakes who must not at any cost ever be even slightly put out is mad and comes at the expense of others, which is not inclusive or kind to them. I just don't get how people doing this can't see how crazy it is.

If you might get offended by being asked your name, IN HOSPITAL ffs, that is what my teen DD would call a you problem. I mean really.

I assume you’d have bigger things to worry about, being in a hospital and all…

The datix system is nationwide isn't it @NothankyouNigel ? So will we all need to enter our patient's gender/sexuality when filling in a datix to report a fall of an elderly patient with dementia? I did one just a couple of weeks ago and didn't notice a question around lgbtquia/sex/gender/sexuality.
Poor person concerned is in a very bad way and definitely wouldn't be able to answer any questions about anything at all and I wouldn't want to presume so I would not be able to fill in that box.

My first baby nearly died at the Royal Free because their maternity services were falling apart.

But what has really left me with lasting trauma is that I was never asked to tell a single member of staff about my sex life.