LGBT+ History Month: Pride in practice

For many people in the lesbian, gay, bisexual, trans, queer, intersex and asexual (LGBTQIA+) community, pride is an important concept.  It is at the heart of the modern LGBTQIA+ rights movement. It dates back to the Stonewall riots in New York, which paved the way for the first Pride marches in 1970. 

Among other things, Pride is the promotion of equality, visibility, dignity, self-affirmation and respect. Physiotherapy is no exception to this, where pride is an important value for many LGBTQIA+ members in practice. 

In a special panel for the UK’s LGBT+ History Month, members of the CSP’s LGBTQIA+ Network discuss why pride is so important to their everyday professional lives – not just in February or during June’s Pride month. 

For these members, it’s vital that they can be completely themselves at work to ensure the best possible care for their patients. Having a diverse and inclusive workforce is better for members, patients and the profession. 

Working alongside the BAME and DisAbility networks, the CSP’s LGBTQIA+ Network is crucial to ensuring that all members feel represented – and listened to – within the profession. In recent years, the CSP has taken greater steps to promote the importance of diversity within the workforce, including running its Call Out Microaggressions campaign.

Meet the panel

Harriet Mottershead (she/they): ‘I am currently working as a rotational band 5 in a respiratory setting, and I also do a bit of private work on the side.’ Harriet is also the communications officer for the CSP’s LGBTQIA+ Network. 

Sarah Smith (she/her): ‘I’m a senior lecturer and programme lead for physiotherapy at University College Birmingham. I did 17-plus years in the NHS until I went into education.’

Sarah Griffiths (she/her): ‘I currently work at Bupa as a Physioline team manager, for a MSK digital triage service, and I also do some private work as well. I’m based in Huddersfield.’

Jon West (he/him): ‘I work in outpatient physio, and I’m based at Colchester, which is part of the East Suffolk and North Essex NHS Trust.’

What does Pride mean to you when it comes to your everyday professional lives?

Sarah S: For me, it’s about just being visible. I’m lucky because I work in the university and it’s a young person’s place, generally speaking. Within Birmingham there are lots of universities so every year at Pride we do a float with all the universities from the city. I think it’s just about being visible and creating a sense of inclusion for my students, which is something that I didn’t have when I was 18. 

Sarah G: I definitely echo what Sarah said there about being visible. I think pride in a professional sense allows me to bring my whole self to work, and allowing myself to belong hopefully creates vulnerability - and sharing stories for others to allow them to feel like they belong. 

Jon: For me, pride is advocating for myself and for any of my patients who are LGBTQIA+, and just making sure it’s a safe space for them where they feel like they can open up and be themselves without fear that we’re going to discriminate against them. 

Harriet: Working in Northern Ireland, I see a lot of prejudiced views and opinions from people who are quite religious – whether that be people in the workplace or patients. So, for me, being part of the community, and being able to advocate for my community, it’s really important to try and help change that stigma.

Why is expressing pride within practice an important form of activism for some LGBTQIA+ people? What are the ways in which you may choose to do this?

Sarah S: We tend to do some quite small but significant things. Those of us who are LGBTQIA+ and allies, we all wear little Pride badges with the inclusive flag that’s got the trans and rainbow flags on it. We get given them and we can also get little badges that have got your pronouns on. We ask students how they want to be referred to in their student information, and what their pronouns are as well. 

Harriet: I work with the CSPs LGBTQIA+ Network and that’s something that I’ve brought into my practice working in the NHS. It’s really helped because I’ve actually delivered a few presentations to teams I’ve worked in about the inclusivity of the network and the CSP. It’s okay to present as who you are, and it’s okay for patients to be who they are. I’m especially an advocate for using correct pronouns and inclusive language, being someone who identifies as a form of non-binary myself.

Jon: In practice it’s something that it’s impossible not to do. If I’m just sharing my life and living my true self at work, then it’s impossible not to mention things like being part of a gay and inclusive rugby team. It’s just making sure that I’m in a safe space to do that. 

Sarah G: I echo what everybody else says in demonstrating vulnerability by sharing my own personal story. I have a wife, I have an adopted child, and we’re going through IVF. Sharing those vulnerabilities and stories opens up conversations to not just our community but to other communities and everybody. 

Why is pride important to you in the workplace? 

Jon: It’s really important to have that space where I feel like I’m not being treated differently because I’m gay. It’s being able to talk about every aspect of my life with my colleagues without feeling like there’s things that I need to hide or anything that is awkward. It’s that ability really to show that I’m gay and I’m a physio – they’re not the only two things about me, but they are important aspects of my life. And just being able to express yourself fully and equally and giving other people the chance to do the same.

Sarah S: As Jon was saying, I think we’ve all probably in our lives been in an experience where we’re not out, and it could have been years ago, or it could have been recently. You just feel you’re constantly checking what you’re saying without accidentally outing yourself because you’re not sure of the reaction that you’re going to get. Whereas, actually, if you are out from the get-go, then you just feel more comfortable in your own skin.

Harriet: Even for me, I’m quite newly graduated and have been working for just over a year, just being able to be proud of the fact that like I’ve worked through my degree, I’ve got my degree, I’ve done what other physios have done – and it doesn’t matter that I am gay. So just being able to be at work, be comfortable and be able to talk about the fact that [for example], ‘Oh, yeah, I want to go out to a gay club at the weekend’. You don’t want to feel like someone’s going to have a strange opinion of you or not put you forward for something in the future. Advocating for being proud in yourself is how I bring it out in the workplace. 

Sarah G: For me pride is so important just to create a sort of psychological safety for myself, for employees, and for patients. Suppressing your identity and who you are is absolutely exhausting. Now that I’m openly out at work I’ve realised that 10 to fifteen years ago how much energy and anxiety that provoked. I didn’t even realise it was affecting me.

Why does limiting the freedom of LGBTQIA+ professionals to feel able to be and express themselves in the workplace have a negative impact on both the profession and patients?

Sarah G: For me, it provoked a lot of anxiety – I had fear about a potential lack of opportunity when I first went into the NHS. I was so scared to tell anybody that I was gay and in a same-sex relationship that I thought it would actually reduce the opportunity for me to become a band 6 physiotherapist. I couldn’t openly express who I was with patients. There was a lack of psychological safety and actually feeling physically safe. 

When you can feel yourself, you are more creative, you are more productive, you feel part of a team. It’s been proven that diverse and inclusive teams have better productivity and outcomes in any business. Sarah Griffiths

Harriet: I’ve had a few patients recently who have been trans and a few people who have been non-binary, and it is so difficult for them. They don’t want to be treated by people that aren’t going to use inclusive language. They shouldn’t feel scared when they’re in hospital because they’re feeling like they’re being judged for what way they present or what way they have decided to live their lives.

Jon: If we do limit what we can say, then we can’t truly be honest and open with our patients. I think that people will probably pick up on that, because part of our profession is talking to patients about different aspects and areas of their life, not just their physical condition they’re presenting with. So, if we’re kind of closing off bits of our lives, then maybe we’re not going to get the best from our interactions with the patients.

If we do limit what we can say, then we can’t truly be honest and open with our patients. Jon West

Sarah S: When I worked in the NHS, a lot of the systems weren’t set up for trans people. I’ve even seen it written in notes, for example ‘this person’s first name is Denise’ and then they’ll write in the notes, ‘This man has got this wrong with them’. It’ll just be that kind of language that you see in the medical notes. But also things like [at some NHS hospitals], they have a system, everything’s electronic, and when they clock a patient in they have to choose a gender. So, say Denise was a male to female trans person – but once you’ve chosen the gender, you can’t select certain blood tests. [Sarah gives an example of not being able to select a prostate test for a transgender woman who was recorded as female on the electronic system.] 

It’s ingrained in the infrastructure of the NHS. It’s only small things but they must be able to change them to make it more inclusive. 

In recent years, the LGBTQIA+ community has been increasingly scrutinised by both the political and media worlds...How have any anti-LGBTQIA+ narratives or measures impacted the ‘freedom band’ of the CSP’s LGBTQIA+ members and patients? That is, the freedom to express yourselves.

Harriet: It’s concerning the amount of doctors and consultants that agree with the [view] that trans people should be kept separate from other people, which I completely disagree with. 

I have found that being someone who does advocate for people of the community, I’ve had better treatment outcomes from a lot of patients because they are actively engaged in rehab and physio a lot more. They feel like they’re able to have a chat and do their physio without being judged. Harriet Mottershead

Jon: Some of my colleagues have made comments about trans patients, and I think a lot of them are quite scared when they get a trans or non-binary patient. They kind of feel like, ‘Well, you know, this person is so different. 

I don’t know what to do with them.’ I just say: ‘They’re still a normal person.’ I think you just need to break down those barriers, and also try and reduce the jokes that they make as well.

Sarah S: All too often, it’s that terrible banter word that comes into it. I work with a lecturer who also works a lot in football and she’s heard a lot of general homophobia and transphobia in that sport, which is labelled as banter. She finds that really difficult, as it’s hard to rein it in because people think it’s funny ‘banter’, and it’s just not.

Sarah G: I think it’s intent versus impact: what your intent was versus the impact - and being able to call that out as well. 

How can the CSP best support its LGBTQIA+ members to ensure that they can have pride in practice? And have you noticed an impact from any of its campaigns, such as its Call Out Microaggressions campaign?

Sarah G: I used [the microaggressions campaign] to help educate the wider team at Bupa and other colleagues. I think it’s really important to share the knowledge and what we do have because I do feel grateful that the CSP is starting to step into that space and promote it. Over the last year or so, it’s been brilliant. It’s actually given me the empowerment when people don’t understand what a microaggression is, or to call other people out.

Jon: I think just knowing they have our back if we do come across anybody, maybe in the physio profession, who’s openly making comments on social media that are anti-LGBTQIA+ and seemingly getting away with it. And potentially them [the CSP] getting involved if there is a person who is continually making comments that go beyond ignorance. It’s just knowing that we’re being supported by our profession.

Sarah S: The Health and Care Professions Council (HCPC), who we have to be registered with, they’ve updated their standards of proficiency recently. One of them is about equality, diversity and inclusion, and I’ve noticed it’s quite big when you look at the HCPC website. I think the CSP is hopefully picking up on that and driving that forward as well.

I think it’s just about being visible and creating a sense of inclusion for my students, which is something that I didn’t have when I was 18. Sarah Smith

Harriet: Myself, my network and the committee members have actually worked on creating different kinds of social media posting. We’ve started doing educational posts for people who maybe don’t have the time to read a big leaflet educating themselves on everything. So for the CSP to support that, and boost the awareness of the networks, would be really helpful. And also opening up more communication between the networks and the CSP. [It’s] being able to support the network and listen to the network.

What is the value of having a diverse and inclusive workforce? And what insights and experiences do LGBTQIA+ members bring to both the profession and patients? 

Harriet: Working in the NHS, I have found that being someone who does advocate for people of the community, I’ve had better treatment outcomes from a lot of patients because they are actively engaged in rehab and physio a lot more. They feel like they’re able to have a chat and do their physio without being judged. So being able to have better treatment outcomes just purely based on the fact of respecting someone. 

Sarah G: When you can feel yourself, you are more creative, you are more productive, you feel part of a team. It’s been proven that diverse and inclusive teams have better productivity and outcomes in any business. Those businesses or companies do better – they reflect the whole of society.

Sarah S: In education, historically, certainly when I trained, physiotherapy was very white, female and middle class. Where I work in University College Birmingham, our big agenda is opening up physiotherapy to those that wouldn’t historically have either gone to university or studied physio. So I think it helps to bring another aspect of diversity into it. We’ve got a really high, non-white student body in Birmingham – it’s a very diverse city anyway – so I just think it helps to bring more diversity into the profession. I’ve seen our students come through and they’re graduating now, they’re getting jobs. You have that responsibility: this is the workforce of the future. I don’t want them going out into practice thinking that discriminating against anyone is acceptable. 

Jon: The fact that we are part of a minority community does make it easier to empathise with other patients from minority backgrounds, or anyone who’s been through times in their life where they’ve felt discriminated against or even left out for various reasons. So I think it does make us more empathetic as a profession, having that diversity from different backgrounds. 

Answers from this panel have been condensed and edited for clarity and length.