22 December 2022

Using Quality Improvement to make a difference for ELFT LGBTQ+ Community by Improving visibility and experience

by Fiona Lord (Improvement Advisor for Inequalities in Newham)


The importance of staff networks at ELFT cannot be underestimated as a safe place for staff to discuss real life experiences and to hold honest conversations. I’ve been a member of the LGBTQ+ network since 2009 and have seen things change significantly. Over this time, the network has grown from 5 to 237 members and a fully funded LGBTQ+ lead position.


Much of this has been down to the support we’ve had from the trust board and executive team. We’ve had two amazing senior sponsors in our previous and current Chief Medical Officers, Paul Gilluley and David Bridle. Personally, this support helps me feel more comfortable being in a place knowing I can feel safe to be myself. For the network these factors have generated commitment to its survival, helping people listen to us as a community and make us feel validated and supported.


It is hard to explain the inequalities we face as I think we are not as aware of it as it is so prevalent in heteronormative society, and as LGBTQ people we’ve got used to it[1]. We silence ourselves very often without knowing why or what the reason is. However, we do know that LGBTQ+ staff in the NHS face greater risk of physical violence from service users and abuse from staff colleagues [2]

Despite a growth in the LGBTQ+ community in the UK[3], getting a full picture of the experiences of the LGBTQ+ community is quite difficult as there is a real lack of data about the community. The office of national statistics keeps us invisible as data around LGBTQ+ community is not routinely collected[4]. As a result, it’s hard to define what is being done to tackle experience and increase visibility firsthand

[1] https://www.england.nhs.uk/about/equality/equality-hub/patient-equalities-programme/lgbt-health/

[2] https://www.nhsconfed.org/publications/health-and-care-lgbtq-inclusion-framework


[4] https://www.bmj.com/content/bmj/372/bmj.m4828.full.pdf



This led us to rethink our aim to focus more on the visibility of LGBTQ+ staff and service users. We also collected some great ideas about things we could do differently to tackle this and created a driver diagram.


My Reflections on leading this QI Project  

 One of my key reflections is that you learn as you go.  I initially came up with the idea for this project through a discussion in the corridor. I had no idea about what would be involved and thought it would be a breeze, so I rushed into it. However, I learnt that things are never really that linear and QI can help us provide some structure to think through an issue and not rush to the next stage.  The ELFT sequence of improvement is a helpful reference point for helping understand where you are with your work. We thought we were ready to start developing change ideas, but we hadn’t really identified the issue we were working on. 

The other essential ingredient is getting the right people in the room together. That’s where the magic happens. Think of it like an invitation to a party. Who do you invite? Who is closest to the problem to be solved? For instance, the aim statement we started with is different to our current one as a result of the input of a range of different people. You can’t get anywhere without getting divergent voices contemplating the problem.  

For us we also think this involves Service Users and we’ve extended our aim to also include them. Although we are a staff network, we are ultimately here to improve outcomes for those we serve. For service users who are LGBTQ we don’t have the data as Rio does not record it. Sexuality and gender experience is not captured, yet all other characteristics clearly are. Data is absent and not easily accessible as it isn’t collected. So, we are currently thinking about how can move from little I involvement, essentially consultation, to big I which is meaningful co-design as part of the QI project.  


What’s next for the work  

 The network is a safe space for people, but issues are complex and far reaching and there is still a lot of work to do. Next up we will be testing some change ideas! 

 Yes, we have taken a long time and yes, we have had to reset and are now in a place to move forward. I believe we will get there just not in the way I had originally envisaged. Please watch this space… My top tip? Keep going as you will get there in the end. 

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