The Pride Badge in NHS Scotland - a symbol of unity or division ?

In 2020, while the UK was engulfed with the Covid pandemic, the NHS in Scotland was stretched to breaking point and people were dying, often alone, a working group of NHS staff was established in early 2020. Their purpose ?  To develop a new badge for staff.  The 'Pride Badge'.

 

During 2020 and into 2021, as the pandemic raged, it seems work on developing and planning the ‘Pride Badge’ project was considered so important that NHS staff time could be diverted away from the NHS response to the pandemic.  The then Cabinet Secretary for Health, Humza Yousaf, formally approved development and promotion of the ‘Pride Badge’ project.  Fortunately for us this record of his approval was not deleted from his WhatsApp messages.

 

The ’Pride Badge’ was formally launched in June 2021.  The real purpose, the measurable impact, of the ‘Pride Badge’, was never made clear by Scottish government, and no SMART goals were set for it.  It was only later, in 2022, when government surveyed ‘Pride Badge’ wearers, that a sense of what was being reached for was revealed in a question:

Do you think the NHS Scotland Pride Badge initiative has helped to reduce instances of homophobia, biphobia, transphobia in the NHS Scotland?

Quite why the work on the project development during 2020-2021 did not include establishing a baseline of current levels of homophobia etc. in the NHS Scotland against which progress [or lack of progress] could be measured is never explained.  It is as if success or failure of the ‘Pride Badge’ project was not even entertained as a concept.

 

The Equality & Human Rights Commission [EHRC] has long made it clear that all activities of public bodies should be subject to an equality impact assessment [EQIA], stressing that any EQIA must be done before implementing projects and equally stressing that the EQIA cannot be retrospective.  In essence the EQIA approach helps public bodies to check that even if they think what they plan to do will be positive, that it is thoroughly checked against bringing in any adverse or negative impact on people with other protected characteristics.

 

Scottish government said the pressures of the pandemic meant they had no time to do an EQIA but that they “are currently looking into preparing an EQIA for that initiative retrospectively”.  Even though the EHRC guidance says that a retrospective EQIA is not permitted.  It is as if government thinks the ‘Pride Badge’ project is somehow exempt from all constraints, good practice or legal duties.

 

The 22 Scottish Health Boards who all opted-in to the ‘Pride Badge’ project all confirmed they too had not conducted an EQIA of what they rolled out in their workplaces and services.  Some of them believed government had  carried one out.  Most of them offered the excuse for not doing an EQIA that it was a ‘national initiative’.  The reality is that each Health Board is legally responsible for what happens in their workforce and their services, no matter who sets policy or strategy at national level.  By not doing an EQIA, all Scotland’s Health Boards failed their workforce and failed their service users.

 

When asked if anyone had evaluated what the Health Boards had rolled out in their workplaces and services, again not one of the 22 Health Boards had done this, claiming again that government had evaluated the ‘Pride Badge’ project.  In 2022 government carried out a survey of 1,489 self-selecting ‘Pride Badge’ wearing employees [out of a workforce of 171,726].  No health service users from across the spectrum of sexual orientations were involved and asked for their experiences during the project. No ‘gender critical’ employees were asked for their views and no employees who were not badge wearers were asked for their experiences and perceptions during the project. In other words the survey did not gather views which reflected a 360 degree examination of the project, instead looking through the eyes only of those who shared the beliefs inherent in the ‘Pride Badge’ project.

 

Given the very poor design and delivery of the ‘Pride Badge’ project to date, it comes as no surprise that when asked ‘Do you think the NHS Scotland Pride Badge initiative has helped to reduce instances of homophobia/biphobia/transphobia in the NHS Scotland?’, the 1,489 employees said:

 

Yes – 18%; No – 25%; Unsure – 57%

 

It is as if the ‘Pride Badge’ project was set up, developed and delivered with failure as the primary outcome. 

 

In yet another illustration of the omnishambles that passes for project development, planning, delivery and evaluation in NHS Scotland, all Health Boards and government were asked what mitigations had been built into the project to take account of the views and beliefs of people who hold ‘gender critical’ beliefs, that sex is immutable and not to be conflated with gender identity ?  Every Health Board and government advised that no mitigations had been built in and that they were not necessary.  And yet, at the time [June 2021] the ‘Pride Badge’ project was being launched the Employment Appeal Tribunal [EAT] Forstater case was decided, where the EAT considered her belief that sex is immutable and not to be conflated with gender identity.  Yet there is no evidence that Scottish government in the detailed design of the ‘Pride Badge’ project, or in the project guidance issued to Boards, took account of the case or the judgment.  Likewise there is no evidence offered by NHS Boards that the ‘Pride Badge’ project, as rolled out in their Board, took account of the judgment. 

 

It is highly unlikely that Scottish government and NHS Scotland senior staff, including Equality managers, were unaware of the Forstater case [which evolved between 2018-21] as they developed the ‘Pride Badge’ project.  The only reasonable conclusion is that the implications of Forstater for the design of the ‘Pride Badge’ project and its impact on people who hold ‘gender critical’  views were deliberately ignored or overlooked.  Inevitably, the flawed ‘Pride Badge’ project can be seen as an emblem not of unity but of division in and across the NHS workforce.

 

The 'Pride Badge' continues to run in NHS Scotland, with no end-date to the project.  Government has advised that there is no formal end date planned for the project but that monitoring of its impact concluded with the evaluation survey.  In other words a project which government's own ‘evaluation’ found was ineffective continues to run across the NHS in Scotland and no further monitoring for its effectiveness [or failure and even adverse impact] will take place.

 

If the ‘Pride Badge’ project is typical of how the NHS in Scotland goes about designing, planning and delivering projects generally, then it can no real surprise as to why the NHS is seriously underperforming and why no extra funding appears to generate the urgently required improvements.

 

The full research report into the 'Pride Badge' project can be read here.