‘Pride in the NHS’ Week: Part 2: Trans and Non-binary Allyship

About the event

I have no ideas what their doctorates are in, presumably not MDs.

Needless to say, difficult questions around the complex medical problems arising from cross sex hormone use were never fully discussed. GPs up and down the country are probably the main prescribers of these, after they have been forced into shared care agreements (the route is: get your first prescription privately and then the GP has to repeat).

Leslie Cove

Dr Leslie Cove starting by explaining that her pronouns were she/her and that the idea for this particular session on trans and nonbinary was her own. She works for NHS England and told us that her role there, as Head of Equality and Diversity, was ‘activism’. She even describes herself thus on her LinkedIn entry, much to my surprise.

Is this her real job title, I wonder.

She was excited by the T-shirt she was wearing because it had the correct colours on.

Cove first learned about being an trans ally herself about two and half years ago when she attended a one day workshop run by Dr Tara Hewitt, who she was now sharing a platform with. Prior to training she had never heard about transgender people or transgender rights. She had never ‘knowingly met’ a trans person. She had ‘never used’ pronouns. The session was the most uncomfortable and challenging she had ever done. She could not get her head around gender identity initially, explaining that it was an exciting journey we all need to go on. She is now a ‘trans rights advocate’ publicly.

Today Cove, armed with her new learning, now understands the barriers that trans colleagues face in the workplace, in hospitals, the stigma they experience. Moreover trans people in the NHS almost always occupied ‘the lower ranks’ in the NHS and it was hard to find anyone above a band 6 or 7 (bands above this are 8 a-d and 9 – the most senior management and logically account for the smallest number of posts).

Tara Hewitt

On one hand, Hewitt couldn’t be a less perfect pick for a LGBTQ+ themed event, being on record as anti-abortion, anti-surrogacy and against the use of sperm banks – see the Pink News article – Cove and team clearly don’t know how to Google.

On the other, Hewitt has posted one of his own talks to YouTube on the subject of cancer and trans people, which is much more up their street. At around the 5 minute mark he tells his audience that men wearing women’s clothes for sexual kicks is perfectly fine. At 18 minutes he informs the NHS audience that some women use the word ‘cock’ to talk to about their clitoris, and some men use ‘clitoris’ to talk about their cocks.

Tara was on the Conservative Party candidate list in the last election and came under fire when a Sun report ‘revealed’ her sexual fetishes.

Hewitt reportedly described herself as an “advocate of the BDSM (bondage, discipline and sadomasochism) community”, and into “swinging” and “pet play”, which is dressing up as an animal for sex.

from the Liverpool Echo article on Tara Hewitt

The original Sun article which revealed Hewitt’s sexual predilections no longer exists, however what does exist is a considerable number of tweets either replying to, or tagging in Tara Hewitt on the topic of BDSM. Clearly he has had a bit of clear out, but not good enough – particularly notable is the response from lead trans activist Roz Kaveney.

How did Hewitt get into training and what has changed?

Hewitt is an equality specialist and has ‘lived experiences’ relevant to subject (i.e. he is a bisexual trans-identified male with purple hair). As such he was expected to step up to the plate, as it were, but at the same time said that he realised there was a ‘vacuum’. He describes his background as human resources and law and came out as ‘trans’ at Liverpool University aged 21. He says that he became the Vice President of the Student Union whilst there.

Predictably Hewitt reported that things had not gotten better and that he currently feels less safe now working in the NHS than he did at the start of his career. The only other trans person he knew when he started working in the NHS was Christine Burns, a trans activist who was advising on trans health issues to an NHS authority in the North West at the time.

The current trans network has now about 170 members, most of whom are in operational roles without the opportunity for senior promotion (thereby tacitly admitting progression is an NHS-wide problem).

Thus, despite the addition of ‘nice language’, a fully fledged trans network supported by senior management, endorsement of allyship and the slogan ‘trans rights are human rights’, Hewitt still feels very unsafe. He couldn’t give a list of positive changes!

Allyship needed to accelerate.

Who is your trans role model? What does a good ally look like?

Sadly Hewitt doesn’t have any trans role models to look up to right now in the NHS because there is no one in a more senior role. He knows other trans colleagues in management roles who feel the same.

A good example of allyship was the response of someone who worked at a hospital who organised signatories condemning a woman who had criticised trans activism within the NHS – reported in Pink News.

Hewitt assured the audience that there were a ‘wealth of leaders behind us, which want change to happen,’ they simply needed more help to take more action.

Cove was keen to point out that people should go back and look at strategic and business plans and make the links.

Hewitt wanted trans people to be actively involved NHS provision and in lead roles both clinical and management, and not just have roundtable discussions (hosted by the NHS Confederation).

Hewitt says that trans-identified junior doctors and nurses are giving up their training, because they don’t see their future in medicine, nor want to be seen the token ‘trans person’. Hewitt said this was the fault of trolls.

The trolls

Cove agreed that being trolled is a very emotional experience and friends and family had been worried about her safety when it had happened to her. Yes, agreed Hewitt, he had heard of a trans ally recently who was having to leave Scotland because of safety issues (mwah ha ha).

Previously a thread of information had been written about Hewitt on Mumsnet, when he was occupying a band 7 role in poorly performing hospital. Hewitt is disgusted that NHS England uses Mumsnet to recruit nurses.

Both he and his partner, Harriet Brown, who is also a trans-identified male (they describe their relationship as lesbian), are both very scared and want to leave the UK because of how unsafe they feel with regards to trolling online (presumably this won’t exist on the internet abroad).

Hewitt was perfectly prepared to do as many of these events as necessary in order to raise awareness about the bullies who exist online. Receiving ‘ice lollies’ and ‘fluffy cuddles’ from his partner at home was the coping mechanism (both of which sound like coded slang to me).

Cove was eager to explain that instead of crying and rocking herself to sleep, she had simply got in touch with the wider networks and overloaded the twitter feed with ‘why we need this’ – so she wasn’t really upset by the ‘trolling’ at all then, but energised. When you see trolling, Cove told us, allyship is about jumping on and responding.

How to deal with Freedom of Information requests

Organisations are trying to do the right things, maybe put in a policy for trans staff, but leaders don’t necessarily know what to do when they get those five hundred complaints into their organisation, those five FOI requests that are frivolous and really malicious. How do they respond? And we need to give that support to those leaders out there, so they feel able to say ‘actually, no, that FOI request is a frivolous FOI, it’s not in the spirit’.

Tara Hewitt, Group Head of Equality, Diversity & Inclusion at Northern Care Alliance NHS Group

Hewitt went onto say that he was aware of a standard email being used from the
NHS Business Services Authority (responsible for contractors) which effectively put a stop to such requests. In particular, Hewitt said it had put a stop to people asking about Stonewall’s involvement with the NHS and the email said that such a question was not in line with FOI guidance.

In fact, the NBSA’s own website accurately describes FOI as:

The Freedom of Information (FOI) Act gives you the right to access all the information we hold.

From the website page for FOI requests

Communication teams

How many of the 200 plus NHS communication accounts on Twitter knew that if they got ‘trolled’ that they simply shouldn’t engage and simply post a statement instead about your inclusion policy as a way of shutting conversation down, said Hewitt. This would also stop any news stories forming about a twitter storm.

The infrastructure was not there yet to support this kind of activist response, and it was often left to Hewitt to advise (presumably communication) directors on how to respond. (One rather suspects that the communication is really in the reverse direction.)

I’ll do what I can to help, but I’m not paid to do that.

Tara Hewitt, Group Head of Equality, Diversity & Inclusion at Northern Care Alliance NHS Group

Confidence building

Hewitt say if he goes into a hospital for a broken finger he knows he will be seen by the most experienced doctor present. This was because there was a general lack of confidence (more likely fear) at how to deal with transgender patients (it might also be because cross sex hormone users have a unique set of problems, including bone density loss).

In terms of patients being treated by, or near, transgender people, Hewitt believes this is a straightforward issue of discrimination and should not be tolerated. Pennine Care had led the way in this respect in their recent statement.

Everyone makes mistakes

Again Cove was keen to emphasise the difficult nature of brainwashing yourself that biological sex isn’t real, as the journey is for ‘the rest of life’ and found it difficult to use the wrong pronouns for obviously sexed people. However, now Cove has surpassed herself as she once attended a conference and managed to misgender herself and introduced herself as ‘he/them’.

Cove invited Hewitt to give an example of learning from mistake. He responded that people assume that he has the answer to all possible queries about trans people. In particular athletics had come up recently as an issue, but there was no point in asking him about that because he likes to eat cake (yeah, so does Laurel Hubbard).

Hewitt had managed to remain calm whilst being interviewed by Nick Ferrari on the LBC about trans prisoners. (Hewitt help set up TELI – the Trans Equality Legal Initiative just look at the attendance list of the launch, includes Sue Green of Mermaids, Jane Fae, and several barristers from Garden Court Chambers.)

Hewitt once did make a mistake. He was training some nurses and he shared the video
Know who I am and he accidentally described a genderqueer’s experience of maternity care as a woman’s experience of maternity care. The room apparently went dead when he made this faux pas (an idea so ridiculous that I’m fully laughing as I write this).

Don’t make a big deal when you make a mistake! Just move on! But don’t you dare repeatedly misgender someone!

How do you think about allyship when you’re being an ally?

Was the next inane question. Hewitt said that you can only be an equality champion if you champion everyone and everyone will benefit. He said that the NHS wasn’t doing enough about Islamphobia and he was currently building relationships on this basis. The main organiser from NHS England posted in the chat that we can simply ‘grow the pie’ of rights.

Hewitt admitted to making mistakes in the past and that it was important to learn from them, and covertly referred to the furore about his previously stated views. Also his current pinned tweet from 2014 is about mistakes, so he must really mean it genuinely then.

Cove went all swooshy-eyed and told us that you couldn’t look at someone on day 1 of allyship and know where they’d be in a few years’ time and then went immediately to grovel.

I was not this person when you trained me. I asked loads of questions. I was very in my head. Very academic. What about this medically? What about that? I was very engaged. But I don’t think you would have thought in that room, I would be where I am today, if you were to have seen me.

Lesley Cove

Hewitt told us that you cannot re-train someone who is genuinely transphobic, or racist or homophobic, however you could create spaces where allies thrived. When responding to requests for trans equality sessions, say for the forensic services, were people really asking Hewitt to talk about ‘the impact of anti-psychotic medication and the side effects … and how that might impact someone who has gender dysphoria’ (i.e. highly technical advice outside the remit of a HR person – why would anyone being asking him this?).

Hewitt was keen on getting trans people from other sectors to provide advice and training in the NHS, rather than it all being down to him.

Question from the floor on court cases challenging ‘trans healthcare’

Hewitt is asked a lot what he is ‘doing about that’ and said that there wasn’t much he could do to help trans men and non-binary people receive surgery as adults on the NHS. In relation to young people, he believes that the UK is a very conservative country. The care pathway for trans young people is conservative compared to the USA and Europe. However, even the conservative model was considered ‘radical and out there’. Hewitt wishes there was more vocal support from NHS leaders.

The waiting list for specialist care is 4 years long.

There was a barrier for accessing care (i.e. cross sex hormones) in the NHS above a certain weight, which didn’t exist in the private setting (he obviously didn’t say but this is because of the massively increased risk of cardiovascular events).

Having more trans people in the room when you were developing services would improve things. The Trust he works for has a target to have a trans person working on the Board within the next four years – and we needed to see more of these types of target set.

Question from floor about coming out as trans

It was noted that some people had transitioned during the lockdown and working from home period. What kind of support could they seek from their NHS employer?

Hewitt advised people to join the Trans NHS Staff Network and seek support from their line manager. Policies are in place already in most Trusts which will support you. You can contact Hewitt and Cove personally.

Cove said that were two further sessions later in the week which would be helpful to tune into (indeed four of the 19 or so sessions that week were exclusively addressed trans issues).

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