Leading for all: supporting trans and non-binary healthcare staff

Supporting leaders to understand the needs of transgender and non-binary colleagues so they can perform their duties and provide high-quality allyship

19 September 2023



The purpose of this guide is to help healthcare leaders (such as chief executives and chairs), HR directors, those responsible for equality, diversity and inclusion (EDI) work, and LGBTQIA+ staff groups understand the needs of trans and non-binary colleagues, so that they can perform their duties to trans and non-binary staff and provide high-quality allyship for their workforce.


It also discusses challenges that may arise as a result of being an ally, and laws to understand in relation to trans and non-binary people’s rights. It has been produced by the Health and Care LGBTQ+ Leaders Network in collaboration with the LGBT Foundation


This version incorporates updates following further research and an additional legal review, featuring updates to ‘What the law says’, ‘Inclusive facilities’, ‘Balancing views’, ‘Adapting the electronic staff record’, ‘Policies for staff inclusion’ and ‘Terminology’.

On 30 April, the Department of Health and Social Care launched a consultation on the NHS Constitution, which included proposals that could affect access to care for trans and non-binary patients, and working conditions for trans and non-binary staff. The consultation will run for eight weeks. As with any new legislative or policy developments, we will review our guidance for members in light of any potential updates that could be made to the NHS Constitution following the conclusion of the consultation process.

Download the guide and access the checklist of actions to track progress.


Who this guide is for

  • Chief executives and chairs
  • HR directors
  • EDI leads
  • LGBTQIA+ staff groups

Research, and the feedback from both healthcare leaders and trans and non-binary NHS employees, has shown a need for standardised guidance across NHS organisations in England. This feedback will be discussed in detail throughout the guide. To collect information about the specific experiences of trans and non-binary colleagues employed by NHS organisations in England, a qualitative survey was conducted between 14 February and 6 March 2023 and was distributed by the NHS Confederation to various staff networks, and by the British Medical Association using Twitter.

In total, 118 trans and non-binary people employed in a range of different occupations and professions in the NHS in England replied to the survey. Seven responses were removed due to being from people who did not self-define as trans or non-binary.

This survey measured respondents’ experiences of inclusion and exclusion at work, workplace incidents deemed to be transphobic in nature and the categories of employee who perpetrate these incidents (ie, senior doctors/colleagues, doctors/ colleagues at a similar or lower grade, patients and their relatives, and non-medical staff). It also asked respondents to give feedback on certain types of workplace inclusion initiatives and whether they felt these to be useful, including more visible trans and non-binary role models in their workplace and different types of incident reporting procedures.

Of those who had consented to participate in a focus group to discuss their answers further, a random sample of 25 survey respondents were invited to do so. Focus groups were held on 13 and 17 March 2023, with a turnout of 14 overall.

Participants were asked to expand on their answers in relation to reporting transphobic incidents at work, seeking help from colleagues, policies and practices that would help to promote trans and non-binary inclusion within the NHS, and adapting the electronic staff record.

The answers provided by the focus groups have been used throughout this guide to provide insight on various topics and concerns.

The survey and focus group findings are referred to throughout as the Trans and Non-Binary Allyship in NHS Organisations survey.

To support the survey’s findings, the British Medical Association’s (BMA) 2022 Sexual Orientation and Gender Identity in the Medical Profession report has also been used throughout.

How to use this guide

There are different ways to interact with this guidance. You can read the whole text or skip to chapters that are relevant for your job role or responsibilities. At the end of each section is a list of recommended actions; these are also collated at the end of the document.

A glossary of terms can be found in Appendix 1.

While this guidance is intended for healthcare leaders, HR and EDI directors, and LGBTQIA+ staff groups, it is applicable to all staff employed by NHS organisations in England, including community mental health and care professionals. Everyone is responsible for maintaining an inclusive work environment for all.

If you have questions about any of the issues raised in this guidance, you may wish to contact: This guide has been produced by the Health and Care LGBTQ+ Leaders Network in collaboration with the LGBT Foundation

For advice and support on LGBTQIA+ issues, contact 0345 3 30 30 30 or email

If you have been affected by any of the issues addressed within this guide, you may wish to contact one of the services listed below:

  • LGBT Switchboard (national LGBTQIA+ helpline): or contact 0800 0119 100
  • Galop (national charity for LGBTQIA+ victims of domestic abuse, hate crime or violence): or contact 0800 999 5428
  • Mind (national mental health charity): Citizen’s Advice (national charity for workers and consumer rights):

Download the guide and access the checklist of actions to track progress.

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