Intended for healthcare professionals


The end of the rainbow? Preserving a symbol of LGBTQ+ allyship in the NHS

BMJ 2022; 379 doi: (Published 21 October 2022) Cite this as: BMJ 2022;379:o2534
  1. Nicholas Phillips, fifth year intercalating medical student
  1. Cardiff University, Cardiff, UK

Efforts to promote a safe and positive healthcare environment for the LGBTQ+ community should be undertaken with renewed focus in the wake of the pandemic, says Nicholas Phillips

The covid-19 pandemic saw the image of the NHS logo next to a rainbow become a national symbol of appreciation for patient facing workers. Rainbows and messages of thanks were scrawled on the windows of homes, unfurled on flags and signs outside shops and public buildings, and emblazoned on badges and tote bags. As the use of this image as a token of thanks to NHS staff proliferated, however, the message it initially represented in the NHS—as a symbol of LGBTQ+ allyship—started to blur.

NHS rainbow badge

The modern Pride flag is a globally recognised symbol of the diversity and unity of the LGBTQ+ community.12 In recognition of the healthcare challenges people who identify as LGBTQ+ face—a Stonewall survey found that almost one in four LGBTQ+ people in Britain had heard negative remarks about LGBTQ+ people from healthcare staff while accessing services3—NHS rainbow badges were introduced in Evelina London Children’s Hospital. Featuring the NHS logo against the backdrop of the six stripe rainbow flag, the badge was developed in 2018 with the idea that it could be displayed on staff uniforms to show patients that sexuality and gender identity could be safely discussed with the wearer.

To attain a badge, staff were expected to read various articles and resources. This ensured they not only supported the message the badge embodied, but were informed enough to be a useful ally who could help to create an inclusive environment.4

After the success of the rainbow badges at Evelina they were launched across the UK, creating the Rainbow Badge Initiative, which over 90% of NHS trusts have taken part in.56

“Thank you, NHS” symbol

Meanwhile, as the pandemic escalated in 2020, the public were keen to show their thanks to NHS staff and the rainbow began to be adopted as a symbol of this appreciation. Flags and signs bearing rainbows and sentiments thanking the NHS began to pop up outside homes, businesses, schools, and on billboards and roads.

From the beginning, concerns were raised about the similarities between the two distinct meanings of the rainbow symbol, with some fearing that the original message was at risk of being forgotten and this important symbol for the LGBTQ+ community co-opted.78

Of course, no person, organisation, or movement owns the symbol of a rainbow.9 It is, however, the appropriation of an active symbol containing both the NHS logo and the six striped flag that is of specific concern. Instead of creating an original symbol of hope and support for the NHS, an existing symbol has been rebranded—quite literally in some cases10—and misused, stripping it of its original values.

We shouldn’t forget that the NHS rainbow badge was created in response to the health inequalities the LGBTQ+ community experience, as well as explicit discrimination within healthcare services. Healthcare facilities are supposed to be safe spaces, but that isn’t always the reality for LGBTQ+ people. The NHS rainbow badge was meant to signify to patients that they were with a healthcare provider they could trust. Yet this message is now at risk of being lost or at least diluted.11

The end of the rainbow?

At the start of the pandemic, there should have been a greater push to protect the symbol for the LGBTQ+ community, rather than mixing its messages.12 Recognising that the public wanted to show support for the NHS, those with influence should have promoted something original, such as the blue heart symbol that was used by some.13 Yet, as the public continue to associate NHS and rainbow visuals with the efforts of NHS staff during the pandemic, we must now look to what we should do next.

It is possible that with time the public’s association of the rainbow flag with giving thanks to the NHS will diminish, but it is not guaranteed. Furthermore, evidence continues to emerge that underscores why NHS rainbow badges are necessary. Data published in 2021 show that a higher proportion of LGB adults have a limiting longstanding illness (26%) compared with heterosexual adults (22%),14 and the 2021 NHS staff survey found that LGBTQ+ NHS staff are much more likely to face physical violence, bullying, and harassment in their workplace than other staff.15 LGBTQ+ people have poorer experiences within a healthcare environment, whether as patients or staff. We can’t neglect the ongoing work we need to do to promote a safe and positive healthcare environment for the LGBTQ+ community.

In the wake of the pandemic, governing bodies and hospital trusts must put greater effort into promoting the NHS rainbow badge and the initiative behind it, reclaiming what it symbolised and highlighting this message to the public. The badge’s use as a tool to educate staff on LGBTQ+ matters and to help LGBTQ+ patients feel safe should be accompanied by wider efforts to tackle healthcare inequalities and discrimination, promote inclusion, and celebrate diversity. Making healthcare a safer space for LGBTQ+ people is within our grasp and should be worked towards with renewed focus in the NHS.


  • Competing interests: none declared.

  • Provenance and peer review: not commissioned, not externally peer reviewed.