A new NHS language guide warns doctors against calling disabled people “inspiring,” branding the remark a “microaggression”, in a move critics say exemplifies the creeping regulation of ordinary speech in public institutions.
Gloucestershire Hospitals NHS Foundation Trust has issued guidance instructing medical professionals to avoid “putting people in broad categories” or relying on “stereotypes” when addressing disabled patients. According to the guide, telling a disabled person, “You people are so inspiring” constitutes a microaggression.
First developed in American academia, the concept of ‘microaggression’ refers to subtle, often unintentional remarks or actions perceived as reinforcing stereotypes or marginalising identity groups deemed ‘historically oppressed.’ The term gained prominence following the Black Lives Matter protests of 2020 and has since made its way into British institutional policy on workplace language. Though framed as a means of fostering inclusion, such speech codes inevitably raise concerns about their chilling effect – particularly when imposed in hierarchical workplaces like the NHS, where staff may feel compelled to self-censor rather than risk transgressing vague and subjective rules.
The trust’s guide, which was issued in September 2024, remains in use despite Health Secretary Wes Streeting last week ordering the NHS to crack down on “misguided” diversity, equality and inclusion practices.
Elsewhere, the guide advises the trust to consider phasing out titles in official correspondence to ensure “gay and transgender people are more included”.
“This could include removing titles such as ‘Mr, Ms, and Mrs’ for communications, removing gender boxes on forms where it is unnecessary, avoiding heteronormativity… and making sure the community is visibly included in materials,” the document states.
Critics have called the guide a relic of the previous political era, with Lord Young, founder of the Free Speech Union, telling The Telegraph:
“Did this NHS Foundation Trust not get the memo? All this woke gobbledegook has been consigned to the dustbin of history.”
“Issuing an inclusive language guide at this juncture is the equivalent of an NHS Trust telling nurses to use the word lavatory rather than toilet because the latter is non-U. It’s hopelessly – comically – out of date.”
Far from being an outlier, the NHS Trust’s document illustrates how deeply embedded certain ideological assumptions remain in public sector bureaucracies. Speech-policing frameworks built around critical race theory concepts such as “microaggressions” and “intersectionality” do more than simply encourage inclusivity; they establish informal constraints on expression. Employees subject to such rules may find themselves unsure whether a perfectly anodyne remark could be interpreted as offensive by someone else, with professional consequences to follow.
The Gloucestershire Hospitals guide also promotes several contested ideas drawn from contemporary identity politics. It encourages NHS staff to adopt terms like “sex assigned at birth”, which implies that biological sex is a subjective classification rather than an objective fact, and endorses “intersectionality” as a “critical concept”, asserting that individuals experience overlapping layers of oppression.
“Historically, individuals who are Black have faced discrimination due to their race, and those who are gay have faced discrimination due to their sexuality,” the document states. “Therefore, a Black gay person faces discrimination on two fronts, placing them at an intersection of disadvantage”.
Staff are urged to take an active role in correcting their own linguistic missteps. If unsure about the correct terminology, NHS workers are told to “educate yourself”, “listen”, and “strive to improve”.
“Always listen, educate yourself, and ask politely if unsure about the appropriate terminology,” the guide states. “Learn from mistakes, apologise if you cause offence and strive to improve.”
Elsewhere, the document flags common phrases such as “the blind leading the blind” and “deaf to reason” as problematic, advising staff to replace them with neutral alternatives such as “they don’t seem to know what they are doing” or “they are unresponsive to reason”.
Meanwhile, medics are warned against describing someone as “Irish Traveller”, “South Asian”, or “Caribbean”. Instead, they must say “a person from the Irish Traveller community” to avoid “reducing someone to just their ethnicity”.
Such linguistic strictures exemplify the expansive nature of contemporary speech codes: terms that have been long understood as neutral descriptors or common idioms are being recast as potential sources of harm, with the onus placed on individuals to pre-emptively adjust their language.
Mr Streeting said last week that there were “really daft things being done in the name of equality, diversity and inclusion” in the NHS that “undermine the cause”.
He also warned that the “ideological hobby horses need to go” in order to focus attention on health inequalities, such as black men being twice as likely as white men to suffer prostate cancer.
Will his intervention have any impact? In 2023, Steve Barclay, the then Tory health secretary, ordered an end to creating specialist inclusion roles. Yet since then NHS bosses have hired dozens of new senior equalities staff, with a combined salary of more than £750,000.
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