LGB+ NHS workers who disclose their identity tend to earn more

By Dr. Priyom Bose, Ph.D.Reviewed by Lauren HardakerMar 9 2026

A large survey of NHS staff reveals that while overall pay gaps between LGB+ and heterosexual employees are not evident, workers who disclose their sexual identity tend to earn more, highlighting how openness and workplace dynamics may shape economic outcomes. 

Study: Pay gaps in the National Health Service: Gender and sexuality. Image credit: Jo Panuwat D/Shutterstock.com

A recent study in PLoS One used NHS employees to examine whether relative pay was influenced by LGB+ identity disclosure for both men and women.

Theoretical perspectives on pay gaps and labor market inequality

Traditional theories often provided only limited insight into pay differences between LGB+ and heterosexual employees. One widely used theory, Human Capital Theory (HCT), suggests that people’s wages are linked to their investments in skills and education. The idea is that those who spend more time training or studying become more productive and, as a result, earn higher wages. This approach also assumes that individuals act rationally to maximize their own financial well-being.

HCT was later expanded to include the idea that family and household roles affect decisions about education and career. Women who expect to take time off work for childcare might choose to invest less in career-related training, which could lower their future earnings. Critics of this approach point out that it ignores how social expectations and workplace barriers can influence career choices and might actually reinforce stereotypes that limit women’s long-term employment.

Neoclassical economics builds on the idea of self-interest and rational choice but adds that other factors, such as bargaining power, specific skills, and workplace rules, can also shape pay. Even with these additional influences, the basic link between education and earnings remains a strong predictor of earnings.

Inconsistent trends in wage disparities linked to sexual orientation disclosure

LGB+ individuals often navigate complex decisions about balancing work and family and may experience workplace discrimination based on assumptions or bias. Unlike gender or race, sexual orientation can be concealed, making disclosure a significant variable in pay gap research. However, many studies lack direct information about individuals’ openness at work, limiting our understanding of how disclosure, relationship status, and occupation intersect with wage disparities.

Existing research shows inconsistent trends in pay gaps. Early studies found that gay men and lesbians earned less than heterosexuals. More recent findings suggest that lesbians may earn more than heterosexual women, and the pay gap for gay and bisexual men, though reduced, persists.

Disclosure of sexual orientation has occasionally been associated with reduced wage premiums and limited advancement opportunities, particularly for men, suggesting potential workplace discrimination. However, these outcomes can be context-dependent, as openly LGB+ employees may also self-select into more inclusive yet lower-paying occupational sectors or workplaces that prioritise inclusive working environments.

Despite growing attention to sexual identity and workplace outcomes, significant research gaps remain. Most notably, the impact of disclosure, occupational segregation, and supportive workplace policies on LGB+ pay and advancement remains poorly understood.

Study rationale and NHS workforce characteristics

The current study explored the determinants of pay, partnership status, occupation, and openness about sexual orientation among NHS employees in England. Using data from the National Health Service Employee Engagement Survey (EES-NHS), the analysis focused on this large, diverse, and unionised workforce, recognised for its anti-discrimination policies and relatively structured public-sector pay system. This dataset enabled a meaningful examination of the workplace experiences and outcomes of LGB+ staff in the public sector.

For this study, NHS employees were invited to participate in EES-NHS voluntarily and confidentially via an online survey. A total of 3,724 NHS employees, representing less than 1 % of the potential workforce of 1.19 million, participated in the survey. Approximately 12 % of respondents identified as LGB+. It should be noted that openness about sexual orientation (60.3 %) and life satisfaction (70.9 %) were similar to those in national LGBT surveys.

Excluding participants with missing data, 3,556 employees, including 440 LGB+ individuals, were included in this study.

Disclosure’s impact on LGB+ pay equity

In the initial analysis, which controlled only for gender and LGB+ status, it was found that men’s earnings were 4.4 log percentage points higher than women’s, with no significant pay difference between LGB+ and heterosexual employees. LGB+ employees who disclose their sexual orientation earn 6.1 log percentage points more than heterosexuals, while those who do not disclose earn 6.1 log percentage points less, resulting in no overall LGB+ pay gap.

To better understand these pay gaps, the analysis used a method called decomposition. This approach separated differences in pay into two parts: one that could be explained by measurable factors like education, experience, or job role, and another that could not be easily explained and might reflect other influences, such as discrimination or differences in the returns employees receive on their observable characteristics, meaning that similar qualifications or experience translate into different pay outcomes.

In the most detailed analysis, the model explains about 62 % of the variation in earnings. Men’s earnings remain about 3.9 log percentage points higher than women’s. For LGB+ employees, those who disclosed their sexual orientation reported earnings around 4.4 log percentage points higher than heterosexuals, while those who did not disclose earned around 4.9 log percentage points less. This showed that both gender and disclosure status continued to affect pay.

Further analysis comparing LGB+ employees who disclosed their identity with those who did not found that disclosed LGB+ workers earned about 12.99 log percentage points more on average than non-disclosing LGB+ workers, with much of this difference linked to higher returns on their observable characteristics rather than differences in the characteristics themselves.

Overall, there was no significant pay gap between LGB+ and heterosexual employees, but disclosure was associated with higher pay for LGB+ employees, while non-disclosure was linked to lower pay. This pattern held for both men and women, with particularly strong effects observed among gay and bisexual men.

Conclusions

The current study sheds new light on the nuanced relationship between sexual identity disclosure and pay among LGB+ employees in the NHS. While overall pay gaps between LGB+ and heterosexual workers were not observed, disclosure of sexual identity was associated with higher pay for LGB+ individuals, partly because disclosed employees received higher returns on their observable characteristics.

These findings highlight the importance of inclusive workplace policies that encourage openness, which may help reduce disparities associated with non-disclosure and support more equitable workplace outcomes. However, the study cannot establish a causal relationship between disclosure and pay, and limitations in sample representativeness underscore the need for further research across varied settings to deepen understanding of these complex dynamics.

The authors also note that the findings are based on employees working within the English National Health Service, a large public-sector organisation with relatively structured pay scales and strong equality policies, which may limit the generalisability of the results to other sectors or labour markets.