From tabloid outcast to breaking endless pink ceilings in the decades since, Professor Andrew Hartle reflects on his incredible 40+ year career for LGBT+ History Month.

November 2024 marked 40 years since I joined the RAF and 35 years since I started in anaesthesia; my career is nearer its end than its beginning. It might be described as successful. Council member, president (both several times), and Professor of Practice – none of that was in my plan as a young doctor. Being the first out gay man to hold these positions would have terrified and amazed me. Yet it nearly didn’t happen.

I’ve always been gay, but only realised when into my teens how different I was to most other people. I arrived at medical school aged 17, naive and in denial. My first year coincided with the first mainstream news of HIV/AIDS, which put me firmly and deeply in the closet. Aged 19, I joined the RAF as a medical cadet. This wasn’t as strange a decision as it seems – civilian life had few positive LGBT role models, the medical profession had none. Discrimination was widespread, and sex would now kill you. I was giving nothing up by joining up.

After house jobs, I started in uniform, firstly a Junior Medical Officer on a fast jet station, then an anaesthetist in a military hospital. Those early years were great. I undertook search and rescue and aeromedical evacuation duties with a walk-on part in the first Gulf War, plus all the perks of living in an Officers’ Mess. I enjoyed myself and was rated highly by my seniors in annual reports. But there was growing internal conflict between the real, gay me, and RAF me.

So why not just resign? Although homosexuality in England and Wales was partially decriminalised in 1967. The armed forces were excluded, and serving LGBT personnel lived in constant fear of detection. Some were administratively or medically discharged, others subject to intrusive interviews by service police (who were ‘enthusiastic’ in their task), summary or court martial justice, even imprisonment. Invasive medical examination and treatment without consent was the experience of others. We had no rights to confidentiality from our doctor or priests. Some personnel were accused and dismissed because of rumour, and weren’t even LGBT. There was no ‘easy’ way out.

Life got more complicated. I was caught up in a service police witch-hunt, typically following an accusation against another serviceman. I was interviewed under caution and on tape for hours for ‘infamous conduct’. This was intrusive and degrading. My performance, while not BAFTA-worthy, was enough to warrant no further action. I now lived with the shame of being gay, the shame of lying about it, the shame of not meeting the standards expected of an officer.

By 1996 I’d spent a study leave year at St Mary’s, Paddington passed the FRCA and had my first proper relationship. I was 31 and, although the RAF was the career I wanted, I couldn’t continue living with the constant worry and threat. I decided to leave, but before I could I was outed in a Sunday tabloid by someone I met casually that summer. The headline was terrible: ‘RAF DOC’S GAY FLING WITH AN AIDS VICTIM’.

I was suspended. I avoided further police involvement or court martial, but the initial RAF report accused me of putting patients at risk (as well as being gay, breaking confidential orders and lots more). This clearly put me at risk of GMC censure (as court martial would also have done) but I was able to rebut this. The GMC’s track record with gay doctors also wasn’t good.

From the moment of suspension, I became an outcast. I was banned from my NHS place of work and only allowed on RAF bases with permission and at specified times. This lasted seven months, during which time I had no contact from any RAF colleagues except some close friends and an admin officer who acted as my contact. I was finally ordered to resign.

Thankfully, I arranged my own inter-deanery transfer back to St Mary’s. Life in the NHS was no picnic. Weeks into my first rotation I was summoned from theatre by the Occupational Health Director and forced to either have an HIV test or be suspended.

In 2001 I was appointed as (the first out gay) consultant anaesthetist at St Mary’s. The ban on LGBT personnel had been ruled unlawful by the European Court of Human Rights and was lifted in January 2000. I was still ‘quite cross’ with the RAF and took every opportunity to ‘show them’ what they’d missed out on. This is not a strategy I’d recommend.

In 2005, I became Service Director for Anaesthesia at St Mary’s, and was elected to the Association of Anaesthetist’s (then known as AAGBI) Council the next year, becoming honorary secretary in 2010 and president in 2014. This led to inevitable interaction with the Defence Consultant Advisor in Anaesthesia, and then the Tri-Service Anaesthetic Society. I didn’t find that easy, but none of those were involved in my dismissal, and by then all three services had changed and moved on. LGBT personnel were no longer just tolerated but encouraged and supported.

Same-sex marriage meant that I was the first President of the AAGBI to open their Annual Congress Dinner speech with the words ‘My husband and I...’. I’d achieved so much, but in reality things weren’t great. I had concentrated so much on ‘success’ and ‘proving myself’, while burying the impact of the outing and dismissal. My mental health deteriorated, and I missed the last few months of my term as president. My apologies and thanks go to everyone who picked up the pieces and kept the Association on track with barely a ripple.

After the AAGBI I served a term on the Council of the World Federation of Societies of Anaesthesiologists (WFSA) and joined the Council of the Anaesthesia Section at the Royal Society of Medicine as its 100^th president.

LGBT personnel have served openly and proudly since 2000, but those of us who were impacted most by it were forgotten. Then a new charity, ‘Fighting With Pride’, campaigned on our behalf resulting in a government-appointed independent review, led by Lord Etherton.

Recently, accepting all 49 recommendations from the review, the then Prime Minister, Rishi Sunak, said the ban was an ‘appalling failure’ of the British State when he apologised on behalf of the nation. Since then, medals have been restored, berets returned and LGBT veterans welcomed back into the military family – if they want to. Most currently serving in our armed forces have never known anything else, and many were unaware of ‘the ban’.

Triggered by their own LGBTQ+ Staff Network, the GMC apologised during LGBT History Month 2024 for its historic homophobic actions against gay doctors. Bolstered by my experience with Fighting With Pride, anaesthetic trainee Duncan McGregor and I represented GLADD (the Association of LGBTQ+ Doctors and Dentists) in guiding the GMC to their final position.

Twenty years after ordering me to resign, the RAF appointed me Honorary Civilian Consultant Advisor in Anaesthesia, the ‘Civilian Head of Specialty’. A year later, I became President of the Tri-Service Anaesthetic Society. With Fighting With Pride, I’ve marched with the Defence contingent at two London Prides – excited and jealous to see service personnel celebrating their diversity and supported by the most senior officers in the Armed Forces. In September 2024, I attended a Restorative Action event at RAF Cranwell and received a written apology from the Chief of the Air Staff.

And Defence Anaesthesia? As CA I sit on Armed Service Consultant Approval Boards – the additional hurdle every military trainee must pass. A single ASCAB this summer approved an out gay man, a trans woman, and two women with children. They were all outstanding, their diversity was incidental, and none could have served in the military I joined. The NHS can learn much from Defence today – Defence invests time and money in individual LGBTQ+ personnel and networks when all too often the NHS pays lip service.

Coming out as I did was not my plan. Most residents do it slowly, repeatedly, in each new hospital, each list with a new consultant or ODP. Breaking pink ceilings was never my goal. I didn’t set out to be a role model, and I wouldn’t call myself one. But you can’t be what you can’t see, so some of us must be visible. As one anaesthetist told me ‘If the AAGBI President can write about his husband in Anaesthesia News, I can talk about my boyfriend at work’.

Role model: no. Proud out gay anaesthetist: yes. Let’s all feel prouder in 2025!

Photo credit: Dunleavy-Harris photography