Health and social care and LGBT communities: inquiry launches

3 August 2018

Existing evidence shows that health outcomes are generally worse for LGBT people than for the rest of the population. The Women and Equalities Committee launches an inquiry to consider whether provision is adequate, whether discrimination is still occurring, and what more needs to be done to improve access to health and social care.

The Government's recent survey of 108,000 LGBT people found that many had difficulties accessing healthcare services, some had experienced inappropriate questioning and curiosity from healthcare staff, and that many feel their specific needs are not taken into account in their care.

Government findings

The Government's findings included:

At least 16% of survey respondents had a negative experience of accessing public health services because of their sexual orientation, and 38% because of their gender identity;
72% of LGBT people who had accessed or tried to access mental health services reported that it had not been easy. Fifty one per cent said they had to wait too long, 27% were worried, anxious or embarrassed about going, and 16% said their GP was not supportive;
Twenty one per cent of asexual people have had a negative experience of healthcare in the past year, as have 40% of trans people, with over a third saying that accessing sexual health services is “not easy”;
Nearly half of bisexual people say they have never been out to anyone in a care setting, and 67% have never disclosed their sexuality to a healthcare professional;
Nearly a quarter (23%) say that being out in a care setting has had a negative effect on their care.

Chair's comments

Committee Chair Maria Miller said:

"Evidence suggests that the healthcare needs of LGBT people are not currently being met effectively, some report that they still face discrimination in health and social care, and there are inequalities in outcomes between LGBT groups and the wider population.
We welcome the Government's recently announced Action Plan and its commitment to ensuring that LGBT people's needs are at the heart of the NHS.
This is therefore a crucial time for us to look at how services can best be provided and improved for LGBT patients.
We want to hear from organisations, individuals, researchers and service providers about what can be done to make health and social services more effective for LGBT people."

Send a written submission

The Committee will look at the following issues:

Understanding and addressing LGBT health inequalities:

In what areas of health do LGBT people experience worse outcomes than the general population?
What is known about why this is, and what interventions are effective in improving outcomes? What are the gaps in evidence?

Meeting the needs of LGBT people in health and social care:

What evidence shows that LGBT people have particular needs as health and social care users? What are these needs?
How effectively do health and social care providers take into account the needs of LGBT people? How should provision of specialist services be balanced with a mainstreaming approach?
What should be done to improve, what examples of best practice are there, and what is the evidence about what works?
What particular challenges do older LGBT people face in accessing social care, housing and end-of-life care?
What evidence is there that LGBT people with other protected characteristics (older people, people from BAME communities, disabled people) face particular problems with discrimination in or access to health services, and what actions could be taken to improve health and social care experiences and outcomes for these different groups?

Discrimination in health and social care:

What does the evidence show about levels of discrimination against LGBT people when they access health and social care? What types of discrimination are faced and in what areas of health or social care?
What are the causes of that discrimination?
What actions have been taken by health and social care providers to reduce levels of discrimination? How effective have these actions been?

The National Adviser for LGBT healthcare:

How should the new National Adviser for improving LGBT healthcare go about their work? What needs to happen for this role to be effective?
What should the National Adviser's priorities be, and what would you like them to achieve?

Send a written submission to the inquiry on Health and social care and LGBT communities.

The deadline for submissions is 5 October 2018. Guidance for giving evidence is available here.

Background

Health inequalities

At an event on LGBT and health inequalities held by the Parliamentary Office for Science and Technology (POST) in July 2018, researchers noted that there is often an unhelpful conflation of LGBT health services with sexual health services.

As well as sexual health services, health issues around misuse of alcohol drugs and tobacco were flagged up as significant areas of health inequality for men who have sex with men.

Additional known inequalities among women who have sex with women included pregnancy and reproductive health, some types of cancer, and incidence of intimate partner violence.

NHS staff

Stonewall's 2015 report Unhealthy Attitudes found that only 59% of all health and social care staff think their employer is taking effective steps to prevent and respond to discrimination and poor treatment of lesbian, gay and bisexual people. It also found that:

57% of health and social care practitioners with direct responsibilities for patient care, such as social workers, nurses and mental health workers, say they do not consider sexual orientation to be relevant to a person's health needs.
10% say they are not confident in their ability to understand and meet the specific needs of lesbian, gay or bisexual patients and service users.
72% of patient facing staff have not received any training on the health needs of LGBT people, the rights of same sex partners and parents or the use of language and practices that are inclusive of the LGBT community.
7% of patient-facing staff have witnessed bullying, abuse or harassment at work toward a patient or service user because of their sexual orientation over the past five years, and 5% have witnessed other collegues discriminate against or provide poorer treatment to a patient or service user because they are lesbian gay or bisexual over the same period. The report concludes that health and social care staff are “unequipped to challenge prejudice […] often lacking any equality and diversity training as well as the confidence to understand and meet the needs of LGBT patients and service users.”

End of life care

Hiding who I am: the reality of end of life care for LGBT people, a 2016 report by Marie Curie, Kings College London and the University of Nottingham, identifies a number of issues which LGBT people face at the end of life, including:

not accessing services due to anticipated discrimination
assumptions being made by others about their identity and family structure
a lack of support for partners and carers.

The report recommends training staff on the specific concerns or needs of LGBT people, ensuring literature and materials about end of life care services represent all diverse groups, working with local LGBT groups to understand more about end of life care needs, and exploring specifically issues relating to LGBT communities when considering national implementation strategies.

Transgender equality

The Committee's report on transgender equality published in January 2016 made a number of conclusions and recommendations relating to access to health and social care for transgender people, in areas which include:

NHS Services
professional regulation of doctors
treatment protocols
capacity and quality of services
social care for young people.

Further information

Image: Wikimedia