HC 1048-III Health CommitteeWritten evidence from The National LGB&T Partnership (PH 133)

Summary

The National LGB&T Partnership is a member of the Department of Health Strategic Partner Programme, working to highlight the inequalities and needs of LGB&T people and communities across Government and the statutory sector.

Health inequalities suffered by lesbian, gay, bisexual and trans people remain largely marginalised in public health and are not given the same level and amount of focus as other protected characteristic groups, such as ethnicity.

The continuing lack of evidence around the public health of LGB&T people represents a major entrenched barrier to the discovery and meeting of their needs.

All health and social care services should collect the sexual orientation of their service users.

LGB&T voluntary and community sector preventative activities are being disproportionately cut at local levels.

In order for GPs and other statutory sector professionals to contribute to better public health, the relationship between healthcare staff and LGB&T communities must be improved as a matter of urgency.

Public Health England needs to co-ordinate a national level response to the public health issues facing LGB&T communities, in partnership with LGB&T service delivery organisation in the voluntary and community sectors.

High quality LGB&T specific services are unsustainable over a purely local footprint.

The time lag between any new ring fenced public health monies for local government, and the highly challenging funding environment as we move through 2011/12, needs to be recognised for the under-resourced LGB&T sector.

In order for the Big Society to succeed, commissioners need to broaden their understanding of value to include social value.

There should be a mandatory inclusion of all the protected characteristic groups in the JSNA process.

The health premium should identify or at least be calibrated to reflect the real experiences of LGB&T people.

Introduction

1. This report provides feedback from the National LGB&T (lesbian, gay, bisexual and trans) Partnership, a member of the Department of Health Strategic Partner Programme. The National LGB&T Partnership is an England-wide group of LGB&T voluntary and community service delivery organisations that are committed to reducing health inequalities and challenging homophobia and transphobia within public services.

2. The National LGB&T Partnership members intend to positively influence the policy, practice and actions of Government and statutory bodies, in particular the Department of Health, for the benefit of all LGB&T people and communities across England.

3. The National LGB&T Partnership will ensure that health inequalities experienced by LGB&T people are kept high on the Government’s agenda and that best use is made of the experience and expertise found within the LGB&T voluntary and community sector. The National LGB&T Partnership is also establishing a National LGB&T Stakeholder Group which is open to interested groups, organisations, service providers and individuals, giving a direct voice to the LGB&T sector. See http://www.lgf.org.uk/the-national-lgbt-partnership/ for more information.

General Comments

4. The National LGB&T Partnership is concerned that health inequalities suffered by lesbian, gay, bisexual and trans people remain largely marginalised in public health, despite a growing body of evidence demonstrating that LGB&T communities are disproportionately affected by many of the national priorities for public health. ‘Healthy Lives, Healthy People’ states:

“[Britain has] among the worst rates of sexually transmitted infections recorded, a relatively large population of problem drug users and rising levels of harm from alcohol. Smoking alone claims over 80,000 lives every year. Experts estimate that tackling poor mental health could reduce overall disease burden by nearly a quarter”

5. The continuing lack of evidence around the public health of LGB&T people represents a major entrenched barrier to the discovery and meeting of these needs. Addressing this lack of evidence appears to be of a low priority despite the strong indicative evidence that exists:

LGB people are more likely than heterosexuals to say their health is poor: more likely to experience tension and worry; to abuse drugs; to smoke; suffer from asthma; or to be victims of sexual abuse, and this is evidenced anecdotally for the trans population among the cases seen by TREC and GIRES.

Men who have sex with men account for two thirds of HIV infections occurring in the UK in 2010.

35% of trans adult people report having made at least one suicide attempt prior to accessing the treatment they are seeking.

23% of the gender variant young people referred to the UK’s sole treatment centre have engaged in self harm/overdose.

LGB people are significantly more likely to have taken an illicit substance in the last month, compared to the general population.

72% of trans people have experienced harassment in public with the result that 21% avoid going out in public due to fears for their safety.

29% of [trans] respondents experienced verbal harassment whilst at work.

6. All health and social care services should therefore collect the sexual orientation of their service users so better and more complete evidence can be used to increase the impact of public health campaigns amongst LGB populations, or be used to inform targeted campaigns. The resources required to start this monitoring would save money in the medium and long term. For trans people a more urgent need is to assess the attitudes of healthcare staff towards them as fellow employees or service users.

7. Many member organisations of the National LGB&T Partnership engage in preventative activities, but despite the strong message of support for both prevention and the voluntary and community sector, voluntary and community sector preventative activities are being disproportionately cut on the ground.

8. For example, the Lesbian & Gay Foundation’s gay and bisexual men’s HIV prevention and sexual health programme across Greater Manchester receives £650,000 per year from the 10 Primary Care Trusts in Greater Manchester. The scheme involves the distribution of targeted HIV prevention and sexual health promotion in a variety of methods, HIV and STI testing services, outreach and the distribution of over 600,000 condoms and 600,000 sachets of personal lubricant. The HIV related cost to the health services over a single person’s lifetime is estimated to be over £300,000. Despite this obvious financial argument for the HIV prevention and sexual health programme, it has already been cut by up to 100% by some of the PCTs in Greater Manchester. Greater protection for this sort of work is essential for both LGB&T communities and for the future resource implications for health and social care services.

9. Inequalities arising from sexual orientation and gender variance are not given the same level and amount of focus as other protected characteristic groups, such as ethnicity. This can be seen throughout many strategic public health documents such as the equalities impact assessment for the funding and commissioning routes for public health, and the Marmot review itself.

10. It needs to be recognised that ethnicity, gender and disability are far better established in the minds of policy and decision makers as sources of inequality and disadvantage. The lack of evidence relating to sexual orientation and gender variance is identified but there seems to be of lack of consensus within the highest levels at DH, NHS and local authorities that this lack of evidence is a major barrier to securing equal access to services for LGB&T communities. The National LGB&T Partnership would like a commitment from the highest levels that the level of data collected on sexual orientation and gender variance of staff and service users, including staff attitudes, will be increased to match the level of data collected around other protected characteristics.

11. In order for GPs and other statutory sector professionals to contribute to better public health, the relationship between healthcare staff and LGB&T communities must be improved as a matter of urgency, and training around LGB&T issues must be prioritised:

One in five trans people have found their GP to be unhelpful.

99% of teachers witness homophobic abuse on at least a termly basis.

20% of health care professionals admit to being homophobic.

Only one in three older LGBT individuals believes their health professionals to be positive towards them

12. The new commissioning architecture represents both challenges and opportunities for the LGB&T voluntary and community sector. The National LGB&T Partnership would like to see Public Health England co-ordinate a national level response to the public health issues facing LGB&T communities, in partnership with LGB&T service delivery organisation in the voluntary and community sectors. In engaging with these communities, the Department of Health needs to recognise that, although there are many voluntary groups that provide them with support, these groups are typically small and acutely under resourced. This is particularly the case for the 125 trans specific groups, who are almost entirely invisible.

13. The National LGB&T Partnership welcomes the greater involvement of local government in public health, if local voluntary and community groups and marginalised communities are both explicitly involved in the process. LINks and the proposed local HealthWatch have valuable roles to play, but their involvement is not a replacement for engagement with, and inclusion of, LGB&T communities and LGB&T service delivery voluntary and community organisations.

14. While commissioning will be the means by which most services are procured, it should be remembered that where investment is relatively small, a grant may be ultimately more cost-effective in terms of administrative burden on all sides, than a full procurement and commissioning process.

15. Tendering and procurement processes should be designed in partnership with the civil society sector, in order that they meet the needs and resources of all stakeholders. The National LGB&T Partnership would like to see a pragmatic approach taken to model contracts with community providers. Requirements for performance measurement and management should be proportionate and not “one size fits all”. Partnership arrangements in the civil society sector should be supported and encouraged by all bodies in the new architecture.

16. Contracts for community providers would ideally include full cost recovery. It should also be recognised that the involvement of voluntary and community organisations is itself is a capacity building function and that contract timescales should be a minimum of three years, but preferably more.

17. The National Partnership welcomes the recognition that sub-national or supra-local commissioning can take place, but is concerned that this might not be supported or encouraged at the highest levels in the new architecture. High quality existing specialist LGB&T services that are currently funded at these levels, as well as future innovations, may be put at risk because of the proliferation of commissioning bodies, none of which may see such services as their particular responsibility.

18. LGB&T voluntary and community organisations face major problems in demonstrating their value because of the lack of sexual orientation and gender identity monitoring of public service users—for organisations working to support LGB&T people the lack of information about LGB&T people’s issues and needs is a major barrier to discovering and meeting those needs, and makes evidence difficult to produce for a section of the community that is largely ignored by central and local Government datasets, the 2011 Census and local public service monitoring data.

19. The time lag between the new ring fenced public health monies for local government, and the highly challenging funding environment as we move through 2011–12, needs to be recognised for the under-resourced LGB&T sector. The OCS Transition and DH Financial Assistance funds are welcomed but may not meet the funding shortfalls of the LGB&T voluntary and community sector. The National LGB&T Partnership recommends and extension of these funds into at least the 2012–13 financial year.

20. Social value is an important component of the value voluntary and community sector organisations such as the members of the National LGB&T Partnership can add when delivering frontline services, or when advising local or central Government to deliver mainstream services in a way that is more LGB&T inclusive. The National LGB&T Partnership welcomes and supports the Public Services (Social Enterprise and Social Value) Bill.

21. In order for the Big Society to succeed, commissioners need to broaden their understanding of value to include social value. The members of the National LGB&T Partnership have a growing number of highly dedicated volunteers, so a recognition of the value any volunteer input may have when commissioners are making decisions, would be welcomed. The continued existence of organisations such as the members of the National LGB&T Partnership which are unique in their strong links to “hard to reach” LGB&T communities as well as to Government allows a rare conduit of information and support to flow between these groups and Government who are often extremely separate.

22. The member organisations of the National LGB&T Partnership are reported by service users as to be one of the first points of contact for them when they have been at a crisis point in their lives. This specialised LGB&T crisis support needs to be supported by new commissioning arrangements and valued for the life and cost saving mechanism that it is.

23. The role of Joint Strategic Needs Assessments has been strengthened in the new system. There should be a mandatory inclusion of all the protected characteristic groups in the JSNA process.

24. There needs to be careful consideration of what proportion of total public health funding is earmarked for the health premium. The premium must take account of work targeted at marginalised LGB&T communities who suffer doubly from inequality and a lack of robust public health evidence. LGB&T people may also be more likely to be homeless, as a result of homophobic and transphobic harassment. This then impacts upon their health and mental health when homeless, or in poor housing, or in housing with care/support. There is an unintended risk that the premium, given the challenging economic climate, will ensure that the focus is only on the most ‘mainstream’ of public health concerns.

25. The National LGB&T Partnership believes that the health premium should identify or at least be calibrated to reflect the real experiences of LGB&T people. There is an unambiguous body of evidence that many of the most common and significant public health challenges that we face disproportionately impact upon LGB&T people. These include higher rates of:

HIV and Hep B infection in gay and bisexual men.

Alcohol dependence in LGB&T people.

Smoking among LGB&T people.

Common mental health problems such as anxiety and depression in LGB&T people.

Self harm and attempted suicide among LGB&T people.

Domestic and Familial Abuse.

June 2011

Prepared 28th November 2011