Conclusions and recommendations
The disparities in health and social care experienced by LGBT people
1.Services that already monitor sexual orientation are clearly aware of the health disparities that are uncovered through data collection. If sexual orientation monitoring remains optional, health disparities will remain hidden across the services that choose not to implement it. In line with ethnicity monitoring, sexual orientation monitoring should be made mandatory across all NHS and state social care providers within the next 12 months. Any service provider who does not implement it should face fines at a level equivalent to those imposed for not monitoring ethnicity. (Paragraph 12)
2.Monitoring both sexual orientation and gender identity is far too important to be an aspiration rather than a concrete goal with clear timelines for delivery. The NHS needs to understand where the disparities are in order to formulate strategies to tackle them. This is especially true for the transgender population, where the LGBT Survey found that some of the greatest health disparities exist. (Paragraph 15)
3.Gender Identity monitoring work should be accelerated with a view to creating a standard by the end of 2019. This should then be rolled out on a mandatory basis to all NHS and state social care providers before the end of 2020. (Paragraph 16)
Leadership and creating policy that results in measurable improvement
4.It is vital that all local health and social care organisations actively consider the needs of their LGBT communities, as required by the public sector equality duty. This should be mandated directly from the Department of Health and Social Care and from NHS England as a part of commissioning requirements and as a requisite for receiving funding. (Paragraph 42)
5.All commissioning outcome frameworks should include an explicit requirement to demonstrate how a service provider will meet equalities obligations and best practice and show that it has consulted on and considered the needs of LGBT service-users. This should include both NHS contracts and local authority contracts for social care provision. (Paragraph 43)
6.We also recognise that some NHS and social care providers will not have considered LGBT issues as part of their commissioning requirements before. We have seen plenty of good practice among individual CCGs but this practice needs to be promoted throughout the NHS and social care. DHSC and NHS England should work together to create an LGBT inclusion commissioning toolkit that health commissioners can use to spread best practice in commissioning LGBT-inclusive services. (Paragraph 44)
7.NHS England should review all new bids for funding from CCGs and Integrated Care Systems to ensure that not only are they having due regard for the need to eliminate discrimination but also that the needs of the LGBT populations of their areas have been specifically taken into account. Any bids that are found to be lacking should be passed on to the Equality and Human Rights Commission for enforcement action. (Paragraph 45)
8.We do not consider such interventions to be specific enough to tackle the unique inequalities that LGBT people are experiencing. The Government, in the LGBT Action Plan, acknowledges that these problems need bespoke solutions, so it is disappointing that most of the measurement of success seems to be tied to the long-term plan and is therefore too general to be able to pinpoint whether LGBT service-users are benefiting. (Paragraph 47)
9.We feel that the split between the LGBT Action plan, on which GEO has the lead, and the NHS Long Term Plan is extremely unhelpful and seems to imply that responsibility for LGBT-inclusive healthcare lies with GEO rather than within the health and social care institutions. In order to ensure that the LGBT Action Plan is integrated into NHS England strategy, the Chief Executive of NHS England should work with the GEO to produce the next LGBT Action Plan update and should be a signatory to it. The Government Equalities Office and Department of Health and Social Care should formulate and publish a list of key inequalities in LGBT health that the NHS need to be accountable for and include in the LGBT Action Plan and should report back to the Committee annually on progress in eliminating these. (Paragraph 53)
10.While we agree that it is important for the National Advisor to look across the piece of the NHS, we also believe that Dr Brady does not currently have the authority to make any of the structural changes that are needed for LGBT-inclusion. The continued funding of the role of the National LGBT Health Advisor should be prioritised in the next Spending Review and should be confirmed for, at least, the next three years. The National Advisor should be embedded at a senior level and report directly to the Chief Executive of NHS England. (Paragraph 55)
Creating LGBT-inclusive services
11.Publishing materials in isolation, with no guarantee that they will be taken up or even seen is a waste of time and resource. Public Health England need to step up their efforts in raising awareness of materials and disseminating them. Given that PHE is keen to work with stakeholders, the National LGB&T Partnership, a group made up of 10 LGBT organisations, is an ideal partner for this work. (Paragraph 58)
12.Public Health England should work with the National LGB&T Partnership to prepare a five-year plan of LGBT-specific campaigns. The plan should include measurable performance indicators on disparities such as smoking and alcohol abuse and should be reviewed annually. (Paragraph 59)
13.We agree with stakeholders who say that clear signs of LGBT-inclusion are to be welcomed. Markers of individual inclusivity are important, but this cannot be a replacement for service-wide commitment, which should also be clearly visible to all service users in an organisation’s aims and strategy and communicated visibly through posters and other visible markers. It is vital that staff who want to be identified as allies are properly trained to take on this role. All NHS and social care providers should ensure that all staff understand their legal responsibility to deliver a service that is inclusive of LGBT people but that, until this is rolled out in the NHS and in social care provision, only staff that have had training should be allowed to identify themselves in this way. (Paragraph 64)
14.We agree with Dr Brady that, while LGBT-specific services play a vital role in the health and social care landscape at the moment, these services often exist because mainstream services are not yet fully inclusive. These services should continue to be sustained and supported for as long as they are needed. In the meantime, the priority should be for mainstream services to become inclusive to the needs of the LGBT communities. (Paragraph 68)
Staff training and regulation
15.Understanding the real needs of LGBT people is necessary in order for health and social care professionals to truly deliver person-centred care. Those responsible for the education and training of health and social care professionals should treat training on LGBT needs with the same integral importance as other basic training. This must happen early in training and not be seen as a “specialism” to be delivered post-qualification. (Paragraph 76)
16.The GMC and NMC should review their guidance for medical schools with a view to ensuring that LGBT content exists in every medical school curriculum. This content should be spread across modules rather than being restricted to modules on, for instance, sexual health. (Paragraph 77)
17.We would urge the GMC to look again at its curricula to truly assess whether the mandatory training for these specialties includes LGBT content and, if they are found lacking, to revise them. (Paragraph 80)
18.Training can be the first exposure that students have to LGBT health needs. All registration bodies should ensure that case studies featuring LGBT people are included in courses in a way that does not play into stereotypes. Registration bodies should develop these case studies in cooperation with local LGBT organisations. (Paragraph 83)
19.The Government should consult on ways in which effective knowledge and understanding of unacceptable discriminatory practices and the Equality Act could be ensured amongst the widest range of health and social care providers. This should include staff feeling empowered to take action when they are aware of LGBT discrimination. All NHS and social care providers should ensure these expectations are embedded into their interactions with new patients or residents and provide staff with the relevant training so they feel confident in challenging discriminatory behaviour. The CQC might consider how to strengthen the monitoring of these issues as part of their existing inspection regime. (Paragraph 89)
20.We agree that advocacy services can be a way to increase access for LGBT people who have concerns about their care. We also feel that more and clearer information is required to help LGBT people to take a complaint forward. The Government should help fund more capacity in national health advocacy services as part of the LGBT Action Plan. The GMC and NMC should, in addition to this, produce information specifically for LGBT patients that clearly explain what level of service they can expect from their doctor, nurse or midwife and how to complain if they encounter discrimination. (Paragraph 95)
21.While the steps that the CQC have been taking to ensure that inspections are looking for evidence of LGBT-inclusive practice, inspection cannot always be the solution as it cannot uncover every incident of poor practice. (Paragraph 98)
22.The CQC should conduct a thematic review of social care services for LGBT people which should include examples of best practice and guidance to social care providers around how to create LGBT-inclusive care services. (Paragraph 99)
23.CQC and NHS England should work together to produce a guide to making complaints along with an online form that can be used to ensure that complaints are received by the appropriate body to address them. (Paragraph 100)
Published: 22 October 2019