Health providers play a key role in improving the experiences of the LGBT+ community
As part of LGBT+ History Month, NHS general management trainee Lewis Thomas reflects on the inequalities that persist for LGBT+ people, and on the important role healthcare providers have in improving the experiences of LGBT+ staff, patients and communities.
Reflecting on the meaning of LGBT+ History Month
February is LGBT+ history month, an annual celebration that seeks to promote equality and diversity by providing education and insight into the issues that LGBT+ people face. LGBT+ stands for lesbian, gay, bisexual, transgender, and the + simply means that we are inclusive of all identities, regardless of how people define themselves.
LGBT+ History Month is a moment of reflection, contemplation and celebration. As we celebrate our past and how far we have come, it is important not to overlook how far we have yet to go to achieve LGBT+ equality – and the role which everyone in society has to play to get us there.
Here in the UK, the number of reported homophobic hate crime cases almost trebled from 2014 to 2020, more than 24 per cent of homeless young people are LGBT+ with the majority made homeless after coming out to their parents, and lockdown has resulted in unique problems for some LGBT+ people facing discrimination at home.
Health inequalities for LGBT+ people
LGBT+ history month is not only relevant to LGBT+ people or those who consider themselves allies of the community, it is relevant to each and every one of us in the NHS due to the disproportionate health inequalities LGBT+ people face.
NHS England and NHS Improvement are clear: "The evidence that LGBT people have disproportionately worse health outcomes and experiences of healthcare is both compelling and consistent. With almost every measure we look at LGBT communities fare worse than others." In a national 2017 survey quoted below, some of the reasons for this are apparent:
- at least 16 per cent of survey respondents who accessed or tried to access public health services had a negative experience because of their sexual orientation, and at least 38% had a negative experience because of their gender identity
- 51 per cent of survey respondents who accessed or tried to access mental health services said they had to wait too long, 27% were worried, anxious or embarrassed about going and 16 per cent said their GP was not supportive
- 80 per cent of transgender respondents who accessed or tried to access gender identity clinics said it was not easy, with long waiting times the most common barrier.
There is also emerging evidence from the United States that Covid-19 may have a disproportionate impact on LGBT+ people at a population level, with a study published by the CDC finding that: "Because of longstanding social inequities and higher prevalence of several underlying health conditions, sexual minority populations might be vulnerable to Covid-19 acquisition and associated severe outcomes, and this vulnerability might be magnified when coupled with other demographic characteristics such as race/ethnicity."
The role of healthcare providers in making a difference
Stonewall, a leading LGBT+ charity, underline that healthcare providers have a key role to play: "By ensuring that health and social care providers understand and feel confident to meet the needs of LGBT people in their care, we can tackle the persisting health inequalities experienced by our community." Each of us as individuals, teams and organisations have a duty to our patients and can play a key role in improving the experiences of LGBT+ people. One way in which NHS workers can show their support for LGBT+ patients and colleagues is to wear an NHS Rainbow Badge, to signify that you can and will offer support to staff, patients, families, friends and visitors who identify as LGBT+.
At Imperial College Healthcare NHS Trust, we continue to develop and enact comprehensive strategies to make the organisation an equal, diverse and inclusive place to work through our equality, diversity and inclusion committee. Our LGBT+ network aims to connect staff across the trust, focus on reducing health inequalities and improve patient experience of our LGBT+ service users. Recently, we were honoured to feature in Attitude magazine and receive the first ever Attitude Community Award on behalf of LGBT+ NHS workers. As an organisation, we are also striving to become a recognised inclusive employer for the LGBT+ community by achieving Stonewall accreditation in the future.
NHS organisations are anchor institutions rooted in the communities of the populations they serve, with significant influence on their health and wellbeing. It is vital that in recognising their cornerstone role in society, NHS organisations strive to ensure the best possible health outcomes for everyone including those from more marginalised groups.
"NHS organisations are anchor institutions rooted in the communities of the populations they serve, with significant influence on their health and wellbeing. It is vital that in recognising their cornerstone role in society, NHS organisations strive to ensure the best possible health outcomes for everyone including those from more marginalised groups."
This has been of fundamental significance throughout the Covid-19 pandemic with recognition and now greater understanding of the disproportionate impact that Covid-19 has on Black, Asian and minority ethnic groups. However, to truly ensure a reduction of health inequalities in post-pandemic Britain, NHS organisations should be innovative by not just considering access and outcomes inequalities in clinical aspects of their work, but also positively leveraging other elements of their role within their community. For instance, developing apprenticeship and employment schemes specifically for people from minority groups who are likely to face greater challenges – especially socially disadvantaged young people – or choosing to partner with local businesses and start-ups to provide their on-site cafés rather than multi-million-pound franchises.
LGBT+ history month is a moment to claim our past, celebrate our present and create our future. The last 12 months have been characterised by hardship and uncertainty, with many marginalised and lower socioeconomic communities more greatly affected, making our future work against health inequalities even more challenging – and no clear end is yet in sight. As we move forwards, NHS organisations must redouble their efforts to address these challenges, using uncertainty as an opportunity for innovation, and strengthening their ties with all those communities they exist to serve.
This article was initially published as part of NHS Providers' inclusive leadership series