Lesbian, Bisexual and Trans Women’s Health Inequalities
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The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)
I congratulate the hon. Member for Livingston (Hannah Bardell) on securing this debate and on the sensitive but frank way she has approached it. We came into this place together, and I am grateful to her for the way she has given a voice to other women. As the hon. Member for Ellesmere Port and Neston (Justin Madders) said, that is the theme this year, and as my hon. Friend the Member for Reigate (Crispin Blunt) said, having this debate on the Floor of the House and giving a voice to those who feel their voice is not heard sufficiently is something we really can do. It was great to see hon. Members from all four nations coming together in the Chamber today to give a voice to the LBT community.
I have drawn from the contributions of all hon. Members a selection of themes, especially around mental health barriers and discrimination. As the hon. Member for Livingston said, we are on a journey. My hon. Friend said we were making history today, but history is yesterday; tomorrow is the future, and that is where we need to refocus and start to deliver. I thank him, the hon. Member for Sheffield, Hallam (Olivia Blake), my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer) and the hon. Member for North Down (Stephen Farry) for their considered contributions.
We have heard about the challenges facing those for whom life is so tough they think of taking their own lives —I know that the 52% figure, which the hon. Member for Livingston mentioned, is for Scotland, but the figures do not vary particularly across the nations—and about the higher rates of self-harm and eating disorders, and the barriers to conversations about people’s health that can prevent them from taking responsibility for their health and the effect that can have on general wellbeing. I pay tribute, as several Members did, to the charities and institutions working hard, day after day, to give people a voice and provide better access to services.
As my hon. Friend the Member for Reigate said, the global LGBT rights position is very different. We have made great strides in legislation in this country, but health outcomes are the key. Individuals should not have to fit the system; the system should adapt to them, because if it does not feel right or give the right outcomes, it is highly unlikely they will access it in the right way. My hon. Friend also highlighted the lack of training, and the fact that it was a mainstream problem throughout the healthcare system—as the hon. Member for Sheffield, Hallam also did, very eloquently. He pointed out that this was a challenge for all elements of the healthcare profession, from general practice and nurses to social care and care towards the end of life.
I thank my hon. Friend the Member for Runnymede and Weybridge for making such an informed speech. “Recognising the minorities within the minority” is a phrase that I will take away. He mentioned intersectionality. Stigma does ruin lives, and compounds issues involving gender, sexuality and a plethora of other matters before people even reach the point of access to services.
I was struck by my hon. Friend’s comment about the need to tailor services to the needs of the communities whom we serve. I have been up and down the country, but I particularly remember sitting and talking to people at a charity in Manchester. I learnt that young people in particular will often move towards towns because they feel that services will be better, that there is a degree of invisibility, or that there will be others there with whom they have some connection. So tailoring services in a more compassionate and reasoned way should be at the front and centre of what we do.
In his frank speech, the hon. Member for North Down described how many challenges still exist, but made it clear that if we all work together it will be much easier to overcome that. I noted what he said about the need for a better understanding of the guidelines, and about the position of women who find themselves in need of a termination having suffered sexual crimes and abuse. The beauty of these debates is that sometimes we are given something to think about something that we may not have thought about before.
As we have heard, the debate is timely, given that this is National Lesbian, Bisexual and Trans Women’s Health Week. We have made great strides in advancing equality for LGBT people, from changing the law to allow same-sex couples to marry to introducing the world’s first transgender action plan in 2011. However, we know that we must maintain the progress, and continue to work together on implementing the LGBT action plan.
It is only right that all of us, irrespective of gender or sexual orientation, are able to lead happy and fulfilling lives, with equal opportunities and without fear of discrimination—lives that allow us to look forward to what we have ahead of us, and not back to what we might have missed. People should be able to access healthcare free of discrimination and on the basis of who they really are, and we should ensure that education helps all those in the health sphere to deliver.
Back in 2017 the Government launched a national survey targeting LGBT individuals in order to understand better the real issues impacting communities. Attracting some 108,000 responses, it remains the largest national survey of its kind. My hon. Friend the Member for Reigate spoke very well about that. Such an overwhelming response is a clear demonstration of the strength of feeling in the LGBT community among people who want to be heard and to make a difference wherever they live in the UK, in inner cities or rurally. Living in a rural village can be more isolating then living in a town or city.
In response to that survey, we committed ourselves to bold action, publishing the LGBT action plan in July 2018. It acknowledged the need for a cross-Government approach to tackling inequality. The plan, led by the Government Equalities Office, highlighted key areas of focus including health, education and safety among others. For the purposes of this debate, I will focus on the health commitments.
It is unacceptable that, as the evidence shows, LGBT individuals face significant inequalities, especially in their health outcomes. The provision of comprehensive health and social care for all, irrespective of gender or sexual orientation, remains a cornerstone of the national health service, and one to which we remain committed. Delivery of our health commitments outlined in the LGBT action plan remains a priority for us. We have made significant progress, including appointing the first national LGBT health adviser, Dr Michael Brady. To answer the question put by the hon. Member for Ellesmere Port and Neston, the Secretary of State for Health and Social Care gave a commitment to the Women and Equalities Committee last July that the health adviser’s role would continue beyond March this year. Final arrangements to confirm that are currently being agreed with NHSE&I. Starting to identify the organisations best able to deliver adult gender dysphoria services and funding the Royal College of Physicians to develop the UK’s first accredited training course in gender medicine are examples of the significant progress that we have made.
It is worth reflecting for a minute on the appointment of Dr Brady, who is a sexual health and HIV consultant at King’s College Hospital, as well as medical director of the Terrence Higgins Trust. He remains committed to working across the NHS and to ensuring that the needs of LGBT people are considered throughout the health service. He is passionate about the creation of a workforce equipped with the relevant knowledge and skills to enable them to better deliver patient care that is focused on the needs of individuals. We have heard repeatedly this afternoon that the individual is sometimes lost when they are trying to access healthcare out there. I would like to take this opportunity to thank him and his team for their continued efforts and dedication in driving that work forward.
We have focused on the needs of the community as a whole, but it is important that we do not fall into the trap of thinking that this is a homogenous group. That was something that my hon. Friend the Member for Runnymede and Weybridge bought up. I recognise that we must think carefully about different needs, including understanding the needs of lesbian, bisexual and trans women within their own communities. It is vital that we develop a sound evidence base to support future policy improvements. That will also help with the education of others, because unless we can explain why we are doing something, it is hard to train others in why they should be doing it.
I have heard the concerns about the lack of data on sexual orientation and the impact of this on evidence-based policy decisions. We know that robust data collection on sexual orientation enables policy makers, commissioners and providers to better identify potential health risks. We can then provide targeted preventive early interventions to address health inequalities. As with most things, when these issues are tackled early, there is often much less consequential damage further down the line.
The national LGBT health adviser continues to lead on the introduction of effective sexual orientation, gender identity and trans status monitoring across the NHS and social care system. That is no easy task. It is imperative that lessons are learned from the previous sexual orientation monitoring information standard pilot, and that the work is aligned across Government. The national adviser plans to relaunch the SOM across the system to raise awareness about why we need to collect data on sexual orientation and how we share the learning from areas that are already implementing things successfully. If we can learn from best practice, we should do so. I understand that progress on this seems slower than some would hope, but we want to make this happen in the most effective way in order to reduce health inequalities.
Access to, and the provision of, mental health services for LBT people is constantly reported as a major inequality. The GP patient survey last year found that lesbian women were nearly three times as likely, and bisexual women more than four times as likely, as heterosexual women to report a long-term mental health condition. As the hon. Member for Livingston articulated so well, this has a real effect on real lives. I firmly believe that the publication of the NHS long-term plan and the actions it contains will enable us to better identify such inequalities and implement tailored interventions. Local areas are being supported to redesign and reorganise core community mental health teams, and to move towards more place-based, multidisciplinary services that align with the primary care networks.
We remain focused on the need to reduce suicide across the LGBT community, while recognising that today we are talking specifically about women. There are several cross-Government initiatives, including the national suicide prevention strategy, the cross-Government suicide prevention workplan, which was published in January 2019, and the local authority suicide prevention plans. Suicide and self-harm is more prevalent among LGBT communities. It should not surprise anyone that the right to be happy includes being able to be who you are.
I recognise that there is concern about access to screening programmes, particularly for the trans community and for trans women in particular, and that that might lead to poorer outcomes for this population group. It is imperative that all groups are treated with dignity and respect at all times, and that they should not fear embarrassment or intrusive questions when accessing such services. The focus must be on ensuring that trans and non-binary people are aware of the screening programmes for which they are eligible, and understand those to which they will not routinely be invited. Public Health England’s comprehensive screening leaflet, “Information for trans people”, aims to improve accessibility to screening for trans and non-binary individuals. It has been developed in collaboration with NHS Choices and representatives of the trans community.
As I am sure many Members are aware, there has been a significant increase in demand for adult gender identity services. These crucial NHS services treat individuals with gender dysphoria, whereby they experience distress and discomfort due to a mismatch between their biological and gender identity. In response, NHS England launched an ambitious programme of work to tackle waiting times and improve access—which I know is still challenging —setting out places to establish new gender services in primary and community settings, and increasing the amount of surgical services and the number of gender dysphoria clinics. That is critical if the Government are to achieve their ambition to support everyone, irrespective of gender and sexual orientation, to live a happy and healthy life.
In conclusion, it is clear that, while we have made significant progress, there is still much more to do. As the hon. Member for North Down (Stephen Farry) said, we are all the same, no matter where we live in the UK. I reiterate that the Government have made real progress and we will continue to make a positive change. I am sure that the House is united on the need to reduce LGBT health inequalities. We all have the right to have our healthcare needs met. The contributions made to this debate will undoubtedly help drive forward our commitment and keep us focused.