LGBT+ People and Spouses: Social Care

Tuesday 12th September 2023 Westminster Hall

16:30

[Helen Hayes (Dulwich and West Norwood) (Lab)]

I beg to move,

That this House has considered the treatment of LGBT+ people and their spouses in social care settings.

It is a pleasure to serve under your chairmanship, Sir Robert. I sought this debate because of the horrific experience of my constituent Ted Brown and his late partner, Noel Glynn. Ted is present in the Public Gallery this afternoon. Ted and Noel were together for almost 50 years. They met at the first Gay Pride event in 1972, which Ted helped to organise. They were civil partners; they were devoted to each other. Sadly, Noel developed dementia in older age and, in 2018, he was placed in Albany Lodge care home in Croydon after Lambeth Council was unable to find a place in a care home any closer to Ted in Brixton.

One day, Ted noticed that Noel had suffered bruising and a cigarette burn to the back of his hand, and two whistleblowers at Albany Lodge confirmed that Noel was being subjected to homophobic abuse from some of the staff. The whistleblowers recounted two staff members asking him, “Are you a gay man? Do you like gay men?” before dragging him to his room, where other residents heard a disturbance going on and Noel’s voice. In January 2019, Noel told a social worker, “I don’t like it here—they beat me up”. The social worker recommended moving Noel to another care home, but he remained at Albany Lodge for nine more months. Throughout that time, Ted was paying £1,400 a month to Albany Lodge for Noel’s care. Ted told me that staff at the care home refused to recognise his relationship with Noel, and that he was warned by two other LGBT residents in the home not to tell staff that they were a couple, because, “It won’t be good for either of you”.

Noel was a vulnerable man with dementia. He should have been safe in Albany Lodge. The abuse he suffered was horrific and inexcusable, and it was a clear breach of his human rights. That was recognised in a court judgment against Lambeth Council, which placed Noel in Albany Lodge, that awarded the couple £30,000 in compensation. Sadly, Noel died in 2021 before the compensation was paid.

Ted told me that when Noel was first placed in Albany Lodge, there was a delay in undertaking a necessary medical assessment. He contacted the care home to chase this on Noel’s behalf and received an email notifying him that an assessment would be done that day on his father. He was not invited to attend this appointment, which would usually be supported by a spouse or close family member since the aim of the assessment was to gather information about the person’s health history, including matters such as allergies and eating habits. Noel, by then, had dementia.

Ted went to the home anyway and was initially not allowed into the room with Noel, despite bringing documents demonstrating their civil partnership, his power of attorney for Noel and evidence that they had been partners for 49 years. As Ted waited outside the room, he could hear Noel calling out for him. This utterly distressing situation speaks to a total lack of dignity for LGBT+ couples in the care system that urgently needs to be addressed. Prior to being admitted to Albany Lodge, Noel initially received care at home. Ted believes that Noel was also subjected to homophobic abuse by one of the carers, who he observed treating him roughly. In an indication that these experiences are not at all uncommon, Ted also told me that prior to the carers coming in, he had been warned by a friend to remove all traces of his relationship with Noel as a couple from their home.

In a report titled “Stripped of all Pride”, Compassion in Care documented 486 reports of homophobic abuse in care settings and of LGBT+ staff who were afraid to disclose their sexuality. I strongly encourage the Minister to read the report, if he has not already done so; the testimonies are shocking and devastating. One whistleblower wrote:

“There was one gay resident in the home, staff were so cruel to them, some staff treated this poor man as if he had something catching. I saw one staff member spit on this man whilst telling him to repent as he was a filthy pervert. Another staff member slapped this man around the back of his head, really hard. I reported it, I was horrified. The staff started shouting at me are you a pervert lover? Are you gay? Nothing was done, I went to the authorities and left”.

That is hate crime, happening behind closed doors and being perpetrated against some of the most vulnerable people. There are many similarly shocking testimonies in the Compassion in Care report.

[Tulip Siddiq (Hampstead and Kilburn) (Lab)]

My hon. Friend is giving a powerful and emotional account of her constituents. I welcome Ted to the Chamber; I wish it was under happier circumstances. I want to raise something that happened in my constituency a few years ago. A gay couple were taunted with offensive and degrading questions about their sexuality on a bus in West Hampstead. They were then brutally attacked. It was in the news, so my hon. Friend might have heard about it. This year, Rainbow Europe announced that the UK has fallen to 17th place in terms of safety for LGBTQ people. Nine years ago, it was in first place. Does my hon. Friend agree that crimes that are targeted at someone’s LGBTQ identity should have tougher sentences?

[Helen Hayes]

I thank my hon. Friend for her intervention and for raising that shocking case, which I remember from media reports at the time. We cannot ever take progress on equality for granted, and it is vital that we take seriously that drop in protections for LGBTQ+ people and that the current increase in hate crime is met with the toughest possible sanctions that can be delivered.

Perhaps even more shocking than the testimonies in the Compassion in Care report is the fact that, of the 486 services involved in the testimonies, 481 were still rated as good by the Care Quality Commission. A 2016 CQC-commissioned report found that older people were hiding their sexual orientation and gender identity because of fears of discrimination. The abuse that Noel suffered and the abuse documented by Compassion in Care are utterly abhorrent, and there should be no place for them anywhere, still less in settings that are trusted to look after our most vulnerable loved ones—older people who are physically frail or suffering the disorientation of dementia.

For the current generation of older LGBTQ+ people, such abuse can also be a re-traumatisation. Those aged 75 and older were adults before homosexuality was decriminalised in 1967. They lived through the long years of section 28, have experienced life in a deeply homophobic society, are very likely to have spent a significant period of time concealing their sexuality, and have lived through the trauma of the HIV/AIDS epidemic—suffering the loss of much-loved partners, friends and community members while society stigmatised them. Older people who are LGBTQ+ are also disproportionately likely to have become estranged from family members and may lack people around them to advocate on their behalf in the care system.

I am particularly concerned about the poor response to Noel’s case. Once the horrific abuse he suffered was identified, it should have been the job of the care home, the local authority, the CQC and the Government to ensure that it could never happen again, but the reality was far from that. When Noel’s abuse was reported, staff were suspended, but Ted understands that they were allowed to return to work on a different floor of the same home. Following inspections in 2019 and again this year, the CQC continued to rate Albany Lodge as good. The fact that one local authority placed Noel in a care home in a different local authority has also presented problems in ensuring accountability.

No one should have to fear that they or a loved one will be abused in a place that has a responsibility to care for them. No one should have to fear that their sexuality or gender identity might result in such abuse. In 2016, the CQC recommended that commissioners, providers, and health and care staff should

“consider the needs of LGBT people in planning and delivering end of life care services”,

that health and care staff should

“communicate openly and sensitively about sexual orientation and gender identity as a routine part of their delivering good quality, personalised end of life care”

and that commissioners and providers should

“collect data on sexual orientation and gender identity as part of an equalities approach to monitoring end of life care outcomes.”

The Government also mentioned the need for improved monitoring in their 2018 LGBT action plan, but there is little evidence of progress. There are examples of good practice, both in the delivery of LGBT affirmative retirement housing, such as Tonic Housing in Lambeth, and in the Pride in Care quality standard championed by Care England, but it is unacceptable that monitoring the experiences of LGBT+ residents is not a mainstream part of CQC assessments. Albany Lodge should not have continued to be rated “good” while an LGBT resident was being abused under its roof, and it certainly should not have continued to be rated “good” after that abuse had come to light.

What progress does the Minister believe has been made following the publication of the Government’s LGBT action plan five years ago in 2018? What action is he taking to protect the rights of LGBTQ+ residents in adult social care? Will the Government ensure that gathering the experiences of LGBTQ+ residents and their spouses forms part of the CQC inspection framework for care homes? Will he take steps to ensure that no care home or care agency found to have allowed homophobic, biphobic or transphobic abuse can continue to be rated “good” by the CQC? Will he consider further support to roll out the Pride in Care quality standard to more care homes across the country?

When Ted spoke with me about Noel’s experience, he told me about the guilt he feels about being unable to protect the man he loved from abuse. I am sure all of us can understand that guilt, even though it is entirely misplaced. Ted should have been able to trust Albany Lodge to care for Noel and that trust was fundamentally broken. We cannot undo what happened to Noel, but we can work to ensure that it does not happen to anyone else. I hope that the Minister will set out the meaningful action that he will take to this end.

16:42

[Rachael Maskell (York Central) (Lab/Co-op)]

It is a pleasure to serve under you in the Chair, Sir Robert. I pay tribute to my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes) for her powerful advocacy for both Ted and Noel. It was shocking and very difficult listening, and she was eloquent and forceful in making the case to support LGBT people in social care.

I am grateful for the work of York LGBT Forum. It has tirelessly campaigned for the rights of LGBTQ people across the community. It engages with stakeholders to advance the rights of LGBT people across the city and the region. As part of its “Free to be Me” work in social care, the forum is hosting a seminar this coming Friday entitled “Don’t Leave Me in Silence” reflecting on the experiences of people in social care. I spoke to one member last weekend and she talked through the work she had engaged with, and it echoed the inquiry the all-party parliamentary group for ageing and older people, of which I am chair, undertook a few years ago, which recognised the importance of identifying the social care needs of LGBT+ people and their partners.

In the session, which was held in Parliament, we heard how partners were often ignored in social care settings, not least when determining the wishes of their loved ones in care. We heard how, on so many occasions, they were unable to communicate the needs of their relationships before they entered care—instead becoming a distant friend. People in care often felt that they could not even put a picture of their partner up in their room, almost eradicating the memory of their relationship. We heard the distress, the loss of identity and how they felt shame, not to mention their facing some pretty intrusive questioning, too.

With good social care, this should not be an issue. On entering a care setting, a relationship should be established that takes all the needs of individuals into account. It does not take much to ask what someone’s requirements are and who their family is, and to ensure that their family is honoured. It is a central part of care. It is what care is: recognising the human, not just the physical, needs that someone has. It does not take much to ask, and it does not cost much to train staff.

LGBT+ awareness training would significantly enhance the experience of LGBT people in care. The CQC should monitor the training that staff have, and the Skills for Care workforce, which has set out a learning framework, should review that framework, not least in the light of today’s debate, and ensure that it is rolled out to all care settings. It should be a marker that the CQC looks for when examining care settings.

Recently, I talked to a constituent who was still at home and seriously ill. She knew that in the not-too-distant future her time would come for more intense care. She asked that she would be in a setting that recognised her gender identity; she feared being placed in one that would recognise only her birth identity. Such dying wishes must be honoured. That is about respect for the individual and understanding their care needs. It is about ensuring that they are cared for holistically and that they and their families are given the time, care and support that they need. It is about listening; it is about acting. I heard one story about someone who started to be dressed in the clothing that represented their birth gender identity, because no one had taken the time to listen. That cannot be a matter for a care facility to determine; it is a matter for the individual and their family.

This debate has focused on the family, but it is worth remembering that many LGBT+ people may not have family. The chair of York’s Ageing Well Without Children, or AWOC, Sue Lister, has explored what it means for individuals who might not have family at all, or whose partner has passed. She wrote a poem, which I would like to close with today. It is called “Lesbian Loneliness”. It is written about a care setting:

“Magnolia walls house the non-absorbent thrones.

Dry voices whisper round the walls like leaves that fall unnoticed.

Uniformed bursts of energy swirl according to the clock

Bringing this, taking that.

Weathered skin, brittle bones, ghosts of the past

Gather on these barren shores.

My life, my love, has passed away, leaving me hung upon the thorns of grief in a waste of loneliness.

Unspoken. Living too long in the shadow of social shame

I dare not rock the boat and she is buried forever.

‘My love’ I cry in the dark hours and hold her in my heart

By day I pass as an ordinary old woman.”

16:47

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Robert, and to respond to the debate on behalf of the shadow Health and Social Care team in my first outing as the newly appointed shadow Minister of State for Social Care. It is always good to see the Minister for Public Health in his place.

I sincerely thank my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes) for securing the debate and for all her work on this important subject. Her contribution this afternoon was heartbreaking —the way in which her constituent was treated was utterly shameful. I also thank my hon. Friend the Member for York Central (Rachael Maskell) for her contribution. She ended on such a powerful poem, which speaks to so many who suffer in care home settings.

The Care Quality Commission guidance for all providers of adult social care clearly states that people using care services

“must not be discriminated against in any way and the provider must take account of protected characteristics, set out in the Equality Act 2010.”

As we have heard today and as we know from other studies, however, that is not always the case.

A survey conducted in 2017 found that 23% of open LGBT+ respondents who had been in a care home or other form of institutional care reported that being gay, trans, bisexual or lesbian, or having other protected characteristics, had a negative effect on the care that they received. Those examples are varied, but each and every one of them is concerning. Some respondents to the 2017 survey said that they felt invisible. Other responses related to use of language—for example the assumption that a partner or spouse is of the opposite sex, when that is not necessarily the case.

At their worst, the experiences of LGBT+ people in care home settings can be traumatic, as demonstrated by the story of Noel Glynn and his partner Ted Brown, who is a constituent of my hon. Friend the Member for Dulwich and West Norwood. Before he died, it is reported that Mr Glynn, who had dementia, suffered bruising across his body and had a cigarette burn on the back of his hand because of abuse from care staff. Other residents warned his partner Ted not to reveal to staff that he and Noel were a couple, saying, “That won’t be good for either of you”.

Mr Glynn and Mr Brown sued Lambeth Council, but Mr Glynn very sadly died before any compensatory payments were made. This case is beyond abhorrent. I hope the Minister will set out how it happened and what steps the Government are taking to ensure that it never happens again. The Minister will know that the Care Quality Commission does not currently consider the extent of homophobia or transphobia in inspections, despite its fundamental standards. Following this case, will the Minister look again at that guidance?

More generally, what this issue comes down to is the importance of personalised care. A report by the Women and Equalities Committee published in 2019 points to research showing that 72% of care workers do not consider sexual orientation to be relevant to one’s health needs. That same report states that

“most health and social care professionals feel under-equipped to deal with LGBT people’s needs rather than intentionally discriminating.”

The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 are clear on this subject. Regulation 9 states that people using a service should have care or treatment that is personalised specifically for them. It is important that care providers respond to the serious concerns raised by LGBT+ people and ensure that those accessing services feel respected and safe, and benefit from care that is tailored to their needs.

My questions to the Minister are as follows. Given the extraordinary shortages in adult social care staff—sitting at around 165,000—what work are he and his Department doing to protect the principle of personalised care? Further, what steps is the Department taking to monitor the experiences of LGBT+ people in social care settings? In the 2018 LGBT action plan, the Government pledged to develop best-practice guidance for monitoring and to make this openly available to the public sector. Why were these pledges not implemented? Have they simply been abandoned alongside a plethora of other Government commitments, from banning conversion therapy to tackling waiting lists? Finally, LGBT+ organisations have called for better guidelines and staff training for those working in care settings. Can the Minister outline whether the Government support these calls?

The next Labour Government will address the vacancies in social care by delivering a new deal for care workers, guaranteeing fair pay, training, terms and conditions and career progression.

[Richard Foord (Tiverton and Honiton) (LD)]

I am curious to know from the shadow Minister what fair pay in the social care sector would be. What does he think of the Liberal Democrat proposal to pitch an additional £2 per hour minimum wage for social care workers?

[Andrew Gwynne]

If the hon. Gentleman had been at the TUC conference today, he would have heard the shadow Deputy Prime Minister, my right hon. Friend the Member for Ashton-under-Lyne (Angela Rayner), outline precisely what Labour’s fair pay deal will be for the social care sector, but we need to go beyond that. We need to ensure that social care becomes a valued profession again, rather than just assuming that agency staff can fill the vacancies. We need to make sure that social care once again has parity with the rest of the healthcare system and that care workers want to work in the care sector not just because of pay, terms and conditions, but because it is a profession—which, sadly, many feel it no longer is.

We will work in partnership with users and families and develop a set of national standards based on existing minimum entitlements and legal rights, including legal rights that exist in the Equality Act 2010—a piece of legislation of which I am fiercely proud, and which the last Labour Government took through Parliament and put on the statute book. We need to make sure that all service delivery, particularly in social care, meets the ambitions and legal expectations of the Equality Act—sadly, that has let down so many LGBT+ people in the social care sector, as we have seen from the statistics in the surveys that I have cited this afternoon.

We would also ensure that our commitment to raise standards right across the sector is upheld by requiring all care providers to demonstrate financial sustainability and, crucially for this debate, to deliver high quality care for service users before they are allowed to receive contracts from local authorities, making sure that local authorities commission care providers who are capable of delivering the care that people need at the standard we should expect. That would result in more personalised and ultimately higher-quality care for all individuals.

In 2023 people who are lesbian, gay, bisexual, trans and others should not feel ostracised by a system that is there to support them. They should not feel ignored and that their personal needs are not being met. Ultimately, they should not feel the need to hide the fact that they are gay, lesbian, bisexual, trans or other. I hope that the Minister will agree with me that we can get to work on delivering that higher standard of care for all service users. The testimony that we have heard today from my hon. Friend the Member for Dulwich and West Norwood should stand as that end point. Never again should somebody from the LGBT+ community be treated as we have heard. “Never again” should be more than a slogan. It should be deeds.

16:58

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O'Brien)]

It is a pleasure to serve under your chairmanship, Sir Robert. I apologise if this important debate is interrupted by a vote. I also apologise for the fact that my colleague the Minister for Social Care, my hon. Friend the Member for Faversham and Mid Kent (Helen Whately), has been in a car accident and cannot be here today.

I pay tribute to the hon. Member for Dulwich and West Norwood (Helen Hayes) for securing this debate on a hugely important issue, which is only likely to grow in importance over time. I express my sympathy to Ted for the appalling, abhorrent experience that he and Noel suffered. I am glad that compensation has been paid, although it is not enough, and I am happy to continue to discuss that case with the hon. Lady and her constituent after this debate.

People have a right to live in safety, free from abuse and neglect, and they should expect high-quality care and tailored support to meet their personal care needs. Nobody should be disadvantaged due to their background, sexual orientation, gender identity, culture or community.

The hon. Member for Denton and Reddish (Andrew Gwynne) has mentioned some of the guidance and the clear recent legislation we have passed to ensure that is the case. Care workers, social workers and everyone working in social care need to be sensitive to people’s individual needs and circumstances, including their sexual orientation and gender identity. It is vital they have the confidence to discuss individuals’ differences to find out how they can best provide care and meet individuals’ needs.

I want to thank our amazing social care workforce, who work tirelessly to deliver high-quality care to individuals. It is important to recognise the hard and brilliant work of the social care workforce, even though today we are talking about some horrendous failures in social care, where things have not gone right, as highlighted in a report by Compassion In Care that has been mentioned several times and which is called “Stripped of all Pride”. I read the report and found it absolutely harrowing. Some of the cases discussed are almost unbelievable. The report shines a spotlight on how LGBT people are subject to prejudices and biases, potentially from the workforce and, if they are in the workforce, from people receiving care. I want to pay tribute to the whistleblowers who spoke to that people working on that report for speaking out against the abuse and vulnerability they face, not just in the case of Ted and Noel but across the country. It is vital that LGBT people are free to live and work in care homes where the culture is inclusive and respectful.

Many people who require care and support may not have children; not just LGBT people but, as the hon. Member for York Central (Rachael Maskell) pointed out, other people too. It is essential that we have strong systems to protect them and we do not just rely on other friends and family members to pick up discrimination or abuse.

Care providers have a key role in safeguarding, and all the relevant care professions are subject to employer checks and controls. Guidance from the National Institute for Health and Care Excellence is clear that care homes must have a safeguarding lead and that they should make sure everyone knows who that is. As part of its inspection regime, the Care Quality Commission checks that care providers have effective systems to keep adults safe from abuse and neglect. I will set out some of those robust processes.

Local authorities have a duty to investigate safeguarding concerns under the Care Act 2014. Anyone who is concerned that an adult with care or support needs is at risk of or experiencing abuse or neglect should contact the provider and the adult safeguarding team in the relevant local authority. If someone is in immediate danger or it is believed that a crime, including hate crimes, has been committed people should contact the police too. Any form of abuse or neglect is unacceptable, and we need a focused and effective safeguarding system.

All social care providers already have a duty to be respectful of an individual’s protected characteristics, including their sexual orientation, and make sure that their staff have the appropriate training to cater for the individuals in their care. In its role, the CQC takes a preventive approach to people experiencing prejudice or abuse, and looking at the quality of care for LGBT people in adult social care has been one of its equality objectives over a number of years. It is important that those who may be more likely to experience discrimination are listened to and have their needs understood by the local authority. That is why, from now on, the CQC will assess equity in outcomes and consider how local authorities ensure that people with protected characteristics under the Equality Act 2010 are understood. The new duty we have created for the CQC to assess local authorities’ delivery of their Care Act duties went live in April 2023, and that will make a big difference in ensuring that those at the authority level are thinking actively and working on this vital issue.

CQC assessment of local authorities will increase transparency so that those who might be more likely to experience discrimination, such as LGBT people, are able to hold their local authority to account. It is not just about raising and enforcing standards; it is about having the resource to provide a good service. That is why I am making the record increase in social care funding that we have set out, with an extra £7.5 billion overall, including nearly £600 million for the workforce development plan, so that we have a high-quality social care workforce as well as strong rules.

Leadership is key to developing an inclusive culture. The funded delivery partner of the Department of Health and Social Care, Skills for Care, has produced resources for care providers to help to develop a stronger awareness of the importance of equality and diversity standards. That helps social care leaders and their teams develop an inclusive and confident approach to diversity. I am aware that there are some providers that cater specifically to the LGBT community, which I think is great, and I want to recognise their important work. The hon. Member for Dulwich and West Norwood mentioned Tonic and I pay tribute to it and others across the country for their work. However, it is not just about them; it is about making sure that social care settings are suitable for everyone, whatever the setting.

I thank the hon. Members who have taken part in this important debate today and for shining a light on this important issue.

[Mr Jonathan Lord (Woking) (Con)]

I congratulate the hon. Member for Dulwich and West Norwood (Helen Hayes) on securing this debate, and on her moving and thoughtful speech. A lot has been said about driving such behaviour out of social care settings, but I wonder whether the Minister might say a little bit about the role that the police might have. We all want a fantastic ethos from social care settings, from local government and from national Government, but even with reasonable recruitment policies and so on, if there are bad apples in the sector, the damage they can do to vulnerable people over years or decades can be quite devastating. We need to make sure that those people are driven out if they get a police record, and are never able to enter that sector again.

[Neil O’Brien]

Absolutely. The police take this issue more and more seriously, which is vital. Some of the things that we have been talking about today, including in the “Stripped of all Pride” report, are clearly criminal offences, and it is important that we bring to justice all the people who do them. There is always much more to do, but the Government take this matter deadly seriously; it is horrific and appalling to hear about some of the treatment that people have experienced, and we are determined to stop that, using every single tool we have.

17:04

[Helen Hayes]

Let me put on record a matter that I should have done at the beginning of my opening speech: I co-chair the all-party parliamentary group on adult social care—apologies for not mentioning that earlier.

I thank my hon. Friend the Member for York Central (Rachael Maskell) for her moving and powerful speech, particularly for the poem with which she finished; sometimes prose is not quite enough to convey the depth of emotion on such issues, but that poem did so very well. I thank my hon. Friend the Member for Denton and Reddish (Andrew Gwynne), who was right to locate this issue within the wider pressures facing social care and to discuss the esteem within which the sector is held. There are many good people working extremely hard every single day to deliver high-quality care, but the pressures of social care, the difficulty local authorities have finding placements and the difficulty of recruitment and retention faced by many organisations certainly do not help with the issues of scrutiny and accountability that we are concerned with today.

Finally, I thank the Minister for the tone of his remarks and his commitment to address the issue. I urge him to look more at an issue that he did not mention in his response: the Pride in Care standard, which shows already what good can look like for LGBTQ+ people in care settings, and can give assurance to relatives looking for care placements for their loved ones that the setting understands and takes seriously the very specific personalisation needed, and the need to ensure absolutely that homophobia, transphobia, discrimination and abuse are eradicated from such settings.

Question put and agreed to.

Resolved,

That this House has considered the treatment of LGBT+ people and their spouses in social care settings.

16:03

Sitting adjourned.