Lesbian, Bisexual and Trans Women’s Health Inequalities

Ben Spencer Excerpts

Tuesday 10th March 2020 Commons Chamber

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

I thank Members across the House for some very powerful speeches. It is always an invidious task to single out individual ones, but the hon. Member for Livingston (Hannah Bardell) spoke very powerfully when she opened the debate.

I have a declaration of interests of sorts to make. Before being elected to this place, I worked as an NHS doctor specialising in mental health. For almost eight months or so, I was an in-patient consultant looking after women with psychiatric problems and I looked after quite a few bisexual, trans and lesbian women. I went on to work as an HIV mental health specialist in south-east London, where, as Members will understand, these issues are relevant.

Today’s debate highlights the importance of understanding and addressing health inequalities wherever they are. We must ensure that everyone has access to great opportunities, with a safety net when things do not go to plan. The health service and our public services in general are a key part of that. That means breaking down barriers to accessing those opportunities and services. I wish to focus a bit today on stigma, research and tailored services.

As we have heard today, LGBT health inequalities need to be addressed, but to do so we first need to understand why they exist. This debate focuses specifically on lesbian, bisexual and trans women’s health inequalities, raising an important and often overlooked point about the LGBT community: the assumption that the LGBT community is one community with one set of needs. If we are to address inequalities, we must also understand complexity. We must tailor our services to support and reflect the communities in which we live. For example, many black, Asian and minority ethnic women face different cultural pressures from those of white Europeans, which can affect their ability or willingness to access services. With regard to the LGBT community, we must recognise “the minorities within the minority”.

On the recent report by the all-party group on HIV/AIDS, I am in a rather unusual position: I was a witness providing evidence for the report when I worked as a doctor and I went on to become an officer of the group, after I was elected. I do not know whether I am the first, but I would be interested to hear whether other people have had similar experiences in engaging with all-party groups. The report found that a key contributor to inequality is the stigma that many people still face.

Stigma ruins lives. Many communities still view sexual orientation and gender identity issues as shameful or dishonourable. More than 70 jurisdictions around the world still criminalise same-sex consensual relationships and fear of these views can prevent those who need help and support from seeking it. Those suffering from mental health problems also face stigma. When these issues overlap, people can feel increasingly marginalised and isolated. The point about intersectionality was well made by the hon. Member for Livingston. It is a crucial issue.

Mental health issues, in particular, disproportionately affect people who are more vulnerable, marginalised and suffer from socioeconomic deprivation, including LGBT communities. Although health inequalities among the LGBT community are well documented, they are not well researched or understood, especially the intersectionality element of that, which, as I say, is a huge issue. This lack of data perpetuates stereotypes. A good point was made about NHS stereotypes. The service that I used to work for submitted to the all-party group on HIV/AIDS concerns about anecdotal stories of NHS workers having awful stereotypes about people accessing their services. That is an area where we need to seek out, educate and transform. It is sad that that still exists.

Most of the research that does exist in this area is on men’s health and it is predominantly focused on HIV and sexual health. Sexual inequality debates usually focus on sexual health and wellbeing, overlooking inequalities such as access to mental health services, drug and alcohol services and the like. For lesbian, bisexual and trans women, there is even less awareness and understanding. Inequalities for these women include pregnancy and reproductive health issues: for example, they are more likely to miss cervical screening, as has already been mentioned.

In order to fully understand LGBT health inequalities, we need more detailed clinical research and data. With improved understanding must also come improved tailoring of services. Multiple complicated issues, such as those experienced by the LGBT community, are often exacerbated by a lack of integrated care. Research published by Stonewall in 2018 found that 52% of LGBT people experienced depression. For lesbian, bisexual and trans women struggling with reproductive issues, the challenge is accessing both physical and mental health services in a clear and co-ordinated way.

The move towards sustainability and transformation partnerships in the NHS in 2015 was a step in the right direction. It is now vital that these partnerships develop into integrated care systems to deliver on the Government’s NHS long-term plan. I congratulate the 14 areas in England that have already become—or are near to becoming—integrated care systems, including Surrey Heartlands health and care partnership, which looks after my constituency of Runnymede and Weybridge. However, I urge the Government to ensure that all sustainability and transformation partnerships meet the April 2021 deadline to become integrated care systems, so that all our residents can benefit from integrated services that operate in the community and are tailored for the communities they serve. These changes are an opportunity to break down barriers, and to provide a comprehensive, inclusive and co-operative approach to the services we deliver.

Only by engaging and learning from our communities can we understand the inequalities that they face. Only by ensuring fully integrated health services can we address the inequalities affecting minorities such as lesbian, bisexual and trans women. Only by addressing those inequalities can we ensure that everyone has equal access to the support services and opportunities they need.