Lesbian, Bisexual and Trans Women’s Health Inequalities

Crispin Blunt Excerpts

Tuesday 10th March 2020 Commons Chamber

[Crispin Blunt (Reigate) (Con)]

May I start by congratulating the hon. Member for Livingston (Hannah Bardell) on securing this debate? I am very pleased, as chair of the all-party parliamentary group on global LGBT+ rights, to support her wholeheartedly. She has made some excellent points. Obviously, her personal testimony is immensely powerful, and her points about the trans issue were extremely well made. I had immediate sympathy with her comments on coming out with political privilege, which describes my own coming out in 2010.

The APPG on global LGBT+ rights is, at present, the only APPG organised in support of such rights. It focuses on global LGBT rights, where the position is very different from that in the United Kingdom. I thank the group’s administrator, Anna Robinson, for her help and the briefing she has afforded colleagues and me for this debate.

I also thank the Backbench Business Committee for allocating time in the Chamber to debate this important subject. This is the first time that lesbian, bisexual and trans women’s health inequalities have received a dedicated debate in this House. The issue was debated in the other place in 2014. This debate is timely because it is National Lesbian, Bisexual and Trans Women’s Health Week. The importance of what began as a civil society initiative was acknowledged in the Chamber last year by the then Minister for Women and Equalities, my right hon. Friend the Member for Portsmouth North (Penny Mordaunt), who I am delighted to see in her place.

Let me try to put this issue in its context in the United Kingdom. This debate is taking place in a Parliament that has more out LGBT MPs than any other. This Parliament, over the past two decades, has gone from equalising the age of consent—which took it five years; I think we were both special advisers when the process began, Madam Deputy Speaker—and being coerced by the European Court of Human Rights to allow LGBT people to serve in the armed forces, to delivering adoption rights, civil partnerships and, finally, equal marriage. All those measures were taken with increasing enthusiasm by Parliament. The legal case for equality in the United Kingdom has been made. I think we can be proud of Parliament’s leadership today in what a former Father of the House, the late Sir Peter Tapsell, who was elected in 1959, rightly described as the most profound social change of his lifetime.

The change has been very profound in my party. Sir Alan Duncan was the first Conservative MP to come out in 2002. Nick Herbert was the first successful out Conservative to be selected in 2005. Yet just 15 years later, the Conservative party now has the largest caucus of out LGBT MPs in Parliament. That change is perhaps reflected in the sensitivity and the priority the Government have given the issue since 2010. It is reflected in the really excellent “LGBT Action Plan 2018”, authored by my right hon. Friend the Member for Portsmouth North, and a year later, the follow-up report. I have not heard it challenged that that is the most comprehensive plan of its kind in the world, and that sets the context for today’s debate.

We have delivered equality in law, but we now need to deliver equality in outcome. Unequal health outcomes are perhaps the most concerning of all. We know that LGBT+ people of all genders still face inequalities when it comes to access to and the provision of health services. Last year, the Women and Equalities Committee, chaired by my right hon. Friend the Member for Basingstoke (Mrs Miller), produced a groundbreaking report on health and social care and LGBT communities, which showed that unacceptable inequalities remain in the provision of health and social care services when it comes to the LGBT community. The report identified that deep inequalities exist in health outcomes for LGBT communities; that LGBT people are expected to fit into health systems that assume they are not LGBT, which has a significant impact on LGBT people’s ability to access the services they require; and while the LGBT community does generally have the same health and social care needs as the rest of the population for the majority of the time, the Committee found that LGBT people do not in fact always receive the same level of service as non-LGBT people. The evidence gathered also illustrated that across many health areas such as smoking, alcohol abuse and even cancer, the LGBT population had poorer health outcomes. The report acknowledges that although few people set out to discriminate, lack of training and knowledge on LGBT communities, coupled with an assumption by many healthcare professionals that sexual orientation and gender identity are not relevant, result in services that are not fully LGBT inclusive.

This debate is about the very specific area of LBT women in particular, and we know that they face particular barriers because of their gender, and when women are older, have disabilities or belong to an ethnic or religious minority, those barriers grow even larger. Those inequalities, as we have heard from the hon. Member for Livingston, take various forms. Lesbian, bisexual and trans women can often face discrimination and poor treatment when accessing general healthcare services. When they have experienced, or expect to experience, inappropriate questions, misgendering or homophobic, biphobic and transphobic comments, as well as ignorance of their health needs, such as incorrectly advising lesbian women they do not need smear tests, it can deter lesbian, bisexual and trans women from accessing healthcare when they need it We also know that the waiting times for gender identity services, averaging a two to three-year wait, are simply too long. Research shows that LBT women experience higher rates of poor mental health, and yet they have significant difficulties in accessing mental health support.

There are other worrying statistics, such as that bi women are more than twice as likely to have cervical cancer as heterosexual women, and lesbian and bi women are more likely to describe themselves as having fair or poor health than heterosexual women. As the Royal College of Obstetricians and Gynaecologists points out, those figures highlight something wrong in the prevention, diagnosis and treatment of those conditions.

In July 2018, the Government published their LGBT survey and action plan, which clearly identified the health disparities facing LGBT people and committed to ensuring that LGBT people’s needs will be at the heart of the national health service. The survey was remarkable: 108,000 people participated, making it the largest survey of LGBT people in the world to date and thus an incredibly valuable resource to understand better the needs of the whole LGBT community.

It is encouraging to see the Government’s focus on delivering some of the health-related commitments in the action plan, which I greatly welcome. The appointment of an LGBT advisory panel made up of representatives from the LGBT field is also a welcome action by the Government, as is the appointment of Dr Michael Brady as the first national adviser on LGBT health. The funding pilot on LGBT health is another initiative that I am sure Members on both sides of the House will welcome, but there is still a vast amount of work to do to close the gap. I will focus on some of the recommendations in the Select Committee report, particularly those relating to LBT women.

First and foremost, we must ensure that, where multiple initiatives, agencies, action plans, advisers and Departments are working on an issue, they do so in a co-ordinated manner to increase their effectiveness. In relation to LBT women’s rights specifically, as well as those of the whole LGBT community, we must ensure that the Government Equalities Office, which has responsibility for the action plan, and the Department of Health and Social Care, which has oversight over the NHS long-term plan, collaborate to ensure that LGBT-inclusive healthcare is mainstreamed across the NHS England strategy and to ensure that its implementation is the responsibility of health and social care institutions, and not solely of the Government Equalities Office.

Those organisations need to ensure that data collection on both sexual orientation and trans status is introduced to prevent health disparities being hidden, and they need to ensure such data collection acknowledges that some women can be lesbian or bisexual and transsexual. The Select Committee report recommends that sexual orientation monitoring should be made mandatory across the NHS, and that there should be a timeline for implementing mandatory monitoring on both sexual orientation and trans status, calling it

“far too important to be an aspiration rather than a concrete goal with clear timelines for delivery.”

I hope today’s debate prompts the Minister to review plans for mandatory monitoring.

In addition, LGBT+ issues are routinely omitted from needs assessments and planning, resulting in a lack of necessary services for the LGBT community. That must change and, given the unique challenges faced by LBT women, special attention must be given to their unique needs. The solution should be simple: all commissioning outcomes frameworks should have the explicit requirement to consider the needs of the LGBT community, with specific consideration of LBT service users.

Equalities training for frontline staff must be improved and made mandatory to ensure high-quality and consistent delivery across all our services. That will empower health professionals to provide appropriate care so that LBT women are treated with the dignity and respect they deserve, as well as helping NHS and social care staff to identify discriminatory behaviour. Initiatives such as the NHS rainbow badge are a welcome start; it should be noted that it was started and continues to be run by individuals at trust level, not by NHS England, but there is clearly much more to do.

Professional registration bodies also have a role to play in developing training, as well as in making sure they include non-stereotypical examples of LBT women in their educational and training materials so that their students are aware of the specific needs of LBT women.

Finally, with a large task ahead, it is clear that Dr Brady’s role as the national health adviser on LGBT health must continue, yet continued funding for his role has yet to be confirmed. The health adviser not only needs his position to continue but needs increased resources and authority to make the structural changes needed to improve LBT women’s health, and I hope my hon. Friend the Minister can help make that happen.

Looking internationally, the UK has taken up the co-chairship, with Argentina, of the Equal Rights Coalition, an intergovernmental organisation that exists to protect the rights of lesbian, gay, bisexual, transgender and intersex people. As part of this role, and in upholding a commitment in the LGBT Action Plan, UK Government will hold an international LGBT conference, which will present a unique opportunity to raise issues such as LBT women’s health inequalities in an international sphere. I hope we will all be putting that event into our diaries. At the moment, it is due to sit on 27 to 29 May —coronavirus possibly puts it in some doubt, but we shall see.

In summary, progress has been made in this area, and in a context where the United Kingdom has been in a globally leading role. However, legal equality does not deliver practical equality on the ground. We must be more co-ordinated, and more effective in the collection of data and on training, and funding for initiatives needs to be made central and permanent until that inequality is addressed. LBT women’s specific health and social care needs will not otherwise be adequately met. Much overdue improvement is happening in the area of women’s rights generally, and of course more needs to happen. Weeks such as LBT Women’s Health Week are hugely important—I am very grateful to my right hon. Friend the Member for Portsmouth North for recognising that—in order to ensure we do not lose focus on this issue. That is why I am grateful to the Backbench Business Committee for giving us the time in the main Chamber to debate it. With LBT women facing the double barrier of gender and sexuality in accessing healthcare, we must ensure that LBT women’s health needs do not remain invisible.