Lesbian, Bisexual and Trans Women’s Health Inequalities

Kate Osborne Excerpts

Tuesday 10th March 2020 Commons Chamber

[Olivia Blake (Sheffield, Hallam) (Lab)]

I wish to refer Members to my declaration in the Register of Members’ Financial Interests regarding NHS services in this area. I am thankful we are having this debate today. I, too, thank the Backbench Business Committee for bringing it forward. It is particularly important for my city, which is home to the Porterbrook centre, which is a specialist gender identity clinic.

I want to highlight some of the health inequalities faced by trans people, but before I do I will flag up some of the more general issues in health and social care for the LGBT community. I could have spoken about mental health, access for women, particularly LGBT women, to drug and alcohol services or, as has been expressed by others, access to screening for the detection of cancer. Today, however, I shall focus primarily on social care because it is one area that will affect all LGBT families at some point.

I recommend that anyone with an interest in LGBT health inequalities take a look at a recent report by Stonewall called “Unhealthy Attitudes”. Rather than focus on health inequalities and disparities, it focuses on and investigates the culture in our health and social care system, and asks how inclusive it is for LGBT people.

Some of the report makes for shocking reading. The report details the discrimination and abuse that LGBT staff, patients and service users have encountered in the health and social care sector. The report is based on data collected from health and social care workers. One stark thing about it is that it does not shy away from quoting what the staff themselves say about LGBT patients and colleagues. Although there are a lot of positive comments, there are quite a lot that could be considered bigoted. It is a telling feature of the culture of an institution that this minority of staff feel comfortable expressing these bigoted views.

The report also features direct testimony from LGBT staff on their experience of bullying and discrimination, and from staff who would like to do more. In fact, 38% of social care workers agree that more needs to be done to tackle bullying and discrimination—interestingly, this is more than the figure for health workers, which is 31%. Importantly, it is also clear from the report that staff often feel disempowered to challenge homophobia, transphobia or biphobia when they see it. Sometimes, they also feel like managers will not support them if they are challenging the bigotry of a patient or service user—in fact, in one of the testimonies the person said that their manager was the main offender. For that reason, I wonder whether trade unions, and especially their LGBT sections, might be given more powers to intervene in workplaces to provide education and training.

Training is important. The recent House of Commons report on LGBT health inequalities talks about the systemic roots of injustice in the system, and that is manifested in a lack of training given to workers in the sector. One in four health and social care workers say that their employer has never provided them with any equality and diversity training, and the proportion increases to one third in privately funded services. It is often social care workers who feel least confident dealing with trans patients and service users: 34% of advice workers said that they are not confident, as did 31% of social workers and 24% of support workers. The report finds that one in 10 care and social workers feel unequipped to meet the needs of LGBT people.

[Kate Osborne (Jarrow) (Lab)]

Does my hon. Friend agree that we need to ensure that the health and social care needs of the most marginalised and vulnerable LBT women are urgently addressed?

[Olivia Blake]

Absolutely—I completely agree. This is an urgent matter and the Government should take note and take action.

We need to put person-centred care front and centre. Fifty-seven per cent. of health and social care practitioners say that they do not consider sexual orientation to be relevant to someone’s health needs. Among care workers, that proportion rises to a staggering 72%. This view probably comes from an admirable commitment to equality but, as the recent review of the Marmot report reminds us, equality is not the same as equity. A person-centred approach to healthcare should be holistic: it is about understanding how someone’s personal life and background affects how they receive care and experience care settings, and how their experience of the health and social care system affects their health outcomes. Again, there is massive scope for training, and for unpicking a one-size-fits-all approach.

I wish particularly to mention trans peoples’ experience of the health and social care system. As I said, Sheffield is home to the Porterbrook gender identity clinic, which is a regional provision. We need more resourcing for such clinics to bring down the long waiting times. We also have to look at the experience of trans women as they use the services. A recent Healthwatch Sheffield report explored the experience of trans people using healthcare services in my city. The participants in the report stressed that the care they had received at the Porterbrook centre was good, but they could not say the same about their interactions in other parts of the healthcare system. An issue that they flagged was understanding—understanding from staff about the rights and entitlements for trans service users, and sometimes more basic things, such as the use of correct pronouns. The participants also flagged up the reluctance of many providers and professionals to acknowledge non-binary gender identities.

There is a long way to go in addressing health injustices for LGBT people—and they should be called injustices. Equal treatment is not the same as equitable treatment. We need to acknowledge the specific life experiences that LGBT people have and how those experiences affect their interaction with the health and social care system. We also need to acknowledge the bullying and discrimination that LGBT staff and service users encounter and how that contributes to health inequalities through people’s reluctance to engage with and use services when they have had, or fear, a bad experience.

We need to make sure that our health and social care system is properly resourced. The austerity agenda has been a key driver of the crisis in health and social care, which has hit LGBT people especially hard and hit women hardest, so there is a double impact for LBT women. Injustices are not natural; they are a product of choices. This is about not only NHS-funded services but the massive cuts to local authorities, particularly the cuts to public health grants, which fund services that LGBT communities rely on more than other communities. I hope the Government choose to end the injustice of LGBT healthcare inequality by properly investing in the resourcing and training that is necessary to build health and social care services that work for all our people, so that no one is afraid to access healthcare and everyone has an inclusive health and social care experience.

--- Later in debate ---

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

It is a pleasure to take part in today’s important and informative debate on health inequalities faced by lesbian, bisexual and trans women. I am grateful to my hon. Friend the Member for Livingston (Hannah Bardell) and the hon. Member for Reigate (Crispin Blunt) for securing today’s debate.

The aim of LBT Women’s Health Week is to raise awareness of lesbian, gay, bisexual, trans and queer women’s health inequalities, to make it easier for service providers to empower service users and for communities to support LGBTQ women. It is important for a range of reasons that we eliminate LBT health inequality and improve LBT health, to ensure that all individuals can lead long and healthy lives. It is worth considering Public Health England’s review of health inequalities for lesbian and bisexual women, which reported:

“There is consistent evidence from the UK and internationally that there has been a paucity of attention, concern and research on lesbian and bisexual women’s health inequalities.”

That emphasises the importance of today’s debate.

As we have heard today, the LBT community experience significant health inequalities and specific barriers to services and support. The many benefits of addressing these health concerns and reducing inequality include reducing disease transmission and progression, increased mental and physical wellbeing, reduced healthcare costs and, of course, increased longevity for the people involved.

We have heard from a range of speakers today, with some powerful testimony. My hon. Friend the Member for Livingston made many good points, talking about her own life experience and the value of her supportive network, which not everyone in the community benefits from. She said that coming out can be more traumatic for trans people than gay and bi people. I had not given that much consideration, and we should all remember that point. She highlighted a whole range of issues around safe sex and gave us details of dental dams. I go away informed—every day is a school day!

The hon. Member for Reigate talked about his personal experience of coming out in 2010. I am grateful for his work on the APPG on global LGBT rights. He informed us that this Parliament has more LGBT MPs than any other. As I say, every day is a school day, and it is a pleasure to take part in debates where we go away having learned more than we came in knowing. He also said that we have delivered equality in law, and we now need to deliver in outcomes, and I wholeheartedly agree with that profound point.

The hon. Member for Sheffield, Hallam (Olivia Blake) gave us some interesting statistics, including that 34% of advice workers said they were not confident dealing with trans people. That is a really important figure. In my research for today’s debate, I had been looking at it from the other side, and that backs up what trans people are saying—Stonewall Scotland says that one in four LGBT people have experienced healthcare staff having a lack of understanding of their specific needs.

[Kate Osborne]

Does the hon. Member agree with me that it is essential to ensure that all NHS mental health services train all staff on the mental health needs of LGBT people, including the specific experiences and inequalities faced by LBT women?

[Martyn Day]

I thank the hon. Lady, and she has read my mind because that is exactly the point I was coming to. We are hearing it from both sides—from the healthcare workers and from the community—and both feel that there is a gap, so there is clearly a training requirement that we need to address as a society.

The hon. Member for Runnymede and Weybridge (Dr Spencer) spoke about stigma, and he used a phrase, “minorities within the minority”, which probably sums things up and really gets to the crux of it for the people we are discussing. Latterly, we heard from the hon. Member for North Down (Stephen Farry), who gave us the Northern Ireland perspective. I think we can echo the issues of bias being ingrained in society and concerns about homophobic bullying throughout the rest of the United Kingdom, and I will touch on some of the Scottish perspectives.

Of course, no debate on health goes by without my mentioning that health is devolved and that in Scotland we do some things a little bit differently. Scotland has a really high record of health funding—up by over 60% under the SNP—and frontline health spending in Scotland is £136 per person higher than in England. In our recent budget, which has been termed the equality budget, we will continue to maintain Scotland’s position as one of the most LGBTI-progressive countries in Europe. The budget’s investment in mental health will have a positive impact on LGBTI people, who have higher rates of attempted suicide, self-harm, depression and anxiety.

Tackling hate crime also continues to be a top priority for the Scottish Government, and they will work with LGBTI stakeholders to challenge discrimination and to encourage understanding. An important point that we should take home is that every individual is some mother’s son or daughter, and we need to be far more accepting of one another in our own society.

The definition of gender identity and transgender used in the Offences (Aggravation by Prejudice) (Scotland) Act 2009 is considered to be one of the most inclusive definitions in use. The Scottish Government will continue to work to reduce the stigma of HIV, raise awareness of the condition and reduce its transmission. Scotland is the first country in the UK to make PrEP available free of charge to those at the very highest risk of acquiring HIV.

It is clear that this is one area where our nations face many of the same challenges. In Scotland, LGBT people are at a higher risk of experiencing common mental health problems than the general population. Stonewall Scotland’s survey of LGBT people in Scotland found, as we have heard, that almost half of LGBT people—49% on its figures—have experienced depression over the last year. My hon. Friend the Member for Livingston went through the whole range of figures, so I will not repeat them, but they bring home the very powerful point that there are real questions about inequality.

Scotland is an open and welcoming country. Prejudice, hate and discrimination will never be tolerated, and I believe that diversity makes Scotland richer and stronger, as well as happier and, I hope, healthier. The SNP Government are clear about the central equality of human rights to Scotland’s future and the importance of inclusive growth, fair work and social justice to our economic success and our social wellbeing. Scotland is considered one of the most progressive countries in Europe in terms of lesbian, gay, bisexual, transgender and intersex equality, and we aim to preserve and advance Scotland’s reputation as one of the most progressive countries in Europe for LGBTI equality.

In its 2015 rainbow map, the European Region of the International Lesbian, Gay, Bisexual, Trans and Intersex Association ranked Scotland as the most inclusive for LGBTI equality and human rights legislation: it met 92% of the ILGA’s 48-point criteria. Changes by the SNP mean that Scotland has been named the best country in Europe for LGBTI legal equality by Pink News. Those are all achievements of which we can be proud. However, there remains much that needs doing, and we must continue tackling homophobia, biphobia, transphobia and all forms of discrimination, stigma and inequality.

This debate goes some way to highlighting these issues, and I would just end as I began by once again thanking the hon. Members responsible for bringing it here today.