Lesbian, Bisexual and Trans Women’s Health Inequalities

Debate between Kate Osborne and Olivia Blake

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.