People who are LGBTQ+

The House of Commons Women and Equalities Committee reported in 2017 that the NHS is letting down trans people. Factors include:

• negative reactions, ignorance and offensive stereotypes by health professionals
• perceptions that trans people’s needs are too complicated leading to being denied treatment or being pushed around the system
• a lack of cultural competency

The astonishingly negative reaction by a few GPs when a trans person appears for the first appointment to ask for an assessment to begin. “You’ll be taking money away from more deserving cancer patients” is one quote that we have heard.

Trans people’s health care needs are too often reduced to a function of their trans status… We call it the “trans cold”: if you go to your doctor’s with a cold, it will be a trans cold.

… an individual with possible cervical cancer being referred back to a Gender Identity Clinic for a further psychiatric assessment before being sent to an oncologist.

Research by Stonewall in 2018 found:

• One in eight trans employees have been physically attacked by a colleague or customer in the last year
• A quarter of trans people have experienced homelessness
• Two in five trans people who would like to undergo medical intervention as part of
  their transition, haven’t done so yet, because they fear the consequences it might
  have on their family life.
• More than a quarter of trans people in a relationship in the last year had faced
  domestic abuse from a partner.
• When accessing general healthcare services in the last year, two in five trans
  people said healthcare staff lacked understanding of trans health needs.

A key recommendation was to call out anti-trans abuse whenever they see it,
so long as it is safe to do so. Supporting those being targeted lets them know
they have allies.

Human Fertilisation and Embryology Authority (HFEA) 2021 survey of people using NHS and private services found:

• 7 in 10 patients were satisfied with their latest experience of fertility treatment, with almost 2 in 10 dissatisfied.
• Of those dissatisfied with treatment, issues included costs, not being treated as an individual, or being treated with a lack of compassion. Many same-sex couples were dissatisfied with how they were treated:

“The whole process as a gay couple has been demoralising and upsetting, from the cost of the treatment, to the disorganisation of the clinic and lack of clarity around a ‘shared motherhood’ cost package”

• 78% spoke to a GP prior to starting treatment. Less than half were satisfied with their experience, some feeling ignored or being treated with a lack of empathy, and waiting times for investigations or surgery.

“The GP kept forgetting to refer us…This happened a few times, costing me what I believed to valuable time for my fertility in my mid-thirties”

• Treatment generally started within 6-18 months of seeing a GP – a quarter waited over 18 months. Those waiting longest were primarily those using only NHS services and ethnic minority patients.

An HFEA survey explored the impact of COVID-19 on access to, and experience of fertility treatment:

• Respondents were twice as likely to report a delay to starting treatment if they were NHS-funded (41%) compared to privately funded (21%).
• Respondents mentioned concerns over restrictions in partner attendance to clinic appointments, NHS waiting lists and the use of online/phone appointments.

The government’s Women’s Health Strategy 2022 highlights:

• Lesbian and bisexual women face stigmatisation and discrimination in interactions with sexual health and fertility services.

The LGBT Foundation’s recent report on Improving Trans and Non-binary Experiences of Maternity Services (ITEMS) found:

• Trans and non-binary people’s experiences of perinatal care are consistently worse across the board compared with cis women. This is also reflected in the proportion of trans and non-binary birthing parents who didn’t access any perinatal care during pregnancy – 30%, compared with up to 2.1% of the general population.
• Transphobia and racism in perinatal care intersect to produce particularly poor outcomes for trans and non-binary birthing parents of colour.
• There are examples of good practice, where midwives and services as a whole take a proactive approach to gender inclusion, from language used to provide care options that clearly centred the needs of the individual patients. However, these were generally localised and not supported at a wider scale by the necessary resources for training/development and national-level guidance.

The report recommended:

• Supporting the delivery of personalised and trauma-informed perinatal care
• Proactively adopting inclusive language and targeting outreach to trans and non-binary birthing parents
• Implementing IT and demographic monitoring systems to enable the sensitive collection of data about gender identity and trans status in perinatal services.

• People who identify as LGBTIQ+ are between 2–3 times more likely than heterosexual people to report having a mental health problem in England

Source: Centre for Mental Health

Joint Collegiate Council for Oncology statement on improving cancer care for sexual and gender minorities (SGM) reflects the needs for staff training, better data and valuing diversity:

• Integrating cancer care considerations for LGBTQ+ patients into the training and assessment of the oncology workforce.
• Co-produced education and training materials on the cancer care needs of LGBTQ+ patients.
• Local training in cultural competency and humility with feedback from LGBTQ+ patients.
• The recording of sexual orientation, gender identity, preferred name and pronouns as part of routine oncology consultations, with example scripts for how to do this sensitively.
• Increased sexual orientation and gender identity recording in primary and secondary care providers and disease registries.
• Ongoing audit and quality improvement of the care of LGBTQ+ patients within oncology.
• Encourage diversity within the oncology workforce and representative committees.

Carers Trust’s ‘No Longer Able to Care’ highlights barriers faced by LGBTQ+ carers, including:

• Reluctance to access support due to services’ lack of awareness of how to provide good personalised support to LGBT people – perpetuating a lack of available high quality support.
• Fear of homophobia in mainstream services and support groups.
• LGBT carers may also be caring for an LGBT person, and worry that services may not be respectful of their LGBT identity, understand or meet their needs, or be aware of LGBT people’s legal rights.

In the LGBT Foundation’s report ‘Can You See Us?’ report, carers explained why they felt support services need to do more to be more LGBT friendly:

“It’s awkward when I have to explain who my partner is.”

“Stop with the assumption of heteronormative families and relationships. More awareness of carers who are stuck in the closet because of their caring responsibilities towards homophobic dependants.”

“[Support services need] more awareness and signposting, having LGBT champions in their services – so there was a point of contact who understood the community and topics we might wish to discuss.”

Marie Curie reported in 2016 on the barriers to care and quality of care LGBT people experience at end of life:

1.Anticipating discrimination – can lead LGBT people to access palliative care services late or not at all.

2.Complexities of religion and LGBT end of life care – not always ensuring LGBT patients and their families have their spiritual needs addressed.

3.Assumptions about identity and family structure – by health and social care staff, impacting on LGBT people’s experiences of care; some clinicians discriminate on the basis of sexual orientation.

4.Varied support networks – choosing to be surrounded by close friends and constructed support networks alongside biological ones; ensuring loved ones are respected and recognised as next of kin.

5.Unsupported grief and bereavement – partners feeling isolated during bereavement because of their sexuality.

6.Increased pressure on LGBT carers – increased pressure on informal carers where people are accessing palliative and end of life care services late or not at all.

LGBT people may also experience barriers to palliative care because they are:

• three times more likely to be single
• less likely to have children
• far more likely to be estranged from their birth families (though many have alternative family structures)
• significantly more likely to experience damaging mental health problems

coming soon

coming soon