Delivering an LGBT-inclusive approach in the NHS

Dr Michael Brady, a Sexual Health and HIV Consultant at King’s College Hospital and Medical Director of the Terrence Higgins Trust (THT), was appointed as the Government’s first National Adviser for LGBT Health in March this year. In this month’s eFeature, Dr Brady reflects on progress to date and identifies the key priority areas he and his team are working on. Although he believes sexual health, sexual and reproductive health (SRH) and HIV teams are leading the way in addressing LGBT inequalities, he recognises that much still needs to be done to deliver a truly inclusive approach that respects all gender identities and sexualities and ensures everyone feels confident they will be treated fairly when they access NHS services.

The role of National Advisor for LGBT Health was created as a specific commitment in the Government’s LGBT Action Plan, which was based on the findings of the 2017 national LGBT survey. This was an impressive undertaking: with over 108,000 respondents it is the largest survey of its kind in the world. Even though the survey ran for 3 months, over half of the responses were received within 48 hours of it being launched and most had been received within 3 weeks! This is a clear reflection of the importance of the subject and the need for the LGBT community to be asked these questions and to be meaningfully involved in decisions that are made to improve LGBT equality.

The survey described a situation where LGBT individuals too often do not have their needs met, had a poorer experience than others and wanted more to be done to allow them to access the right health care. We now have plenty of evidence that LGBT individuals fare worse than others in terms of access, experience and outcomes and it is clear that we need to increase our efforts to address this issue.

Addressing LGBT inequalities in sexual health

Sexual health is an area where particular and specific LGBT health inequalities exist. For example: rates of gonorrhoea and syphilis in gay, bisexual and other men who have sex with men (MSM) continue to rise, with Black, Asian and Minority Ethnic (BAME) MSM disproportionally affected; it is estimated that, globally, trans women are 49 times more likely than other adults to be living with HIV and lesbian and bisexual women are almost twice as likely as heterosexual women to not go for cervical screening, an issue which NHS England is already working to tackle.

In many ways, sexual health, SRH and HIV teams are leading the way in addressing LGBT health inequalities. Access and experience of sexual health services scored well in the national LGBT survey compared to other areas such as mental health and primary care services. 74% of respondents who had accessed sexual health services in the past year reported that it was easy and 87% rated sexual health services in a positive way.

The British Association for Sexual Health and HIV (BASHH) recently published excellent recommendations for the delivery of integrated sexual health services for trans and non-binary people. Although focussed on sexual health services, they contain advice on access, inclusivity, monitoring, adopting an individualised approach and staff training that are relevant for all services. In addition, the Faculty of Sexual and Reproductive Healthcare (FSRH) has guidance on the specific contraception needs of trans and non-binary people. 

Key priority areas relevant to sexual health services

I am currently focussing on a number of key priorities, all of which are relevant to sexual health services. The first is data collection and monitoring: to offer the right services we need to understand what LGBT people need. We cannot begin to address the problems and improve experience until we understand the inequalities and use that as a baseline to measure the impact of what we do.

I also want to ensure that training for all staff is truly inclusive of the needs of LGBT people and that we embed the equality agenda at every level of NHS workforce development. This needs to be in training and assessments for both undergraduates and postgraduates as well as in induction and Continuing Professional Development (CPD). There are already many examples of good practice in this area and the challenge is how to best to share this work and embed the provision of LGBT inclusive training across the health and social care system to ensure that every LGBT individual can expect to engage with staff who use appropriate language and understand their needs.

Alongside this I have started working with a number of teams across NHS England who are delivering the commitments in the Long Term Plan to ensure that the priorities for LGBT health are integrated with the broader health inequalities agenda and embedded into the strategic work at both a national and local level. We have started working with the primary care team to understand the needs of LGBT people coming into GP surgeries, provide better support for trans and non-binary people and embed LGBT specific training. We’re also working with the personalised care, mental health, cancer, elderly care, children and young people and maternity teams to address specific LGBT inequalities in their clinical areas.

Support for LGBT people

It has become clear to me over the last few months that although the data on LGBT health inequalities can sometimes make difficult reading, there are many examples of NHS and community organisations delivering services around the country that provide incredible support and care to LGBT individuals. It’s great to see initiatives like the Rainbow Badge taking off and individuals and organisations pledging to be allies, to provide support and advice for LGBT patients and to be truly LGBT inclusive. I’ve also been impressed with the impact of the LGBT Foundation’s Pride in Practice programme that is working with GP practices across the country to improve experience and outcomes for LGBT people. They employ simple principles that could easily be used in other areas of health and social care and I want to work to ensure we share this and other examples of best practice throughout the NHS so that all can benefit.

We have made great strides in the UK to address LGBT inequalities but there remains so much more work to be done. I look forward to working with LGBT individuals, community groups and all partners across national and local government and the NHS to deliver a truly inclusive approach that respects all gender identities and sexualities and ensures that everyone feels confident they will be treated fairly when they access NHS services.

If you would like to contact me and my team we can be e-mailed at : england.lgbtadvisor@nhs.net