Equality Groups : Personalised Care

LTP Priority: Equality Groups: Personalised Care

Population Intervention Triangle: Segments (link to Section 1 PHE PBA): Service

Type of Interventions:

  • Prevention and health inequalities
  • Personalised Care
  • End of Life

Major driver of health inequalities in your area of work

As the Government’s LGBT Action Plan highlights; your sexual orientation or gender identity can have a significant impact on your physical, mental and sexual health and wellbeing. Existing evidence shows that health outcomes are generally worse for LGBT people than the rest of the population, and that many LGBT people feel that their specific needs are not taken into account in their care (NIESR (2016), ‘Inequality among lesbian, gay bisexual and transgender groups in the UK July 2016’).

The national LGBT survey asked questions about people’s experiences of public healthcare in the 12 months preceding the survey. It asked questions about people’s access to physical, mental and sexual health services, and gender identity services. It also asked whether they had disclosed their sexual orientation or gender identity to healthcare staff, and how they felt this affected their care. While many respondents to the survey said they had a positive experience accessing healthcare, there is clearly more to do. The survey showed that large numbers of respondents had difficulty accessing healthcare services and especially gender identity clinics. It also showed many respondents had experienced inappropriate questioning and curiosity from healthcare staff, and that some respondents feel their specific needs were ignored or not taken into account when accessing healthcare. Some of the most important findings include:

  1. at least 16% of survey respondents who accessed or tried to access public health services had a negative experience because of their sexual orientation, and at least 38% had a negative experience because of their gender identity.
  2. 51% of survey respondents who accessed or tried to access mental health services said they had to wait too long, 27% were worried, anxious or embarrassed about going and 16% said their GP was not supportive.
  3. 80% of trans respondents who accessed or tried to access gender identity clinics said it was not easy, with long waiting times the most common barrier.

Target groups

Protected characteristic: LGBT

Intervention

Pride in Care

Description

Championed by Care England and with accompanying training endorsed by Skills for Care, the Pride in Care® quality standard is awarded by Opening Doors London to all organisations assessed as providing quality care and support to older LGBT+ people. The quality standard is attained through a short, step-by-step process, including policy reviews, staff surveys and site-visits supported by consultancy advice throughout the accreditation process from our specialist LGBT+ policy advisors and CIPD qualified trainers and management consultants.

Evidence

Research has identified that older LGBT+ people are a relatively vulnerable population with a lack of family support who rely more than their heterosexual peers on the support of their social care professionals. The need for an LGBT+ social care quality mark has been evidenced in several consultations with LGBT+ communities, most recently Brighton and Hove, whose CCG commissioned two reports (2015 and 2016) both of which found that having a recognised standard of LGBT+ awareness in health and social care services was a high priority for older LGBT+ people who need to easily identify LGBT+-inclusive health and social care practitioners. While exact numbers of LGBT+ people are unknown, and the older generation are the least likely to ‘come out’ for fear of poor treatment, most statutory bodies work to the estimate of 5-7% of the general population. With an aging population there is a clear organisational advantage for those care providers who engage positively with the needs of older LGBT+ people, and Pride in Care assists this both by directing older LGBT+ customers to their services and giving them extra assurance of the inclusive welcome they are likely to receive.

The Equality Act 2010 has made the law stronger and more enforceable, especially where litigation is concerned, and several cases have now been brought against organisations who have been proven to have discriminated on grounds of sexual orientation. The comprehensive policy review and management briefing which form part of the quality standard package all mitigate against the dangers of litigation as a result of poor staff awareness of LGBT+ inclusivity or non-compliance with the Equality Act 2010.

Although the 2014 Care Act requires organisations to address the health and care support of older LGBT+ people by tailoring services to their particular needs, the Care Quality Commission (CQC) say they have found very limited evidence of services proactively engaging with LGBT+ people or specifically considering their needs and as a result, inspectors may now raise this concern as a question during inspection. Open Door London’s formal and informal meetings with CQC have helped tailor Pride in Care management consultancy to highlight the priority areas of LGBT+ inclusivity that better ensure organisations are rated as good or outstanding by CQC inspectors.

Guidance for Commissioners