‘People use the term ‘hard to reach’ don’t they, they use that a lot. But hard to reach for who?’ asks Peter Molyneux, chair of the NHS Confederation’s LGBTQ+ Leader Network.
Mr Molyneux says there has been a slight tendency to silo patients in the NHS and ‘almost over-specialise’ the messaging for services – something that the network is keen to address.
‘I think you have to recognise that you have to do your best, show that you’re interested, show that you’re going to respond, and I think then people will come forward,’ he says.
Mr Molyneux was speaking to Healthcare Leader following the network’s February report, which outlined steps services can take to improve confidence and visibility. The report includes a series of recommendations based on feedback from LGBTQ+ staff working in the NHS.
Mr Molyneux says he was struck by both the ‘remarkable degree of consistency’ among respondents, but also by how straightforward they were.
‘They weren’t asking for a huge shift,’ he says. ‘They felt like quite measured, small changes that ought to be easy to put in place.’
For example, one point noted that staff should be ‘confident and competent’ in recording gender identity and sexual orientation information from service users. Another suggested that health leaders should work with local community organisations to ensure services going forward are appropriate to the local population, and to LGBTQ+ people within that.
Much of the work of the network to date has focused on improving support for LGBTQ+ staff and Mr Molyneux says he’s always struck by a conversation he once had with a frontline employee, who was from a BAME background and LGBTQ+, who told him: ‘I’m just tired of doing the heavy lifting in my organisation.’
‘I think partly what we wanted to do was to try and find a way of supporting all those people who feel they’re doing the heavy lifting,’ he says.
Access to care
Mr Molyneux is also hopeful that improving support for staff and enabling them to feel more visible will lead to better outcomes for patients and help those ‘hard to reach’ groups to feel similarly.
The Covid-19 pandemic has underlined a number of inequalities in how patients access the NHS, with the promise of tackling these forming the core message of many national recovery plans.
However, there has been limited reference to addressing LGBTQ+ specific health needs – a £2m funding boost for ‘smaller specialist organisations helping ethnic minority, LGBT or disabled victims’ of sexual assault and domestic abuse in the Government’s Covid-19 mental health and wellbeing recovery action plan being one of the only mentions.
But it’s clear that more support is needed. According to a survey conducted towards the end of England’s first lockdown by OutLife – LGBT HERO’s advice centre for young people – 24% of LGBTQ+ people said they were depressed ‘very often’ or ‘every day’. This rose to 43% between March and May 2020.
And data indicates that many of them may not be accessing the care they need to address this, with almost two-in-five (39%) of LGBTQ+ people missing medical appointments during the same period.
Mr Molyneux says there’s ‘no silver bullet’ to addressing inequalities but adds that there is a need to build confidence and trust, especially following the significant shift towards more ‘online delivery of care’, which he says has been positive for lots of people – but not everyone.
‘Not everyone has privacy, not everyone has a room they can retreat to do an online conversation, in the same way as not everyone has a study that they can retreat to to do that do their work during the day. We have to be careful to remember that,’ he says.
Mental health support
A video consultation requires a privacy many patients will not be able to find at home. This is especially true among LGBTQ+ patients, who may have found themselves in lockdown in unsupportive homes or who were yet to disclose their sexuality or identity to family.
A study published by the University of Oxford in July found school closures have led to a rise in complaints that young trans people are experiencing transphobia at home.
Young trans persons are also more reliant on children and adolescent mental health services (CAMHS) than cis individuals – people who identify with the sex they were assigned at birth, according to University of Liverpool briefing The Impact of Covid-19 on Young Trans People.
Mr Molyneux says there have been some milestones over the last 30 years when it comes to progress on support for LGBTQ+ staff and patients, but he says one area where there is still over-representation is mental health services.
‘Clearly, we still have a way to go in terms of preventing that, and also then responding to it properly,’ he adds.
There is also a need to take a more inclusive approach to how data is collected and recorded, but also how services get to know their patients, friends, families and communities, Mr Molyneux says, adding that ‘we’re much more likely to respond to something we’ve measured’.
In its recommendations to service managers, the LGBTQ+ Leaders Network reiterated that ‘LGBTQ+ people are not one homogenous group’. Staff should not only be proactively seeking orientation and gender identity information from all service users, the report said, but should also be competent in reporting that data.
‘I don’t think the NHS is any better or worse than the rest of society. I think it’s a big enough organisation that it kind of represents society in that sense,’ Mr Molyneux says.
‘But I think we still find that there’s an assumption of heterosexuality – it’s quite a heteronormative culture – and that perhaps sometimes there isn’t the curiosity or openness to other alternatives in the way in which people are asked questions or the way in which their histories are gathered.’
When asked whether the NHS can address the barriers facing LGBTQ+ people in trying to access care and show it is a service for LGBTQ+ people, Mr Molyneux concludes: ‘I think the more that we reach out to some of those community organisations and actually try and co-produce solutions with them, that will build confidence.
‘And I think that the more we record data and are seen to use data, that will also start to build confidence.’