Equality and Diversity - Consider equality in sexual orientation

James Taylor, health officer at Stonewall, looks at the legal requirements for clinical commissioning groups (CCGs).

Patients in same-sex relationships may be put off seeking healthcare (Photograph: Getty Images)

The past 12 months have seen a massive change in the health sector. The Health and Social Care Bill currently going through parliament proposes to establish clinical commissioning groups (CCGs) and to remove the regional and sub-regional tiers of management, PCTs and SHAs. Equality and diversity are a vital component of these changes and should be embedded within CCGs now, as they begin to form.

Equal rights
The recently published draft CCG authorisation document sets out six domains that are critical for the success of a CCG. Equality and diversity feature in all six, are cited in the Bill and are central to the proposed operation of the NHS Commissioning Board. However, there is work to do to achieve equality for lesbian, gay and bisexual people in the health sector.

Stonewall's research has shown that many lesbian, gay and bisexual people expect discrimination when accessing primary healthcare services, while also reporting poorer experiences of the GP surgery than heterosexual people.

The next 18 months are a critical time for CCGs to develop their governance processes and accounting structures and, vitally, to build the capacity and capability to establish equality and diversity duties and responsibilities, especially concerning sexual orientation.

James Taylor: Many lesbian, gay and bisexual people expect discrimination when accessing primary healthcare services (Author image)

Negative experiences
'Prescription for Change', Stonewall's 2008 research into the health needs of nearly 6,200 lesbian and bisexual women, found that half of the respondents reported a negative experience of healthcare in the past year.

These problems ranged from inappropriate comments about their relationships and being assumed to be heterosexual, to not feeling that their partner could accompany them to their consultation.

These experiences can result in patients not seeking healthcare when they need it and could potentially increase the cost of treatment if the need for it escalates at a later stage in the patient's condition.

The research also found that half of the women surveyed were not open to their GP about their sexual orientation, which is a worrying finding, considering the specific healthcare needs that lesbian and bisexual women can have.

Prevalence of mental health conditions, alcohol abuse, smoking and drug misuse are all higher among lesbians and bisexual women. Shockingly, 16 per cent of lesbian and bisexual women under the age of 20 years have attempted to take their own life in the past year, compared with less than 1 per cent of women in the general population aged under 20.

Later life
Our latest piece of research, published this month, considers the experiences of lesbian, gay and bisexual people in later life. It highlights the fact that many are growing older alone, without the formal support networks on which older heterosexual people can draw. 'Lesbian, Gay and Bisexual People in Later Life' also highlights that while older gay people are more likely to rely on GP services than older heterosexual people, many are not confident that services will meet their needs.

CCGs must take these statistics into consideration when planning services and GPs should also use them to create an inclusive environment, where patients feel comfortable being open about their sexuality.

What are the legal requirements? Since 2007, it has been unlawful to discriminate against lesbian, gay and bisexual people in the provision of goods and services, and last year the Equality Act became law, bringing together all existing pieces of equality legislation.

The Equality Act 2010 is applicable to the NHS as an employer and as a service provider. Equally, the Act will apply to the work of CCGs in the provision, development and delivery of services.

Foster good relations
CCGs will need to ensure that they comply with their responsibility to have due regard to the elimination of harassment, the advancement of equal opportunities and the fostering of good relations between different groups.

Yet discussions with some GPs have made it clear that there has been little, if any, work on sexual orientation equality at practice level. Last year's patient survey by Ipsos MORI for the DoH highlighted the differences in reported quality of service between lesbian, gay and bisexual people, and heterosexual people. Fewer lesbian, gay and bisexual people were able to see their preferred doctor, fewer had trust in their doctor and fewer were satisfied with the care they received.

This is why equality and diversity work must begin now, to improve patient experience and ensure all groups' health needs are being met.

Through its Healthy Lives programme, Stonewall has begun working with two GP groups to raise staff awareness, ensure patient environments are inclusive of lesbian, gay and bisexual people, make sure policies are inclusive and, using the data from 'Prescription for Change', support thinking concerning health inequalities.

Stonewall provides sexual orientation equality expertise through the Diversity Champions programme to more than 600 major employers in Britain, including a large number of NHS organisations.

There are several simple actions CCGs should take at this stage to begin to improve the experiences of the lesbian, gay and bisexual people with whom they work (see box below).

  • Make sure your training is up-to-date on equality and diversity, covering the legislative requirements and health inequalities relating to sexual orientation.
  • Ensure that you have in place specific policies on confidentiality, discrimination and bullying.
  • Avoid making assumptions about a person's sexual orientation and ask open questions.
  • Make sure your patient areas are inclusive - for example, use images of same-sex couples.
  • Establish links with local community groups - use their knowledge to shape service provision.
  • Monitor sexual orientation to avoid unfair treatment.
  • Nominate an equality and diversity champion to focus on progress with your agenda.
  • James Taylor is health officer at Stonewall, a lesbian, gay and bisexual charity. www.stonewall.org.uk

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