We’ve had the Equality Act
since 2010 (1) and for many LGBT people it has been a game changer. It requires
that anyone providing a service for the general public, including healthcare
providers, does not discriminate who they provide that service to, no more “We
don’t serve your sort in here, this is a family establishment.” In October
2017, NHS England has only just waken up to the fact the Equality Act also
applies to the NHS, and in response they have released their latest initiative.
They announced that they want
all patients’ sexuality recorded, with their other demographic details (2). So
at every face to face encounter with a patient with doctors and nurses and all
healthcare professionals have to ask patients what their sexuality is, if it
does not already state so on their demographies. Patients do have the opinion
to decline to answer.
But this is NHS England’s
only response to the Equality Act, to gather data on patients’ sexuality,
nothing more. We’ve had several studies, in recent years, about the poor
treatment LGBT patients have received from the NHS, there have also been
studies into what an unfriendly working environment for LGBT staff the NHS is.
Back in 2007, Stonewall
published their study Being the Gay One
(3), on the homophobia faced by staff working in health and social care, it was
more than an uncomfortable read. Since then they have published four different
studies on the experience of LGBT patients in the NHS (4, 5, 6, 7) and all of
them have highlighted the negative and homophobic experiences they have
received, with many LGBT patients unwilling to be open about their sexuality
for fear of homophobic treatment from healthcare professionals.
In 2015 Stonewall published Unhealthy Attitudes (8), their report
into a survey of LGBT healthcare staff. The findings of this report showed so
little had changed since 2007, and Stonewall’s first report (3). Unhealthy Attitudes found that 25%
people surveyed had been the victims of homophobic abuse at work. Last year a
BMA study found that 70% of LGBT doctors had experienced homophobia at work,
and three quarters of them had never reported it out of fear of reprisals (9).
Last year we had the unpleasant sight of NHS England itself going to the High
Court to win the right not to fund the HIV preventative drug PrEP (10).
Yet we also have areas of
good practice and there are resources out there for NHS Trusts that want to
turn around this situation. In 2012 Stonewall published Sexual Orientation, A guide for the NHS (11), which is full of
practical advice for combatting homophobia in healthcare. Back in 2009, the
Department of Health produced Sexual
Orientation: A practical guide for the NHS (12), which was designed to help
reduce the healthcare inequalities faced by LGBT people.
We already have a lot of
evidence about the homophobic treatment many LBGT people have received at the
hands of the NHS, NHS Choices acknowledged the problem back in 2012 (13), there
is also guidance on how to reverse this, and yet all NHS England can think to
do to combat healthcare homophobia is to ask patients what their sexuality is.
A third of gay and bisexual men are not open about their sexuality to their GPs
(7) and half of Lesbians and bisexual women (5). Why isn’t NHS England
launching a high profile initiative to tackle homophobia in the NHS and to make
it a welcoming place to LGBT people? Why isn’t NHS England ensuring that the
NHS complies with the Equality Act? Instead all they can do is collect data on
LGBT people. So typical of NHS England, too little and much so late.
But why should nurses, be
concerned about this? How can we say we are providing open and non-judgemental
nursing care when so many LGBT people are afraid of being open about themselves
in front of us?
(This was originally written for the Nursing
Standard)
Drew Payne
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