Abstract
When we are feeling unwell and vulnerable we need to be assured that we will be cared for in a welcoming, trusted and safe environment. We expect that no one will judge us, that our wishes will be acknowledged and our loved ones will be supported and reassured. We anticipate that health and social care professionals will, if necessary, take on an advocacy role for us should we lose capacity to voice our wishes and concerns. These are just some of the core values espoused by caring institutions and health and social care professionals’ codes of conduct. Furthermore, the employees working in these health and social care organisations are assured through legislative and corporate governance that their employers are committed to equality, inclusivity, non-discriminatory practice and a zero tolerance of marginalisation, bullying or harassment. We need then to examine why health and social care inequalities persist for lesbian, gay, bisexual and transgender (LGBT) people when there are robust supports in place. Moreover, the Public Sector Duty Equality Act (United Kingdom Parliament, 2010) protects these communities in legislation. Is this being ignored?
Although the situation for LGBT communities is improving, with most health and social care professionals now demonstrating ‘acceptance’ and positive attitudes to those who identify differently from what is the perceived ‘norm’, there is still some way to go. There are some stark ‘exceptions’ to this overarching requirement for acknowledgement, acceptance and inclusivity. This has exacerbated some very concerning health and social care inequalities for LGBT people which are reflected across the lifespan (Elliott et al., 2014; Lick et al., 2016; Whittle et al., 2007). The illuminative detail provided in Stonewall’s (2015) ‘Unhealthy Attitudes’ survey highlights the often harrowing significance of this for LGBT people: just three in five (59%) of all health and social care staff agree that their employer takes effective steps to prevent and respond to discrimination or poor treatment as a result of a person’s sexual orientation, and just under half (48%) on the basis of a person’s trans identity; almost three in four (72%) patient-facing staff have not received any training on the health needs of LGBT people, the rights of same-sex partners and parents or the use of language and practices that are inclusive of the LGBT community; transgender issues often remain unaddressed in training, with only a quarter of those trained reporting that the legal rights of trans staff (27%) and trans service users (23%) were included.
The persistence of these revelations causes some embarrassment to our noble health and social care professions.
Douglas-Scott et al. (2004) identified ‘homophobia, heterosexism and social exclusion as the root causes of these inequalities’. The need for education against prejudice and the value and need for positive role models and allies are recommended. Stonewall (2015) recommends that health and social care organisations should encourage and celebrate LGBT role models at all levels within the organisation and encourage allies to speak up about the importance of LGBT equality in the workplace.
Overwhelmingly in the research literature on attitudes to and perceptions of LGBT people, both health and social care academics and practitioners alike tell us that the potential needs of LGBT people were often never addressed in their own education or training programmes (Lim et al., 2015). Their voices concur that if there was some address, it was perhaps a fleeting mention, sometimes stereotyped and often pathologised; too brief (and easily forgotten); didactic as opposed to discursive; and often not reflective of LGBT people (and the myriad identifiers that each individual LGBT person may adopt) across their lifespan. In the most recent Pride and Prejudice in Education (Forum for Sexual Orientation and Gender Equality, 2016) report just over half the staff sample (n = 575, 72% of whom were from Higher Education) said no sexual orientation or gender identity training was provided. The National Union of Students (2014) survey of students found that, on a scale of 1–10 in respect to seeing LBG and transgender experiences reflected in their curricula, students reported only 3.9 and 3.5, respectively. In some research it is revealed that it is LGBT health and social care students themselves, when feeling confident enough to do so, who are the catalysts generating the discussions that are needed (Röndahl, 2011). Examination of prescribed health and social care curricula also reveals little, if any, specific indicative content on the subject (Brennan et al., 2012), despite generally advocating in their overarching philosophies a commitment to equality, diversity and (cultural) inclusivity.
This lack of education and knowledge fuels ignorance and a lack of confidence, potentially leading to a sense of anxiety. As a consequence, the voices of many LGBT people, who tell us very differently, are not being heard and the true nature of what constitutes holistic care is neglected. It is also known that LGBT people who may still be invisible, or who have had previous negative healthcare experiences, can be reluctant to disclose their identities for fear of further discrimination. This too only serves to strengthen the barriers to providing equitable, respectful and inclusive health and social care delivery.
Healthcare professionals need to be equipped with the evidence-based knowledge and confidence to start the conversation, to provide ‘permission’ and a sense of safety and security to allow LGBT individuals to express their authentic self. Educationalists and practitioners alike need to be encouraged to examine their curricula, fields of practice and the evidence base to see whether there are specific issues that should or could be addressed. They need to be willing, able and ready to normalise what is often perceived to be different. They need some useful frameworks and tools to facilitate analysis and meaningful reflection of their practice, supported by role models and champions. They need access to supportive resources and information that very often cannot easily be found unless they know what to look for and where to look for it. Legal obligations and professional accountability may need to be contextualised too.
Stonewall, in collaboration with Cardiff University School of Healthcare Sciences, has developed an innovative, highly interactive one-day training programme, with supporting resources, which aims to equip healthcare academics (and as an anticipated consequence, the learners and future practitioners they educate) with some of what is known to be needed.
During our pilot phase 60 academic participants from a range of healthcare disciplines have offered most encouraging evaluative feedback. Sustainability and vibrancy of the programme is now a most crucial consideration, but we can already see its value not only to the healthcare disciplines but to a range of other professional disciplines where LGBT acceptance does indeed have exceptions.
If you would like to hear more about our programme we would be delighted to hear from you.
