Frontline health and care staff need to better understand the lives and needs of LGBT people
The Report of the Inquiry into Health and Social Care and LGBT Communities was published at the end of 2019. Conducted by the Women and Equalities Committee the Inquiry focussed on:
- discrimination faced by LGBT communities in day to day interactions with health and social care
- the adequacy of provision
- what more needs to be done to improve access.
Certain disparities in health outcomes in the LGBT community are well known, whereas others are not widely discussed. Research has been slow to develop outside the traditional areas such as sexual health. The Inquiry found LGBT people are let down by structures and services which are not designed with them in mind. The Inquiry found that the attitude of some health and social care staff was concerning, among a range of other evidence.
This briefing summarises the aspects of the report dealing with training and registration of those working in the profession. Health and care sector workers are encouraged to read the full report to gain a broader awareness of the issues and of the likely consultations and changes to the regulatory landscape which may follow in due course.
Staff Training and Regulation
The report notes that every witness to the inquiry emphasised the need for front-line health and care staff to better understand the lives and needs of LGBT people under their care. The need for person-centred care was consistently emphasised. A lack of training leaves staff under-confident and ill-equipped to deal with LGBT-specific issues, or working under the misconception that equal treatment demands that everyone is treated the same.
- Pre-Qualification Training
The Inquiry heard mostly about the training provided to doctors and nurses. The educational institutions will in the main determine the content of any training with parameters set by bodies such as the General Medical Council (‘GMC’) and Nursing and Midwifery Council (‘NMC’).
Witnesses described inclusion of the subject matter varying across institutions and where touched upon, this tended to be within a broader context rather than exploring specific inequalities.
It is recognised that understanding needs of LGBT people is necessary to deliver truly person-centred care. The GMC and NMC are to review their guidance for medical schools with a view to ensuring the requisite content exists in every curriculum. The content should be split across modules and not confined to for instance sexual or reproductive health.
- Post Qualification Training and Continuing Professional Development
The Report highlighted that training post qualification is widely inconsistent. Decisions on training relating to GPs tend to be set by Clinical Commissioning Groups which could vary from region to region. Some institutions were developing specific training but this tends to be by way of optional modules.
Witnesses were critical of e-learning and noted that even where training was delivered in person this could be lacking. The LGBT Foundation gave an example of where stereotypes were used instead of a holistic approach, noting an example of a gay man catching HIV being used as a case study. The Report recommends that registration bodies should develop case studies with local LGBT organisations.
- Registration of individual professionals in heath or social care
The Report acknowledges that the registration requirements for all those working in the sector vary hugely. There was particular concern about the lack of any registration or qualification requirements in England to work as a care worker and to offer counselling services (where those practising may choose to register with a trade organisation but this is not mandatory). Those working as personal assistants outside a formal organisational structure are not subject to CQC inspection and it was recognised that discrimination may therefore go unnoticed.
Both the NMC and GMC outlined processes they have in place to ensure that medical professionals are trained to UK standards, which include being tested on the Equality Act 2010.
The Inquiry recommends at para 89:
The Government should consult on ways in which effective knowledge and understanding of unacceptable discriminatory practices and the Equality Act could be ensured amongst the widest range of health and social care providers. This should include staff feeling empowered to take action when they are aware of LGBT discrimination. All NHS and social care providers should ensure these expectations are embedded into their interactions with new patients or residents and provide staff with the relevant training so they feel confident in challenging discriminatory behaviour. The CQC might consider how to strengthen the monitoring of these issues as part of their existing inspection regime.
The Inquiry agreed that advocacy services could be a way to assist LGBT people who have concerns about their care. It is recommended that the GMC and NMC should produce information for LGBT patients about what they can expect from their doctor, nurse or midwife and how to complain should they wish to do so.
- Recommendations regarding the CQC inspection regime
It was accepted that a method of identifying and dealing with poor practice is through the CQC’s inspection regime. The LGBT Action Plan (Government Equalities Office, July 2018) specifically includes the CQC within its commitments as follows:
The [CQC] will continue to improve how it inspects the experience of LGBT people in adult social care and mental health inpatient wards, and we will begin to inspect all gender identity clinics on a risk basis. The [CQC] will develop guidance for care quality inspectors on the healthcare pathway for people who are transitioning their gender, and embed LGBT equality issues into the methodology used by inspectors.
As regards the relevant key lines of enquiry (KLOEs), providers will be assisted by reviewing Appendix 1 of the 2019 CQC Guidance in respect of sexuality and relationships in adult social care, which we have summarised in an earlier briefing.
The Inquiry recommends that the CQC undertakes a thematic review of social care services for LGBT people which should include examples of best practice and guidance to social care providers regarding how to create LGBT inclusive services. We have detailed the relevant comments made in the report in a further briefing.
The CQC and NHS England should work together to produce a guide to making complaints and an online form that can be used to ensure complaints are received by the appropriate body to deal with them. We will provide updates in relation to any changes and/ or guidance from either these organisations. The full report can be accessed via the link below:
This briefing is for guidance purposes only. RadcliffesLeBrasseur accepts no responsibility or liability whatsoever for any action taken or not taken in relation to this note and recommends that appropriate legal advice be taken having regard to a client's own particular circumstances.