Experiences of Healthcare

Patient experience is at the heart of good healthcare. Patients should be treated with dignity and respect by healthcare staff they can trust. This briefing provides evidence that for many LGB&T people this is simply not the case. Lesbian, gay and bisexual people are more likely to be open to their manager, to friends and to colleagues than their GP or healthcare professional. Gay people also report having assumptions made about them by healthcare staff that can impact on the care they receive.

Improving patient experience needn’t be difficult, and there are some simple and cost effective measures which can help. Healthcare organisations that put patients at ease, and have well informed staff, are much more likely to deliver high quality care to diverse communities.

Lesbian and Bisexual Women

Stonewall’s research into the health needs of lesbian and bisexual women, Prescription for Change (2008), has found clear differences in their health compared to that of women in general. Lesbian and bisexual women are more likely to have smoked and to drink heavily than women in general. Levels of attempted suicide and self-harm are much higher than in the wider population. In addition, many lesbian and bisexual women have had a negative experience of healthcare in the past year.

Half of lesbian and bisexual women who had accessed healthcare services in the last year have had a negative experience. Lesbian and bisexual women have experienced the following when accessing healthcare in the last year:

  • Two in five  lesbian and bisexual women said that, in the last year, healthcare practitioners had assumed that they were hetrosexual, and this meant they did not receive appropriate advice
  • One in five felt that there was no opportunity to discuss sexual orientation, and they  had sometimes had to stop mid-procedure to correct assumptions
  • One in ten stated that when they did come out to a healthcare worker, they were either ignored or the health worker continued to assume they were hetrosexual
  • Five per cent  say that healthcare workers have made inappropriate comments when they have told them their sexual orientation

Few lesbian and bisexual women had positive experiences of healthcare in relation to their sexual orientation in the past year:

  • Just one in eleven  said that their health worker had provided them with the opportunity to come out
  • Less than a third said that their healthcare worker acknowledged they were lesbian or bisexual  after they had come out
  • Only one in nine  said that they had been told that their partner was welcome to be present during a consultation
  • Just one in eight said that healthcare workers had specifically given them information relevant to their sexual orientation
  • Only one in ten said that the GP surgery displayed a policy stating that they would not discriminate against people because of their sexual orientation
  • Just over a quarter said that that their GP had a clear policy on confidentiality

Less than half of lesbian and bisexual women are out to their GP or healthcare professional.

Gay and Bisexual Men

Stonewall’s Gay and Bisexual Men’s Health Survey (2012) demonstrates that their health needs are not being met, and there are areas of significant concern – most notably in mental health and drug use - that have been overlooked by health services which too often focus solely on gay and bisexual men’s sexual health.

A third (34 per cent) of gay and bisexual men in Scotland who have accessed healthcare services in the last year have had a negative experience. Gay and bisexual men have experienced the following when accessing healthcare in the last year:

  • One in six (15 per cent) said their GP or healthcare professional assumed that they were straight
  • One in seven (13 per cent) felt there was no opportunity to discuss their sexual orientation

Few gay and bisexual men had positive experiences of healthcare in relation to their sexual orientation in the past year:

  • One in eleven (nine per cent) said that their healthcare professional had provided them with the opportunity to come out
  • Only a quarter (27 per cent) said their healthcare professional acknowledged that they were gay or bisexual after they had come out
  • Only one in ten (ten per cent) said they had been told their partner was welcome to be present during a consultation
  • Just a quarter (26 per cent) said healthcare professionals had given them information relevant to their sexual orientation
  • Only one in four (23 per cent) said their GP surgery displayed a non- discrimination policy that included sexual orientation
  • Just two in five (41 per cent) said their GP surgery has a clear policy on confidentiality

‘As a healthcare professional I have come across issues where the partners of gay men have had difficulties in visiting their loved ones because they were gay or other healthcare professionals deemed it inappropriate for them to be there although other relatives were allowed to visit.’

Tom, 21, Wales

More than a third (37 per cent) of gay and bisexual men in Scotland are not out to their GP or healthcare professionals. 

Transgender people

The Scottish Transgender Alliance carried out research into transgender people’s experiences of living in Scotland, which included questions around their experiences of accessing healthcare.

The full report can be found here  

The survey highlighted a great deal of positive experiences of using NHS services, and many respondents praised the respectful and non-judgmental ethos of services, and their willingness to treat service users according to self-identified gender identity regardless of physical body characteristics.

The report did, however, reveal certain key issues that transgender people face when accessing healthcare in Scotland:

  • 14 per cent  of respondents rated the service they received from their GP as “very poor” or “extremely poor”, and the reasons for this included a lack of knowledge about transgender health needs, for example in regard to long-term prescription of hormones, post-operative care and possible complications after genital surgeries. The most commonly reported problem was having NHS records fully updated to reflect a change in gender
  • Many respondents highlighted barrier in accessing telephone based services (such as NHS24), due to fears around the assumptions people make about them based on the sound of their voice
  • Transgender people are at risk of avoiding using out-of-hours medical care due to fears around how unfamiliar NHS professionals may react to their transgender identity or background
  • Respondents reported that when accessing mental health services they experienced a lack of understanding and knowledge about transgender issues by GPs which often resulted in inappropriate treatment, leading to delays in being assessed by a gender specialists

The Scottish Transgender Alliance has also recently carried out research into transgender people’s experiences of mental health. For more information about this report please see Stonewall Scotland’s mental health information page or the report can be found here. 

This survey highlighted some significant issues when accessing Gender Identity Clinics. 20 per cent of respondents had wanted to harm themselves in relation to, or because of involvement with a Gender Identity Clinic or health service. Reasons included long waiting times, delays to treatment, appointment cancellations, inaccurate assessments, being denied hormones, being denied surgery, being denied access to a Gender Identity Clinic, being given the wrong information or advice, receiving negative or inappropriate treatment, and being discharged from a Gender Identity Clinic.

What the health service can do

Treating patients with dignity and respect is at the heart of a good healthcare service. Many lesbian, gay, bisexual and transgender people report that they are assumed to be heterosexual by healthcare staff which impacts on the way they interact with the health service and on how comfortable they feel using health services.

There are a number of steps health services can take to improve the experiences of lesbian, gay, bisexual and transgender people:

  • Train staff on the importance of not assuming someone’s sexual orientation
  • Use posters, leaflets and information that include images of lesbian, gay and bisexual people to help create a welcoming environment
  • Provide health information that is relevant to lesbian, gay and bisexual people

Stonewall Scotland’s Online Learning Resource www.lgbtgoodpractice.org.uk can be freely accessed by all public bodies in Scotland as an effective means of rolling out LGB&T equality training to frontline staff. 

What you can do

Stonewall Scotland has produced a plain English guide to engaging with public services, with step by step points on why it is worth keeping your services on their toes. You can download the guide here or to order a hard copy email info@stonewallscotland.org.uk.

For more information about your rights in relation to discrimination in accessing public services see here.

The Studies

The findings in this briefing are taken from a number of Stonewall publications:

Gay and Bisexual Men’s Health Survey

In 2011 Stonewall and Sigma Research asked gay and bisexual men from across Britain to complete a survey about their health. 6,861 men, including 633 from Scotland responded making it the largest survey of its kind in the world.

Prescription for Change: Lesbian and bisexual women’s health check 2008

In 2007 Stonewall and De Montfort University asked lesbians and bisexual women from Britain to complete a survey about their health. 6,178 women, including 514 from Scotland, responded making it the largest survey of its kind in Europe.

 


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