Industry Insight

Betsy Goodfellow from Pharmafocus considers Pride month and the state of LGBTQ+ healthcare in the UK

Each year, June marks LGBTQ+ Pride month, with the first Gay Pride Parade taking place on 28 June 1970 in New York City, US.1 Since then, Pride has grown, with June being recognised as Gay and Lesbian Pride Month by then-US President Bill Clinton in June 2000, and expanded to the more diverse Lesbian, Gay, Bisexual and Transgender Pride Month in 2009 by former US President Barack Obama.1

Although society has come a long way in terms of LGBTQ+ inclusion since the 1970s, healthcare remains an area in which improvements are still needed. For example, approximately 13% of LGBT people state that they have experienced unequal treatment from healthcare staff due to being LGBT, and around 23% of LGBT people have witnessed discriminatory or negative remarks against LGBT people by healthcare staff.2 The NHS has recognised that LGBT+ people tend to have disproportionately worse health outcomes compared to heterosexual, or straight, people.3

According to a 2017 National LGBT Survey, over 16% of survey respondents who had accessed or tried to access public health services had a negative experience due to their sexual orientation, and 38% had a negative experience due to their gender identity.3 Similar statistics exist for those trying to access mental health services – 51% of respondents who accessed or tried to access mental health services stated that they had to wait too long, 27% were worried, anxious or embarrassed about attending their appointments, and 16% stated that their GP was not supportive.3 Also according to this survey, 80% of trans respondents who accessed or tried to access gender identity clinics said it was ‘not easy’, citing long waiting times as their main barrier to treatment.3

As well as these disproportionately poor outcomes and bad experiences of healthcare for LGBTQ+ people, many clinics serving these communities have recently closed. For example, the Gender Identity Development Service at the Tavistock and Portman NHS Foundation Trust was closed earlier in 2024.4 In addition, during the lead-up to these closures, some leaked NHS emails revealed that numerous hospital executives were concerned about the cancellation of appointments, meaning a lack of information for patients and poor communication with the new gender identity services being established.5 The service’s director, Dr Polly Carmichael, stated that cancellations could ‘potentially put patients at risk’, however NHS England has insisted that there would be a ‘continuity of care’ for NHS patients.5 Despite these closures, two new children and young people’s gender services ‒ the first of eight that are intended to be commissioned within the next two years ‒ have opened, and are based in the North West and in London.4

The barriers facing LGBTQ+ people in accessing healthcare are directly linked to significant mental health declines in this population. According to a health report by Stonewall, approximately 52% of LGBT people reported experiencing depression within a year. Of that, 13% of LGBT people aged 18-24 have attempted to commit suicide within a year, and 46% of trans people and 31% of non-trans LGBT people have considered suicide.6 Similarly, 14% of LGBT people said they had avoided treatment due to a fear that they’d be discriminated against.6 Stonewall’s report also includes direct quotes from some of the survey respondents, describing their own experiences of healthcare, and the lack of support seems to span age groups and other characteristics. Rosemary, aged 70, from Wales, stated: “I am being treated for depression, which is caused in part by not being able to access any LGBT senior age-related groups within 80 miles of me. I would be actively involved in such a group if I could find one, but there is nothing. I feel very isolated.”6

This shows how healthcare experiences of LGBTQ+ people span from homophobic, to neglectful and isolating, none of which reflects positively on the healthcare system. Clearly, there is a huge need for change within the NHS in terms of its treatment and care for LGBTQ+ patients, from removing barriers to care, through to ensuring all care is inclusive and positive.

The government has published a National LGBT Action Plan, which outlines its priorities for ensuring that healthcare becomes more positive for LGBTQ+ people.7 This covers the following areas: advice and influencing; sexual orientation; inclusive gender and trans status monitoring; evidence base; and education and training.7 The NHS has outlined its priorities under these five topics. In terms of advice and influencing, it has stated: ‘We will work with NHS England and NHS Improvement colleagues and external partners to reduce LGBT health inequalities and improve experience and care.’ The sexual orientation and gender identity monitoring section outline plans to ‘scale up the roll out of Sexual Orientation Monitoring across health and social care services and start work to develop inclusive gender identity/trans status monitoring’.7 The Action Plan also reflects on its evidence base, stating that it ‘will review and share the evidence base on LGBT health inequalities and use this to inform change’, as well as considering education and training by explaining that it ‘will work to develop and share best practice education and training to improve healthcare professionals’ awareness of LGBT issues to improve experience of care’.7

It is clear that the treatment of LGBTQ+ people within healthcare is lacking, both in terms of barriers to accessing healthcare, mental health implication and, in some cases, the personal views of staff. Healthcare needs to become more inclusive for LGBTQ+ people. Changes could be as simple as healthcare staff and patient information using inclusive language such as ‘they/them’ pronouns rather than ‘she/her’ or ‘he/him’ so as not to exclude trans or non-binary patients, or as complex as ensuring gender identity services are as efficient as possible. On the whole, there are some obvious issues within this section of the healthcare system, however, we can be hopeful that with the recent publication of a government action plan, change is near.