Share your views on the new questions for The National Surveys of Sexual Attitudes and Lifestyles

The National Surveys of Sexual Attitudes and Lifestyles (Natsal) are among the largest surveys on sexual behaviour in the world. The surveys have taken place every 10 years since 1990. NatCen Social Research, University College London, London School of Hygiene and Tropical Medicine and University of Glasgow are currently preparing for the next Natsal survey.

NatCen Social Research, an independent research institute, will be testing some questions which may be used in the next Natsal survey and are looking for respondents to take part in face-to-face interviews.

Who are they looking for?

We are looking to speak to a variety of people who consider themselves to be members of the LGBT+ community.

What is the study about?

The aim of this project is to try out new questions and changes to questions for the next Natsal survey to make sure they are easy to understand and answer. By trying out the questions with a range of different people, such as yourself, we will be able to check that the questions are understood easily and work as intended.

What is involved?

Taking part would involve arranging a suitable time to talk to you about the questions. In the interview you will be asked the questions which have been developed and asked for your thoughts on the questions. The interviews will last about an hour. They will be audio-recorded, with consent. Respondents who take part in a face-to-face interview will receive a £30 high street voucher as a token of our appreciation for participating in the research.

When & where will the interviews take place?

The interviews will take place in London during the day. Interviews will be taking place until the 25th of November.

Will the interview be confidential?

Yes, completely. Any answers you give will be treated in the strictest confidence in accordance with the General Data Protection Regulation (GDPR). Everything you tell us will only be used for the purpose of this research and will not be shared with anyone outside the project research team unless you say it can be. The research will be written up as a report. Your name will not be used in the report. With your permission, the interview will be audio-recorded.

Interested in finding out more?

If you are interested in finding out more about this research and what is involved, please contact Emma Corteen, emma.corteen@natcen.ac.uk

Greater Manchester Trans Health Service Pilot

NHS England has launched a selection process to find a suitable provider, or group of providers, to deliver a pilot healthcare service for trans and non-binary adults (17 and above) in Greater Manchester. The pilot will initially run for up to three years.

As an outcome of a significant programme of work to improve gender dysphoria services, NHS England has concluded that a new delivery model is necessary for England that offers access to specialist care by trained professionals in primary care and other local settings.

NHS England is looking to establish – for evaluation – a multi-disciplinary team based in primary care in Greater Manchester that will deliver NHS services that are currently only available in designated Gender Dysphoria Clinics.

The advantage of this model, if positively evaluated, is the ability to increase clinical capacity to an extent not possible using the current delivery model; more timely and accessible care delivered (initially) in the Greater Manchester area; and a better join-up between the team providing specialist care and the individual’s own GP.

The Greater Manchester Trans Health Service will work to an adaptation of NHS England’s national service specification for gender dysphoria services (that was agreed in 2018 as an outcome of public consultation).

A key feature of the selection process is for bidding organisations to describe a delivery model that has been co-designed with the trans and non-binary communities of Greater Manchester, and which is tailored to meet their particular needs. A common theme heard during consultation was around the need for a more inclusive service, streamlined referral processes and multi professional/multi-sector staffing.

As well as providing a range of support to people, the Trans Health Service will work closely with GP practices and build collaborative relationships with local statutory services and voluntary sector services, so that individuals may be easily referred or sign-posted to other services in Greater Manchester that meet their overall health and social care needs.

NHS England is working collaboratively with the Greater Manchester Health and Social Care Partnership (GMH&SCP), which combines health and local government, on the pilot. GMH&SCP will support NHS England in setting up the service and consider how additional services could be incorporated over time.

The service will initially focus on supporting individuals from Greater Manchester who are on the waiting list for a first appointment at a Gender Dysphoria Clinic.

The invitation to tender for the Trans Health Service is open to health and social care and third sector organisations. More information about requirements of the service for potential bidders is available on the Government Contracts Finder website. The tender process closes on 22 November 2019.

The Trans Health Service is expected to be in place in 2020.

For more information about NHS England’s work on gender dysphoria, please contact england.scengagement@nhs.net.

Call for Evidence: Barriers for marginalised groups to accessing breast screening

Background

In England, breast screening is currently offered at 3-yearly intervals to women aged from 50 up to their 71st birthday. In 2017/18, 2.54 million women aged 50-70 were invited for breast screening of which 70.5% attended. Early diagnosis is key to improving the likelihood of successful treatment of an ageing population. The NHS breast screening programme has been experiencing decreasing uptake over a number of years. Whilst attendance for breast screening is a personal choice, and this must be respected, it should be an informed choice, and the screening service should be aware of, and able to respond to, the barriers that some population groups face in accessing the service.

The Project

In order to effectively reduce the impact of inequalities, The National LGB&T Partnership, in collaboration with Health and Wellbeing Alliance Members Friends, Families and Travellers, Faith Action, Race Equality Foundation, Mental Health Consortia and Win Win Alliance, and supported by Public Health England, are working on a project which will identify reasons why some people are not attending for breast screening. Barriers to screening can include physical and communication barriers as well as cultural and social barriers, and there is a current lack of evidence of the barriers to attendance experienced by groups who experience marginalisation and inequalities.

The project will undertake significant consultation through focus groups with various seldom heard groups to identify whether there are issues affecting the different community groups in relation to breast screening. Practical measures to reduce these barriers and reduce variation in participation will be identified, including through consultation with staff working within breast screening services, and outlined in a national toolkit, for use by these staff to better engage and communicate with the various population groups.

Call for Evidence

To support the development of the project, particularly the questions that will be asked of participants in focus groups, we are asking you to share any research, investigations, projects or information you have conducted or are aware of which relates to barriers to accessing screening and preventative care for marginalised groups. Our priority is to consider access to the breast screening programme, but as we know there is limited evidence in this area, we are extending this call to capture all evidence which may shine a light on the issue. We are interested in the experiences of people covered by all 7 main protected characteristics* (age, disability, gender reassignment/trans status, race/ethnicity, religion or belief, sex/gender, sexual orientation), 5 health inequality areas (Gypsy, Roma, or Traveller communities, vulnerable migrants, homeless people, people in contact with the criminal justice system, sex workers), and mental illness, people without English as a first language, people with caring responsibilities and people with experience of sexual violence and/or trauma.

*at this time, the remaining two protected characteristics: marriage/civil partnership and pregnancy/maternity are not key areas for investigation.

How to contribute

Please send any documents and/or links to: harri.weeks@lgbtconsortium.org.uk by October 25th.

The role of the GP in caring for gender-questioning and transgender patients

The National LGB&T Partnership welcomes that the RCGP have established a position on the role of the GP in caring for gender-questioning and transgender patients and recommendations for ensuring these patients receive equal access to the highest standard of care. We particularly welcome the assertion that “GPs are expected to approach the holistic care of gender-questioning and transgender patients as they do with every patient – openly, respectfully, sensitively and without bias” and the recognition that “The gaps in education, guidance and training for GPs around treating gender dysphoria for both adults and children, and managing broader trans health issues, also needs to be urgently addressed”, particularly the recommendation that “if GPs feel a lack of knowledge or experience about the healthcare needs of trans people, they…address their training needs as part of continuing professional development.” 

However, our support of the position statement is not without its hesitations.

We of course welcome further research which will support the development and extension of positive support for trans people, however we are concerned that there is yet again call for further research when we know that this is used as a stalling mechanism in policy change and that national and international evidence is increasingly widely available, as is community-developed intelligence. The possibility of future innovations should not be used as a reason to ignore or undermine current good practice.

We welcome the progressive position that “people who are uncomfortable or distressed by their biological sex or gender roles and behaviours assigned to them by society, but do not wish to alter their sexual characteristics” deserve appropriate support. We call on NHSE to describe how this support will be provided through a model which restricts provision of care through the NHS England commissioned services (GICs) to those who receive a diagnosis of gender dysphoria.

We contest that GPs are “being pressured into prescribing”, particularly given the numbers of service users who state their GP is refusing to prescribe, even after instruction from a GIC, and also argue that prescribing should not be seen to “fall outside the limits of one’s competence” when detailed clinical guidance on hormone therapy has been available to GPs in the NHS publication Guidance for GPs, other clinicians and health professionals on the care of gender variant people since May 2008.

We have some concern that the statement made in section 28 ii may prevent those GPs who might feel competent prescribing from the point of a patient’s presentation to them from doing so, as they are instructed to “refer patients to a GIC or equivalent if they exhibit signs of gender dysphoria and request treatment”. This is compounded by the fact that the position statement also refers to the GP “taking on the ongoing prescribing of medication for patients and the monitoring of any side effects…after a patient has been discharged from a GIC”. The statement also acknowledges the lack of capacity of GICs, long waits between appointments, and long distances that many patients are required to travel to attend. Many trans people will not be discharged from the GIC until after they have received surgical interventions, which, between the requirements of the service specifications and the capacity-affected long waiting times between appointments is often a number of years after starting hormone treatments. Requiring patients to travel to GICs to obtain prescription, administration and monitoring of their hormone regimens during this time is clearly unreasonable.

We encourage the RCGP and the NHS to further investigate the opportunities and detailed complexities of altering NHS data collection systems with regards to sex, gender and trans status, so as to find a solution which serves patients, practitioners and researchers, as the suggestions outlined in UK Wide Policy Recommendation iii (page 10) do not appear to sufficiently consider the appropriateness of the changes recommended.

We are pleased to see that the statement suggests it is “vital that frontline GPs, patients and the broader trans community are involved in the design and implementation of changes to the current system”, and welcome the RCGP to call on the National LGB&T Partnership, it’s members and colleagues to support them in this work.

#LBTWomensHealth18 – If you’re not counted you don’t count.

Mike Cullen at the LGBT Foundation wrote the following blog post for us about Sexual Orientation and Trans Status Monitoring and Lesbian, Bisexual and Trans Women’s health.

LBT Health Week is a great opportunity to talk about monitoring, which continues to be a key part of the work of the LGBT Partnership and has been for a number of years. For those of us working in the sector we’re very aware of the health inequalities that LBT women experience, such as poor mental health, sexual and reproductive health inequalities and higher rates of cancer. Yet often these inequalities are not addressed by mainstream services and so the needs of our communities go unmet. To put it simply, if we’re not counted we don’t count.

Invisibility within services means that they are unaware of the specific health needs our communities often experience. Monitoring the sexual orientation, trans status and gender identity of service users is the simplest way to start addressing clipboardthat.

It means that an evidence base can be built and as a result targeted preventative work can be done to help reduce these inequalities. We know for example that LB women are less likely to access cervical cancer screenings than their heterosexual counterparts. Monitoring means that when LB women access services health care professionals can ensure they are given the correct information.

Another benefit of monitoring is that it shows you are acknowledging someone’s identity and are seeing them as a whole person. This helps to reduce barriers to accessing services and creates an environment of openness where people are more likely to discuss their health concerns. When services have a fuller picture of who is sat in front of them, they are able to diagnose and treat people faster, as well as signpost to services suited to individual needs. Monitoring alone isn’t going to reduce all of the health inequalities that LBT women experience, but it’s a great first step.

 

 

For further guidance on monitoring please visit lgbt.foundation/monitoring

Sexual Orientation Monitoring Standard introduced

The National LGB&T Partnership welcomes new sexual orientation monitoring as game changer towards better LGB health and social care services

The National LGB&T Partnership has welcomed the launch of a newly published NHS Information Standard for sexual orientation monitoring as a significant game changer in the future health and social care provision for lesbian, gay and bisexual people (LGB) in England.

Released by NHS Digital today (5th October 2017), it aims to better meet the needs of LGB people through improved data collection. The new standard will provide a mechanism for recording the sexual orientation of all patients and service users aged 16 years and over across all health services and Local Authority social care providers in England.

The Standard was commissioned by NHS England and developed by LGBT Foundation working with NHS Digital, the Department of Health, Public Health England and a cross-system group with representation from leaders across health and social care as well as organisations representing the workforce. It also involved an extensive consultation with organisations across the health and social care system, service users and the public.

Research by LGBT Foundation has shown that LGB people are disproportionately affected by a range of health inequalities and experience significant barriers to accessing health and care services.1

  • LGB people are twice as likely as the general population to commit suicide.
  • LGB people are seven times more likely to use drugs, twice as likely to binge drink, and show higher levels of substance dependency compared to their heterosexual peers.
  • LGB people are more likely to experience many cancer risk factors including stress, smoking, problematic alcohol use and poorer diet and exercise.
  • LGB people are less likely to access mainstream health services, including cancer screening.
  • LGB people are more likely to rate their experiences of health and care services as poor, and fear that they will suffer unequal treatment as an LGB person.

The research also pinpointed the better sexual orientation monitoring as a vital step towards addressing these specific health inequalities and improving access to care.

The sexual orientation Information Standard sets out a consistent question and answer options for recording this data:

Which of the following options best describes how you think of yourself?

  1. Heterosexual or Straight
  2. Gay or Lesbian
  3. Bisexual
  4. Other sexual orientation not listed
  5. Person asked and does not know or is not sure
  6. Not stated (person asked but declined to provide a response)
  7. Not known (not recorded)

Research has shown that between 90-95% of people are happy to be asked this question, as long as they understood why it was being collected, and that it is similar in terms of public acceptability to collecting demographic data on religion, a question which is now commonplace on demographic forms. 2,3

Commenting on today’s launch, Paul Martin, Chair of The National LGB&T Partnership said:

“The Partnership is thrilled to see the sexual orientation monitoring standard go live today. This issue has been a key focus for the Partnership for years, as much of the work we want to do with LGB communities has been limited by the lack of evidence around need.

Today’s launch is a significant step in the right direction towards addressing LGB health inequalities.”

 

 

If you would like more information on sexual orientation monitoring, please visit Lgbt.foundation/SexualOrientationMonitoring or email nationallgbtpartnership@gmail.com

 

1,2 http://lgbt.foundation/bhp

3 Office for National Statistics, July 2017, Sexual Identity: update on research and testing, Census Roadshows. Available at: https://www.slideshare.net/secret/HwBiX0XCGQSAGN.

Consultation: NHSE Gender Identity Services for Adults

The National LGB&T Partnership has developed a response to the national consultation on Adult Gender Identity Services in England, which closes on Monday October 16th 2017. More information, and links to respond to the consultation, can be found here: www.engage.england.nhs.uk/survey/gender-identity-services-for-adults/

To read our response, which may be reproduced in your own response, please click here.