What is Hidden Figures?

Hidden Figures is a document that presents our assessment of the health inequalities faced by LGBT communities. Health inequalities arise at different stages of people’s lives, and LGBT people often experience specific further discrimination and marginalisation when accessing services to address these health inequalities. This report therefore uses a life course approach to highlight the importance of these stages and their cumulative impact on health and wellbeing. It also attempts to showcase the unique inequalities faced by LGBT people throughout the entirety of their lives, from cradle to grave. 

As such, this report is designed to showcase how multiple health inequalities across a lifespan can impact sequentially and can lead to significantly worse health outcomes. It also touches on the wider determinants of health as well as some of the persistent causes of poor health experienced by LGBT people. 

Who is it for?

This document is intended for commissioners and decision makers, those working with and supporting LGBT people, and those conducting research or writing media articles about the needs of LGBT people. We set out to make this document accessible, relevant and easy to navigate. Each section of the report may be pulled out as a stand-alone fact sheet, offering insight into a particular inequality area facing LGBT people.

We have deliberately decided not to make any recommendations. Rather, we are providing an insight into the lives of LGBT people and the issues affecting them, as evidence to support improved access to services, and evidence to support a range of campaigning and lobbying activity for LGBT equality. 

LGBTQ+ Health Inequalities at a glance

Below are ten key statistics which we believe most clearly evidence the sequential and significant impact of experiencing inequality over the life course. Where possible, these have been compared to the general population. 

• In 2017, 21% LGBT people reported that they had experienced a homophobic, biphobic or transphobic hate crime in the previous 12 months, with this rising to 41% for trans people.
• 23% of LGBT people have at one time witnessed anti-LGBTremarks by healthcare staff.
• In 2017, 1 in 6 LGBT people reported drinking almost every day in the last year, this compares to 1 in 10 adults in the general population who report drinking alcohol on five or more days per week.
• 45% of trans young people (aged 11-19) and 22% of cis LGB young people have tried to take their own life. Among the general population the NHS estimates this figure to be 13% for girls and 5% for boys aged 16-24.
• 24% of homeless people aged 16-24 are LGBT and 69% of these people believe parental rejection was a main factor in becoming homeless.
• 42.8% of LBT women said that they had experienced sexual violence compared to an estimated 20% of all women in the UK.
• 55% of gay, bisexual and trans men were not active enoughto maintain good health, compared to 33% of men in the general population.
• In 2017, 52% of LGBT people reported experiencing depression in the previous year. This includes 67% of trans people and 70% of non-binary people.
• In 2017, 40% of trans people who had accessed or tried to access public healthcare services reported having experienced at least one negative experience because of their gender identity in the previous 12 months.
• 93% of LGBT specialists and service users consider that more work needs to be done to improve end of life services for LGBT people.

Can you help us?

It is important that this information reaches as many people as possible, and to do that we need your support. Can you help us by sharing this research with your contacts, colleagues and networks? You could also share this on social media to ensure that this information and these experiences reach the widest possible audiences.

If you have any questions about the report, you can reach our research team at research@lgbt.foundation.

In May 2020, LGBT Foundation published findings from the largest and most substantive research into the impact of the Covid-19 pandemic on LGBT communities in the United Kingdom to date. This research has uncovered some of the wide-ranging and profound effects the pandemic has had on the lives of LGBT people in areas such as mental health; isolation; substance misuse; eating disorders; living in unsafe environments; financial impact; homelessness; access to healthcare; and access to support.

Hidden Figures: The Impact of the Covid-19 Pandemic on LGBT Communities is a culmination of the findings from our online survey, existing research on LGBT health inequalities, and our own unpublished service user data. Our survey found that of LGBT people who responded:

This report shines a light on some of the experiences of LGBT people and the very real impact that the pandemic is having on their lives. One respondent shared –

“I’m transgender but not out, my parents are transphobic, having to pretend to be someone I’m not all the time is physically, mentally, emotionally and spiritually exhausting”

This research is a development of our earlier report The Essential Briefing on the Impact of COVID-19 on LGBT Communities in the UK, and sits alongside our Hidden Figures: LGBT Health Inequalities in the UK report published in February 2020.

Whilst the impact that the crisis is having on some minority groups, including black, Asian and minority ethnic (BAME) and disabled people, has been more widely recognised, LGBT communities have been absent from much of the narrative. This report seeks to redress this lack of information and recognition. We hope that this research sparks a national conversation that ensures that no community is left behind.

The report looks at some of the disproportionate impact of the pandemic on certain LGBT communities. For example, BAME LGBT communities face greater need for access to mental health services, disabled communities have had a higher rate of medical appointments cancelled, and trans and non-binary people are twice as likely to feel unsafe where they are staying. This research is ongoing, and we are planning to continue this work with partners to look at the effects on other LGBT communities.

Can you help us?

It is important that this information reaches as many people as possible, and to do that we need your support. Can you help us by sharing this research with your contacts, colleagues and networks? You could also share this on social media to ensure that this information and these experiences reach the widest possible audiences.

If you have any questions about the report, you can reach our research team at research@lgbt.foundation

“I’ve received good care as a transgender woman from the GP practice, without feeling patronised”

Pride in Practice works to improve the experiences of LGBTQ+ people accessing primary care services.  

Whether you’re visiting a GP, dentist, pharmacist, or optometrist, you deserve a service where you feel safe, accepted, seen, and supported by the healthcare professionals who provide your care.

Pride in Practice Map

“The more I discuss my sexual orientation the more I realise it is helpful not just to me, but to the health professional too.”

Established in 2010, the Pride in Practice team has worked with over 1000 primary care services across the UK, presenting over 650 accredited awards recognising excellence in LGBTQ+ healthcare.  

The Pride in Practice team can share information, signposting, and resources with patients and registered practices. For more information email pip@lgbt.foundation.
 
Find out more about how Pride in Practice supports healthcare professionals.

HEALTHCARE PROFESSIONALS

The NHS Rainbow Badge was created to be a way for NHS staff to demonstrate that they are aware of the issues that LGBTQ+ people can face when accessing healthcare.

There were two phases to the programme:

Phase 1: Wearing the NHS Rainbow Badge 

The NHS Rainbow Badge was developed and led from Evelina London Children’s Hospital by Dr. Michael Farquhar as a way for NHS staff to demonstrate they are aware of issues that LGBTQ+ people can face when accessing healthcare. 

When wearing the badge, people were: 

• Accepting that it is a responsibility. 
• Acknowledging the barriers which LGBTQ+ people may face. 
• Committing to promoting an environment that is open, tolerant, and inclusive. 
•  Showing up to listen without judgement. 

Phase 2: Creating LGBTQ+ inclusive healthcare environments 

Phase 2 was funded by NHS England and delivered by a collaborative partnership consisting of LGBT Foundation, Stonewall, LGBT Consortium, Switchboard, and GLADD.  

It involved an assessment and accreditation model aimed at supporting your NHS Trust to create an inclusive healthcare environment. 

Trusts were assessed on: 

• Clinical service provision 
• Workforce inclusion 
• Leadership 
• Sexual Orientation, Gender, and Trans Status monitoring 
• Facilities 
• Engagement 

Trusts received a graded award reflecting your current LGBTQ+ inclusion work, either Bronze, Silver, or Gold, and a comprehensive feedback report and action plan, designed to help the Trust facilitate meaningful change and achieve the next grade. 

Improving the experiences of LGBTQ+ patients and professionals

The Rainbow Badge partnership also facilitated the NHS LGBTI+ Sounding Board, a group of LGBTI+ volunteers who have lived experience of being LGBTI+ and knowledge of the health inequalities that can occur for LGBTI+ people. 

Put simply, sexual orientation and trans status monitoring is asking people about their sexual orientation, trans status and gender identity and recording this information. This can be for a variety of reasons, but, in all cases, it needs to be done with sensitivity and compassion. 

When monitoring sexual orientation and trans status, it is important to ask questions in the right way so that communities understand how to answer in a way that ensures accurate and robust data is collected. When done appropriately, monitoring can demonstrate that services are culturally competent and can help LGBTQ+ people feel included.

WHY IS SEXUAL ORIENTATION AND TRANS STATUS MONITORING IMPORTANT? 

LGBTQ+ communities are likelier to face higher rates of health and social inequalities, as well as greater discrimination and marginalisation. 

All research and services should be taking proactive steps to improve LGBTQ+ experiences. Monitoring sexual orientation and trans status is essential to understand the specific needs of LGBTQ+ communities and recognise the ways in which their experiences need to be improved. 

TRANS STATUS MONITORING

There is currently no national trans status monitoring information standard, although there is ongoing work to develop a standardised approach and to update IT systems so that trans status can be properly recorded. However, this should not hold services back; there are ways to effectively monitor without an information standard. 

Trans status monitoring is becoming more prominent and LGBT organisations such as LGBT Foundation and Brighton and Hove Switchboard have supported services to implement trans status monitoring effectively. 

Services which have implemented trans status monitoring usually gain consent from the individual to place a note on their medical record to say that they are trans and/or to say that their gender identity is something other than male or female. 

A 2017 primary care patient experience survey conducted by LGBT Foundation found that LGBT people who shared their sexual orientation with their GP were 21.4% more likely to feel their GP met their health needs than those who did not. Trans people who shared their trans status with their GP were 62.1% more likely to feel their GP met their health needs than those who did not.