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UNISON is the UK's largest healthcare trade union – with 450,000 members working in the NHS and for private companies providing NHS services. Our health members include nurses, midwives, healthcare assistants, paramedics, cleaners, porters and admin and clerical staff.
Overall, UNISON has more than 1.3 million members who work in the public sector, the community and voluntary sector and for private companies delivering public services.
UNISON campaigns for a fairer society and defends public services. We want to see people put before profit and public interest before private greed. We are committed to campaigning for lesbian, gay, bisexual and transgender equality at work and in how public services are delivered.
UNISON’s national LGBT members committee has produced this guide to provide an overview of our key campaign priorities for LGBT health equality, so that branches and members can get involved and raise these issues at a local level, too.
Our NHS: what we want
Equal access: we want LGBT people to have access to inclusive services, free from harassment and discrimination.
Specific needs recognised: we want LGBT people’s particular needs – including improved access to gender identity services and appropriate sexual health, fertility and mental health services – to be recognised and met.
Support for LGBT staff: we want LGBT staff working in the NHS to work with dignity and respect and without fear of discrimination or harassment.
Health for the whole person: we want acknowledgement that our sexual orientation and gender identity is important in our health and well being – healthcare is not just about extending life but improving its quality.
Our NHS: steps towards equal access
Community care: most healthcare is accessed through a GP practice. The quality of this care can colour a person’s whole experience of the NHS. LGBT people and their families must feel comfortable discussing their issues with their GP so they can get the right care and be assured they will be treated without discrimination.
Mental health: most people will experience, or know someone who is affected by, mental health issues at some time in their lives. These include stress and depression and may arise from issues at work, experience of hate crime or family or relationship problems. Cuts to jobs, benefits and services can make this worse. Although these issues can affect everyone, homophobia, biphobia, and transphobia may place additional pressure on LGBT people.
Good support mechanisms can help to deal with stress, but if problems persist, professional advice or counselling may be needed.
LGBT people need to feel comfortable discussing all aspects of their life with health professionals. Mental health workers must not attribute all problems to a person being LGBT or assume that an LGBT identity is part of the problem.
Sexual health: HIV and other sexually transmitted infections continue to be a significant challenge. Men who have sex with men are still at greater risk of many of these. The key to dealing with HIV and other infections is to give people the ability to reduce risky behaviours. This requires a number of approaches including improving self-esteem and confidence in negotiating sexual activity and reducing drug and alcohol use, which can impair judgment.
It's also important to promote testing services for HIV and reduce the possibility of other people being infected. Cuts to these services must be stopped.
Gender identity services: many health services, not just specialist gender identity clinics, are involved in supporting gender reassignment. A person may also need services such as endocrinology, speech therapy, reconstructive plastic surgery, electrolysis, urology, gynaecology and mental health services. UNISON believes it is vital that trans people are able to take charge of the direction of their own treatment.
Waiting lists for NHS funding for treatment vary around the UK but are often years rather than weeks or months-long. UNISON gives a cautious welcome to the move to national commissioning of gender reassignment services. We welcome the NHS Scotland Gender Reassignment Commissioning Protocols published in July 2012. We believe these should be fully implemented across Scotland and used as a model for services elsewhere in the UK. We note the interim protocol for services in England published in October 2013, based on the Scottish protocol. There needs to be improved funding of gender identity services and a reduction in waiting times, rather than cutting and rationing of services.
Fertility and maternity services: until recently, few fertility services were available to people in same sex couples. Legal changes have meant that services must now be provided without discrimination on the basis of sexual orientation. However, UNISON wants to see more than just an absence of discrimination. We want fertility and maternity services where single LGBT people and LGBT couples feel welcome and included and do not have to guard themselves against ignorance or prejudice.
As cuts to health services bite, criteria for access to NHS fertility services are being more tightly drawn. This must not be allowed to increase sexual orientation discrimination.
Drug and alcohol use: research shows consistently higher levels of drug and alcohol use by LGBT populations. Reasons for this include socialising in a commercial LGBT-scene based in drinking venues, use of drugs and alcohol in response to discrimination and issues such as anxiety and depression. UNISON therefore believes that addiction services must recognise the needs of LGBT people and provide services accordingly.
Cancer: it’s important that health services do not overlook the needs of LGBT people in cancer screening programmes. Trans men and lesbian women, for example, must be included in cervical screening programmes.
Also, some lesbian and bisexual women may be at a higher risk of breast and cervical cancers due to risk factors thought to include higher levels of alcohol, smoking, obesity, childbirth after the age of 30 or not having given birth. These risks will be compounded if women avoid contact with health professionals because of past experiences of discrimination or poor attitudes.
Our NHS: campaigning to protect the NHS
There have been significant strides towards recognising LGBT people’s healthcare needs in recent years.
The NHS Constitution makes it clear that healthcare and human rights go hand in hand. The 2010 Equality Act bans discrimination and harassment of staff and service users because of sexual orientation or gender reassignment and placed a duty on those providing public health services to give due regard to the need to promote equality for LGBT people. The introduction of civil partnerships helped healthcare professionals recognise the diversity of families and made it easier for people in same sex couples to designate their next of kin.
But now, the massive changes to the NHS brought in by the government in the Health and Social Care Act 2012 are leading to a huge increase in the use of the private sector to deliver what were once publicly-provided services in England. These moves will undermine the system that has thrived for years on co-operation and solidarity to provide quality patient care.
UNISON has been working with other health unions and community groups to campaign against these cuts and increasing privatisation to ensure that the NHS remains a quality public service that provides universal and comprehensive care that is free at the point of need for everyone.
Our NHS: the effect of austerity on LGBT people
Cuts to services are taking place across the NHS, most severely in England. Research commissioned by UNISON by NatCen Social Research into the implications of austerity for LGBT people and services, published November 2013, clearly shows this.
Sexual health services: a number of different sexual health services were reported to have closed or to be under threat of closure. In particular it was reported that some sexual health services were now being commissioned through local authorities who in a drive to make efficiency savings had cut much of the service provision as well as outreach, health promotion and prevention work.
Mental health services: emotional and mental health services were observed to have reduced and some participants reported difficulties even finding a GP. There was a view that mental health services were not as well protected from cuts as other parts of the NHS.
Drugs and alcohol services: for example a specialist LGBT harm reduction drug and alcohol service described having lost funding and as a result having to undergo restructuring, loss of staff and change premises away from the gay community where LGB people were more likely to access them.
Gender reassignment services: waiting times were reported to have increased for gender reassignment services over the last two years and services such as facial hair removal were reported to have been withdrawn (although sometimes it was unclear whether this was due to austerity or the often controversial way that gender reassignment is presented in society).
Information services: were observed to have diminished under the funding cuts with the closure of libraries and inability of services to keep websites running and up to date. A participant explained that these means of accessing information were particularly important to LGBT people because they were ideally placed to provide health advice, lifestyle support and general links to the LGBT community, particularly for those with barriers to accessing face to face support.
Reduced outreach: some LGBT outreach projects, for example a service offering information and advice on sexual health, had stopped due to lack of funding.
The knock-on effects of these cuts to will be felt for years to come.
Our NHS: join the campaign
If you share our belief in equal access to a National Health Service that is publicly owned and not driven by profit - join our campaign.
The new NHS structures in England allow for a number of ways we can make the NHS work for us – not big business. You can help defend the NHS by:
Joining a patients' group, such as HealthWatch, which is commissioned by local authorities and which generally allow people to join as members and have a say in how patients’ interests are represented
Becoming a member of a foundation trust, which will ensure you get information and can vote in governor elections
Becoming a governor of a foundation trust either by being elected as a public member or a staff governor or, in some cases, being appointed. You can even become a non-executive director of a trust if you are appointed;
Becoming a patient rep on one of the new clinical commissioning groups Many will co-opt patient representatives onto their boards and create patient groups.
Health and wellbeing boards are made up mostly of councillors and council officers but many will set up sub groups which may offer opportunities for lay people to get involved.
Websites like NHS choices www.nhs.uk can tell you what NHS organisations serve your local area. The individual NHS organisation’s website will give details of how you can get involved.
If you work in the NHS, your UNISON rep and members of your branch will have knowledge or experience to share.
Join us in UNISON!
In UNISON, we have a flourishing network of LGBT members who meet locally and nationally. UNISON advice and publications on LGBT equality are on our website, where members can find information about regional and national events and sign up for monthly LGBT e-bulletins and for our newsletter ‘Out in UNISON’.
To find out more, visit www.unison.org.uk/out or email us at out@unison.co.uk .
To join UNISON, go to www.unison.org.uk/join.
November 2013
UNISON LGBT group 120 Euston Road London NW1 2AY
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