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Stonewall Healthcare Equality Index 2014Welcome to Stonewall’s Healthcare Equality Index 2014, our second guide to England’sbest healthcare organisations for lesbian, gay and bisexual patients, families and carers.Stonewall’s research demonstrates that there are many lesbian, gay and bisexual peoplewho continue to face poor health outcomes as well as expecting poorer treatment fromhealth services. The organisations that have taken part are sending a powerful signal ofcommitment to equality in healthcare.This year we have seen a range of organisations take part from across the health sectorincluding providers, commissioners and charities. The Index provides evidence of howthese organisations are improving the health and expectations of lesbian, gay andbisexual people across England.Congratulations to everyone included in the Healthcare Equality Index. Together, they arehelping to tackle health inequalities and deliver a high quality health service for everyone.Ruth Hunt Acting Chief Executive

Stonewall’s Top Healthcare OrganisationsStonewall’s Top Ten healthcare organisations in England are committed to improving the health oflesbian, gay and bisexual people. These healthcare organisations recognise the importance ofpromoting equality and have taken active steps to improve their services for lesbian, gay andbisexual people.1 Central and North West London NHS Foundation Trust2 Sussex Partnership NHS Foundation Trust3 St Andrew’s Healthcare4 Liverpool Community Health NHS Trust5= County Durham and Darlington NHS Foundation Trust5= London Ambulance Service NHS Trust7= Leeds Community Healthcare NHS Trust7= Royal Liverpool and Broadgreen University Hospitals NHS Trust9 Central London Community Healthcare NHS Trust10 Brighton and Sussex University Hospitals NHS TrustStonewall’s Patient Feedback SurveyAs part of the Healthcare Equality Index, Stonewall sought feedback directly from participatingorganisations own lesbian, gay and bisexual patients. The results of this feedback provide an insightinto the experiences of lesbian, gay and bisexual people accessing healthcare services.•Two in five respondents said they felt their healthcare organisation theyused was lesbian, gay and bisexual friendly•68 per cent of respondents felt they were treated with dignity and respectall the time•Just under half (45 per cent) of respondents felt comfortable tellinghealthcare professionals their sexual orientation all of the time•3 in 4 respondents would recommend services to friends or family if theyneeded similar care or treatment

What a good healthcare organisation looks likeStaff members understanding the needs of lesbian, gay and bisexualpatients All of the Top Ten provide training to staff on the health needs of lesbian, gay and bisexualpeople, up from 80 per cent last year. Of the Top Ten, seven have training which includes the diversityof the lesbian, gay and bisexual community.Clear sexual orientation equality messages Nine of the Top Ten have clear nondiscriminationmessages on posters or leaflets that explicitly reference sexual orientation. These aredisplayed in patient waiting areas or through their outreach work.Patient’s sexual orientation data is used to inform services Eight out of theTop Ten monitor patient’s sexual orientation on patient’s records. 100 per cent collect this data throughpatient feedback forms or surveys. Half of the leading healthcare organisations use the data onpatient’s sexual orientation to develop specific actions to improve their services.Providing lesbian, gay and bisexual people with tailored servicesEight of the leading healthcare organisations have dedicated services for lesbian, gay or bisexual people.Working in partnership 70 per cent of the Top Ten healthcare organisations work with arange of partners in the public, private and third sector, such as local authorities, the police andcharities, to improve the health and wellbeing of lesbian, gay and bisexual people.Lesbian, gay and bisexual patients influence servicesHalf of the Top Ten have a formal lesbian, gay and bisexual patientgroup or patient representation within a staff group which advisetheir organisations on service delivery.Making sure lesbian, gay and bisexualpeople are treated fairly 60 per cent of the besthealthcare organisations explicitly address sexual orientation intheir complaints policy or procedure.Diversity Champions leading the wayNine of the top performing healthcare organisations workwith Stonewall through our Diversity Champions programme,up from 60 per cent last year. This demonstrates that acommitment to workplace equality is important to deliverequality in service delivery.

Case StudiesCentral and North West London NHS Foundation Trust is the highest performing healthcare organisation in theHealthcare Equality Index 2014. The Trust provides mental health, sexual health, community physical health, addictions, eatingdisorder and learning disability services.For a number of years the Trust has run a Gay Men's Therapy Group. The group was set up in response to national researchidentifying the high levels of alcohol consumption in the gay and bisexual male population. The group meets weekly and is designedfor gay and bisexual men. It provides support to attendees and a confidential space to discuss issues in relation to their alcohol anddrug use, as well as other topics in an accepting and non-judgemental environment. Common themes that are discussed by thegroup include how to socialise and meet other people without the use of alcohol or drugs and issues of self-esteem. Frequentlymen join the group at a time when they are chaotic alcohol and drug users. With support from the group many have achievedabstinence and often a return to employment.Sussex Partnership NHS Foundation Trust is well established in promoting sexual orientation equality within its services.The Trust understands that a key way to provide the best services for lesbian, gay and bisexual people is to have data about theirhealth needs and how they are accessing services. Subsequently the Trust has worked hard to improve practices regardingmonitoring patient’s sexual orientation.The Trust wanted to improve their sexual orientation data. The Trust worked with Stonewall to host a series of focus groups withstaff from teams with high rates of valid data and those with low rates. These focus groups were designed to identify the barriersand benefits of monitoring patient’s sexual orientation from a front-line staff perspective. As a result of this work the Trust hasamended its monitoring systems to enable staff members to feel competent and comfortable to collect this data without intrudingon the rest of their work. This has helped develop a climate where patients feel happy to disclose their sexual orientation.The Trust have developed an innovative tool to present and collate equality and diversity data, called the Equality Performance Hub.The Hub provides data on a whole range of areas including staff training, service user experience, recruitment, incidents andcausation as well as membership data. The Hub is one of a range of ways Sussex Partnership analyse how they are tacklinginequalities and promoting equality.St Andrew’s Healthcare is a charity providing specialist services including mental health, learning disability, autism and braininjury at sites across the UK.The charity has a Lesbian, Gay, Bisexual, Transgender and Questioning (LGBTQ) and Straight People's Alliance for patients. Given thechallenges of being situated in complex secure units and multi-site environments as well as working with vulnerable adults andyoung people the Alliance focuses around activities which bring smaller groups together, such as learning and celebration events,the Equalities Allies and Alliances newsletter, or sharing personal stories for displays in spaces used by patients, visitors and staff.In 2013 over 150 equality ally certificates were given out to patients, and staff too, for projects and activities they’d been part of topromote sexual orientation equality at St Andrew’s Healthcare. These opportunities to experience success are therapeutically importantand valued by patients at St Andrew’s Healthcare.Equality Allies discussed the wishes of lesbian, gay and bisexual patients within the low secure units to have Pride activities. As aresult the patients worked with staff to hold a carnival-themed event which was inclusive of people of all backgrounds and sexualorientations and which included a ‘Stamp out Hate Crime’ pledge.Leeds Community Healthcare NHS Trust provides a range of community services for adults and children and has consistentlyworked to communicate with the local lesbian, gay and bisexual communities.Communications have included Stonewall posters and briefings in patient waiting areas including in all health centres; materials onhomophobic hate crime displayed across the Trust; articles in the Trust’s magazine and in the local press; and updates regularly onthe Trust’s social media.The Trust has also developed a patient leaflet that highlights key health issues for lesbian, gay and bisexual people including alcoholuse, smoking, emotional wellbeing, eating disorders and body image, and sexual health. The leaflet includes information on relevantservices within the Trust or from local and national partners. The Trust worked with the learning disability charity CHANGE to makesure the information is accessible. The Trust has sent this leaflet to local community groups including lesbian, gay and bisexualgroups and learning disability groups. Copies have also been placed in patient waiting areas. The aim is to improve awarenessamongst lesbian, gay and bisexual people in Leeds about their health and clearly communicate the Trust is gay-friendly.

Recommendations Improvements to healthcare12345Put policies in place Healthcare organisations should make sure that theirpolicies make clear to lesbian, gay and bisexual patients that they can expectthe same level of service, regardless of their sexual orientation and regardlesswho treats them. Health and social care staff should be supported in tacklinghomophobia whether from staff or other patients.Provide training to staff Healthcare organisations should provide trainingto staff that goes beyond legislation and policies and addresses caring forlesbian, gay and bisexual patients and their families. Training should be targetedto relevant teams such as palliative care, paediatrics, mental health andcommunity health teams.Communicate what you are doing Many lesbian, gay and bisexual peoplestill expect to be treated worse than heterosexual people when accessingtreatment at a hospital, from a GP, from care home staff or a paid carer in theirhome. This might prevent them from being open with health and social care staffmeaning they might not get the best personalised care. Health organisations canbreak down these expectations by communicating that they are gay-friendly.Tackle health inequalities Compared to the general population, lesbian, gayand bisexual people have higher rates of mental ill health as well as alcohol anddrug consumption. Lesbians are also more likely to have never had a cervicalsmear test, while gay and bisexual men are more likely to experience domesticviolence. As well as being the right thing to do, there are legal and financialreasons why health organisations should be seeking to reduce these inequalities.Improve monitoring Unless health organisations know who their patientsare they cannot know if they are addressing health inequalities or combatingpoor patient experience. This should be the case for sexual orientation in thesame way as gender and ethnicity. Organisations should take steps to includesexual orientation on monitoring forms and communicate why they are askingpatients these questions.Findings are taken from Stonewall’s health research Prescription for Change (2008),Gay and Bisexual Men’s Health Survey (2012) and Gay in Britain (2013).Missed out on entering the Healthcare EqualityIndex this year?For more information on how your organisation can take part in the Healthcare EqualityIndex 2015 next year visit www.stonewall.org.uk/HEI

Further Resourceswww.healthylives.stonewall.org.uk/resourcesGAYIN BRITAINStonewallHealthBriefingsLESBIAN, GAY AND BISEXUAL PEOPLE’SEXPERIENCES AND EXPECTATIONSOF DISCRIMINATIONGay in BritainSexual Orientation:A guide for the NHSGay and Bisexual Men’sHealth SurveyPrescription for Change:Lesbian and bisexualwomen’s health checkFar left: Lesbian, gayand bisexual people inLater LifeLeft: Working with olderlesbian, gay and bisexualpeople: A guide for careand support servicesRight: Sexual Orientation:The Equality Act madesimpleHealth ChampionsprogrammeWork with StonewallStonewall research has clearly demonstrated that lesbian, gay and bisexual people face significanthealth inequalities as well as poor treatment when accessing health services.Stonewall's Health Champions programme, funded by the Department of Health, provides freesupport to 20 health organisations in England over the course of a year to improve health servicesfor lesbian, gay and bisexual people. The programme offers member organisations practical advice tohelp them achieve real improvements in the care they provide to local gay people and their families.EachHealthChampionreceives:• Consultancy support from Stonewall worth over £6,500• An initial needs assessment based on Stonewall health research• Support to establish a lesbian, gay and bisexual network group for staff• Access to specific training on sexual orientation equality and lesbian, gayand bisexual health• Support entering the Healthcare Equality Index• A benchmarking meeting to identify next steps at the end of the yearTo find out more and to apply for your organisationto become a Health Champion please visitwww.healthylives.stonewall.org.ukor email us healthchampions@stonewall.org.ukDesign Lucy Ward / Illustrations Christian Tate