Inequalities for lesbian, gay, bisexual and transgender (LGB and T) people in UK social care, health and medicine are increasingly well documented. For example, within the past two months, two new research studies have appeared that provide further evidence on the inequalities experienced by LGB and T service users, patients and staff in social care and health.
Stonewall’s ‘Unhealthy Attitudes’ report on the treatment of LGB and T people in health and social care found that ‘whilst the majority of health and social care staff want to deliver the best possible service to LGBT people, LGBT bullying and discrimination are often left unchallenged, and there is too little understanding of LGBT health concerns across vital health and social care services’ (Somerville, 2015 p.5).
PACE’s five-year study into LGB and T mental health shows that ‘participants reported that a lack of awareness and training means responses from medical or professional staff can feel inadequate’ (Nodin et al, 2015 p.5).
So, in this context, this study into LGB and T curriculum and accreditation inclusion in social care, health and medicine, provides an important addition to the body of evidence. By examining what students learn and professional accreditation standards, the research has the potential to explain why LGB and T people are not receiving the care and support they deserve and are entitled to.
Davy and colleagues describe their study as aiming to investigate
…how and in what ways barriers and facilitators of providing LGBT medical, health and social care curricula content figure in the accreditation policies and within undergraduate and postgraduate medical and healthcare teaching.
The authors used a mixed methods approach for this small-scale qualitative study.
Face to face and telephone interviews lasting around an hour were carried out with members of university teaching staff in one large region in Britain. The researchers sent out emails to 360 staff teaching on social care, health, medicine, social work or psychology courses in 6 universities in the region. Only 10 educators responded from 5 universities, giving a response rate of 3 percent.
The semi-structured interview schedule covered question about whether they thought:
- teaching was informed by accreditation policies;
- how important LGBT issues were for the course they taught;
- LGBT content in their and colleagues’ courses; and
- whether inclusion or exclusion of LGBT issues was a ‘personal pedagogical choice’.
Transcripts were thematically analysed by two researchers.
A ‘thematic discourse analysis’ of 18 UK social care, health and medical accreditation policies from the key professional colleges and councils was also conducted. These included the General Medical Council, Royal College of Nursing and Health Care and Professional Council (which covers social care and social work). These policies are used to set standards about knowledge, skills and behaviour that students must have when they graduate and start practicing.
Data from the accreditation policies was thematically analysed in relation to the research questions.
The themes from the two datasets were then mapped together and developed into final themes that all members of the research team agreed on and that they believed reached ‘conceptual generalisabilty.’
The researchers developed the following three themes and sub-themes from analysis and mapping of the accreditation policies and interviews:
Values and competencies
- Impact of teaching LGBT issues
- Professional competencies
- Equality, diversity and ethics
- Patient centredness
Curriculum time and space
- Clinical practice
- Pedagogical commitment
- School level commitment
Resistances by students and colleagues
- Student choices
- Homophobia and transphobia
- Balancing curriculum and cultural differences
The researchers highlighted issues with administrative, ‘broad deposit-making gestures’ towards covering equality and diversity in health and social care accreditation and curricula which can marginalize the social complexities for LGB and T people. They note that
Despite the multiple accreditation policies in place and gestures towards LGBT content it tends not to be “naturally integrated” throughout the courses we considered.
In the classroom, the researchers found that
…sometimes teachers were anxious about including LGBT curricula content because of student responses.
Overall, they found that the inclusion of LGB and T issues in health and social care curricula was effected by the lack of specific focus on LGB and T issues in policies underpinning practice and anti-discriminatory work.
The authors concluded that
The evidence presented suggests that LGBT content teaching is often challenged at various points in its delivery…these include the lack of collegiate, colleague and student cooperation.
They also concluded that
…non-hostile and open healthcare environments for LGBT patients are required and need to be created, in part, by knowledgeable teachers equipped to engage with the richness and complexity of LGBT patients’ lives.
Strengths and limitations
This study provides important insight into the to extent which accreditation policies of the major social care, health and medical councils and colleges are inclusive of LGB and T issues and thereby ensure that practitioners are fully competent to practice in an anti-discriminatory, person-centred way.
The authors are clear about the limitations posed by the very small response rate to their call for interview participants from universities in one UK region and they also note that they are not intending to generalize the findings.
The findings are also only representative of one UK region, the broad characteristics of which are not given. The universities are also not described in any way. This decision may have been based on ethical concerns about identification, but some brief information about the setting would have been helpful.
The interview part of the study was presented as being an exploratory investigation into the teaching of LGBT issues and what the facilitators and barriers are. So while this part of the study is weaker because of the very small response rate, and any conclusions should be drawn with caution, it provides an initial snapshot of a situation that merits further investigation as the research findings should be of considerable concern.
Despite the limitations of the interviews, the thematic mapping of the two datasets strengthens the findings.
National policy for health and social care determines that it should be person- or patient-centred, with practitioners who are culturally competent and sensitive to the strengths and needs of individuals.
More broadly, practitioners in social care, health and medicine are delivering support to the public, within the context of the Equality Act 2010. As such, these services should be accessible to and effective for LGB and T people.
However, this research suggests that current education and accreditation in social care, health and medicine may not be supporting students and practitioners to fully understand LGB and T issues or even to become competent or fit to practice with LGB and T people.
This situation needs urgently addressing if legal obligations under the Equality Act 2010 are to be fulfilled and, more importantly, all LGB and T people are to experience good quality, empowering, non-discriminatory, person-centred care and support.
If same-sex couples can now legally marry on an equal basis with opposite-sex couples, then all LGB and T people should be able to access safe, supportive social care and health services with confident, competent staff. Education and accreditation is one of the first places to start in ensuring that this happens.
Davy, Z., Amsler, S., and Duncombe, K. (2015) Facilitating LGBT Medical, Health and Social Care Content in Higher Education Teaching. Qualitative Research in Education, 4 (2) pp. 134-163 [Full Text]
Somerville, C. (2015) Unhealthy Attitudes: The treatment of LGBT people within health and social care services London: Stonewall
Nodin, N., Peel, E., Tyler, A., and Rivers, I. (2015) The RaRE Research Report: LGB&T Mental Health – Risk and resilience explored London: PACE [Full Text]