PARLIAMENTARY DEBATE
Lesbian, Bisexual and Trans Women’s Health Inequalities - 10 March 2020 (Commons/Commons Chamber)

I beg to move,

That this House has considered lesbian, bisexual and trans women’s health inequalities.

It is a pleasure to move the motion and to speak in this very important debate on lesbian, bisexual and transgender women’s health in the week we have been observing for considering such issues. The aim of the LBT Women’s Health Week is to raise awareness about lesbian, gay, bisexual, trans and queer women’s health inequalities, to make it easier for service providers to empower service users and to make it easier for communities to support LGBTQ women.

Up front, I will declare an interest as a lesbian, who also suffers from anxiety and other mental health issues. I know that my own experiences have taught me a huge amount. In recent months and years of reflection since I came out in 2015, I have had a little bit of time, despite the political storms we have lived through in recent years, to reflect on some of the reasons why it took me so long to come out.

I am very grateful to the Backbench Business Committee for granting this debate, and to the many charities and organisations that operate in the LGBTQ space that have provided briefings for today, as well as our healthcare professionals—I know we will discuss them today, but we must pay tribute to them—and to the Women and Equalities Committee and the Parliamentary Office of Science and Technology, which have done much work and produced reports that many of us will draw on. I know some controversial issues will be discussed today, but I am certain that we will hold this debate and have our discussions with respect and integrity.

I also want to thank the many folk who contacted me after I put a shout-out on social media asking for lesbian, bisexual and transgender women’s experiences of health inequality. I am sure that everybody in this House will agree on the ills of social media, but I also hope we can agree that there are times when it can be incredibly positive and constructive as a tool to help us engage. At a time when this Parliament and the politics of this place can seem very far from folks’ lives, I have appreciated the ability to reach out to the public via Twitter and other social media channels, and I will shortly share some of the experiences that members of the public have shared with me on this issue. I know that some of them were very painful and very difficult to relive and to recount.

There are many facets to the debate on the healthcare of LGBTQ people and women in the LGBTQ community, and the fact that there is a specific week to raise awareness when there are so many other issues going on is really helpful. The Science and Technology Committee report states that there is

“emerging evidence demonstrates that lesbian, gay, bisexual and trans (LGBT+) people experience significant health inequalities across their lifespan, often starting at a young age.”

I came out literally as I was being elected, initially to myself, then later to my family and friends and publicly sometime after that, and that was challenging. It is fair to say that the impact on my mental health was profound. As most of us who have been here since 2015 will know, there was not exactly time to process any personal challenges or issues. But my experience of coming out publicly was hugely positive. Social media played a part in that, such as taking part in a photograph of LGBTQ MPs and peers, which then went online and attracted much attention; that showed the solidarity not just in this place and at the time in the other place for LGBT politicians, but across wider society. It was hugely positive, but I am also very conscious that I had an incredibly supportive network of family and friends, and that I have a very privileged position; in many ways I came out with the cover of political privilege. That is something that very few other people across the UK and beyond have, and we must always remember the challenges that folk across the UK and beyond face in coming out and those in the many countries where it is still illegal and people are persecuted for being LGBTQ.

Does the hon. Lady feel that at this time we should include in our thoughts those lesbian, bi and trans women who are asylum seekers and have been asked by this Government to prove that?

I absolutely agree with that. There are a number of stories in the press at the moment about LGBT asylum seekers that are hugely concerning, and I would like to think that, given the distance we have travelled, this Government will review their processes and policies and look very carefully at the treatment of LGBT asylum seekers. I have met a number of them myself, and some incredibly important work is ongoing, but the stories that we are reading in the press and the experiences that we are hearing of LGBT asylum seekers are deeply troubling, and I absolutely agree with what the hon. Lady said.

On coming out later in life, I discovered recently that middle age is classified as being between 30 and 50. I have to say that that was a shocking discovery.

It is middle youth.

I agree with that.

For me, and for many other people, in coming out later in life there is an element of regret, and in fact mourning, for a life not lived as my authentic self, and it is hard to describe what that feels like. I try very hard to look forward—to make the most of what is in front of me, not to look back and have regrets that I was not living my life as my true self. There are many reasons why people come out later in life, and there is also much research around the profound impact that that has on people’s mental and physical health.

Coming out as lesbian, gay or bisexual can be a very different experience from coming out as trans. I cannot imagine how incredibly difficult that is, particularly in the current climate. We owe it to our trans and non-binary citizens to support them and ensure that discussion around changes in legislation or any matters relating to their lives and healthcare is conducted in a respectful and decent way. Sadly, I think we can all agree that there have been times recently when that has not happened.

Does my hon. Friend agree that while it now seems socially unacceptable to express anti-gay thoughts and feelings, by contrast we appear to be having an open season on trans people, which is deplorable. Does she also agree that that must be deeply disturbing for young trans people who are trying to come to terms with who they are?

I absolutely agree. Technical details of legislation and the concerns that people may have can and should be discussed, but they have to be discussed in a respectful way. As my hon. Friend says, there is open season on trans people. We could literally cut and paste some of the rhetoric that was used against lesbian, gay and bi people the ’70s and ’80s. That it is now being used against trans people is just utterly deplorable. We must do everything we can to protect trans and non-binary people’s rights and their mental health.

We know the LGBT community, including lesbian, bi and trans women, experience significant health inequalities and specific barriers to services and support. Stonewall Scotland’s survey of LGBT people in Scotland found that half had experienced depression in the past year, including seven in 10 trans people, and that more than half of trans people have thought of taking their own life in the past year. Let us just reflect on that. Half of trans people have thought of taking their own life in the past year. So when we think about and reflect on the debate that is currently ongoing, we must look at that statistic and take it very, very seriously.

The hon. Lady refers to half of trans people. Can she put a figure on that? I would like to know, because that is terribly sad.

The statistic in the Stonewall Scotland report is 52%. That is specific to Scotland. I do not have the exact number, but I am very happy to get it and to share it with the hon. Gentleman. It is a significant number.

One in six LGBT people have deliberately harmed themselves in the past year. One in four LGBT people have witnessed discriminatory or negative remarks against LGBT people by healthcare staff. One in eight LGBT people have received unequal treatment in the healthcare system because of their sexual orientation or gender identity. Almost two in five trans people have avoided healthcare treatments for fear of discrimination. One in four LGBT people have experienced healthcare staff having a lack of understanding of specific lesbian, gay and bi health needs, and nearly three in five trans people have experienced healthcare staff having a lack of understanding of specific trans health needs.

I understand that some of these matters are very technical. They are challenging and they require a level of expertise. That is why education, open discussion and proper resourcing in Scotland and across the UK is absolutely vital. We know how incredibly hard staff in the NHS work in all countries and parts of the UK. We salute them. However, the studies show that there is a bit more work to be done. I want to share some of the experiences that a number of lesbian, bisexual and trans women have been kind enough to contact me and offer. Their very personal experiences and perspectives are invaluable. It is right that today in this debate we give them a voice.

One trans woman who transitioned a number of decades ago in another country, but who now lives in the UK, contacted me with her experience. She says:

“Almost all of my medical appointments have been for general medical issues. The only time I have seen anyone in the GIDS”—

Gender Identity Development Service—

“pathway was once when I had a consultation with a surgeon…regarding a long-term consequence of the particular type of gender reassignment surgery I had, which was satisfactorily resolved.”

She mentioned issues with access to drugs, but that was not necessarily about her being trans; it was about two health boards in England not speaking to each other, and it was resolved. She said that all these appointments were handled in a very courteous, respectful and professional manner. “However,” she says,

“I suspect the combination of my age, the length of time since my transition, and especially my professional status may have afforded me a certain degree of privilege. I’m not certain others, particularly younger transwomen or those who are just beginning transition, would necessarily have the same experience.”

Interestingly, she says, although all of her doctors have been aware of her transgender status, as it affects some aspects of her medical care, no doctor has ever inquired about her sexuality or whether she is sexually active.

It may be useful to know that she is a registered clinical and forensic psychologist, a long-time member of the World Professional Association For Transgender Health, an affiliate member of the British Association of Gender Identity Specialists, and a member of the editorial board of the International Journal of Transgender Health. She has been a full-time faculty member at many universities and is, by all accounts, an expert in her field.

My hon. Friend the Member for Ochil and South Perthshire (John Nicolson) just passed me a note with some of the numbers. To go back to the point made by the hon. Member for Beckenham (Bob Stewart), there are up to half a million trans people in the UK, according to the Government Equalities Office. If we break that down in terms of the percentage of Scotland’s population, a significant number of people are being affected and are considering taking their own lives, so the seriousness of that is very important. I thank my hon. Friend for that wee bit of information.

The woman who got in touch with me advises that she was recently offered a position as a psychologist at a specialist clinic in the UK. That is good news, given her expertise, but there are a number of reasons why she declined the position. In her own words:

“The most important reason why I declined the position, however, was the horrendous amount of transphobia currently rampant in the UK, spurred on by what seems to be an ever-growing number of highly inaccurate, one-sided, or genuinely bigoted and hateful articles and columns in the press…I felt that to be a trans woman working within the GIDS would place me directly on the firing line for a barrage of hatred and abuse—something which, honestly, I was not willing to endure.”

Those are the words of someone who is highly professional with specialist training, who I imagine that the NHS would have been hugely fortunate to have. That is the lived experience of a trans woman in our society, and it should give us all pause for thought and reflection.

The reality of the services not being properly or fully funded was highlighted to me by another person who contacted me. They raised the issue of the very long waiting list to access the gender identity development service. They explained that there is

“very long (2+ years) between referral and first appointment, leaving hundreds of children and adolescents in distress for extended periods. The UK government promised an inquiry into the massive increase of referrals, but it appears to have vanished. These”

young people

“are in desperate need of better care but are being ignored. GIDS say that they should be treated under Child and adolescent mental health services (knows as CAMHS) in the interim, but for the most part CAMHS won’t touch them once gender identity issues are mentioned.”

They advised me that they

“are lucky enough to be able to afford private therapy”

but that the

“the children’s GIDS service is failing and should form part of your debate.”

I hope that the Minister will consider those matters and perhaps update not only the Chamber but me in writing, so that I can share it with the person who got in touch with me.

On gender recognition legislation and why it is needed, I was struck by a contribution by Time for Inclusive Education, which created a podcast called TIE Talks, which is well worth a listen. Mridul Wadhwa, a trans woman of colour who lives and works in Scotland, recently spoke alongside Sharon Cowan, professor of feminist and queer legal studies from Edinburgh on the podcast. They spoke compellingly about the Gender Recognition Act 2004 and the impact of the current system on the mental and physical health of trans people. I urge people to listen to it because it is hugely informative. I pay tribute to Jordan Daly and Liam Stevenson, who founded TIE, and the chair, Rhiannon Spear; they do remarkable work in Scotland for young people around LGBT education.

Mridul spoke about the patriarchal nature of the gender recognition panel and how a group of anonymous people decide other people’s future and fate in a way that echoes and has parallels, in her view, with the immigration system, which she has direct experience of. I was interested in hearing more about that and had a discussion with her about the differences and parallels of coming out as trans versus coming out as lesbian, gay or bi. She came out and transitioned in a different country, but she was clear that there are inherent similarities. I certainly remember people saying to me when I came out, “You can look forward to coming out every day.” I have to say, that is still pretty true nearly five years on, but what she told me was that as a trans person, there are so many hurdles to overcome. At times, she feels:

“how many people do I need to convince that I’m a man or a woman?”

I cannot imagine what it is like for someone to have to justify their very existence repeatedly. It must be exhausting and take a huge toll—as we saw from the statistics—on their mental and physical health. Back in 2013, a study in the US said, unsurprisingly, that legalising gay marriage might improve health and reduce healthcare costs. Another similar study last year found that legalising equal marriage could improve the mental health of same-sex couples. Wow—what a revelation! You can marry the person you love and live the life you want as the person you are, and it might actually make you happy and reduce the burden on the healthcare system.

On behalf of the people of Northern Ireland, I want to thank every single Member who did the work that could not be done in Northern Ireland to ensure that our brothers and sisters were entitled to full equality where they had been denied it for far too long. One of the groups at the forefront of that campaign and of our work in particular with lesbian and bisexual women in Northern Ireland was HERe NI, but it is about to have its funding cut. Does the hon. Member agree that that cannot be allowed to happen and that the Northern Ireland Office and the Northern Ireland Executive have to do everything in their power to protect that vital service? One of the key things it does is look after the mental health of lesbian people in Northern Ireland. It cannot be allowed to happen.

I agree with everything the hon. Member said. I was proud to vote for equal marriage in Northern Ireland and for abortion reform. I will not lie: it was a strange position to be in. I abstained several times to give Stormont the opportunity to get back up and running, but I was always clear that if it did not, and that if people there wanted it to happen, there would be no other option, so I was very proud to support that legislation and to see that happen. I pay tribute, as he does, to the many people who fought hard to make it happen. The thought that funding would be pulled is hugely concerning, so I agree with everything he said on that front.

We know that legislative change does not in itself necessarily change culture or fix the problem, but it is an important step. We all remember section 28— section 2A in Scotland—and how hugely damaging those discriminatory pieces of legislation were to LGBT people, not just then but now. I saw someone online recently ask how, because one of my colleagues had not even been born when that legislation came into force, it could possibly have affected her. What an outrageous and ridiculous thing to suggest. I did not have to fight for the equality I now have, but I certainly felt the effects of the discrimination that the legislation left behind, as have and do many people.

We are only now getting the inclusive education we should have had when that legislation was repealed in Scotland and across the UK. In Scotland, we are working with TIE, the Equality Network, Stonewall, the Scottish Trans Alliance and other organisations. TIE has been at the forefront of making sure that our Government in Scotland roll out inclusive education. I started school the year that that legislation came into force, and it was hugely damaging. The UK Government have also said that they are rolling out inclusive education, and I hope they stay true to that commitment, because we have to be resolved and determined to make those changes happen.

Such inclusive education is not necessarily about the details of sex of LGBT people; it is just about teaching children and young people that LGBT people exist, that some people have two mums, some people have two dads, some people have one mum, some people have one dad, some people have a mum and a dad, some people are brought up by kinship carers or grandparents. Family makeup across the UK is, and has been for many years, very varied, and we should welcome and celebrate that.

I know from my own experience that healthcare appointments can throw up unexpected issues. For many people, a smear can be a difficult and distressing thing, but for most people it will be fairly straightforward. At this point, I wish to mention the My Body Back clinic, an LGBT-inclusive clinic that provides specialist services for survivors of rape, domestic abuse and sexual violence.

A number of years ago, I went to my local service for one of my first smears after coming out. The nurse, wrongly assuming that I was heterosexual, asked what contraception I used. When I explained, “Well, for a start I am a lesbian”, her eyebrows went up and she looked a bit awkward. She said, “Oh, well, you will not need any then”, and brushed over the matter. That, unfortunately, was a wrong assumption, because lesbian and bi people do need and should be considering protection during sex.

I am going to go into some detail, which I hope will not make anyone feel too awkward. If it does, perhaps that should prompt the question of why it makes people feel awkward, and perhaps it demonstrates how important it is to discuss these issues. They are really important issues, but they are not widely discussed. Safe sex for lesbians and bi and trans people, and indeed non-binary people, is very important, particularly when it involves oral sex and the sharing of sex toys, and if you or your partner have had, or have, or suspect you have, a sexually transmitted infection or disease.

It seems that, sadly, the nurse who saw me was not apprised of those matters, but it is important for us to remember that we still live in a very hetero-normative society, and that it is not just heterosexual couples who need to ensure that they use protection against pregnancy and sexually transmitted diseases. That includes washing and the sterilisation of sex toys, but also the use of items such as dental dams. For the benefit of those who may be less well educated and not know what a dental dam is, let me explain. It acts as a barrier to prevent sexually transmitted infections from passing from one person to another. It sounds like something that would be used when people are having their teeth polished, and it was originally made for dentistry purposes and used to protect the mouth when dental work was being done, so that is not too far from the truth. However, it is now used as protection during lesbian or bi sex. Thinner versions were apparently later produced specifically for promoting safe oral sex.

I do not know whether anyone has ever tried to buy a dental dam, but they are nowhere near as readily available as condoms. In fact, they often have to be ordered via the internet. I do not want to put anyone off, but they are also not particularly nice or attractive things to use. It is interesting to note the huge innovation and investment that has been put into the development of condoms over the years—for instance, to make them thinner for maximum pleasure. They can also be ribbed, dented or flavoured. Dental dams do not come in quite the same range, for, I would imagine, a variety of reasons. The manufacturers and the marketers have not even seen fit to rename them. I think that that is an important point, and one that is little discussed.

We know how much women’s bodies are affected by contraception and the toxins that many of us put into our bodies, be they from the implant, the pill or the coil. I have been discussing that with one of my colleagues. So much of our sexual health is centred on heterosexual male pleasure, with heterosexual or bi women bearing the brunt of the responsibility for contraception.

“There is a common misconception that oral sex is ‘safe’”,

explains Simone Taylor, the education and regional lead at Brook, a sexual health charity for young people.

“But while you can’t get pregnant from oral sex, you can still catch STIs.”

In 2008, Stonewall published the results of a study of the health of 6,000 lesbian and bisexual women, which revealed that half of those who had been screened had an STI, and a quarter of those with STIs had only had sex with women in the last five years. It is very important for us to take account of those issues.

I have only a few more points to make. I know that a number of other Members want to speak. The specific health needs of disabled people who are also LGBT are often overlooked by healthcare professionals. According to Stonewall, which has produced some compelling briefings on the subject, disabled people in the LGBT community can be left with a lack of trust in their healthcare providers. Multiple needs are often not taken into account, which affects some of the most vulnerable people. LGBT people are not necessarily open about their sexual orientation and/or gender identity when seeking medical help, because of a fear of unfair treatment and invasive questioning.

Stonewall goes on to talk specifically about issues around personal independence payment assessments and it has said that one in five non-binary people and LGBT disabled people have experienced discrimination. Similarly, one in five black, Asian and minority ethnic LGBT people, including 24% of Asian LGBT people, have experienced it. One of the testimonies it offers is from someone who was going through the PIP assessment. They said:

“I held out my hand to shake and the nurse didn’t look at myself or my wife after I introduced who she was and no eye contact throughout the interview. We felt we wanted to leave.”

Someone else who shared a testimony said:

“An NHS nurse asked about my recent gender reassignment surgery and then went on to compare me to being a paedophile as if being trans is the same thing.”

That testimony, from somebody in the east of England, was taken from Stonewall’s website and I have to say that it is hugely concerning. This reinforces the point about LGBT education and why it is so incredibly important that the misinformation that is out there and being used against trans people should be busted.

The hon. Lady is giving an incredibly powerful and informative speech. I have certainly learned a lot up to this point and I thank her for that. The point about intersectionality is incredibly important, and the point she makes about how important it is that sex and relationships education is delivered in schools is well made. Does she agree that it is also time to remove the exemption that allows some families to remove their children, particularly in primary schools, from age-appropriate relationship education? Headteachers who have to deliver this tell me that this is a big barrier and puts them up against their parent bodies. We need to make that stop, and help people to help themselves.

I absolutely agree with the hon. Lady. We know that it is sometimes the most vulnerable children who are being taken out of schools who need that relationship education. That is causing huge issues. As we know, there are many LGBT young people who are suffering profoundly for various reasons, whether it is their parents taking them out of school or the schools not yet providing that education. My own sex education in high school was literally about putting a condom on a banana and a quick discussion about the pill, and that was it. It is frightful to think that that is what children were being taught, and we have come a long way, but there is still a long way to go.

The work that Time for Inclusive Education—TIE—and Pink Saltire are doing in Scotland is hugely important. In 2019, TIE delivered 41 education sessions across Scotland, and found that 85% of the pupils it worked with who had previously held negative views or had a negative attitude towards LGBT peers reported that their opinions had changed positively after TIE had delivered a session. I have seen and been involved with some of the materials that TIE has produced. Its work is not just around sexuality; it is also around harmful gender stereotypes, which have a hugely negative impact. The learning outcomes highlighted that all the young people involved had an improved understanding of challenging those stereotypes, being true to themselves and speaking up if they were struggling. The testimonies that TIE shared with me included an S1 pupil saying that they had learned

“to never bottle anything up and to speak to someone about problems”.

Another said they had learned that

“no matter how bad things are it can get better if you try”.

Another had learned that

“it’s ok to ask for help…that you shouldn’t be afraid of who you are”.

Another had learned

“that it’s ok to be a bi girl and that things will get better”.

Another had learned that

“it is fine to be LGBTQ+ and as a lesbian I felt a lot better about myself after this”.

A poster created by pupils in Primary 7 read:

“Girls can play football, we’re all equal!”

I could not agree with that more.

In closing, I just want to say how grateful I was to Members of this place, to the Speaker and to the House authorities when I recently suffered homophobic abuse—that is the only way to describe it—from a Member of the other place. I named him at the time, and I am not going to name him again, but it had a profound impact on my mental health. I also want to mention the support that I have had from the police. That was the first time I had ever experienced that kind of discrimination in my workplace. We all know that there are workplaces across the UK where LGBT people are facing discrimination, but to have experienced it in such an acute way, with a Member of the House of Lords saying homophobic things about me in the press, is still something that I find utterly incredible. There is not very much I can say about it, because the matter is ongoing, but I do want to say how grateful I am to the Members of all political parties who supported and contacted me, and to the public. The Member in question is a former MP from Northern Ireland who now sits as a life peer in the House of Lords. I received a number of emails from people in the Northern Ireland LGBT community, telling me about the damage he had done to their community over many decades. I did not know who he was before I came across him.

I appreciate the hon. Member’s shock and revulsion at the comments that were made. May I stress that they are very much unrepresentative of Northern Ireland today? My hon. Friend the Member for Foyle (Colum Eastwood) and I are putting forward a different face of Northern Ireland for these types of debates. As the hon. Member has indicated, many people in Northern Ireland have suffered and been at the brunt of similar comments in the past, including from that Member, but I hope we are turning the page.

I thank the hon. Member for his intervention, and I could not agree more. I have a deep affection for, and many friends in, Northern Ireland. I have spent a lot of time there. I got emails from people saying, “We’re so sorry. This person doesn’t represent us.” I knew that, but none the less I was heartbroken to hear of the profound impact that this individual has had on the LGBT community in Northern Ireland.

Putting that to one side, I am glad that we are having this debate. I hope all Members will agree that there is still a long way to go and that debates such as this one are part of the picture of making sure that good and proper healthcare is available for everybody in the LGBT community. We as Members must do everything we can to make sure that no one suffers from poor mental or physical health just because of their gender, sexuality or gender identity. We are all equal. At the end of the day, we are all human.

May I start by congratulating the hon. Member for Livingston (Hannah Bardell) on securing this debate? I am very pleased, as chair of the all-party parliamentary group on global LGBT+ rights, to support her wholeheartedly. She has made some excellent points. Obviously, her personal testimony is immensely powerful, and her points about the trans issue were extremely well made. I had immediate sympathy with her comments on coming out with political privilege, which describes my own coming out in 2010.

The APPG on global LGBT+ rights is, at present, the only APPG organised in support of such rights. It focuses on global LGBT rights, where the position is very different from that in the United Kingdom. I thank the group’s administrator, Anna Robinson, for her help and the briefing she has afforded colleagues and me for this debate.

I also thank the Backbench Business Committee for allocating time in the Chamber to debate this important subject. This is the first time that lesbian, bisexual and trans women’s health inequalities have received a dedicated debate in this House. The issue was debated in the other place in 2014. This debate is timely because it is National Lesbian, Bisexual and Trans Women’s Health Week. The importance of what began as a civil society initiative was acknowledged in the Chamber last year by the then Minister for Women and Equalities, my right hon. Friend the Member for Portsmouth North (Penny Mordaunt), who I am delighted to see in her place.

Let me try to put this issue in its context in the United Kingdom. This debate is taking place in a Parliament that has more out LGBT MPs than any other. This Parliament, over the past two decades, has gone from equalising the age of consent—which took it five years; I think we were both special advisers when the process began, Madam Deputy Speaker—and being coerced by the European Court of Human Rights to allow LGBT people to serve in the armed forces, to delivering adoption rights, civil partnerships and, finally, equal marriage. All those measures were taken with increasing enthusiasm by Parliament. The legal case for equality in the United Kingdom has been made. I think we can be proud of Parliament’s leadership today in what a former Father of the House, the late Sir Peter Tapsell, who was elected in 1959, rightly described as the most profound social change of his lifetime.

The change has been very profound in my party. Sir Alan Duncan was the first Conservative MP to come out in 2002. Nick Herbert was the first successful out Conservative to be selected in 2005. Yet just 15 years later, the Conservative party now has the largest caucus of out LGBT MPs in Parliament. That change is perhaps reflected in the sensitivity and the priority the Government have given the issue since 2010. It is reflected in the really excellent “LGBT Action Plan 2018”, authored by my right hon. Friend the Member for Portsmouth North, and a year later, the follow-up report. I have not heard it challenged that that is the most comprehensive plan of its kind in the world, and that sets the context for today’s debate.

We have delivered equality in law, but we now need to deliver equality in outcome. Unequal health outcomes are perhaps the most concerning of all. We know that LGBT+ people of all genders still face inequalities when it comes to access to and the provision of health services. Last year, the Women and Equalities Committee, chaired by my right hon. Friend the Member for Basingstoke (Mrs Miller), produced a groundbreaking report on health and social care and LGBT communities, which showed that unacceptable inequalities remain in the provision of health and social care services when it comes to the LGBT community. The report identified that deep inequalities exist in health outcomes for LGBT communities; that LGBT people are expected to fit into health systems that assume they are not LGBT, which has a significant impact on LGBT people’s ability to access the services they require; and while the LGBT community does generally have the same health and social care needs as the rest of the population for the majority of the time, the Committee found that LGBT people do not in fact always receive the same level of service as non-LGBT people. The evidence gathered also illustrated that across many health areas such as smoking, alcohol abuse and even cancer, the LGBT population had poorer health outcomes. The report acknowledges that although few people set out to discriminate, lack of training and knowledge on LGBT communities, coupled with an assumption by many healthcare professionals that sexual orientation and gender identity are not relevant, result in services that are not fully LGBT inclusive.

This debate is about the very specific area of LBT women in particular, and we know that they face particular barriers because of their gender, and when women are older, have disabilities or belong to an ethnic or religious minority, those barriers grow even larger. Those inequalities, as we have heard from the hon. Member for Livingston, take various forms. Lesbian, bisexual and trans women can often face discrimination and poor treatment when accessing general healthcare services. When they have experienced, or expect to experience, inappropriate questions, misgendering or homophobic, biphobic and transphobic comments, as well as ignorance of their health needs, such as incorrectly advising lesbian women they do not need smear tests, it can deter lesbian, bisexual and trans women from accessing healthcare when they need it We also know that the waiting times for gender identity services, averaging a two to three-year wait, are simply too long. Research shows that LBT women experience higher rates of poor mental health, and yet they have significant difficulties in accessing mental health support.

There are other worrying statistics, such as that bi women are more than twice as likely to have cervical cancer as heterosexual women, and lesbian and bi women are more likely to describe themselves as having fair or poor health than heterosexual women. As the Royal College of Obstetricians and Gynaecologists points out, those figures highlight something wrong in the prevention, diagnosis and treatment of those conditions.

In July 2018, the Government published their LGBT survey and action plan, which clearly identified the health disparities facing LGBT people and committed to ensuring that LGBT people’s needs will be at the heart of the national health service. The survey was remarkable: 108,000 people participated, making it the largest survey of LGBT people in the world to date and thus an incredibly valuable resource to understand better the needs of the whole LGBT community.

It is encouraging to see the Government’s focus on delivering some of the health-related commitments in the action plan, which I greatly welcome. The appointment of an LGBT advisory panel made up of representatives from the LGBT field is also a welcome action by the Government, as is the appointment of Dr Michael Brady as the first national adviser on LGBT health. The funding pilot on LGBT health is another initiative that I am sure Members on both sides of the House will welcome, but there is still a vast amount of work to do to close the gap. I will focus on some of the recommendations in the Select Committee report, particularly those relating to LBT women.

First and foremost, we must ensure that, where multiple initiatives, agencies, action plans, advisers and Departments are working on an issue, they do so in a co-ordinated manner to increase their effectiveness. In relation to LBT women’s rights specifically, as well as those of the whole LGBT community, we must ensure that the Government Equalities Office, which has responsibility for the action plan, and the Department of Health and Social Care, which has oversight over the NHS long-term plan, collaborate to ensure that LGBT-inclusive healthcare is mainstreamed across the NHS England strategy and to ensure that its implementation is the responsibility of health and social care institutions, and not solely of the Government Equalities Office.

Those organisations need to ensure that data collection on both sexual orientation and trans status is introduced to prevent health disparities being hidden, and they need to ensure such data collection acknowledges that some women can be lesbian or bisexual and transsexual. The Select Committee report recommends that sexual orientation monitoring should be made mandatory across the NHS, and that there should be a timeline for implementing mandatory monitoring on both sexual orientation and trans status, calling it

“far too important to be an aspiration rather than a concrete goal with clear timelines for delivery.”

I hope today’s debate prompts the Minister to review plans for mandatory monitoring.

In addition, LGBT+ issues are routinely omitted from needs assessments and planning, resulting in a lack of necessary services for the LGBT community. That must change and, given the unique challenges faced by LBT women, special attention must be given to their unique needs. The solution should be simple: all commissioning outcomes frameworks should have the explicit requirement to consider the needs of the LGBT community, with specific consideration of LBT service users.

Equalities training for frontline staff must be improved and made mandatory to ensure high-quality and consistent delivery across all our services. That will empower health professionals to provide appropriate care so that LBT women are treated with the dignity and respect they deserve, as well as helping NHS and social care staff to identify discriminatory behaviour. Initiatives such as the NHS rainbow badge are a welcome start; it should be noted that it was started and continues to be run by individuals at trust level, not by NHS England, but there is clearly much more to do.

Professional registration bodies also have a role to play in developing training, as well as in making sure they include non-stereotypical examples of LBT women in their educational and training materials so that their students are aware of the specific needs of LBT women.

Finally, with a large task ahead, it is clear that Dr Brady’s role as the national health adviser on LGBT health must continue, yet continued funding for his role has yet to be confirmed. The health adviser not only needs his position to continue but needs increased resources and authority to make the structural changes needed to improve LBT women’s health, and I hope my hon. Friend the Minister can help make that happen.

Looking internationally, the UK has taken up the co-chairship, with Argentina, of the Equal Rights Coalition, an intergovernmental organisation that exists to protect the rights of lesbian, gay, bisexual, transgender and intersex people. As part of this role, and in upholding a commitment in the LGBT Action Plan, the UK Government will hold an international LGBT conference, which will present a unique opportunity to raise issues such as LBT women’s health inequalities in an international sphere. I hope we will all be putting that event into our diaries. At the moment, it is due to sit on 27 to 29 May —coronavirus possibly puts it in some doubt, but we shall see.

In summary, progress has been made in this area, and in a context where the United Kingdom has been in a globally leading role. However, legal equality does not deliver practical equality on the ground. We must be more co-ordinated, and more effective in the collection of data and on training, and funding for initiatives needs to be made central and permanent until that inequality is addressed. LBT women’s specific health and social care needs will not otherwise be adequately met. Much overdue improvement is happening in the area of women’s rights generally, and of course more needs to happen. Weeks such as LBT Women’s Health Week are hugely important—I am very grateful to my right hon. Friend the Member for Portsmouth North for recognising that—in order to ensure we do not lose focus on this issue. That is why I am grateful to the Backbench Business Committee for giving us the time in the main Chamber to debate it. With LBT women facing the double barrier of gender and sexuality in accessing healthcare, we must ensure that LBT women’s health needs do not remain invisible.

I wish to refer Members to my declaration in the Register of Members’ Financial Interests regarding NHS services in this area. I am thankful we are having this debate today. I, too, thank the Backbench Business Committee for bringing it forward. It is particularly important for my city, which is home to the Porterbrook centre, which is a specialist gender identity clinic.

I want to highlight some of the health inequalities faced by trans people, but before I do I will flag up some of the more general issues in health and social care for the LGBT community. I could have spoken about mental health, access for women, particularly LGBT women, to drug and alcohol services or, as has been expressed by others, access to screening for the detection of cancer. Today, however, I shall focus primarily on social care because it is one area that will affect all LGBT families at some point.

I recommend that anyone with an interest in LGBT health inequalities take a look at a recent report by Stonewall called “Unhealthy Attitudes”. Rather than focus on health inequalities and disparities, it focuses on and investigates the culture in our health and social care system, and asks how inclusive it is for LGBT people.

Some of the report makes for shocking reading. The report details the discrimination and abuse that LGBT staff, patients and service users have encountered in the health and social care sector. The report is based on data collected from health and social care workers. One stark thing about it is that it does not shy away from quoting what the staff themselves say about LGBT patients and colleagues. Although there are a lot of positive comments, there are quite a lot that could be considered bigoted. It is a telling feature of the culture of an institution that this minority of staff feel comfortable expressing these bigoted views.

The report also features direct testimony from LGBT staff on their experience of bullying and discrimination, and from staff who would like to do more. In fact, 38% of social care workers agree that more needs to be done to tackle bullying and discrimination—interestingly, this is more than the figure for health workers, which is 31%. Importantly, it is also clear from the report that staff often feel disempowered to challenge homophobia, transphobia or biphobia when they see it. Sometimes, they also feel like managers will not support them if they are challenging the bigotry of a patient or service user—in fact, in one of the testimonies the person said that their manager was the main offender. For that reason, I wonder whether trade unions, and especially their LGBT sections, might be given more powers to intervene in workplaces to provide education and training.

Training is important. The recent House of Commons report on LGBT health inequalities talks about the systemic roots of injustice in the system, and that is manifested in a lack of training given to workers in the sector. One in four health and social care workers say that their employer has never provided them with any equality and diversity training, and the proportion increases to one third in privately funded services. It is often social care workers who feel least confident dealing with trans patients and service users: 34% of advice workers said that they are not confident, as did 31% of social workers and 24% of support workers. The report finds that one in 10 care and social workers feel unequipped to meet the needs of LGBT people.

Does my hon. Friend agree that we need to ensure that the health and social care needs of the most marginalised and vulnerable LBT women are urgently addressed?

Absolutely—I completely agree. This is an urgent matter and the Government should take note and take action.

We need to put person-centred care front and centre. Fifty-seven per cent. of health and social care practitioners say that they do not consider sexual orientation to be relevant to someone’s health needs. Among care workers, that proportion rises to a staggering 72%. This view probably comes from an admirable commitment to equality but, as the recent review of the Marmot report reminds us, equality is not the same as equity. A person-centred approach to healthcare should be holistic: it is about understanding how someone’s personal life and background affects how they receive care and experience care settings, and how their experience of the health and social care system affects their health outcomes. Again, there is massive scope for training, and for unpicking a one-size-fits-all approach.

I wish particularly to mention trans people’s experience of the health and social care system. As I said, Sheffield is home to the Porterbrook gender identity clinic, which is a regional provision. We need more resourcing for such clinics to bring down the long waiting times. We also have to look at the experience of trans women as they use the services. A recent Healthwatch Sheffield report explored the experience of trans people using healthcare services in my city. The participants in the report stressed that the care they had received at the Porterbrook centre was good, but they could not say the same about their interactions in other parts of the healthcare system. An issue that they flagged was understanding—understanding from staff about the rights and entitlements of trans service users, and sometimes more basic things, such as the use of correct pronouns. The participants also flagged up the reluctance of many providers and professionals to acknowledge non-binary gender identities.

There is a long way to go in addressing health injustices for LGBT people—and they should be called injustices. Equal treatment is not the same as equitable treatment. We need to acknowledge the specific life experiences that LGBT people have and how those experiences affect their interaction with the health and social care system. We also need to acknowledge the bullying and discrimination that LGBT staff and service users encounter and how that contributes to health inequalities through people’s reluctance to engage with and use services when they have had, or fear, a bad experience.

We need to make sure that our health and social care system is properly resourced. The austerity agenda has been a key driver of the crisis in health and social care, which has hit LGBT people especially hard and hit women hardest, so there is a double impact for LBT women. Injustices are not natural; they are a product of choices. This is about not only NHS-funded services but the massive cuts to local authorities, particularly the cuts to public health grants, which fund services that LGBT communities rely on more than other communities. I hope the Government choose to end the injustice of LGBT healthcare inequality by properly investing in the resourcing and training that is necessary to build health and social care services that work for all our people, so that no one is afraid to access healthcare and everyone has an inclusive health and social care experience.

I am grateful for the opportunity to speak in this debate, and for the fact that the debate has been organised.

This debate has largely focused on how equality has been implemented in most of the United Kingdom—that is, Great Britain—but of course the context is very different in Northern Ireland. Not only do we share many of the problems that have been set out this afternoon, in relation to accessing rights and how that works in practice, but we have had long-running battles for equality that have only come to fruition in the past few months. For example, take the issue of abortion, which is relevant to this debate for reasons I will come to in a moment.

The Abortion Act went through this House in 1967, but it was only last year that reforms for Northern Ireland were put through this House. I pay tribute to the hon. Member for Walthamstow (Stella Creasy) in that regard. Similarly, through the efforts of the hon. Member for St Helens North (Conor McGinn) and others, legislation passed to provide for equal marriage for Northern Ireland has passed through this House—again with a number of years’ time lag. People in Northern Ireland are no different from people anywhere else in these islands, but very sadly we have had a much longer fight for our rights. The Irish sea has tended to form some sort of barrier where, in some people’s eyes, natural biology seems to change, but the exact same issues and challenges exist in Northern Ireland, and it is very disappointing that we have had that struggle.

There has been some pushback in relation to why this House should have legislated for Northern Ireland, but sadly, owing to blockages in our system, previous attempts at reform have been unsuccessful in the Northern Ireland Assembly, and, of course, that Assembly was out of operation for a while. It is now operational again, but it is still uncertain whether these kinds of serious reforms can be taken forward. Speaking as a former Member of that Assembly, I had no difficulty whatsoever in this House last year having to legislate in both of those respects. I want to put on record my thanks and, indeed, the thanks of many other people in Northern Ireland who are only now benefiting from these changes following the House having taken those particular actions.

As I mentioned in an intervention, Northern Ireland is a very diverse society, and often the views that have been expressed in this Chamber and, indeed, by Members of the other place, have not been representative of the views of Northern Ireland, where there is clear majority support for LGBT rights right across the political spectrum. We very gladly see a change in that regard, but obviously we are on a journey that is still being made.

I want to make a number of points to specifically address the issue of LBT women and trans people.

The hon. Member has spoken extremely passionately and compellingly about the changes in Northern Ireland. Will he join me in paying tribute to the late, great Lyra McKee and the work that she did? Northern Ireland has some fine champions of equality and diversity, and she was one of the greatest. I recently had the privilege of meeting her partner, Sara Canning, who is also an incredible woman and also a great champion for LGBT equality. Lyra is sadly missed. I am sure that she will not be forgotten and that people in Northern Ireland will feel the power of her work for a very long time to come.

I am grateful to the hon. Member for that intervention. Indeed, Lyra McKee’s legacy has many forms, not least in terms of giving further voice to social reforms that are being delivered. Her very sad death set in a particular context efforts made by both the UK and Irish Governments over the past number of months in relation to the restoration of devolution. Her memory will live long in Northern Ireland and, indeed, far beyond our shores.

I want first to make reference to the issue of abortion that I mentioned. I stress that this is a critical issue for lesbian and bisexual women, who are more likely to be pregnant as a result of sexual crime than heterosexual women. In Northern Ireland we have a mental health crisis. Homophobic and heterosexist bias is often, sadly, deeply ingrained in our society. LBT women and trans people therefore face huge levels of discrimination and social isolation. That often relates to issues such as how relationships and sex education is taken forward in our schools. That is not being done on a purely level playing field and on a purely objective basis. Sadly, homophobic bullying is still far too often a feature for our young people having to deal with their own experiences. Last year, the Northern Ireland Council for the Curriculum, Examinations and Assessment issued an exam question stating: “Explain two negative effects of sexual orientation on the wellbeing of a young person.” That question was actually asked in an exam by a publicly funded body, so it is an example of how the situation is often loaded.

According to recent studies in Northern Ireland, about 70% of LBT women and 82% of trans people suffer from depression, and LBT women, in particular, have extremely elevated rates of self-harm. Owing to the effects of austerity and funding cuts in our health service, these issues are magnified for those facing other forms of discrimination, such as working-class LBT women, those with disabilities, and people of colour.

These are just a few examples of the policy reforms that we urgently need to see in Northern Ireland. We need proper research in terms of how we move things forward, notably on cervical screening uptake. We need rules on qualification for publicly funded IVF, and these need to be tailored for women who are in same-sex relationships. We need full implementation of donor intrauterine insemination regulations by the Regional Fertility Centre, as well as guidelines on eligibility.

We need mandatory training for healthcare professionals on aspects of healthcare such as LBT motherhood, and we need a fully operational gender identity clinic. Belfast’s clinic has the longest waiting time of anywhere in the UK, with some individuals waiting as long as five years. We must have a system that is based on self-identification, to protect trans people from being forced down the dangerous path of self-medicating.

To make matters worse, Northern Ireland’s only LBT women’s organisation, HERe, is at risk of closure due to funding ending in June. The local Health Minister has rejected several requests for meetings and instead has lumped them in with a general roundtable on LGBT issues, rather than focusing on the immediate looming consequences. That is unacceptable and needs to be addressed and reversed as a matter of urgency.

Those are some of the particular challenges facing us in Northern Ireland. There is a commonality, to an extent, in terms of the issues. But I trust Members appreciate that we are coming from a further starting point in Northern Ireland, where we have not had the same equality in law, at least in theory, while we share common concerns in terms of equality in practice. I am very grateful, on behalf of the people of Northern Ireland, to all the Members of this House who have shown leadership over the past 12 months in trying to address some of those outstanding issues in our society.

It is a pleasure to take part in today’s important and informative debate on health inequalities faced by lesbian, bisexual and trans women. I am grateful to my hon. Friend the Member for Livingston (Hannah Bardell) and the hon. Member for Reigate (Crispin Blunt) for securing today’s debate.

The aim of LBT Women’s Health Week is to raise awareness of lesbian, gay, bisexual, trans and queer women’s health inequalities, to make it easier for service providers to empower service users and for communities to support LGBTQ women. It is important for a range of reasons that we eliminate LBT health inequality and improve LBT health, to ensure that all individuals can lead long and healthy lives. It is worth considering Public Health England’s review of health inequalities for lesbian and bisexual women, which reported:

“There is consistent evidence from the UK and internationally that there has been a paucity of attention, concern and research on lesbian and bisexual women’s health inequalities.”

That emphasises the importance of today’s debate.

As we have heard today, the LBT community experience significant health inequalities and specific barriers to services and support. The many benefits of addressing these health concerns and reducing inequality include reducing disease transmission and progression, increased mental and physical wellbeing, reduced healthcare costs and, of course, increased longevity for the people involved.

We have heard from a range of speakers today, with some powerful testimony. My hon. Friend the Member for Livingston made many good points, talking about her own life experience and the value of her supportive network, which not everyone in the community benefits from. She said that coming out can be more traumatic for trans people than gay and bi people. I had not given that much consideration, and we should all remember that point. She highlighted a whole range of issues around safe sex and gave us details of dental dams. I go away informed—every day is a school day!

The hon. Member for Reigate talked about his personal experience of coming out in 2010. I am grateful for his work on the APPG on global LGBT rights. He informed us that this Parliament has more LGBT MPs than any other. As I say, every day is a school day, and it is a pleasure to take part in debates where we go away having learned more than we came in knowing. He also said that we have delivered equality in law, and we now need to deliver in outcomes, and I wholeheartedly agree with that profound point.

The hon. Member for Sheffield, Hallam (Olivia Blake) gave us some interesting statistics, including that 34% of advice workers said they were not confident dealing with trans people. That is a really important figure. In my research for today’s debate, I had been looking at it from the other side, and that backs up what trans people are saying—Stonewall Scotland says that one in four LGBT people have experienced healthcare staff having a lack of understanding of their specific needs.

Does the hon. Member agree with me that it is essential to ensure that all NHS mental health services train all staff on the mental health needs of LGBT people, including the specific experiences and inequalities faced by LBT women?

I thank the hon. Lady, and she has read my mind because that is exactly the point I was coming to. We are hearing it from both sides—from the healthcare workers and from the community—and both feel that there is a gap, so there is clearly a training requirement that we need to address as a society.

The hon. Member for Runnymede and Weybridge (Dr Spencer) spoke about stigma, and he used a phrase, “minorities within the minority”, which probably sums things up and really gets to the crux of it for the people we are discussing. Latterly, we heard from the hon. Member for North Down (Stephen Farry), who gave us the Northern Ireland perspective. I think we can echo the issues of bias being ingrained in society and concerns about homophobic bullying throughout the rest of the United Kingdom, and I will touch on some of the Scottish perspectives.

Of course, no debate on health goes by without my mentioning that health is devolved and that in Scotland we do some things a little bit differently. Scotland has a really high record of health funding—up by over 60% under the SNP—and frontline health spending in Scotland is £136 per person higher than in England. In our recent budget, which has been termed the equality budget, we will continue to maintain Scotland’s position as one of the most LGBTI-progressive countries in Europe. The budget’s investment in mental health will have a positive impact on LGBTI people, who have higher rates of attempted suicide, self-harm, depression and anxiety.

Tackling hate crime also continues to be a top priority for the Scottish Government, and they will work with LGBTI stakeholders to challenge discrimination and to encourage understanding. An important point that we should take home is that every individual is some mother’s son or daughter, and we need to be far more accepting of one another in our own society.

The definition of gender identity and transgender used in the Offences (Aggravation by Prejudice) (Scotland) Act 2009 is considered to be one of the most inclusive definitions in use. The Scottish Government will continue to work to reduce the stigma of HIV, raise awareness of the condition and reduce its transmission. Scotland is the first country in the UK to make PrEP available free of charge to those at the very highest risk of acquiring HIV.

It is clear that this is one area where our nations face many of the same challenges. In Scotland, LGBT people are at a higher risk of experiencing common mental health problems than the general population. Stonewall Scotland’s survey of LGBT people in Scotland found, as we have heard, that almost half of LGBT people—49% on its figures—have experienced depression over the last year. My hon. Friend the Member for Livingston went through the whole range of figures, so I will not repeat them, but they bring home the very powerful point that there are real questions about inequality.

Scotland is an open and welcoming country. Prejudice, hate and discrimination will never be tolerated, and I believe that diversity makes Scotland richer and stronger, as well as happier and, I hope, healthier. The SNP Government are clear about the central equality of human rights to Scotland’s future and the importance of inclusive growth, fair work and social justice to our economic success and our social wellbeing. Scotland is considered one of the most progressive countries in Europe in terms of lesbian, gay, bisexual, transgender and intersex equality, and we aim to preserve and advance Scotland’s reputation as one of the most progressive countries in Europe for LGBTI equality.

In its 2015 rainbow map, the European Region of the International Lesbian, Gay, Bisexual, Trans and Intersex Association ranked Scotland as the most inclusive for LGBTI equality and human rights legislation: it met 92% of the ILGA’s 48-point criteria. Changes by the SNP mean that Scotland has been named the best country in Europe for LGBTI legal equality by Pink News. Those are all achievements of which we can be proud. However, there remains much that needs doing, and we must continue tackling homophobia, biphobia, transphobia and all forms of discrimination, stigma and inequality.

This debate goes some way to highlighting these issues, and I would just end as I began by once again thanking the hon. Members responsible for bringing it here today.

I am pleased to be responding to this debate, which falls near the beginning of LBT Women’s Health Week. The theme of this year’s week is visibility, so this debate itself provides an important opportunity to raise awareness of the health inequalities that affect women in LGBTQ+ communities. I know that the other place debated these issues as recently as last week, but as the hon. Member for Reigate (Crispin Blunt) said, this is the first time that these issues have been specifically discussed in this Chamber. The week provides an opportunity for communities, practitioners, local government, health and social care providers and commissioners of services, as well as ourselves in this place, to take a close look at what progress has been made in improving the health and wellbeing of all women in our communities and supporting them to take action, because, as we have heard in the debate today, there are some excellent examples of good practice and progress around the country but more needs to be done to support LBTQ+ women.

The hon. Member for Livingston (Hannah Bardell) opened the debate and said she hoped it would be conducted with respect and integrity, and I believe it has been. As always, she conducted herself with respect and integrity, and she spoke with great openness and sincerity about her own experiences, which I hope will prove an inspiration to others. I was particularly impressed by the humility she showed in recognising that her own position and privilege might have made it easier for her to come out than it would be for other people to do so, but I am sure it was still not an easy thing to do.

The hon. Lady spoke about the mental health challenges facing people and also issues in accessing healthcare. She gave us the staggering fact from a survey in Scotland that about half of all trans people have considered taking their own life. That was particularly worrying and concerning, and should cause us all to think about what more we can do. The personal testimonies she gave were extremely powerful and put many of the figures that we have heard today into a much more personal and meaningful context.

The hon. Member for Reigate was absolutely right to say that equality in law is not the same as equality in outcome, and he highlighted some of the findings from the Women and Equalities Committee report, which I will return to shortly. He was also right to highlight some of the initiatives that have been successful and also some of the areas where we need to do more.

It was a pleasure to hear from my hon. Friend the Member for Sheffield, Hallam (Olivia Blake); it was the first time I have heard her speak in the Chamber. She shone a spotlight on an area we do not talk about very much: the social care sector and some of the bullying and discrimination that is happening there. It is certainly the case that, as she said, much more education and training is needed. My hon. Friend was also right to say that the approach to health and care needs to be much more holistic to take account of the needs of the individual; she got the tone absolutely right in making that point.

The hon. Member for Runnymede and Weybridge (Dr Spencer) gave a very thoughtful speech, and one point I took from what he said was that we need a lot more data and research in these areas to really understand the issues that we are dealing with. The hon. Member for North Down (Stephen Farry) spoke very powerfully and movingly about the progress that has been made in Northern Ireland, but also about some of the challenges that are still faced there.

As we have heard during the debate, there are higher rates of poor mental health, misinformation about sexual health, difficulties in accessing healthcare, and experiences of discrimination, harassment and domestic abuse. There are multiple barriers facing LBTQ+ women that prevent them from having a healthy and happy life, and that is simply because of who they are.

Several Members mentioned Stonewall’s 2018 report, “LGBT in Britain”, and we must use that as a touchstone for what to do in future. It found a worryingly high rate of mental health issues suffered by LBT women. The report itself told of harrowing experiences of discrimination and harassment in daily life, rejection by family and friends and people being subjected to hate crimes just because of who they were. These things clearly all have a devastating impact on a person’s mental health.

Over a quarter of lesbians and 42% of bisexual women report having a long-term mental health condition, with bisexual women being four times more likely to have long-term mental health problems than straight women, and 28% of bisexual women and 40% of lesbians said they deliberately harmed themselves in the last year, compared with 6% of adults in general. The fact that incidents of self-harm are over four times greater for bisexual women and twice the rate for lesbians than for the general population should give us all cause to think about the difficulties these communities are facing. Some 19.2% of lesbian women and 30.5% of bisexual women also reported having an eating disorder. Despite the clear levels of need we have talked about, the 2018 national LGBT survey found that when it comes to accessing mental health care, about 50% of LGBQ women and 53% of trans women found accessing those services “not easy” or “not easy at all”. The LGB&T Partnership also found that lesbians, at 25%, and bi women, at 32%, are more likely to describe themselves as having fair or poor health than heterosexual women, at 21%. Studies have shown that lesbian and bisexual women also have higher risks of obesity and cardiovascular disease. Two national patient surveys in England found that the prevalence of all cancers is higher in lesbians, at 4.4%, and bisexual women, at 4.2%, than heterosexual women, at 3.6%. In terms of sexual health, less than half of lesbian and bisexual women have ever been screened for sexually transmitted infections, but half of those who have were found to have had an STI.

Despite the clear advice from Public Health England that all women aged 25 to 49 should be screened for cervical cancer, there are conflicting messages still from health professionals which mean that lesbian and bi women are much less likely to attend their cervical screening appointments, with one in five lesbian and bisexual women reporting having been told by a healthcare professional that they were not at risk of cervical cancer. Overall, lesbian and bisexual women are up to 10 times less likely to have had a cervical screening test in the past three years than heterosexual women, yet bisexual women are more than twice as likely to have cervical cancer than heterosexual women.

The picture for breast cancer screening is a little more positive, with four in five lesbians over the age of 50 having attended their breast screening invitation, which is a similar figure to that for heterosexual women. But trans women taking oestrogen may be at increased risk of breast cancer and may not be routinely invited for screening, particularly if the gender marker on their records is “male”. Macmillan also found that many breast health awareness messages are delivered to women when they attend clinics for contraception or cervical screening, meaning lesbian and bisexual women and trans men with breast tissue may be less aware.

There are serious concerns that poor access and poor experiences contribute to poorer health outcomes. The National LGB&T Partnership tells us that 8.1% of lesbians, 5.9% of bisexual and 15.4% of trans women experienced inappropriate questions because of their sexuality when accessing healthcare. In its report, Stonewall found that discrimination, both experienced and expected, can deter LGBT women from accessing healthcare when they need it, with one respondent saying:

“Medical professionals are not that good with lesbians. I don’t go to the GP very often because they’re not familiar with lesbian issues usually.”

That is disappointing to hear, because I often stand at this Dispatch Box and praise our wonderful NHS staff. We all know that they do a tremendous job under increasing pressure, but, as this report shows, while most health and social care staff do their best to deliver the best possible care, the fact that one in seven LGBT people avoid seeking healthcare for fear of discrimination shows that there are training issues. I will address those issues a little later.

A Women and Equalities Committee report in 2016 found that trans women face lengthy delays to accessing gender identity services, averaging a two to three-year wait. That is a very long time considering the constitutional target for referral to treatment is 18 weeks. That ought to be addressed as a matter of urgency. The 2018 national LGBT survey found that a quarter of trans women felt their specific needs in relation to their gender identity were ignored or not taken into account when accessing healthcare. Three in five trans people said they have experienced a lack of understanding of specific trans health needs by healthcare staff

The evidence is clear that there is a need for action to reduce health inequalities. Providing the best possible, high-quality healthcare does mean delivering care without prejudice. It also requires an understanding of specific health needs and an understanding of the challenges particular communities face. Following the 2017 national LGBT survey, the Government’s Equalities Office produced an LGBT action plan in 2018 which included more than 75 commitments across a whole range of areas. With regards to health there were commitments to

“ensure that LGBT people’s needs are at the heart of the National Health Service”,

including appointing a national adviser to provide leadership on reducing the health inequalities that LGBT people face, enhancement of fertility services for LGBT people, improving mental healthcare and improving the way gender identity services work for adults.

In the annual progress report for 2018-19, which was presented to Parliament, I know that some progress on those recommendations was made. The National LGBT health adviser was appointed and a funded programme to trial new approaches to tackling LGBT health inequalities was launched.

The Government said that it was their intention to deliver the remainder of the commitments from the action plan over the next three years. Will the Minister update us on how those plans are going along? In particular, the Government’s stated priorities for action are: looking at ways to improve the mental healthcare for LGBT people, developing a plan to reduce suicides among the LGBT population, and the transformation of adult gender identity services. There was also a pledge that NHS England would fund the Royal College of Physicians to develop the United Kingdom’s first accredited training course in gender medicine, which will begin accepting recruits shortly. I am not sure whether the progress report for 2019-20 has been published yet, but perhaps the Minister can update us on that and on what progress is being made and when the next report is due.

As we heard, in October last year, the Women and Equalities Committee published a report on health and social care in LGBT communities following its inquiry, which called for evidence on how well policy makers and service providers were taking into account the health and social care needs of LGBT communities. It received over 100 written submissions and heard oral evidence from people about their experiences, as well as community groups, advocacy organisations, policy experts, local authorities, public service providers and politicians.

As we heard, the report found that unsurprisingly, there are many significant health inequalities for LGBT communities and that they face numerous barriers in accessing health and social care. We are yet to see the Government’s response to the Committee’s report. While I appreciate that it was published just prior to Dissolution, it would be useful if the Minister indicated when the Government’s response to that will be provided.

There are many recommendations in the report—23 in total—and I will not talk about them all today, but I would like to draw one or two to the House’s attention. I agree with the report, Stonewall and the National LGB&T Partnership that monitoring both sexual orientation and gender identity is far too important to be left as an aspiration rather than a concrete goal. If monitoring remains optional, health disparities will continue and remain hidden across services if they choose not to implement it. I believe that all providers must implement sexual orientation and trans status monitoring alongside training for frontline staff to collect the data, so that as with all personal data, information on sexual orientation and trans status is collected and recorded sensitively.

The Committee also recommended that sexual orientation monitoring should be made mandatory across all NHS and state social care providers by October this year and that service providers that fail to implement it should face fines equivalent to those for not monitoring ethnicity. It also recommended that gender identity monitoring work should be accelerated with a view to creating a standard by the end of 2019 and then rolled out on a mandatory basis to the whole NHS and state social care providers by the end of the year. We know that one of the roles of the national adviser is to advise the Government on the implementation of sexual orientation monitoring across the NHS. Will the Minister update us on what progress has been made in implementing the plans and whether the recommendations will be completed in the timeframe set out?

The Committee’s report recommends that all NHS and social care providers should ensure that all staff understand their legal responsibility to deliver services that are inclusive of LGBT people. We have touched on the fact that training will play an important role, and I agree with the Committee that those responsible for the education and training of health and social care professionals should treat training on LGBT needs as being as integral as any other training.

I support Stonewall’s call for all health and social care staff to receive LGBT-inclusive training on meeting the needs of LGBT people throughout their careers. Again, given that one of the national adviser’s specified roles is to improve healthcare professionals’ awareness of LGBT issues, will the Minister update us on what plans the Government have to improve and enhance ongoing training on these issues so that services are inclusive?

The Committee also recommended that the Government should consult on ways in which effective knowledge and understanding of unacceptable discriminatory practices and the Equality Act 2010 could be ensured among the highest range of health providers. Again, will the Minister advise the House whether there has been any progress on that?

Finally, the report made several recommendations regarding the importance of leadership on this issue from the Department of Health and Social Care and NHS England. It is clear that if we are to see the improvements that we need, all local health and social care organisations must actively consider the needs of their LGBT women, as required by the public sector equality duty. I support the Committee’s recommendations that this should be mandated directly from the Department and NHS England as part of commissioning requirements and as a prerequisite for receiving funding. As the hon. Member for Reigate said, the Department and NHS England should work together to create an inclusive commissioning toolkit that health commissioners can use to spread best practice in commissioning inclusive services, and any bids found to be lacking should be passed on to the EHRC for enforcement action.

I also agree with the Committee and the hon. Member that we need joined-up working across the whole of Government. As we know, the Government Equalities Office has the lead on the LGBT issues and the action plan, which includes healthcare, but it is separate from and not included in the NHS long-term plan. This issue was raised in the other place last week, but the response was not particularly helpful. Does the Minister agree that the response implied that all responsibility for LGBT healthcare lay with the GEO and that this is something we need to reconsider?

The Committee also recommends that NHS England and the GEO work together to produce the next LGBT action plan update and be a signatory to it. Will the Government take forward that very practical and sensible recommendation? On leadership, can the Minister provide any assurances that there will be continued funding for the national advisor for LGBT health beyond the end of this month, as they are needed to drive forward the inclusion agenda throughout health and social care? It would be a welcome signal from the Government that they are determined to give this issue the importance it deserves.

I congratulate the hon. Member for Livingston (Hannah Bardell) on securing this debate and on the sensitive but frank way she has approached it. We came into this place together, and I am grateful to her for the way she has given a voice to other women. As the hon. Member for Ellesmere Port and Neston (Justin Madders) said, that is the theme this year, and as my hon. Friend the Member for Reigate (Crispin Blunt) said, having this debate on the Floor of the House and giving a voice to those who feel their voice is not heard sufficiently is something we really can do. It was great to see hon. Members from all four nations coming together in the Chamber today to give a voice to the LBT community.

I have drawn from the contributions of all hon. Members a selection of themes, especially around mental health barriers and discrimination. As the hon. Member for Livingston said, we are on a journey. My hon. Friend said we were making history today, but history is yesterday; tomorrow is the future, and that is where we need to refocus and start to deliver. I thank him, the hon. Member for Sheffield, Hallam (Olivia Blake), my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer) and the hon. Member for North Down (Stephen Farry) for their considered contributions.

We have heard about the challenges facing those for whom life is so tough they think of taking their own lives —I know that the 52% figure, which the hon. Member for Livingston mentioned, is for Scotland, but the figures do not vary particularly across the nations—and about the higher rates of self-harm and eating disorders, and the barriers to conversations about people’s health that can prevent them from taking responsibility for their health and the effect that can have on general wellbeing. I pay tribute, as several Members did, to the charities and institutions working hard, day after day, to give people a voice and provide better access to services.

As my hon. Friend the Member for Reigate said, the global LGBT rights position is very different. We have made great strides in legislation in this country, but health outcomes are the key. Individuals should not have to fit the system; the system should adapt to them, because if it does not feel right or give the right outcomes, it is highly unlikely they will access it in the right way. My hon. Friend also highlighted the lack of training, and the fact that it was a mainstream problem throughout the healthcare system—as the hon. Member for Sheffield, Hallam also did, very eloquently. He pointed out that this was a challenge for all elements of the healthcare profession, from general practice and nurses to social care and care towards the end of life.

I thank my hon. Friend the Member for Runnymede and Weybridge for making such an informed speech. “Recognising the minorities within the minority” is a phrase that I will take away. He mentioned intersectionality. Stigma does ruin lives, and compounds issues involving gender, sexuality and a plethora of other matters before people even reach the point of access to services.

I was struck by my hon. Friend’s comment about the need to tailor services to the needs of the communities whom we serve. I have been up and down the country, but I particularly remember sitting and talking to people at a charity in Manchester. I learnt that young people in particular will often move towards towns because they feel that services will be better, that there is a degree of invisibility, or that there will be others there with whom they have some connection. So tailoring services in a more compassionate and reasoned way should be at the front and centre of what we do.

In his frank speech, the hon. Member for North Down described how many challenges still exist, but made it clear that if we all work together it will be much easier to overcome that. I noted what he said about the need for a better understanding of the guidelines, and about the position of women who find themselves in need of a termination having suffered sexual crimes and abuse. The beauty of these debates is that sometimes we are given something to think about that we may not have thought about before.

As we have heard, the debate is timely, given that this is National Lesbian, Bisexual and Trans Women’s Health Week. We have made great strides in advancing equality for LGBT people, from changing the law to allow same-sex couples to marry to introducing the world’s first transgender action plan in 2011. However, we know that we must maintain the progress, and continue to work together on implementing the LGBT action plan.

It is only right that all of us, irrespective of gender or sexual orientation, are able to lead happy and fulfilling lives, with equal opportunities and without fear of discrimination—lives that allow us to look forward to what we have ahead of us, and not back to what we might have missed. People should be able to access healthcare free of discrimination and on the basis of who they really are, and we should ensure that education helps all those in the health sphere to deliver.

Back in 2017 the Government launched a national survey targeting LGBT individuals in order to understand better the real issues impacting communities. Attracting some 108,000 responses, it remains the largest national survey of its kind. My hon. Friend the Member for Reigate spoke very well about that. Such an overwhelming response is a clear demonstration of the strength of feeling in the LGBT community among people who want to be heard and to make a difference wherever they live in the UK, in inner cities or rurally. Living in a rural village can be more isolating then living in a town or city.

In response to that survey, we committed ourselves to bold action, publishing the LGBT action plan in July 2018. It acknowledged the need for a cross-Government approach to tackling inequality. The plan, led by the Government Equalities Office, highlighted key areas of focus including health, education and safety among others. For the purposes of this debate, I will focus on the health commitments.

It is unacceptable that, as the evidence shows, LGBT individuals face significant inequalities, especially in their health outcomes. The provision of comprehensive health and social care for all, irrespective of gender or sexual orientation, remains a cornerstone of the national health service, and one to which we remain committed. Delivery of our health commitments outlined in the LGBT action plan remains a priority for us. We have made significant progress, including appointing the first national LGBT health adviser, Dr Michael Brady. To answer the question put by the hon. Member for Ellesmere Port and Neston, the Secretary of State for Health and Social Care gave a commitment to the Women and Equalities Committee last July that the health adviser’s role would continue beyond March this year. Final arrangements to confirm that are currently being agreed with NHSE&I. Starting to identify the organisations best able to deliver adult gender dysphoria services and funding the Royal College of Physicians to develop the UK’s first accredited training course in gender medicine are examples of the significant progress that we have made.

It is worth reflecting for a minute on the appointment of Dr Brady, who is a sexual health and HIV consultant at King’s College Hospital, as well as medical director of the Terrence Higgins Trust. He remains committed to working across the NHS and to ensuring that the needs of LGBT people are considered throughout the health service. He is passionate about the creation of a workforce equipped with the relevant knowledge and skills to enable them to better deliver patient care that is focused on the needs of individuals. We have heard repeatedly this afternoon that the individual is sometimes lost when they are trying to access healthcare out there. I would like to take this opportunity to thank him and his team for their continued efforts and dedication in driving that work forward.

We have focused on the needs of the community as a whole, but it is important that we do not fall into the trap of thinking that this is a homogeneous group. That was something that my hon. Friend the Member for Runnymede and Weybridge bought up. I recognise that we must think carefully about different needs, including understanding the needs of lesbian, bisexual and trans women within their own communities. It is vital that we develop a sound evidence base to support future policy improvements. That will also help with the education of others, because unless we can explain why we are doing something, it is hard to train others in why they should be doing it.

I have heard the concerns about the lack of data on sexual orientation and the impact of this on evidence-based policy decisions. We know that robust data collection on sexual orientation enables policy makers, commissioners and providers to better identify potential health risks. We can then provide targeted preventive early interventions to address health inequalities. As with most things, when these issues are tackled early, there is often much less consequential damage further down the line.

The national LGBT health adviser continues to lead on the introduction of effective sexual orientation, gender identity and trans status monitoring across the NHS and social care system. That is no easy task. It is imperative that lessons are learned from the previous sexual orientation monitoring information standard pilot, and that the work is aligned across Government. The national adviser plans to relaunch the SOM across the system to raise awareness about why we need to collect data on sexual orientation and how we share the learning from areas that are already implementing things successfully. If we can learn from best practice, we should do so. I understand that progress on this seems slower than some would hope, but we want to make this happen in the most effective way in order to reduce health inequalities.

Access to, and the provision of, mental health services for LBT people is constantly reported as a major inequality. The GP patient survey last year found that lesbian women were nearly three times as likely, and bisexual women more than four times as likely, as heterosexual women to report a long-term mental health condition. As the hon. Member for Livingston articulated so well, this has a real effect on real lives. I firmly believe that the publication of the NHS long-term plan and the actions it contains will enable us to better identify such inequalities and implement tailored interventions. Local areas are being supported to redesign and reorganise core community mental health teams, and to move towards more place-based, multidisciplinary services that align with the primary care networks.

We remain focused on the need to reduce suicide across the LGBT community, while recognising that today we are talking specifically about women. There are several cross-Government initiatives, including the national suicide prevention strategy, the cross-Government suicide prevention workplan, which was published in January 2019, and the local authority suicide prevention plans. Suicide and self-harm is more prevalent among LGBT communities. It should not surprise anyone that the right to be happy includes being able to be who you are.

I recognise that there is concern about access to screening programmes, particularly for the trans community and for trans women in particular, and that that might lead to poorer outcomes for this population group. It is imperative that all groups are treated with dignity and respect at all times, and that they should not fear embarrassment or intrusive questions when accessing such services. The focus must be on ensuring that trans and non-binary people are aware of the screening programmes for which they are eligible, and understand those to which they will not routinely be invited. Public Health England’s comprehensive screening leaflet, “Information for trans people”, aims to improve accessibility to screening for trans and non-binary individuals. It has been developed in collaboration with NHS Choices and representatives of the trans community.

As I am sure many Members are aware, there has been a significant increase in demand for adult gender identity services. These crucial NHS services treat individuals with gender dysphoria, whereby they experience distress and discomfort due to a mismatch between their biological and gender identity. In response, NHS England launched an ambitious programme of work to tackle waiting times and improve access—which I know is still challenging —setting out places to establish new gender services in primary and community settings, and increasing the amount of surgical services and the number of gender dysphoria clinics. That is critical if the Government are to achieve their ambition to support everyone, irrespective of gender and sexual orientation, to live a happy and healthy life.

In conclusion, it is clear that, while we have made significant progress, there is still much more to do. As the hon. Member for North Down (Stephen Farry) said, we are all the same, no matter where we live in the UK. I reiterate that the Government have made real progress and we will continue to make a positive change. I am sure that the House is united on the need to reduce LGBT health inequalities. We all have the right to have our healthcare needs met. The contributions made to this debate will undoubtedly help drive forward our commitment and keep us focused.

I thank everybody who has spoken in this debate, particularly my hon. Friend, I would like to call him, the Member for Reigate (Crispin Blunt). He gave evidence to the Backbench Business Committee and has done a huge amount of work, as has Anna Robinson of the APPG on global LGBT+ rights. All speakers have conducted themselves in a respectful and thoughtful manner. This place is at its best when we agree on issues that are not often discussed and when we shine a light on issues that are sometimes discussed in a very toxic environment. I hope we have given more light than heat to those issues.

The hon. Members for Sheffield, Hallam (Olivia Blake) and for Runnymede and Weybridge (Dr Spencer) are new Members who have come to this place with experience and insight as health professionals, and I think that will serve us all well. I listened with interest to their contributions on the work that they are doing and have done, which is hugely important.

The hon. Member for North Down (Stephen Farry) brought the Northern Irish perspective. As he rightly said, there have been huge leaps forward in recent times. We wish him and the people of Northern Ireland well as they embark on, hopefully, a new chapter in their history, but also in terms of equality for LGBT people. My hon. Friend the Member for Linlithgow and East Falkirk (Martyn Day) brought the specific Scottish perspective and was able to put a number of points that I did not have time to make—I felt I had been indulgent enough.

The hon. Member for Ellesmere Port and Neston (Justin Madders) highlighted some of the major health challenges that LBT women face, and talked specifically about the report that the Women and Equalities Committee produced on health and social care for the LGBT community. That was a really insightful report and drew on such a wide range of experience. That is why the Committees of this House are so important, and why making sure they function properly is incredibly important. The Minister gave a very thoughtful response, and I know that our constituents and, I hope, the LGBT community will take a lot from that. We know there is still a long way to go, and I hope that she will be able to address the specific points that I raised on behalf of the people who got in touch with me, perhaps in a letter. It was very powerful reading their testimonies and reading the concerns that they had. They show that there is still a long way to go, particularly for those in the trans community seeking to get services.

We have a particular challenge in Scotland. One of the testimonies that the Pink Saltire included in a film that it made a couple of years ago, which I rewatched in preparation for this debate, was from a non-binary person who had to have surgery in England and had to fly home, leading to stitches bursting and terrible scarring. That is real detail that is not much talked about, but we have to reflect on it and make sure that in all parts of the UK and all countries in the UK there are the right services, and people can be treated and supported as close to home as possible.

We have to thank the Backbench Business Committee once again, and you, Mr Deputy Speaker. It has been an important debate and I know that the LGBT community will be grateful to Members for raising these issues. I hope it will take us a step forward in our fight for equality.

Question put and agreed to.

Resolved,

That this House has considered lesbian, bisexual and trans women’s health inequalities.