UNHEALTHY We’d like to change the first paragraph on the inside cover as follows: from ‘LGBT people’s experiences of health and social care’ to ‘lesbian, gay, ATTITUDES bisexual and trans people’s experiences of health and social care’. SCOTLAND The treatment of LGBT people within health and social care organisations in Scotland ROUNDTABLE REPORT AND RECOMMENDATIONS INTRODUCTION

In 2015, Scotland published Unhealthy Attitudes Scotland, looking in detail for the first time at lesbian, gay, bisexual and trans people’s experiences of health and social care.

Colin Macfarlane Director, As well as highlighting the barriers faced by LGBT Stonewall Scotland staff working in the health and social care sector, the report revealed a shocking lack of understanding on the needs of LGBT service users.

In order to take these findings forward, Stonewall Scotland held roundtables discussions with health and social care providers to identify practical solutions and best practice strategies to help them support LGBT service users and staff in their community.

This report brings together the strategies and best practice from the roundtables, and is an important step forward for the sector. We look forward to working in partnership with health and social care organisations to put these into action and ensure that everyone in Scotland can access high quality health and social care without fear of .

2 BACKGROUND

In autumn 2015, Stonewall Scotland ran a series of Despite the legislative protections afforded roundtables across Scotland, inviting organisations to lesbian, gay and bisexual people, the from the public and third sectors to come together lived experiences of LGBT people continue to discuss these findings, as well as other research on hate crime, and how they could improve the to be very different to their peers. experiences of LGBT people as service users or as staff. The roundtables, held in Aberdeen, Inverness In 2014, Stonewall Scotland’s research report Your and Glasgow, were attended by more than forty Services Your Say found that despite duties placed organisations, with representation from health boards, on the public sector by the Equality Act 2010, many health charities, social workers and local authorities. LGBT people still experienced discrimination when Through these roundtables, service providers were accessing public services. One in six (16 per cent) able to learn more about how LGBT people access LGBT people said that they experienced poor their services, their experiences and the problems treatment because of their or they face, and the impact of these experiences. gender identity over the last three years. Experiences Attendees were also able to reflect on how the and expectations of criminal justice agencies and research findings related to their own context and health and social care organisations in particular their own area. Discussions around LGBT people’s emerge as areas of concern. experiences of health and social care were framed Further research has looked into these in more detail. around the recommendations from Unhealthy Unhealthy Attitudes Scotland (2015) revealed that Attitudes. Attendees were encouraged to consider three in ten health and social care staff in Scotland practical steps that their organisation could take had heard colleagues use discriminatory language in to improve experiences for LGBT people, with the last five years. Many did not feel able to confront discussions proving an invaluable opportunity to this, with one in eight staff saying they would not feel highlight and share existing good practice. comfortable to challenge this, even when directed at This report addresses the key themes from these patients or service users. Health and social care staff roundtables, outlines areas of existing good also had a lack of understanding of LGBT people’s practice and suggests recommendations for how needs, with fewer than one in ten having any training organisations can improve the experiences of LGBT on the needs of LGBT service users. staff and service users.

3 KEY THEMES

Staff strongly felt that they wanted to be able to deliver Discriminatory and offensive language was inclusive care, tailoring their service to the individual perceived as a particular problem, with needs of the service user without seeing someone as many staff feeling uncomfortable to tackle inherently different or only seeing one aspect of that this kind of language and others perceiving person. Training on the specific needs of LGBT service users within practitioners specific area was felt to be it as an inevitable part of the job for front critical to supporting their service users as individuals, line staff. and more useful than broad equalities training. Whilst the difficulties of training large numbers of people were acknowledged, many organisations had practical There were concerns about casual discriminatory solutions to this, such as incorporating LGBT issues language and jokes from colleagues, which made into existing training where appropriate, running brief attendees feel uncomfortable at work. Staff wanted to lunchtime sessions, and including more specific training be empowered to challenge their colleagues, even senior within induction. It was also strongly felt that this area ones, without fearing the impact on their careers. Many should be prioritised for training, with greater support attendees felt that internal anti-bullying policies and given to help staff access it. procedures needed to be much clearer, or where these kinds of policies already existed that they should be Many LGBT attendees working in health and social more clearly promoted to staff. Some attendees also care reported that it was difficult to sustain or develop suggested that organisational guidance on how to network groups, partly because staff were often spread challenge this kind of language, such as suggested between many offices or areas as well as the high phrases or a ‘how to’ guide, would make them feel more prevalence of shift work. This made it difficult for them confident as well as assuring them of the organisation’s to get support from other employees. Many practical commitment to a safe and inclusive workplace. solutions to this were discussed, including the potential of starting network groups online and moving the In order to create a workplace culture that is ‘fun but location of meetings. It was also felt to be important inclusive’, where employees can challenge their that managers supported employees to take part, colleagues, attendees felt that their health and social including giving them time to participate. These care organisations should make strong and visible networks can also help openly LGBT staff change their commitments to LGBT equality and to tackling all kinds workplace for the better – attendees felt that personal of workplace bullying, such as signing up to Stonewall’s conversations with their friends and colleagues about No Bystanders Campaign. This would increase the their own lived experiences enhanced their confidence of LGBT staff to challenge bullying and understanding of LGBT issues. harassment. Health and social care organisations should also clearly communicate what actions they are taking to support LGBT staff and service users. Demonstrating that services take these issues seriously would also increase the confidence of LGBT service users, helping them to feel that the service is safe and inclusive.

4 GOOD PRACTICE

By drawing on the personal expertise of trans people, In order to provide the best possible services and through listening to the experiences of LGBT for LGBT people, some organisations had people, it also helps create a workplace culture where actively consulted with LGBT service users individuals feel valued. and staff to develop their practice to be as The Golden Jubilee Foundation (previously the NHS inclusive as possible. National Waiting Times Centre) is one of Scotland’s top employers for LGBT people, and the Top Health and Social Care Provider in the UK in Stonewall’s Workplace NHS Forth Valley worked with the Scottish Equality Index 2016. Their LGBT network group Transgender Alliance and trans individuals to create continues to raise awareness of LGBT issues amongst their first Transgender Protocol, a document aimed other staff, including those that are often overlooked, at ensuring that all trans employees are treated with such as the issues facing older LGBT people, disabled dignity and respect both through transition and in LGBT people and LGBT people of faith. the workplace day to day. The document clearly outlines the organisations legal obligations, and During LGBT History Month in 2014, they introduced their expectations that harassment of staff, service initiatives that set out to dispel common myths and users or patients will not be tolerated. The roles and stereotypes relating to the bisexual community. Over duties of various staff should play in creating an the last year The NHS National Waiting Times Centre inclusive workplace are also outlined. have put initiatives into practice to encourage greater diversity at management level including promoting – The protocol raises organisational awareness of the and sending staff on the Stonewall Role Models needs of trans people, both as staff and by extension Programme, giving all staff the opportunity to reach as service users. their full potential.

NEXT STEPS

Stonewall Scotland hopes that this report and the These roundtables discussions provided a recommendations it contains will help organisations valuable opportunity for service providers to to support their LGBT staff and service users. We will learn more about the health and social care continue to offer support, training and resources to needs of LGBT people, to share ideas and health and social care providers, including through our Programme, to ensure these best practice about how they can provide recommendations become reality. an inclusive service.

5 RECOMMENDATIONS

Health and social care organisations should: Update patient complaints procedures and communicate to all staff that homophobic, Consider joining Stonewall’s Diversity biphobic and transphobic complaints will be Champions Programme and entering the taken seriously. Organisations should Workplace Equality Index to support them communicate a clear message that abuse to develop and measure inclusive and including from patients towards staff is supportive working environments. unacceptable, and provide guidance on how Implement mandatory LGBT-inclusive to respond to homophobic, biphobic and equality and diversity training for all staff transphobic bullying and language, and the that covers homophobic, biphobic and support available to staff. transphobic bullying and language, the Make sure that LGBT staff are supported in diversity within the LGBT community as the workplace through the creation of staff well as understanding the needs of LGBT network groups and staff forums. Where patients and service users. LGBT staff networks exist, they should be Develop highly visible campaigns that supported to contribute to workforce and tackle homophobic, biphobic and service delivery outcomes of their transphobic bullying and encourage organisation, and adequate support should reporting. This should be supported by be provided to help them do this. senior leadership across health boards and Encourage and celebrate LGBT role local authorities and implementation should models at all levels within the organisation form part of appraisal processes for all and encourage allies to speak up about managers. The Stonewall Scotland’s the importance of LGBT equality in NoBystanders campaign can help with this. the workplace. Make sure their bullying and harassment policies communicate a zero-tolerance approach to bullying and abuse on the grounds of sexual orientation and gender identity. Policies should include examples of homophobic, biphobic and transphobic bullying and harassment as well as easy and anonymous routes to reporting through HR, network groups, hotlines or dedicated points of contact.

6 Stonewall Scotland Address: Mansfield Traquair Centre 15 Mansfield Place Edinburgh EH3 6BB Scotland Website: www.stonewallscotland.org.uk Telephone: 0131 474 8019 Email: [email protected] @StonewallScot

Written by Sophie Bridger Designed by www.createpod.com

Stonewall Scotland is a registered charity, number SC039681

7 UNHEALTHY ATTITUDES SCOTLAND The treatment of LGBT people within health and social care organisations in Scotland ROUNDTABLE REPORT AND RECOMMENDATIONS