International Transgender Day of Visibility (31 March) aims to celebrate transgender and gender non-conforming people and raise awareness of their contributions to society and the discrimination that they face. However supporting this visibility shouldn’t just be limited to one day a year and in this blog from February 2020, Shahnaz Aziz, Patient Public Leadership and Inclusion Lead for East Midlands AHSN, reflects on how her AHSN approaches diversity and inclusion of the LGBT community in the quest to spread innovation within the health and care system.
I saw a thought-provoking and inspirational TEDxNHS talk by Jacob Bayliss called ‘Pride in Practice’. Identifying as a trans man, Jacob talks about the issues that the ‘invisibility’ of gender and sexuality can have within the health and care system and the impact this can have.
Jacob gave examples of the specific challenges faced with appointments and a breakthrough he had when a specialist sexual health service for anyone who identifies as trans, non-binary or gender variant asked the right questions before an appointment in order to better meet their patients’ needs and addressed some of the healthcare factors that as a trans man he might not know about. He left feeling disappointed that he had been invisible for this long.
A point that Jacob made resonated with me: “The LGBT community have higher rates of smoking, drug and alcohol use and of mental health issues. If these people are invisible to us, how can we hope to address these inequalities?”
To flip this point on its head, if we as a network of organisations working to transform the health and care system for the better recognise this group, think how we can make a start to breaking down these barriers.
I see that there are three ways that we can celebrate this diversity and strive for inclusivity.
Through our work
As a network of AHSNs we work together on a number of national innovation programmes which look at some of the country’s biggest health and care challenges. We also work on testing and spreading programmes that meet local health and care challenges and needs, specific to the demographics of our region.
At East Midlands AHSN when developing these programmes, we undertake an equality impact analysis. This process helps us to understand the affect of programmes on different groups. We recently undertook an equality analysis for a new element of our Atrial Fibrillation programme. This programme aims to improve detection and treatment of those with Atrial Fibrillation – the most common type of irregular heart rhythm and a cause of stroke. This new element is a collaboration project, where specialist pharmacists work with GPs to identify those who aren’t on anticoagulation treatment and work to create a tailored treatment plan.
This equality analysis picked up that by determining bleed risk relating to stroke based on gender (which has been the way previously), could lead to underestimating the risk to those who do not identify as the sex assigned at birth. This helped us to highlight the risk to patients to health and care professionals when assessing a patient for anticoagulation therapy based on gender, but to base this on HAS-BLED (blood scoring) instead.
This highlights the importance of the NHS Information Standard asking about sexual orientation on medical registration forms. Services should also ask about gender, introducing a question like – ‘is your gender the same as the one you were given at birth?’ This would certainly help build an evidence base and ensure further equality in health and care treatment.
Making measures like this the norm helps us avoid any of our work unfairly or unnecessarily excluding certain groups and ensures safe and effective health outcomes for all patients.
Through our innovations and the innovators we support
We can encourage innovators with lived experience to put forward solutions to health and care challenges they face. For example, is there a bespoke app with relevant health issues and services that could help people from LGBT communities navigate a confusing health and care system? Can this be co-produced with people with lived experience?
Those with lived experience see things through a different lens. They have experience of barriers and issues they face when accessing health and care services. By encouraging and nurturing their innovations and improvement ideas we can create a diverse pipeline of innovations that are more relevant to the needs of our diverse patients and public.
Our Innovation Exchange digital gateway explains how we support innovators to transform patient care and boost economic growth.
Through our workforce
As Jacob says, people need to feel ‘safe to be seen’. Working in a diverse environment helps people feel comfortable to challenge ideas and offer solutions. We want to take steps as a Network to encourage people from all backgrounds to get involved with our work, whether that’s by working for us or with us.
In the East Midlands we host a Patient and Public Involvement Senate and membership comprises patients and carers with strategic experience in patient involvement and the co-production of health and care services. When recruiting to the Senate we highlight underrepresented groups and encourage applications from these groups so we have a range of views and experience that our health and care partners can tap into and benefit from. We want to strive to do the same when recruiting staff.
We can also make a difference through our health and care workforce by raising awareness of different groups and offering advice and training on how to work with these groups more effectively. We’ve organised master classes for staff working across our regions health and care system on how to work more effectively with people from the LGBT+ communities and have produced top tips guides (these can be accessed here: Engaging and involving our transgender communities and Engaging and involving our lesbian, gay, bisexual (LGB+) communities).
AHSN diversity pledges
As a Network we’re committed to celebrating our people and our public. Last year we kicked off our diversity and innovation work – publishing our report Diversity and innovation – a celebration of BAME innovators and our pledges to do more. This report has a focus on innovation in relation to the BAME agenda, however, we’re looking to go further and celebrate different types of diversity in the same way to support some of the areas I have outlined.
We have a number of diversity pledges (see page 6-7) that we have committed to as an organisation, which is a great step. Writing the pledges is the easy part, now we need to live these pledges and commit to making sure we put diversity at the forefront of what we do.
I really believe that by celebrating diversity and prioritising inclusion, innovation can flourish, and we can start to move towards a health and care system that meets the needs of our brilliantly diverse population.