A look at the NHS review into LGBT+ health inequalities

Earlier this week, the NHS launched its first ever review into health inequalities experienced by LGBT+ people. The review, commissioned by Health Secretary Wes Streeting, will examine disparities across mental health, cancer screening, HIV services, and more – aiming to better understand and address persistent inequalities in care. Amid the recent wave of health policy consultations and reform, this inquiry risks being overlooked. Yet it warrants closer attention.

Led by Dr Michael Brady, National Advisor for LGBT+ Health at NHS England, this six-month review will build on existing evidence which highlights poorer health outcomes and greater barriers for LGBT+ individuals, with recommendations expected to be presented to the Health Secretary in December.

In some respects, LGBT+ health has seen significant progress in the UK over the past decade – particularly in the context of HIV. Since the early 2010s, growing access to antiretroviral therapy (ART) has enabled those diagnosed with HIV to live long, healthy lives, with the U=U message (undetectable = untransmittable) gaining mainstream medical and public traction by around 2016.

But despite these medical advancements, stigma continues to hinder true equality in healthcare experiences. Crucially, LGBT+ inequalities intersect with a far broader range of health challenges which have often been under-recognised in national health planning, including mental health, addiction, and barriers to accessing primary care.

• LGBT+ individuals are approximately more than twice as likely to experience mental health problems.[i]
• 1 in 7 transgender people have been refused care or treatment by their GP because they are transgender.[ii]
• LGBT+ populations experience higher rates of smoking and substance misuse.[iii],[iv]

The scope of this review, ranging from mental and sexual health to cancer screening, prevention and perinatal care, feels both necessary and overdue.

What is striking about the review launch, however, is the timing. It follows recent shifts in the inequalities agenda, including the departure of Professor Bola Owolabi as Director of the National Healthcare Inequalities Improvement Programme in July, and the downgrading of targets related to women’s health (i.e. the requirement for every Integrated Care System to establish a women’s health hub) within NHS Operational Planning Guidance.

Against this backdrop, the review reads almost as an outlier, marking a public return to a focus on health inequalities that has been largely absent from the national agenda in recent months.

Streeting’s recent track record adds further complexity to the picture, having faced significant criticism from the LGBT+ community, primarily for supporting the Cass Review. The Review proposed significant changes to NHS care pathways for trans youth and has drawn strong opposition from trans advocacy organisations for undermining access to gender-affirming care. Additionally, Streeting has come under fire for aligning with the Government’s position on the legal definition of sex in public policy, further raising concerns among LGBT+ groups.

In this context, the launch of the LGBT+ health inequalities review, announced shortly after London Trans+ Pride and against a backdrop of wider political shifts on the left, may be viewed by some as a timely moment to re-engage with the health inequalities agenda. However, this moment has yet to be fully capitalised on. Media attention around the announcement has been limited, likely due in part to a busy health news cycle, dominated by coverage of ongoing BMA strike negotiations.

Yet, the potential political ramifications of the review should not detract from its importance as a piece of health policy. LGBT+ health cannot afford to be sidelined. The Government has pledged to take an evidence-led approach, and under Dr Brady’s leadership, there is a genuine opportunity for a meaningful and rigorous exploration of where change is needed most.

Information about submitting evidence to the review can be found here.

[1] Office for National Statistics (2024). Self-harm and suicide by sexual orientation, England and Wales: March 2021 to December 2023. Available here.

[2] TransActual UK (2021). Trans Lives Survey 2021: Enduring the UK’s Hostile Environment. Available here.

[3] Action on Smoking and Health (ASH) & LGBT Foundation (2020). Smoking and tobacco use among lesbian, gay, bisexual and trans (LGBT) people: A joint briefing. Available here.

[4] University College London (2021). Mental health disorders and alcohol misuse more common in LGB people. Available here.