NHS Stockport's decision to withdraw 100% of funding for the
sexual health programmes they buy from the Manchester Lesbian and
Gay Foundation (see
our news story here) is another grim piece in the national
jigsaw of service cuts. I hear from friends and colleagues across
the sector about services being withdrawn, scaled down and shut.
Economies are being made and I do not expect to escape unscathed.
However, apart from the lack of sense in this particular case (gay
and bisexual men are at dramatically increased risk of HIV
infection, prevention saves money, the most effective way to invest
your prevention is by targeting those most at risk - that's not
terribly complicated) what concerns me is the argument being
advanced to justify the decision. It is the classic old chestnut
'we don't need specialist services for sexual minorities - our
general services are open to everyone'.
On the face of it this seems like a reasonable, even desirable
state of affairs. Wouldn't it be lovely if lesbian and bisexual
women could rely on sensitive, appropriate, relevant and well
informed health care from generic mainstream services? Surely this
is possible and should be our ultimate goal, even if there are a
few hurdles to overcome on the way? Whilst I absolutely agree that
generic and mainstream services should indeed be as open, relevant
and accepting of minorities as they can be and that we should do
everything in our power to make them so, I have three basic
problems with this argument as a grounds for making cuts.
Firstly, without commenting specifically on the Stockport
provision (I don't know so I can't say), what is the evidence to
suggest that this is true; that generic services are really 'open
to everyone'?
Stonewall's 'Prescription for Change', a huge study of lesbian
and bisexual women's health and experiences of the healthcare
system, shows that a small number of women are refused services
such as cervical smears on the basis of their identity, 20% have
been told they are not at risk (this isn't true by the way) and
less than half of lesbian and bisexual women have ever had a sexual
health screening.
PACE's 'Where to Turn?' survey asked amongst other things about
people's experience of help seeking when suicidal. Unprompted 23%
of LGBT people reported a negative experience directly relating to
their LGBT identities when accessing mainstream services. Professor
Michael King's study of NHS therapists in 2009 found that 16% of
NHS therapists admitted to having tried to cure or reduce people's
feelings of same sex attraction. Findings like these do not give me
confidence.
Undoubtedly some LGBT people get a very good service from many
parts of the NHS, particularly where the service is not connected
with identity. However, it is clear that many of us don't, or at
least enough of us don't to treat the claim that 'everything's ok
here' with some suspicion. My answer is: 'show me how you know. The
latter point is most relevant for those organisations which do not
even monitor sexual orientation or collect data on their LGBT
clients or analyse feedback from them. In the face of such obvious
self inflicted absence of information I am sceptical about any
claims made about quality of care.
Secondly the claim seems to be based upon certain assumptions
about the advantages of mainstream provision. The big questions
are: whether the generic services are the best value way of doing
things and are they the most effective way of doing things. I
notice Stockport didn't talk about unit costs. Charitable services
like those of the LGF are supported by donations of cash and
volunteer time and run by organisations with very low overheads.
There are savings to be found in this way of doing things.
Also, I do not believe that most people enjoy interacting
with large, factory like bureaucracies. For years the governments
of the day have tried to understand and copy the advantages of
community organisation provision and almost always they miss the
point.
When someone feels they have a direct personal relationship with
an organisation, when the barrier of 'them' and 'us' that can creep
into service provision is removed and services are delivered by
'people like me' there is a huge therapeutic benefit. Here, there
is a direct relationship between the service and those it serves
based upon a shared identity instead of being a number in a factory
which is what large, impersonal delivery can feel like.
Finally, the argument doesn't seem to imagine the possibility
that sometimes specialist services for minorities are genuinely
necessary. PACE has just been forced to close its Girl DIVA lesbian
and bisexual young women's group after withdrawal of local
authority funding. The whole point of this group is that as members
of a minority that can be and are frequently rendered invisible it
is terribly hard for young women to access the kind of peer support
and recognition vital to their healthy development. They need to
interact with people like them. This is simply not replaceable by a
generic, mainstream youth group that is nice to the odd lesbian
when she turns up (even assuming that's true and even assuming she
will do). But the group is gone and more groups will follow. In
this process I expect to hear the Stockport defence mounted again
and again. Get used to these arguments, we are going to need
them.
