The LGA welcomes NHS England’s LGBT+ Health Evidence Review as a timely and necessary initiative to address persistent health inequalities experienced by LGBT+ communities across England. Local government plays a vital role in shaping inclusive, community-based health and wellbeing services, and we are committed to ensuring that the voices and experiences of LGBT+ people are reflected in national policy and practice.
Summary
While we understand that the scope of this Review does not formally extend to social care, it is important to acknowledge that social care services are deeply intertwined with health outcomes and experiences for LGBT+ individuals. The LGA believes that references to social care cannot be excluded from the broader conversation on LGBT+ health, and we encourage NHS England to consider the interdependencies between health and care in its final recommendations.
Councils are at the forefront of delivering public health, social care, housing, and community services that directly impact the health outcomes of LGBT+ residents. As such, the LGA urges NHS England to recognise and embed the role of local government in the final recommendations of the Review. We believe that tackling health disparities requires a whole-system approach, with local authorities empowered to lead on prevention, engagement, and service design in partnership with Integrated Care Systems and voluntary sector organisations.
Furthermore, we advocate for investment in local capacity-building, including workforce training, leadership development, and community engagement strategies that reflect the diversity of LGBT+ experiences.
As the Review progresses, the LGA will continue to work with NHS England, the Department of Health and Social Care, and other stakeholders to ensure that local government is positioned as a key partner in delivering equitable, person-centred care for LGBT+ communities. We look forward to contributing to the final phase of the Review and to supporting the implementation of its recommendations across the health and care system.
This response is based on positions agreed by the four existing LGA Political Groups in Spring 2025 (Labour, Conservative, Liberal Democrat and Independent). A Reform UK Group has now been constituted within the LGA, but is not formally incorporated into the decision-making process until the start of the LGA’s Committee year on 1 September 2025. This response should therefore be read on the basis of having been agreed by the four previously existing Political Groups.
Data collection
A key factor contributing to disparities in health outcomes is the limited availability of consistent and high-quality data on sexual orientation and gender identity (SOGI) both of which are protected characteristics under the Equality Act 2010. Without comprehensive data, it is challenging to fully understand the scope of health inequalities or to design services that effectively address the needs of LGBTQ+ populations.
Although some national datasets have begun to include sexual orientation monitoring, coverage remains inconsistent and data quality varies. Individuals may be reluctant to disclose this information due to concerns about privacy, relevance, or potential discrimination, concerns often rooted in past or ongoing negative experiences in healthcare settings.
Improving data collection requires both technical enhancements to data systems and broader cultural change within services to foster trust and ensure confidentiality. Many NHS datasets still lack fields for sexual orientation or gender identity, and where such fields do exist, data quality and completeness are often limited. These gaps hinder the ability to generate meaningful insights and address complex, intersecting inequalities such as those experienced by LGBTQ+ individuals from ethnic minority backgrounds or other groups with multiple protected characteristics.
At a national level, a recent analysis of Integrated Care System (ICS) strategies revealed that while most mentioned LGBTQ+ populations, only a quarter provided meaningful context about their health needs. Trans people were notably underrepresented, and systemic issues such as homophobia and transphobia were rarely acknowledged. This suggests that while awareness is growing, many strategies still lack depth and actionable commitments.
Local government remains committed to working with national partners to strengthen data standards, enhance inclusive public health intelligence, and co-produce solutions in collaboration with LGBTQ+ communities.
Mental health
Mental health is recognised as a vital component of overall wellbeing, encompassing an individual’s ability to cope with life’s stresses, realise their potential, learn and work effectively, and contribute meaningfully to their community. Promoting mental health involves raising awareness, reducing stigma, and ensuring access to effective interventions and support systems.
However, mental health outcomes are not evenly distributed across populations. Evidence consistently shows that individuals who identify as Lesbian, Gay, Bisexual, Transgender, Queer, Questioning or Intersex (LGBTQI+) face significantly greater mental health challenges compared to their heterosexual peers. These disparities are particularly pronounced among young people.
A systematic review conducted by Wilson and Cariola (2020) synthesised qualitative research on LGBTQI+ youth and mental health in the UK. The review found that approximately one in three LGBTQ+ young people experience mental health difficulties, compared to one in eight in the general youth population.
The authors identified five core themes contributing to these disparities: isolation and rejection, marginalisation, depression and suicidality, policy and environmental factors, and the importance of connectedness.
The review highlights that stigma, discrimination, and victimisation are central to the mental health challenges faced by LGBTQ+ youth. These experiences often lead to feelings of exclusion and psychological distress, including anxiety, depression, self-harm, and suicidal ideation. Furthermore, the lack of supportive environments, whether in schools, families, or communities can exacerbate these issues. Conversely, access to affirming spaces and relationships, including peer support and inclusive policies, can foster resilience and improve mental health outcomes.
The National LGBT Survey conducted in 2018 by the Government Equalities Office shed light on the challenges faced by LGBT+ individuals when accessing public healthcare services, particularly mental health support. Among those who had accessed or attempted to access mental health services, over half (51 per cent) reported that they had to wait too long for care. Additionally, 27 per cent of respondents expressed feelings of worry, anxiety, or embarrassment about seeking help, indicating significant emotional barriers to access. Notably, 16 per cent felt that their GP was not supportive, highlighting concerns around the quality of primary care interactions for LGBT patients.
Data from the Mental Health Foundation, also shows that around one in eight LGBT+ people have experienced unequal treatment from healthcare staff because they are LGBT+. One in seven people have avoided treatment for fear of discrimination.
These findings underscore the need for more inclusive, timely, and supportive mental health services that are responsive to the specific needs of LGBT communities.
LGBT+ people have experienced unequal treatment from healthcare staff because they are LGBT+
Healthy behaviours
Healthy behaviours include behaviours that have a positive impact on an individual’s health and wellbeing. Behaviours such as stopping smoking, drinking less alcohol, moving more and eating more healthily can help reduce the risk of many long-term health conditions. An individual’s health behaviours are influenced by their biological and genetic risk factors as well as their personal and socioeconomic circumstances.
There is evidence linking stressful situations and discriminatory experiences with health behaviours such as substance misuse and smoking. These behaviours can be contributing factors to long-term health conditions. Existing evidence suggests that LGBT+ individuals may experience worse health outcomes than their counterparts.
For example, while there are gaps in existing data for LGBTQ+ communities and specific long-term conditions, international research suggests that LGB women may be more likely to develop type 2 diabetes. In addition, bisexual men may be more likely than heterosexual men to have diabetes. Compared with cisgender adults, transgender women may be more likely to develop cardiovascular disease. While emerging evidence suggests an increased risk of several long-term health conditions among LGBTQ+ individuals, there is limited evidence regarding healthy behaviours in this population.
Alcohol
A 2021 survey by NHS Digital identified that a higher proportion of LGB adults drank alcohol to a level of increased risk or higher risk compared with their heterosexual counterparts. Among adults, LGB individuals were more likely than heterosexual adults to have exceeded the daily recommended amount of alcohol consumption on any given day within the previous week.
Contributing factors included ‘self-medication’ used as a coping mechanism for stress, anxiety and sadness. The greater rates of frequent and risky drinking among LGBTQ+ people may also be attributed to the culture within the commercial gay scene, as a lot of LGBTQ+ venues and spaces are often centred around places that serve alcohol.
Smoking
One in four LGB adults currently smoke, compared with one in five heterosexual adults. The highest proportion of adult smokers is LGB women, while the lowest is heterosexual women. Similarly, amongst current smokers, more LGB adults smoked heavily than heterosexual adults.
There is inadequate data available to provide conclusive evidence for why LGBT+ people smoke more, and more often than the heterosexual population. However, we may be able to draw inferences that it is likely connected with the isolation, prejudice and discrimination LGBT+ people experience due to their sexual orientation or gender identity.
Sexual health
Men who have sex with men are disproportionately affected by sexually transmitted infections (STIs), including syphilis, gonorrhoea, and HIV. This disparity is influenced by a range of factors, including biological susceptibility, social stigma, barriers to healthcare access, and the concentration of sexual networks.
Chemsex, the use of drugs such as methamphetamine, GHB/GBL, and mephedrone to enhance and prolong sexual encounters, remains prevalent among a subgroup of the LGBTQ+ community. This practice is associated with increased sexual risk-taking, reduced inhibition, and challenges around consent, which can further elevate vulnerability to STIs and other health harms.
The LGA is calling for a 10-year sexual health strategy for England in response to mounting pressures on sexual health services and a rapidly evolving public health landscape. This call is rooted in a convergence of urgent challenges and long-term systemic needs that demand coordinated national leadership and sustained investment.
Confidentiality
According to the UK Government’s National LGBT Survey (2018), “outings” were a significant concern, especially among trans individuals (having their sexual orientation and/or gender identity disclosed to others without their consent) by healthcare staff, leading to distress and potential discrimination. It is thought that one in two lesbian and gay people disclose their sexual orientation to their GP, and this is higher than the disclosure rates of bisexual people. It is unclear for people how information about their sexual orientation and gender identity is shared with staff within services and other healthcare providers, and this impacts what is shared with practitioners.
Additionally, a University of Connecticut study found that one-third of LGBTQ+ minors who were outed without their consent experienced increased depression, and two-thirds reported significant stress.
Language use (including misgendering people)
The use of the correct pronouns and gender identity are important to a person’s mental wellbeing. When these are used incorrectly, it can have a negative impact on the experience of care people receive and the care offered to them. People can feel misunderstood, invalidated and unaccepted. Misgendering individuals not only causes distress but also creates barriers in accessing health and care services.
For instance, there is evidence of trans individuals eligible for screening being automatically excluded from the screening invitation list by computer systems when registered with their GP under a different gender. Such occurrences can lead to delays in diagnosis and treatment.
Staff attitudes
There is evidence indicating that some health and care staff may inaccurately perceive a person’s gender identity or sexual orientation as insignificant in influencing their care, leading to the application of heteronormative assumptions. This can result in health and care appointments being missed or distressing for individuals. In the case of cervical screening appointments, reports highlight instances where eligible lesbian and bisexual women did not attend because health professionals informed them that the screening was not applicable to them. Many also felt the screening protocols were not relevant, as it was assumed they were heterosexual. See: Health needs assessment of lesbian, gay, bisexual, transgender and non-binary people.
Training and cultural competence
One in four LGBT persons reported that they have encountered healthcare staff who were unaware of the particular health requirements of LGBT people, and one in ten people had faced this in the past 12 months. Three in five trans people reported a poor awareness by healthcare staff of health needs particular to trans people.
A 2019 Parliament report found that too few health and social care providers actively consider LGBT+ needs in service planning, and that LGBT inclusion is not sufficiently embedded in commissioning strategies or staff training. Rather than purposefully discriminating, health and social care providers feel ill-equipped to meet the needs of LGBT people and lack confidence in specialist needs such as gender identity pathways.
In response to these challenges, Skills for Care developed the LGBTQ+ Learning Framework, a comprehensive guide for social care professionals working with LGBTQ+ individuals in later life.
The framework outlines essential knowledge, skills, and values required to provide affirmative, inclusive care. It addresses topics such as intersectionality, dementia, HIV, intimacy, and sexuality, recognising the complex interplay of factors that shape LGBTQ+ experiences in care.
Importantly, the framework moves beyond compliance to promote cultural competence and reflective practice. It encourages organisations to embed LGBTQ+ issues into recruitment, induction, supervision, and career development processes. Case studies included in the framework illustrate how care providers have implemented inclusive practices, leading to improved outcomes for LGBTQ+ service users.
The framework also aligns with the Care Quality Commission’s Single Assessment Framework, which emphasises personalised, inclusive care. By integrating LGBTQ+ considerations into quality assurance and regulatory processes, the framework supports systemic change across the sector.
Intersectionality and underrepresented groups
While progress has been made in recognising the needs of LGBTQ+ individuals in health and social care, significant gaps remain, particularly for those at the intersections of multiple marginalised identities. Black and ethnic minority LGBTQ+ people, bisexual individuals, and trans/non-binary people are consistently underrepresented in research and policy discussions.
These groups face compounded barriers, including racism, biphobia, and transphobia, which intersect with ageism and ableism in care settings. The LOASCA study and other research initiatives have called for targeted studies to better understand the experiences of these populations and inform inclusive practice
Moreover, LGBTQ+ individuals with experiences of homelessness, substance use, or criminal justice involvement encounter additional challenges in accessing care. A recent scoping review highlighted how anticipated stigma and structural normativity deter engagement with services, leading to poorer health and social outcomes.
Recommendations
Data and intelligence
- To strengthen the inclusion and health outcomes of LGBTQ+ communities, a coordinated approach to data and digital infrastructure is essential. National leadership should establish consistent standards for the collection and use of data on gender identity and sexual orientation, enabling more accurate and equitable service planning and delivery. Alongside this, sustained investment in digital infrastructure is needed to support continuity of care and enable robust population health management across systems.
- Local authorities and ICSs must be supported to build capacity for embedding LGBTQ+ inclusion within Joint Strategic Needs Assessments (JSNAs) and Health and Wellbeing Strategies. This includes training, guidance, and tools to ensure that assessments reflect the diversity and specific needs of LGBTQ+ populations.
- Services must be shaped by community-led approaches that centre on lived experience and intersectionality. Engaging LGBTQ+ communities directly in the design and evaluation of services will ensure that provision is responsive, inclusive, and effective.
Mental health and neurodiversity
- Local NHS organisations, in partnership with councils, public health teams, and the voluntary sector, undertake targeted needs assessments to better understand mental wellbeing, mental ill health, and neurodiversity within LGBTQ+ populations.
- Mental health information and services must be tailored to be inclusive and accessible, with consideration given to developing specialist programmes.
- All mental health strategies should adopt a life-course approach, recognising the evolving needs of LGBTQ+ individuals from youth through to older adulthood.
Healthy behaviours
- Health promotion strategies should be inclusive of LGBTQ+ communities and adopt a life-course approach. Mainstream programmes, such as smoking cessation, alcohol harm reduction, and substance misuse, must be planned with LGBTQ+ needs in mind and co-produced with community members. Consideration should also be given to developing specialist services where appropriate.
Good practice
Directors of Public Health Annual Reports
Directors of Public Health (DPHs) across England are increasingly using their annual reports to spotlight the health and wellbeing of LGBTQ+ communities, though the depth and consistency of this focus varies by locality.
In Croydon, the Director of Public Health dedicated her entire 2023 report to LGBTQ+ health. She emphasised the importance of visibility, representation, and inclusive service design. Her report highlighted significant gaps in local data collection, which hinder effective planning and delivery of services. To address this, she called for improved monitoring of sexual orientation and gender identity, and encouraged public services to challenge assumptions about gender and sexuality. The report also featured a video showcasing lived experiences from LGBTQ+ residents and allies, reinforcing the importance of community voice in shaping public health priorities.
In Kirklees, the Director of Public Health focused on inequalities in end-of-life care for LGBTQ+ individuals. The report identified how heteronormative assumptions in care settings can marginalize LGBTQ+ patients and their chosen families. It called for better staff training on gender identity and inclusive care practices, and advocated for recognition of non-biological support networks in care planning.
Across these reports, several themes are emerging: a push for better data, stronger community engagement, improved cultural competency among staff, and a more intersectional approach to understanding health inequalities. Directors of Public Health are increasingly positioning themselves as advocates for equity, using their reports not just to describe problems but to drive change.
Community-led initiatives: The Outstanding Diversity Forum
The Outstanding Diversity Forum (OSDF), launched by The Outstanding Society, represents a pioneering effort to create a cross-sector platform for LGBTQ+ inclusion in adult social care. Inspired by diversity networks in other sectors, OSDF brings together care providers, regulators, service users, and allies to share best practices, advocate for change, and celebrate diversity.
OSDF’s participation in Pride events, including London and Manchester Pride, symbolises a public commitment to visibility and inclusion. These events serve not only as celebrations but also as platforms for challenging stigma and promoting equity. The forum’s emphasis on peer-led accreditation and benchmarking reflects a shift from mandatory training to voluntary, values-driven engagement. This approach fosters genuine cultural change and empowers organisations to take ownership of their inclusion journey.
Guidance from Circle (Creating Inclusive Residential Care for LGBTQ+ Elders)
Care Home Guidance from Circle (Creating Inclusive Residential Care for LGBTQ+ Elders) part of the University of Kent was developed in conjunction with a group of older LGBTQ+ people and care home managers. Aims to provide “actionable steps that are easy to implement that will help make the care home environment more LGBTQ+ inclusive”. This includes:
- Access to care and resources that is equal and equitable to cis-gender and heterosexual people.
- An environment in which people’s differences in sexual orientation and gender identity are valued and celebrated.
- Acknowledging that sexual orientation and gender identity are relevant to care needs.
- Facilitating full participation in the care environment.
- Discrimination and intolerance are addressed and eradicated.
Contact
Arian Nemati, Public Affairs and Campaigns Adviser
Email: [email protected]