In Summer 2025, NHS England invited submissions of data, research, evaluations and surveys to support their LGBT+ health evidence review. Members of the Socially Inclusive Ageing Across the Lifecourse team at Brunel University of London submitted evidence.
Summary of their written evidence:
- Sexuality and gender identity shape older LGBT+ people’s expectations about society and their sense of self. Older LGBT+ people are telling us they may have different expectations and norms about services, including health and social care. They sometimes have low expectations about inclusion and do not necessarily feel they can be themselves in service settings.
- The current cohort of older LGBT+ people have unique life-course trajectories marked by partial decriminalisation of male homosexuality in England and Wales in the late 1960s, followed by a brief period of gay liberation in the 1970s. The HIV-AIDS epidemic brought an increase in homophobia, enacted by the state in legislation such as Section 28 of the Local Government Act 1988, which described homosexuality as a ‘pretended family relationship’. From 1997, liberalisation followed in several areas including discrimination in employment and access to goods and services, adoption and fostering, and latterly legal recognition of same-sex relationships.
- Inclusive policies and LGBT+ awareness training are not cutting through to the experience of older LGBT+ people in health settings: they do not assume that NHS and other services will be inclusive and heterosexist assumptions are still a feature of their experience: this sometimes has a chilling effect when they access services.
- Some older LGBT+ people are likely to prefer to make their own arrangements in later life: looking to chosen family or members of their community rather than relying on services they perceive as indifferent or even hostile to their needs and identities. But they may not have access to biological family networks that practitioners might assume would be available to provide support.
- Our data highlights the importance of intersectional approaches: older LGBT+ people do not just present for services as people with a sexuality: they also bring unique and complex aspects of identity linked to protected and other characteristics including age, ethnicity, disability, religion and socio-economic status. Health services need to do better to follow person-centred approaches, acknowledging diverse identities rather than focusing on one or two aspects of identity at best.
- Our participants also tell us that the stigma they have experienced across the life-course endures and casts a shadow in later life: they understand that the dismantling of legal discrimination does not mean social equality: LGBT+ equality is far from being a done deal. This is not a time for the NHS to take its foot off the pedal in promoting and embedding LGBT+ inclusion.
Evidence submitted by members of the project team from Brunel University of London: Dr Mike Thomas, Dr Isla Rippon, Dr Amy Prescott, Professor Christina Victor, and Professor Justin Fisher.