King's Fund - Tackling LGBT+ health inequalities or just talking?

21 Aug 2025 01:30 PM

In July, the Secretary of State for Health and Social Care, Wes Streeting, launched a ‘first ever’ NHS review of LGBT+ health inequalities.

The LGBT+ health evidence review will explore barriers to access and poor experiences LGBT+ people have accessing health care, the impact of these poor experiences, and how LGBT+ specific health needs might best be met. A relatively brief exercise, it is due to be completed by December 2025.

It’s good to have renewed attention on the issues faced by the LGBT+ community, especially when many members are concerned about increasing threats to their safety and dignity. For example, limiting access to bathrooms and hospital wards have direct implications for trans and nonbinary people people’s health and access to services. I’m concerned that a review, without specific actions arising, will not be enough. I wanted to understand how government work can lead to tangible change for LGBT+ folk at the sharp end of health inequalities – particularly trans and nonbinary people. To explore this, I went back to the 2018 LGBT Action Plan to see what lessons there might be for addressing LGBT+ health inequalities.

Launched under Theresa May’s government, the LGBT Action Plan addressed a wide range of issues relating to LGBT inequalities in UK society. The plan followed a major national survey of LGBT experiences in 2017 that highlighted significant issues in all parts of life. A chapter was dedicated to health because several issues from the survey related to health inequalities.

In 2021, The King’s Fund podcast colleagues interviewed the National Adviser on LGBT+ health, Dr Michael Brady, who was appointed in 2019 as a result of the action plan. He reflected that there had been some progress against the commitments, but its future was unclear. Although the action plan focused on the whole LGBT community, our other guest on the podcast, Michelle Ross, highlighted how attacks on trans and nonbinary people’s rights meant that despite the plan, the context in which her team were delivering services had become more challenging. Only one progress report was published, after the first year of the plan, and I couldn’t find any evidence that the action plan’s impact had been evaluated.

Additionally, despite the publication of the 2017 national survey, an academic review of LGBT+ health inequalities in 2021 highlighted a general lack of evidence on the topic. They noted that work on LGBT+ inequalities had possibly been deprioritised by an overarching ‘it's getting better’ narrative of continued progress towards equality for LGBT+ people, despite evidence that this is not straightforward or equally felt by the whole LGBT+ community. This review specifically called for more data. It makes me wonder how much new evidence has been captured over the last four years to inform the government’s forthcoming review.

A national Healthwatch report published in July 2025 highlighted many issues trans and nonbinary people still face in relation to accessing primary care, seven years after the action plan was published. They called for the development of ‘a new comprehensive LGBT+ healthcare strategy’ by government and NHS England. While the LGBT+ health evidence review may support the development of a new strategy, there is no timeline or mention of how the review will lead to improvement. For LGBT+ people experiencing health inequalities today, change may come too late, if at all.