Gender and health - Bristol - Healthwatch Bristol

GENDER AND HEALTH QUARTER 1: APRIL TO JUNE 2016 Healthwatch Bristol heard from men, women and through The Diversity Trust, the Trans community during April – June 2016 about their experiences of accessing services. This report summarises the key messages members of the public shared with Healthwatch on this topic.

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GENDER AND HEALTH QUARTER 1: APRIL TO JUNE 2016 Executive Summary Healthwatch Bristol carried out a range of engagement activities with single gender groups including men, women, transgender and non-binary people.

The key themes gathered were: 

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the importance of GP and front line staff training and understanding of the specific health needs and consultation needs of non-binary and intersex patients, transgender patients, male and female patients; the need for gender specific education/ preventative work on signs and symptoms of cancer and on mental health issues (to enable men, women, transgender and non-binary people to feel comfortable and able to discuss their specific health needs); increase in awareness of the requirement for GPs to provide long-term prescriptions for Trans patients after discharge from Gender Identity Clinic services; the importance of single sex service provision, for example women only homeless accommodation.

MISSING LINK FOCUS GROUP The group of six women said that it is hard to become settled and take control of your own wellbeing when you are constantly being moved from one homeless shelter/ service to another. One commentator said that being moved from place to place means that you never feel safe and never have the opportunity to grow and develop.

Recommendations for consideration: 1. Healthwatch will continue to support public health in a gendered approach to data collection including:  Joint Strategic Needs Assessment Women’s Health chapter (currently in development)  Bristol’s Men and Boys Forum 2. Healthwatch and The Diversity Trust will take the recommendations made in the ‘Evidence for Change’ report to appropriate bodies to influence service delivery and design. 3. Healthwatch will continue to acknowledge the needs of male, female, transgender and non-binary participants in the planning of engagement activities in order to reduce potential barriers to participation.

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Contents Why Gender?

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What we did

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You Said Transgender and non-binary health Women’s health Men’s health

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Recommendations for consideration

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Next steps

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Tell Us Your Story; contact details

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Why Gender? Healthwatch Bristol chose ‘gender and health’ as the topic for April, May and June 2016. This topic was selected by the Healthwatch advisory group as a result of feedback received from the public and identified gaps in feedback sources. The quarter starts a year of ‘equalities’ based quarter topics which have been designed, by Healthwatch advisory group members and staff, to enable specific engagement with members of the equality groups identified under the nine protected characteristics (Equalities Act 2010). The Healthwatch quarter work on Gender was planned so that it would:    

feed into the JSNA chapter on women’s health; feed into the Men and Boys Forum; gather data from the Trans population, an extremely seldom heard community; allow Healthwatch Bristol to take a gendered approach to its engagement in response to feedback from members of the public stating they sometimes feel more comfortable sharing their experiences with people of their gender.

What we did During engagement sessions, via our online communications and via our networks, Healthwatch Bristol used the following as prompts for people to feedback to us: 

Are you currently or have you recently used maternity services? Tell us about your experience as a new mother or father.

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Are you transgender, what are your experiences of using health and social care services? Do you attend any male only services or groups? What do you think about them and how do they support you? Do you attend any female only services or groups? What do you think about them and how do they support you? Have you experienced a gender specific cancer? What was your experience?

As part of the quarter’s work on ‘gender and health’, Healthwatch carried out the individual pieces of project work as detailed in the following sections. Each quarter Healthwatch Bristol holds an open meeting to examine the engagement work completed and information gathered during the quarter. It provides an opportunity for members of the public and health professionals to make comment on the findings, share and gain knowledge and add their own experiences. To read the write up from the meeting please visit http://bit.ly/2bvAZJt

You said Transgender and non-binary health The Diversity Trust ‘Evidence for Change’ Bristol Lesbian, Gay, Bisexual and Trans Health and Wellbeing research report August 2016 Healthwatch Bath and North East Somerset (B&NES), Bristol, South Gloucestershire and Somerset commissioned the Diversity Trust to carry out research into the health and wellbeing needs and experiences of Lesbian, Gay, Bisexual and Transgender (LGBT+) people. The following is an extract from the report. For the full report please visit http://bit.ly/2bGgecI The Bristol research was carried out between July 2014 and July 2015. A total of 400 LGBT+ people took part in our research study. We had 271 people take part in our online survey. A further 130 people took part in consultation and engagement events, in interviews, discussion and focus groups and in a short paper-based qualitative survey. A further 100 participants took part in briefing sessions for health professionals which ran between July 2015 and February 2016. The Gender Identity Research and Education Society (GIRES), estimates the number of Trans people in the UK at 1% of the population defined as being on a “gender variant spectrum”. This would give a population of over 4400 Trans people living in Bristol (GIRES, 2009).

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Recommendations: Improving Access for Trans Patients  Ensure the availability of education and training for health care professionals on working with trans patients and on improving knowledge of gender identity  Information on the health needs of trans patients available to GPs and other NHS health service providers  Increased access to facilities and funding to remove facial hair, other than by laser depilation, for trans patients  Increased awareness and implementation of the trans referral pathway direct to Gender Identity Clinics (GIC) by GPs  Improved confidentiality of gender identity when booking into GP surgeries, and in other health care settings  Improvements in confidentiality when discussing trans patients and not outing them during conversations with colleagues  Increase in awareness and understanding, and specific health needs, of non-binary and intersex patients  Increase in awareness of the requirement for GPs to provide long-term prescriptions for Trans patients after discharge from GIC services Further recommendations are made in the report regarding the monitoring of sexual orientation and gender identity with examples. Please read the full report for details. W: http://bit.ly/2bGgecI The ‘Healthwatch Bristol update: Transgender and Gender Identify Services’ gives further information on how Healthwatch Bristol has worked with Healthwatch England and NHS England on the Parliamentary Inquiry into Transgender Equality. W: http://bit.ly/2bwmzvm Healthwatch Bristol will continue to work with The Diversity Trust to take forward the recommendations from the report and ensure the voice of the LGBT+ community is heard in public and patient involvement conversations.

Women’s Health Refugee Women of Bristol Healthwatch worked with staff at Refugee Women of Bristol to plan and promote two days of engagement at the Refugee Women of Bristol drop in sessions. 33 comments were collected. Healthwatch worked with the Community Workers to support people to share their views in Somali, Arabic and Kurdish. The women were encouraged to give feedback on all health and social care services, but were also supported to think about and discuss their knowledge of signs and symptoms of cancer, cancer screening and cancer treatment. There was an opportunity where people were able to give their feedback verbally, in private, if required as Healthwatch recognises that cancer can be a sensitive subject and may be easier to discuss in private.

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Key themes in feedback gathered:  cultural difference and understanding of the health system and seeking treatment;  women were aware of signs and symptoms of cancer only through friends and family having cancer;  engagement with primary care services such as GPs, pharmacies and dentists was generally positive;  there was a generally positive use of interpreters for those with English as a second language;  there was mixed views of hospital care: staff were generally viewed positively with mixed experiences of maternity care. For a full copy of the engagement summary please visit http://bit.ly/2bIZh2n

Dhek Bhal Dhek Bhal Day Centre caters for South Asian women from the age of 55 upwards from Bristol and South Gloucestershire areas. 10 comments were collected. Dhek Bhal was established to help elderly women to meet for friendship and mutual support at a convenient location to help maintain their independence. Healthwatch facilitated a focus group to introduce participants to Healthwatch and to support them to comment on the health and social care services they have accessed. Key themes in feedback gathered:  mixed views about the doctor surgeries and health centres people use;  people waiting for appointments and operations and experiences of waiting a long period of time for hospitals to respond with dates;  a number of people were happy with the standard of care received from their health centres when they were ill or suffering from various illnesses and conditions;  a small number of people commented on receiving home visits when they were very unwell or needed medical assistance. For a full copy of the engagement summary please visit http://bit.ly/2bbwfpG

Missing Link service users Healthwatch Bristol facilitated an informal focus group with women who are currently using or have used Missing Link Services. The focus group participants discussed a range of topics including GP services, mental health services, Missing Link Services and experiences of being homeless and 45 comments were collected. Primary care – specifically GP practices and pharmacies  Commentators felt judged by primary care staff because of their history of drug and/or alcohol addiction and/or mental health issues. They felt that this judgement impacted upon the treatment they received.

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Due to homelessness and being a resident in several different support houses, the commentators had experience of having to regularly change GP Practice. They reported a lack of consistency in their care and frustration at the changes each new Practice made to their medication. The group suggested that primary care staff (including front line staff such as receptionists) receive training on addiction, controlled drugs and mental illness to challenge their preconceptions and reduce judgmental behaviour. The group said that it was difficult to make a complaint about care received because the complaints process was unclear and telephoning the Practice to speak to someone about your complaint was complicated by a lack of credit on their mobile phones. The group valued GPs who took the time to listen to them.

Secondary care  The commentator praised staff on the respiratory ward of the Bristol Royal Infirmary and the Bristol Drugs Project worker who visits the ward for being helpful and nonjudgmental and for ensuring she received her controlled drug medication. Mental health services *Due to time constraints, it was not possible to discuss mental health services in depth. Six comments were, however, made whilst discussing other services. A second focus group to solely discuss experiences of mental health services has been arranged for October 2016. 

The group felt that mental health services need to work around the person rather than trying to place them in a condition specific service. They reflected on how it has been difficult for them and people they know to access support for mental health illness, addiction and homelessness at the same time.

Experiences of homelessness and homelessness services  The group reflected on how it is difficult to feel safe, make progress or develop the ability to look after your own wellbeing, when you are constantly moved from one homeless service to another.  The group members unanimously agreed that, for them, women only accommodation is essential in enabling them to feel safe and make progress.  Group members shared negative feedback about Jamaica Street Project House which they referred to as the worst homeless shelter in Bristol. They said that people with mental illnesses were often taken advantage of by other residents (for example via having money or prescriptions stolen from them). For a full copy of the engagement summary please visit: http://goo.gl/4X14Gk

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Feedback from the Healthwatch Bristol open meeting concerning women’s health. During the final session of the Healthwatch Bristol open meeting in June a number of questions were asked to gather feedback on issues Healthwatch Bristol should consider to take forward. The feedback on women’s health was as follows: Question: From what you have heard today about Women’s Health what issues do you feel Healthwatch should take forward?        

Post natal depression Parenting (children need role models) More relaxed culture Support groups for parents Health workshops for parents are needed Menopause Mental health Raise health professionals’ awareness of specific gender issues in GP Practices for the GPs, nurses and pharmacists W: http://bit.ly/2bvAZJt

Information Sharing Fair - February 2016 The Care Forum supported the Women’s Homelessness Services Information Sharing event organised as part of Homelessness Awareness Week (22 – 26 February 2016) delivered by the Women’s Homelessness Pathway Group. It was the first event of this kind and attracted a lot of interest from agencies and colleagues working across Bristol.

Summary and way forward for women’s health The information gathered during this quarter concerning women’s health will be shared with Bristol Public Health for inclusion in the JSNA chapter on women’s health. Issues will also be taken forward for inclusion in the Women’s Health conference planned for International Women’s Day 2017. Through the engagement activities the importance of talking to people in single sex groups was highlighted for cultural and health condition sensitivity reasons. Healthwatch Bristol will continue to adopt gender appropriate approaches when gathering feedback and influence service delivery and design so that people can feel comfortable and supported when receiving care. With regard specific engagement reports the Missing Link report has been shared with the Preventing Homelessness Board Health subgroup for information and consideration. The issues will also be reviewed in Healthwatch Bristol’s quarter four topic Society and Health when we plan to review the Homelessness report produced in 2015. Information concerning

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cancer will also be shared with the Bristol Clinical Commissioning Group (BCCG) Cancer Steering Group.

Men’s Health Single Parent Action Network Healthwatch worked in partnership with Single Parent Action Network (SPAN) to engage with single fathers in Bristol and gather their feedback on health and social care services. Healthwatch and SPAN developed a questionnaire with eight questions. The questions fell into three categories: 1. General Health Questions 2. Sexual Health Questions 3. Mental Health Questions The questionnaire was given to SPAN members along with the generic Healthwatch Bristol Tell Us Your Story Leaflet. The questionnaire helped to stimulate further themed discussions around their experiences of health and social care services that the Tell Us Your Story Leaflet may not have been able to capture. Five questionnaires were completed. Key themes in feedback gathered:  a good awareness of prostate and testicular cancer (but only one person had been examined);  mixed feedback about seeing health professionals regarding the care of the commentator’s child;  good awareness of sexual health screening, but poor uptake of screening;  a reluctance to provide feedback on mental health services and post-natal depression. For a full copy of the engagement summary please visit http://bit.ly/2bfaBCP

Bristol Men and Boy’s Forum Health Workshop, Tuesday 19 April 2016 Healthwatch Bristol supported the Bristol Men and Boys forum to run a workshop to raise awareness of the inequalities in men and boys’ health in Bristol. The outcome of the workshop was for individuals to pledge actions they would take forward. Clive Gray, Public Health, gave a presentation which highlighted that on average, men die five years younger than women. Only 1 in 5 men make it to the age of 65 and women go to their GP 50% more than men do. He asked, do men prioritise their health? And answered his question with “no, by the time they visit their GP their health problem is often very severe”.

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Feedback from the Healthwatch Bristol open meeting concerning men’s health At Healthwatch Bristol’s open meeting in June a number of questions were asked to gather feedback on issues Healthwatch Bristol should consider to take forward. The feedback on Men’s health was as follows: Question: From what you have heard about men’s health, what issues do you feel that Healthwatch should take forward? 

Men’s health: think local community level to have impact – who has influence within the community, for example sports groups and teams, involve them in conversations.  Mental health – suicide, more research/services identifying why? Men?  More awareness and workshops on ‘private parts’, for men especially but also for women.  Focus on GP Practices: ask gender specific gender questions.  Target ‘vulnerable’ health groups.  Raise public awareness of the Joint Strategic Needs Assessment (JSNA) and what it means for members of the public.  Many homeless services are now ‘corporate’ e.g. the Salvation Army and you cannot get people into them without the Council/Emergency Duty Team  Working with boys and young men, including in schools, to overcome barriers that stop boys engaging about their mental health and wellbeing.  Requesting data on service uptake at a local level. W: http://bit.ly/2bvAZJt

Summary and way forward for men’s health Information gathered during this quarter on men’s health will be shared with the Men and Boy’s forum and where appropriate the BCCG Cancer Steering Group. Healthwatch Bristol will continue to adopt gender appropriate approaches when engaging with men and ensure their views are heard in the design and commissioning of services to reduce barriers to accessing care.

Recommendations for consideration 1. Healthwatch will continue to support public health in a gendered approach to data collection including:  Joint Strategic Needs Assessment Women’s Health chapter (currently in development)  Bristol’s Men and Boys Forum 2. Healthwatch and The Diversity Trust will take the recommendations made in the ‘Evidence for Change’ report to appropriate bodies to influence service delivery and design.

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3. Healthwatch will continue to acknowledge the needs of male, female, transgender and non-binary participants in the planning of engagement activities in order to reduce potential barriers to participation.

Next steps Healthwatch Bristol will….. All the feedback provided through this quarter topic will be shared with relevant Healthwatch Bristol partners including Bristol Clinical Commissioning Group, Bristol City Council, the Care Quality Commission, NHS England and Healthwatch England. The report will also be presented to the Healthwatch Bristol Advisory Group to propose further uptake of the issues identified throughout the quarter. The report will be available on the Healthwatch Bristol website (www.healthwatchbristol.co.uk) and circulated to our mailing lists via the monthly e-bulletin.

Looking forward…. Healthwatch Bristol welcomes and encourages members of the community or those who support them to continue to contribute their feedback to us using the communication methods included at the end of this report. Healthwatch Bristol also supports people to become Volunteer Champions so that they can represent the experiences and needs of their community. If you would like to find out more about volunteering with Healthwatch Bristol, please contact us using the details below.

Tell Us Your Story… Healthwatch Bristol want to hear from you about your experiences so that we can tell services your needs to create the best local services.

Text us - text bris followed by your message to: 07860 021 603 Email us at: [email protected] Call us: 0117 2690400 Write to us at:

Healthwatch Bristol, The Care Forum, The Vassall Centre, Gill Ave, Fishponds, Bristol, BS16 2QQ

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Or visit our website to see more at: www.healthwatchbristol.co.uk