/LGBT_Final_Report

Nicola Hall and Demetrious Panton

ECOTEC Research and Consulting Ltd Vincent House, Quay Place, 92-93 Edward Street, Birmingham, B1 2RA Tel +44 (0) 0845 313 7455 Fax: +44 (0) 0845 313 7454

Email: nicola.hall@ecotec.com demetrious.panton@ecotec.com

www.ecotec.com

ECOTEC ECORYS in the UK

Improving the Region's Knowledge Base on the LGB&T population in the North West Final Report to NWDA and partners

ECOTEC ECORYS in the UK

Improving the Region's Knowledge Base on the LGB&T population in the North West Final Report to NWDA and partners C4064 / October 2009

Nicola Hall and Demetrious Panton ECOTEC Research & Consulting X Vincent House Quay Place 92-93 Edward Street Birmingham B1 2RA United Kingdom T F

+44 (0)845 313 7455 +44 (0)845 313 7454 www.ecotec.com

Contents

PAGE

Acknowledgements ................................................................................. i Executive Summary................................................................................. i 1.0

Introduction............................................................................................. 1

1.1 1.2 1.3 1.4 1.5 1.6

Purpose of this research ..............................................................................................1 Focus of this research ..................................................................................................1 Aims and objectives .....................................................................................................2 Methodology.................................................................................................................3 Data presentation .........................................................................................................3 Structure of this report..................................................................................................4

2.0

Recommendations.................................................................................. 5

2.1 2.2 2.3 2.4 2.5

Recommendations to the NWDA..................................................................................5 Recommendations to the LSC and its successor organisations...................................6 Recommendations to the NHS North West ..................................................................7 Recommendations to Government Office North West..................................................7 Recommendations to all agencies involved .................................................................8

Section A: Background and context ..................................................... 9 3.0

Review of existing evidence ................................................................ 10

3.1 3.2 3.3 3.4 3.5 3.6

Background and context – homophobia and heterosexism ........................................10 Employment ...............................................................................................................11 Enterprise ...................................................................................................................17 Health Services ..........................................................................................................21 Education and Training ..............................................................................................24 Hate crime and the LGBT community ........................................................................26

4.0

Estimate of the region’s LGBT population ......................................... 33

4.1 4.2 4.3 4.4 4.5

Introduction.................................................................................................................33 Background and context.............................................................................................33 National LGBT population estimates ..........................................................................34 North West LGBT population estimates .....................................................................37 Estimate of the LGBT population of the North West...................................................42

Section B: Research Findings............................................................. 46 5.0

Employment .......................................................................................... 47

5.1 5.2 5.3 5.4

Introduction.................................................................................................................47 Experiences at work ...................................................................................................47 Impacts on LGBT individuals......................................................................................54 Implications for the regional economy ........................................................................60

6.0

Enterprise .............................................................................................. 61

6.1 6.2 6.3 6.4 6.5 6.6

Introduction.................................................................................................................61 Experiences of enterprise and self employment.........................................................61 Experiences of business support................................................................................64 Business support in the region ...................................................................................67 Employer’s attitudes towards LGBT employees .........................................................69 Implications for the regional economy ........................................................................72

7.0

Education .............................................................................................. 73

7.1 7.2 7.3 7.4 7.5 7.6

Introduction.................................................................................................................73 Experiences in education ...........................................................................................73 Impact of experiences in learning...............................................................................77 Supporting LGBT learners..........................................................................................78 Current approaches to LGBT equality and support in educational institutions ...........81 Implications for the regional economy ........................................................................83

8.0

Health services ..................................................................................... 84

8.1 8.2 8.3

Experiences of health services...................................................................................84 Impact on LGBT individuals........................................................................................94 Implications for the regional economy ........................................................................96

9.0

Hate crime ............................................................................................. 97

9.1 9.2 9.3

Experiences of hate crime ..........................................................................................97 Impacts on LGBT individuals....................................................................................102 Implications for the regional economy ......................................................................103

10.0

Rural areas .......................................................................................... 104

10.1 10.2 10.3 10.4

Introduction...............................................................................................................104 Experiences of being LGBT in a rural area ..............................................................104 Impacts on LGBT individuals....................................................................................107 Implications for the regional economy ......................................................................108

Annex One: More details on our methodology ..................................A1 Annex Two: Data tables from population estimate .........................A12

Acknowledgements ECOTEC would like to thank all those who gave their time and support for this research.

The research would not have been possible without the dedicated team of thirty community researchers from across the region who undertook this research with enthusiasm and commitment.

We also thank the LGBT individuals and groups from across the region who shared their views and experiences.

We would also like to thank the North West Regional Development Agency who funded the research and its partners within the Research Reference Group: the Government office North West, the LSC North West, 4NW (the Regional Leaders' Forum), the NHS North West and the Lesbian and Gay Foundation.

For this study we worked closely with the Lesbian and Gay Foundation. We thank them for their support and guidance in accessing LGBT individuals and community groups across the region and for access to their publicity, press, website materials and meeting spaces.

We would like to thank Professor Ian Rivers, Brunel University, for his input and expertise and Shameem Malik for her support with the research process.

Thanks also go to the research team including Demetrious Panton, Nicola Hall, Lisa Hancox, Jackie Fox, Sarah Bridgland, Nicolas Lee, Katy Redgrave, Katharine McKenna, Jennifer Dennis and Allie Weir who arranged and undertook stakeholder interviews; supported the community research process; and contributed to producing this report.

The views expressed in this report are the authors’ and do not necessarily reflect those of the North West Development Agency and its partners.

Executive Summary Key messages As a consequence of conducting this research we are in the position to put forward the following key messages.

•

The North West region has a lesbian, gay, bisexual and transgender (LGBT) population of roughly 430,000 – that equates roughly to a population the same size as the region's second city Liverpool. However despite its size, policy makers in the region have a limited knowledge and understanding of the needs of its LGBT population. The LGBT population tends to be invisible within much public discourse regarding equality programmes and initiatives and there exists a general perception that their issues are given low priority status.

•

Although there is recognition of the emerging legal rights of the region's LGBT population there is a view that this that commitments set out in equal opportunities statements and policies are often not translated into the reality of service provision.

•

In spite of the size of the LGBT population within the North West there is no evidence to suggest that it has equity with the other equality strands or causes. This is especially the case with regard to the level of investment with LGBT communities and its third sector.

•

There is a perception that whilst public sector providers in the North West are rightfully "intolerant" of anti LGBT opinions and stances they are accepting of their own lack of knowledge of this community.

•

There is evidence from this research that this sizeable community is underemployed and unable to participate fully in the region's economy or contribute to GVA to the fullest extent due to the discrimination they experience.

•

The region’s LGBT communities have a long history of experiencing discrimination.

•

There is a tendency within these communities to 'opt out' or withdraw from those areas where they perceive they are likely to experience discrimination. This could be in areas such as particular employment or education sectors or in accessing particular services such as health services.

•

Evidence collected during the research suggests there is considerable isolation, not withstanding some notable exceptions, and less support for challenge. LGBT individuals appeared more likely to simply leave a "hostile" environment rather than deploy whatever resources are legally available to challenge this.

i

•

In spite of the notable efforts of LGBT voluntary organisations there seems to be less emphasis on tackling the discrimination faced by the LGBT communities than for other equality groups within public sector organisations. This is potentially linked to the level of investment made to those community organisations who serve the region's LGBT population.

•

As noted in the "Equalities Review" chaired by Trevor Phillips, some of the discrimination faced by the region’s LGBT communities seemed to belong to a "bygone" era when hostility to differences was more accepted. Hate crime seemed to be a regular occurrence for many.

•

There is both a business and moral case for public sector organisations such as the NWDA and it partners to 'engage with LGBT communities', which asserts that engaging with the LGBT communities is good for a region's prosperity. However too often the business case and not the moral case is the driver for action on the part of public sector agencies. Given that these bodies are likely as a consequence of the Single Equality Bill to be given increased legal duties in relation to tackling discrimination and promoting equality for LGBT communities, this is an issue.

•

Tackling the discrimination faced by the region's LGBT population will need to be done in partnership with Third Sector organisations. Third Sector organisations represent the best mechanism currently available to deliver community led approaches designed to tackle the issues raised in our report.

Breaking the Cycle Manchester based Lesbian & Gay Foundation led on developing a pan region strategy designed to support the "delivery of a sustainable Lesbian, Gay, Bisexual and Trans sector in the North West Region. Aimed at the region's statutory service providers, the strategy "Breaking the Cycle" identified three strategic aims; •

Develop the evidence base

•

Increase the knowledge and engagement of policy and decision makers

•

Increase the capacity of the LGB&T voluntary and community organisation

Our report endorses those strategic aims.

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In addition "Breaking the Cycle" identified five key barriers which impacted on the region's LGBT population. The barriers were; •

Limited knowledge and understanding of the needs of LGB&T people

•

Invisibility and (mis) representation

•

LGB&T issues often given low priority

•

Focus is often restricted to the sexual health needs of men who have sex with men

•

LGB&T equality is not yet established as a basic right

Our research has identified similar barriers.

We would strong suggest that this research should be seen as adding to the emerging strategies that exist on a pan regional level and in particular "Breaking the Cycle".

Recommendations The key recommendation arising from the study is that the NWDA and public agencies across the region should use this research as an evidence base and as a starting point to help inform service design and delivery. This research should be a step towards building a more detailed picture nationally and regionally of the needs of LGBT communities. The Agency and partners should seek to use this evidence base to reinforce messages about supporting LGBT individuals and businesses across the whole of the region to help them fulfil their potential to contribute to the regional economy and have access to equal opportunities in terms of employment, learning, health and personal safety in relation to hate crime.

A full set of recommendations are contained in Chapter Two of this report.

Background There is currently a lack of data available on the lesbian, gay, bisexual and transgender (LGBT) communities at national, regional or local level. This lack of data means that policy makers in the North West lack a detailed understanding of need as well as the nature and scope of the discrimination that these communities face. This study, commissioned by the North West Development Agency (NWDA) and partners aimed to contribute to building a better understanding of LGBT communities and help address gaps in understanding as part of their wider work on building the evidence base and understanding the wider population of the North West. This will help to improve the region’s policy response and service provision to LBGT people. This study will also help the region’s public bodies in responding to the existing and potential legislative requirements regarding their duties and responsibilities’ concerning LGBT communities.

iii

This study ran from March to July 2009 and involved a mixture of desk research and community led primary research. This involved a team of 30 community researchers from a range of demographic backgrounds from across the region, who conducted a programme of over 300 in depth interviews and 19 focus groups with LGBT communities from across the five sub regions of the North West. The research also involved interviews with employers in the region and business support organisations such as Business Link and Chambers of Commerce. The research covered the themes of employment, enterprise, education, health, crime and experiences in rural areas.

Key findings 1. The LGBT population There is an extreme paucity of data on LGBT communities at national and regional level. Data on the population or its characteristics is not generally currently collected by public agencies; however from 2009 ONS will start to collect sexual identity in household surveys. Using a range of 'proxy' data sources which provide partial data about sub sets of the population, we calculated an estimate of the LGBT community in the North West. Based on the limited available evidence we can broadly estimate the population of lesbian and gay people in the North West is approximately 430,000 in 2009. This is based on an estimate of 7% in urban areas and 3.4% in smaller towns and rural areas in the region, in line the most recent government estimation of the national figure.

This figure may underestimate the bisexual population since it focussed on same sex couples. We estimate that the number of transsexual people in the North West by the end of 2009 is likely to approximate between 600-700, again in line with the government estimation. However this is a conservative estimate as it covers only those who are seeking, those who intend to seek and those who have undergone gender re-assignment and gender recognition (i.e. transsexuals), and does not include those not seeking recognition. In the absence of other data the real figure is likely to be higher. A further aim of the study was to provide a statistically viable demographic profile of the LGBT communities in the North West (e.g. in terms of gender, age, income, education, ethnicity, etc) however due to the lack of data about the population at regional or national level it was impossible to do this.

2. Experiences of employment People's experiences of being LGBT in employment and work were incredibly varied, with both positive and negative workplace experiences reported. The key findings were that LGBT people were selective about the sectors, companies or workplace settings they entered or felt able to work in. Some sectors and workplaces were perceived as less likely to be open and accepting to LGBT employees, and therefore unlikely to be benefiting from having a diverse workforce that included LGBT people. When seeking employment, some LGBT individuals actively identify and seek out companies that promoted their LGBT friendly status (such as any accreditation they held).

The evidence suggested these experiences impacted on LGBT people's economic level of participation and therefore on the region's gross value added (GVA). There were many cases where LGBT individuals reported they had either left a job, been given the sack/made redundant

iv

after revealing their sexual orientation or gender identity. Many LGBT employees were underemployed (i.e. their skills and expertise were not being fully utilised) and were not given opportunities to progress or develop their careers. There was clear evidence of unequal treatment of LGBT people with regards to in-work benefits, rewards and entitlements (such as unequal application of parental leave or sick pay). Trans people specifically faced a number of issues which limited their ability to participate fully in employment, including difficulties around employment documentation, use of facilities and uniforms. All of these factors indicate that the potential contribution of LGBT individuals to the regional economy is currently not being optimised. For many LGBT individuals difficulties experienced in the workplace led to a series of personal, social and health impacts which negatively affected their quality of life, their personal relationships and in some cases, their mental health leading to associated costs to the regional economy of health care and days lost through sickness.

3. Experiences of enterprise There was evidence of a group of LGBT entrepreneurs contributing to the regional economy through a range of different enterprises and services, the majority of which had either a focus on LGBT issues or targeted LGBT customers. Regarding business support for LGBT led businesses, self-employed LGBT individuals had found business support services such as Business Link to be accessible and useful in addressing their needs, and very few had experienced any difficulties or challenges in accessing business support on the grounds of their sexual orientation or gender identity. Overall, the LGBT business community reported preferring to access mainstream services as they felt that knowledge in their area of business was more important and helpful for their business than accessing an LGBT focussed service.

Employers in the North West identified and supported LGBT communities to a variable extent.

Public sector employers generally had policies in place in line with statutory legal requirements. In the private sector the situation was much more mixed, with some employers having only generic equal opportunities policies that did not cover specific diversity strands. A number of employers that were accredited (as an LGBT friendly employer1) supported LGBT employees through specific mechanisms such as staff support groups however this kind of support was rare in the private sector. Overall, employers in the region were unlikely to be aware of what proportion of their workforce was LGBT and unlikely to be making proactive action to support or encourage the recruitment or development of LGBT employees. Most felt that their existing policies worked well, highlighting a challenge around convincing employers of the opportunity and benefits of doing more in this area.

1 Accredited either via Stonewall’s Workplace Equality Index which is a national benchmarking exercise showcasing Britain’s top employers for lesbian, gay and bisexual staff. Or via Navajo Charter Mark which is awarded to organisations in Lancashire that take positive steps to welcome and encompass LGBT issues within their organisation or service provision.

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4. Experiences of education LGBT people within the sample had a wide range of learning and training experiences, covering schools, apprenticeships, post-16 routes, degrees and postgraduate qualifications, amongst others.1 There were positive experiences of open and accepting staff and educational settings, as well as negative examples of bullying and discrimination.

The impacts of negative experiences included LGBT learners feeling uncomfortable and unable to be open in education; people leaving and not completing their course or studies and ultimately associated impacts in educational underachievement and longer term impact on employment opportunities in the region. Others believed that their experiences had not affected their attainment, but had a serious impact on their self-confidence or personal wellbeing again affecting life chances.

Many regional educational institutions were concerned about the risk to student retention and access to learning of not supporting an LGBT friendly learning environment. As a result, many had specific support in place for LGBT learners including anti-bullying policies or support services.

Institutions recognised that addressing the needs of LGBT learners was a way to give everyone the opportunity to succeed. While 'hearts and minds' in the sector appear to be convinced of the benefits of being inclusive of LGBT learners, the evidence suggests more could be done in implementing that vision to enable them LGBT individuals to fulfil their potential.

5. Experiences of health LGBT people have very varied experiences and perceptions of health services in the region. They acknowledged how far health services had travelled over the last 10 to 15 years in terms of their attitude and response to LGB communities. However availability of good quality and appropriate health services for LGBT people varied considerably by sub region, particularly in relation to provision for trans individuals. While some areas of the health service were praised for their openness and attitude towards LGBT people, there was criticism of other areas, particularly around some general practitioner services and around mental health. Barriers included inappropriate language or behaviour, incorrect assumptions on the part of health staff and a lack of confidence in the preservation of anonymity. Provision was perceived to be geographically variable. Areas like Manchester, Liverpool and Blackpool were generally better equipped but this impacted on some LGBT communities who had the added time and costs of travelling to access those services.

Lack of understanding of LGBT people's health needs and inappropriate health advice may be having an impact on the health of the region's LGBT population and ultimately on their quality of life and ability to contribute to the region economically. For instance poor perceptions of health services may lead to LGBT individuals presenting with health problems later, when problems can be more serious or difficult to deal with and may contribute to poorer health outcomes for LGBT people.

1

The focus was on post 16 education routes in line with the remit of the funders of the study, specifically the LSC. Experiences of school and university were also included where there was useful or relevant learning to be shared.

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This can impact economically in terms of days lost through sick leave and related health and well being issues such as poor mental health outcomes. Supporting the LGBT community to access good quality, appropriate medical care will be vital in support of their contribution to the region's success and prosperity.

6. Experiences of hate crime There was strong evidence that being a victim of hate crime as a result of sexual orientation or gender identity was a relatively common and current experience across LGBT groups in the North West. The experience of hate crime incidents had a significant impact on interviewees in terms of psychological effects and changes in lifestyle, in some cases affecting their ability to participate in employment, thus indicating an impact on the regional economy of the wider impacts of such incidents.

Hate crimes covered a spectrum of incidents from lower level incidents like verbal abuse and attacks on property to serious physical and sexual assault. However LGBT people commonly felt that verbal abuse was not a 'crime' and as such they did not routinely report these incidents to the police or seek help for the issue. Physical incidents were more likely to be viewed as a crime and reported as such. LGBT communities were not routinely reporting hate crimes to the authorities, partly because of the view that police had ‘more important’ things to be dealing with, because there was insufficient evidence to report it or to avoid provoking further attacks. In parts of the region where data was available, reports of hate crime were seen to be rising, which can be viewed positively as it can demonstrate increased propensity to report. The research findings suggest that under reporting of hate crime however remains an issue in the region.

Where hate crimes were reported, subsequent experiences were mixed. Positive experiences were reported when the police were perceived to have listened to the complaint and taken it seriously.

Interviewees welcomed the existence of specific units or dedicated liaison officers in providing a more sympathetic environment for reporting hate crimes. Where negative experiences did exist these tended to relate to reluctance on the part of the police to treat and investigate the crime as a hate crime. In exceptional examples, LGBT individuals perceived there to be homophobic behaviour on the part of individual officers. There was explicit recognition by some LGBT people (living in urban and rural areas) that reporting hate crime in smaller, less cosmopolitan communities was more difficult than in urban areas.

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7. Rural issues In rural areas there were clear issues around a lack of access to a vibrant and visible LGBT community and an associated lack of support services across many sectors; in voluntary sector support groups and in statutory sectors like education, employment, business support and health services. For instance there was evidence of more limited career or work choices for LGBT individuals who reported feeling restricted to 'outdoor' type employment which was perceived to be masculine dominated. Accessing specialist health services in rural areas was a key issue for trans people. Where social network type support did exist it was often targeted to younger people and could not cater for all of the diversity of the LGBT community leading to feelings of isolation. Some of these feelings were being overcome through online support mechanisms. This isolation and lack of services is reinforcing outward migration from rural areas to urban areas and contributing to the decline of the region's rural areas.

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1.0

Introduction ECOTEC Research & Consulting are delighted to present this report to the North West Development Agency (NWDA) and its partners which explores the experiences of lesbian, gay, bisexual and transgender communities (LGBT) in the North West region and aims to help in Improving the Region's Knowledge Base on the LGB&T population in the North West. This research was commissioned by the NWDA in February 2009, and the project took place between March and July 2009 as part of their wider work on building the evidence base and understanding the wider population of the North West.

1.1

Purpose of this research The NWDA commissioned this research in partnership with the Government Office North West, LSC North West, 4NW and the NHS North West. The NWDA recognises there is currently a lack of data available on the lesbian, gay, bisexual and trans (LGBT) communities at national, regional or local level. This lack of data means that regional policy makers lack a detailed understanding of LGBT people's needs as well as the nature and scope of the discrimination that these communities face. The NWDA and its regional partners are committed to building a better understanding to improve policy responses and service provision to LGBT people. This research will support that commitment by helping to address gaps in understanding and build the evidence base as part of their work on understanding the wider population of the North West.

The study was guided by a Research Reference Group which included representatives from the North West Development Agency, the Government Office North West, 4NW, the LSC North West, NHS North West and the Lesbian and Gay Foundation.

1.2

Focus of this research The focus of this research is on lesbian, gay, bisexual and trans individuals and communities across the region. The research includes those individuals and communities that identify themselves as LGBT. It focuses on those who self-identify as LGB in relation to their sexual identity, or as trans in relation to their gender identity. This focus on identity is in line with the approach suggested by the Office for National Statistics as most appropriate for determining sexual identity in social surveys.1 Throughout this report we use the term 'trans' which refers to people that identify as transgender. This definition therefore includes a wide cross section of individuals identifying as transgender including transsexuals and pre and post operative individuals at various stages of transition. Throughout this report, where findings are specific to trans people in relation to gender identity rather than sexual identity these are identified and discussed separately.

1

ONS (2009) See http://www.statistics.gov.uk/pdfdir/siug0509.pdf

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1.3

Aims and objectives The research aimed to provide a picture of the LGBT communities in the North West region, focusing on identifying the barriers which the public sector could then seek to address. It took account of existing and emerging legislation designed to tackle discrimination against LGBT communities. The research was guided by the Research Reference Group to place an emphasis on examining key economic issues in relation to meeting the needs of the region’s LGBT communities. It therefore focuses on exploring experiences in relation to employment, business, education, health and crime in relation to the participation of LGBT communities in the regional economy.

The objectives of this research study were to: 1) review and summarise existing data at local and regional level on LGBT populations 2) provide a statistically viable demographic profile of the LGBT communities in the North West including; age, profile, location, income, education, sector of employment, family status, ethnicity, religion, gender and disability 3) provide a summary of existing evidence on the specific barriers that LGBT people face in accessing; employment, enterprise and economic participation, education, health and hate crime 4) provide primary data on the type of discrimination that LGBT communities face and the barriers faced, along with possible policy responses 5) investigate the attitudes of North West employers and educational institutions 6) development of robust methodologies by which LGBT people can be included in population based evidence and data.

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1.4

Methodology This research study involved a number of strands, designed to meet the research objectives, as follows: • a structured review of current literature and data relating to the key themes of the study • a review of population data on LGBT populations to inform a population estimate of the regional and sub regional population • a programme of community research which involved recruiting, training and supporting a diverse team of 30 LGBT community researchers from across the region and its five sub regions to undertake a programme of over 300 in depth interviews and 19 focus groups with LGBT communities across the region amounting to 462 LGBT individuals consulted as part of the study • a series of in depth interviews with a range of stakeholders including 23 from the business sector, including employers, business support organisations (such as Chambers of Commerce or LGBT focussed business support provided by the third sector), LGBT entrepreneurs, and 13 further and higher education and training providers from across the region.

1.5

Data presentation This report is primarily based on qualitative evidence from in depth interviews and focus groups which present individual's perceptions and opinions. Throughout, use is made of rich qualitative feedback and verbatim comments taken from participants. These comments should be taken as illustrative of the range and nature of opinions, but from such qualitative evidence it is not possible to quantify the breadth or strength of opinion.

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1.6

Structure of this report This report is structured as follows.

Chapter 2 presents the key conclusions and recommendations arising from the research. The evidence base for these recommendations is then presented.

Section A Background and Context presents a review of existing evidence and estimates the LGBT population of the region based on the analysis of secondary literature and data sources: • •

Chapter 3 presents a review of the existing literature and research evidence in relation to the issues and barriers faced by LGBT populations in the theme areas of the study Chapter 4 contains a review of data about LGBT communities in the region using proxy data to give an indicative estimate of the size of the population

Section B Research Findings presents the key findings arising from the primary research evidence: • • • • • •

Chapter 5 presents key findings around employment and economic participation Chapter 6 presents key findings around enterprise Chapter 7 presents key findings around education Chapter 8 presents key findings around health Chapter 9 presents key findings around experiences of hate crime Chapter 10 presents key findings from rural areas of the region

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2.0

Recommendations This chapter presents the recommendations arising from the research evidence, framed within the legal framework. Recommendations are grouped around actions for each of the public agencies supporting this research (Sections 2.1 to 2.4) with recommendations for joint action (Section 2.5).

2.1

Recommendations to the NWDA The Agency should recognise the evidence base identified in this study and use their influence regionally and nationally to encourage other public bodies, such as other RDA's, to develop the knowledge base further and also to act upon this research themselves. This aligns with recommendations made by the LGF in Breaking the Cycle, the regional strategy (LGF, 2009: 14).

This information should also be used in relation to the development of RS2010. At the broadest level, the Agency should work with partners nationally, regionally and sub regionally to ensure that barriers to economic participation for LGBT people are removed in order to maximise the communities' economic contribution in the region. To embed a culture of accepting and supporting LGBT communities in all of the Agency's work, this could be done through specific actions: Internally, in relation to its people, systems and processes the Agency should: • Refresh all monitoring data collected on sexual orientation and ensure that current practices also cover gender identity in line with accepted best practice and ONS definitions. The Agency should raise the importance of collecting such data with the other public agencies and bodies it works with. • The Agency should continue to improve its benchmarked Stonewall Index accreditation on an annual basis, and in the medium term encourage agencies and bodies it works with (for example Business Link) to do the same (through procurement contracts). • The Agency should build into all its procurement contracts a requirement for organisations to meet best practice approaches to equality for LGBT groups. For instance build in requirements for diversity training/awareness raising that covers LGBT with issues for all customer facing staff.

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Externally, in their role as a regional influencer, the Agency should: • Influence and persuade other public bodies of the economic benefits of inclusion for LGBT communities through specific activities similar to those undertaken in other equality strands. For instance ad hoc projects, campaigns, publicity, awards ceremonies, or training/awareness raising activities. Positive imagery of LGBT communities should be used appropriately in the NWDA's press and publicity materials and locations for press advertising.

• Share examples of best practice from employers who are going over and above standard practice in supporting LGBT employees, for example through published case studies.

• Ensure Business Support Services such as Business Link continue to develop links and promote their services to LGBT communities and to LGBT businesses and entrepreneurs to ensure raised awareness of what they provide.

• Work with cluster organisations towards supporting LGBT people into a wider range of sectors particularly those where they are underrepresented in the workforce and including high impact sectors such as bio-medical, digital and creative and renewable energies.

• Extend the role of all NWDA-led business support policies and the Enterprise Fora to not only recognise and value the economic contribution of LGBT individuals and businesses to the region's GVA but also engage and promote them to ensure LGBT individuals’ ability to contribute to the region is fully recognised and supported.

2.2

Recommendations to the LSC and its successor organisations Emerging from the interview evidence are a number of areas where the education and training sector can act to improve LGBT communities' experiences and outcomes from education.

• A clear priority is for the learning sector to work directly with employers to encourage them to provide appropriate workplace cultures for LGBT student placements.

• The sector should make requirements for education and learning providers to create a positive and non-discriminatory environment for students. Through: use of positive imagery, provision of pastoral and support services catering for LGBT students, and in student inductions and staff training to increase confidence in offering support and challenging homophobia.

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2.3

Recommendations to the NHS North West There are a number of opportunities for NHS North West to improve existing practice to enhance LGBT people's accessibility to and experience of health services.

• Adopt a regional ‘standard of care' for the treatment of LGBT people which could help work towards a consistency of service across the region. There is particular need for a 'standard' for care and treatment of transgender people to help to ensure consistent access and levels of treatment for the region's transgender population.

• Revisit diversity training to ensure it is delivered annually to all NHS staff and that it raises awareness of how to effectively meet the needs of LGBT communities with a specific coverage of the needs of trans individuals.

• There is currently limited research or evidence available on the experiences of LGBT people accessing health care services in the North West. Close this evidence gap through a mapping exercise to review the provision available across all PCT services1 in the region and assess whether the provision is fit for purpose in meeting LGBT people's needs and ensuring their confidentiality/anonymity.

• Prioritise funding for specialist support within mainstream services for the LGBT community in areas where provision is limited. In rural areas consider alternate delivery mechanisms to ensure a minimum standard of services across the whole region, for example outreach or mobile services.

2.4

Recommendations to Government Office North West Through supporting local partners' delivery the Government Office for the North West aims to reduce hate crime against the region’s minority groups including against LGBT individuals.

Emerging from the interview evidence are a number of key opportunities that focus on improving LGBT communities' experience of reporting hate crime and the subsequent support available.

A Cross Government Action Plan on Hate Crime will be launched in September 2009, in this context the Government Office along with key agencies, should: • Support local partners to continue to build relations with the LGBT communities, particularly in geographical and police force areas where this relationship is not as well established. This might include encouraging and supporting a greater police presence at LGBT events and in the LGBT community in general to facilitate the positive affects this has on the LGBT community in terms of their overall perception of the police and their propensity to report hate crime incidents.

• Support partners in the more accurate collection of data relating to reporting of hate crime to combat the low rate of non-reporting of hate crime evidenced in this study. For example encouraging replication and support of current good practices around alternative routes for reporting hate crime across the sub regions. For instance the current practice of anonymous 1

E.g. through reviewing online service finders and publicity/information leaflets from PCTs or though a mapping survey.

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hate crime reporting packs or drop in sessions by universities or third sector organisations1 would be beneficial. This information could then be used by Government Office, police forces, or Crime and Disorder Reduction Partnerships (CDRPs) to design appropriate responses. • Encourage partners to expand the numbers of dedicated and specially trained LGBT liaison officers in the police and other agencies and to raise awareness of services that are already in place, particularly those outside of major urban areas. Currently, these specialist units and officers exist only in parts of the region, typically larger urban areas. There would be merit in exploring the replication of current good practice in the region such as the Safer Knowsley Partnership's dedicated phone line for reporting hate crime incidents or the Sigma unit of Merseyside Police particularly in expanding availability in smaller and more rural communities.

2.5

Recommendations to all agencies involved All the agencies involved in this study should work together to take collective responsibility for promoting equality of opportunity for LGBT groups in the region. This should be taken forwards by the Regional Equality Strategy Group (ESG) as part of a refresh of activity in light of the report's findings. The ESG should set aside funding to enable the further collection of data to add to the evidence base in this area. At the ESG individual partners should report back on their own progress towards agreed objectives.

1

Such as that offered by the Lesbian and Gay Foundation (LGF) in Manchester.

8

Section A: Background and context

9

3.0

Review of existing evidence This chapter reviews the existing literature in relation to the experiences of lesbian, gay, bisexual and trans (LGBT) people in the key themes of the study: employment (Section 3.2), business and enterprise (Section 3.3), education (Section 3.4), health (Section 3.5) and hate crime (Section 3.6).

This aspect of the research was guided by the Research Reference Group to place an emphasis on examining key economic issues in relation to meeting the needs of the region’s LGBT communities. It therefore focuses on exploring experiences in relation to employment, business, education, health and crime and how these affect how LGBT communities participate in the wider economy.

The review aims to be specific about where the current literature covers LGB people and where it extends to trans people. However, in an effort to address the paucity of research and evidence available on the experiences of trans people, we have commented on where it is reasonable that the discussion of LGB issues could also be relevant to the experiences of trans people, even if these experiences have not been covered or made explicit by the author(s). This approach aims to ensure that as far as possible, the experiences of trans people are comprehensively considered in the review; by not only drawing on available research relating specifically to trans people, but also by considering where evidence relating to LGB people may also be relevant. The assumptions were tested through the primary research.

3.1

Background and context – homophobia and heterosexism Research by the International Longevity Centre acknowledges that prejudice and discrimination against LGB people is typically in two forms: homophobia and heterosexism. While homophobia describes language, words or actions that are taken to show a hatred, intolerance or fear of homosexuality, heterosexism is the assumption that everyone is heterosexual, and so discrimination may be unintentional. However, when entrenched in societal institutions, traditions and customs, heterosexism marginalises and fails to recognise at the outset that not everyone is heterosexual and so can have a direct impact on whether the needs of a lesbian, gay or bisexual person are met when they access services (Musingarimi, 2008: 5). This review covers experiences of both forms of discrimination. Furthermore, given that sexual orientation has in recent years been included within the UK equalities framework, it is also useful to situate the debate concerning homophobia and heterosexism within the concept of both direct and indirect discrimination.1

1

Direct discrimination: occurs when factors unrelated to merit, ability or potential of a person or group, are used as an explicit reason for discriminating against them. This is often described as “obvious” discrimination. Indirect discrimination: occurs when there are rules, regulations or assumptions in place that have a discriminatory effect on certain groups of people. This is a less obvious form of discrimination.

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3.2

Employment According to the 2007 Equalities Review1 homophobia in the work place has a significant impact on LGBT people and affects both how well people can perform at work and their participation in the economy. Whilst harassment and discrimination on the grounds of sexual orientation has been made illegal in the workplace since 20032, campaigning group Stonewall argues that there is currently no legal framework to support redress and limited public acknowledgement that discrimination is unacceptable, thus discrimination against LGBT people continues to go on unabated (Stonewall, 2007) A 2008 study of lesbian and gay people’s expectations of discrimination found that nearly one in five lesbian and gay people, or approximately 350,000 employees, had experienced homophobic bullying in the workplace during the last five years (Hunt and Dick, 2008: 5). Perceived discrimination in the workplace can lead to LGBT employees feeling unable to ‘come out’ to their employer or work colleagues and this can lead to stress and feelings of leading a ‘double life’.

Estimates of the number of LGB people who are out at work vary from between 32% (Stonewall 2007) and 58% (Colgan et al, 2006a). Nevertheless these figures indicate that a significant proportion of LGB people are not out in the workplace. A study on trans people’s experiences of inequality and discrimination by London Metropolitan University (London Met) and Press for Change (2007) found that 42% of people not living permanently in their preferred gender role were prevented from doing so because they feared it might threaten their employment status (Whittle et al, 2007). In both cases, experiencing discrimination on ground of sexual orientation or trans identity or having to be secretive about one’s sexual orientation/identity in the workplace can have a damaging impact upon LGBT people and, consequently, on the wider economy and workforce, including: lower productivity from employees; lower retention rates and; the exclusion of some sectors as potential places of work for LGBT people. This is discussed below.

1 2

Cabinet Office (2007) Fairness and Freedom: The Final Report of the Equalities Review.

Under the 2003 Employment Equality Regulations.

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3.2.1

The economic impact of discrimination on the grounds of sexual orientation Research by Stonewall found that 55% of those who had experienced homophobia at work stated that it had a negative impact on their experiences of work (Stonewall, 2007: 6). In their 2008 publication Peak Performance: Gay People and Productivity Stonewall found that where an employer had created a culture where LGB people could be open about their sexual orientation without discrimination, they enjoyed work and were more productive (Guasp and Balfour 2008: 5).

Furthermore, Stonewall estimate productivity to be between 20-30% greater amongst those staff who are open and made to feel comfortable about their sexual orientation in the workplace (see Gavrielides 2007). Similar findings also emerged in a study of LGB employees by London Metropolitan University, which found that: A ‘gay friendly’ environment….can lead to greater happiness, openness; and confidence; improved work productivity and effectiveness; enhanced job enjoyment and a feeling of loyalty and pride in the organisation (Colgan et al, 2006: 5).

The research by London Metropolitan found that discrimination on the grounds of sexual orientation in the workplace can also impact on staff retention and a person’s level of commitment to their employer. A ‘gay friendly’ environment was cited by LGB employees as a key factor in relation to retention and future career expectations (9) and some reported that they had chosen to leave organisation’s because they had experienced discrimination and harassment (13).

Stonewall’s research also found that LGB employees felt that a supportive environment increased their sense of loyalty, commitment to and investment in their organisation (Stonewall, 2006a: 9), with one participant saying: ‘You’d have to pay me a lot more than I get paid here to go somewhere else. I think that has to do with a number of reasons including the fact that I just feel very comfortable here and I feel very accepted. I feel very loyal to the organisation.’ (Bill, private sector) Stonewall claims that 36% of gay people would change their jobs if they experienced homophobia in the workplace. This claim was supported in a qualitative study of gay and lesbian workers in Brighton and Hove which found that participants who had been ‘closeted’ in previous jobs had made a decision never to situate themselves in a similar environment again (Ryan-Flood, 2004: 24).

Research into LGB employees also identified they would actively seek to work for organisations where they will be able to be out and open about their sexual orientation. Again in interviews with LGB employees, Stonewall found that some participants felt that clear evidence of an organisation being inclusive is a decisive factor for lesbian and gay people in the decision to apply for a role and that any evidence of a non-inclusive environment would be a ‘powerful deterrent’ for any applicant (Guasp and Balfour, 2008: 8). A case study of lesbian and gay workers in Brighton and Hove also found that some had made deliberate choices not to enter certain professions such as law, because they perceived them to be homophobic (Ryan-Flood, 2004: 23).

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Trans people who are unable to be open about their identity and live in their preferred gender face the same types of negative pressures in the workplace as LGB individuals. Trans people also potentially face a different type of discrimination in the workplace if it is clear to their colleagues that they are crossing the conventional boundaries of gender in terms of their clothing or they way they present themselves. In these circumstances, trans people are directly open to discrimination, either in terms of being treated differently in a negative way or even subjected to inappropriate comments or abuse (Whittle et al, 2007: 36). The most comprehensive study to date on trans people’s experiences of inequality and discrimination is the report by London Metropolitan and Press for Change for the Equalities Review Engendered Penalties: Transgender and Transsexual People’s Experiences of Inequality and Discrimination (2007). The review found that over half had changed employers either because they were forced to leave by their previous employer, or felt compelled to leave due to the working conditions post-transition (23). It also found that one in four trans people are made to use an inappropriate toilet in the workplace and that over 10% have been verbally abused, with 6% being physically abused (15). Some had also reported that they were now employed in lower paid work since their gender transition (23). As evidence of the negative impacts that this discrimination can have on a trans person’s ability to effectively participate in the workforce, the Lesbian and Gay Foundation in their strategy for the North West point to evidence that trans people have higher than average qualifications, but below average earnings (LGF, 2009: 56).

3.2.2

Facilitators of a gay-friendly workplace As noted above current research tends to suggest that creating a supportive and diverse workplace culture where LGBT people feel they can be open about their sexual orientation increases the productivity and commitment of LGBT employees to an organisation. This section outlines some of the key factors identified by LGBT employees which help them to feel that they can be themselves at work and to come out about their sexual orientation at work.

Overwhelmingly, research has shown that the most common source of (potential) support in relation to discrimination and harassment is the manager/line manager (see Colgan et al, 2006; Guasp and Balfour 2008; and Dickens et al, 2009). The presence of a line manager who is supportive and positive about equal opportunities and diversity is deemed critical to a person performing effectively at work. LGB employees also emphasise that it is often managers who are a barrier to employers’ initiatives and efforts to create an inclusive environment for staff (Guasp and Balfour, 2008: 1).

The critical role of the line manager is clearly recognised as a priority by ACAS1 and the CIPD2.

Research they commissioned3 used a one-day ‘deliberative’ event to explore the experience of sexual orientation and religious belief issues among employers and managers including the challenges they faced; examples of good practice; and the generation of solutions to challenges.

1

Advisory Conciliation and Arbitration Service Chartered Institute of Personnel and Development 3 See Dickens, Creegan and Mitchell (NatCen) (2009) Management handling of sexual orientation, religion and belief in the workplace.

2

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The study found that sexual orientation issues were concerned mainly with the need to challenge prejudice and deal with the harassment and victimisation that could result (Dickens et al, 2009: 19), rather than day to day administrative issues experienced within other equality strands, such as time off for cultural holidays. However a key concern was that line managers often lacked the necessary awareness of the issues and case law relating to sexual orientation and had a fear of dealing with complaints or issues (23-24). Smaller businesses were seen to be particularly prone to challenges around sexual orientation as they lacked the HR or diversity experts to devote the time to issues (27). The importance of HR training, raising awareness about sources of information and providing confidential advice for employers were highlighted by the researchers.

Other sources of support noted by Colgan et al. (2006) included human resources; equalities officers; employee counselling services; colleagues; and LGB groups and networks. However, research for Stonewall on lesbians in the workplace (Miles 2008) found that there was concern that LGB networks were becoming more focused on socialising, particularly drinking, and that there were not enough opportunities to tackle work issues such as career development (Miles, 2008: 1922). Conversely, research with trans people for Calderdale NHS trust (2009) has indicated that most trans people avoided being part of a ‘trans community’ preferring to simply get on with their lives and avoid standing out (Calderdale, 2009: 10).

Trade Unions Representatives were also seen as playing an effective role in encouraging and negotiating LGB issues in the workplace and are also seen as a source of information on LGB issues by both employees (Colgan et al, 2006) and employers (Dickens et al, 2009: 50). The TUC have produced a guide for union negotiators on lesbian, gay, bisexual and trans issues - TUC: LGBT Equality in the Workplace (2006).

14

The TUC guide also provides information on how Trade Union Reps can support trans people in the workplace, particularly around the time that a person is undergoing gender changes.

Transitioning periods are considered to be the most difficult time for trans employees where support and advice from an employer is crucial (LGF, 2009). This is particularly the case as if it is shown that a trans person undergoing gender reassignment cannot function well in their acquired gender at work, their application for a Gender Recognition Certificate may be jeopardised. The TUC guidance provides the following advice for its members in relation to supporting trans employees: • that any steps to be taken to support a trans employee must be agreed with the member and maximum confidentiality observed throughout the process • negotiating with managers to ensure that no disclosure is made without the express permission of the individual • developing a plan with the individual to cover some of the key issues/steps to be taken (e.g. time off for medical treatment, changing identities on personnel records and security passes), and taking these issues to management to secure agreement to the proposed steps • supporting the member in changing positions within the company whilst limiting the number of people who know (should the individual want this); • identifying what information and training will need to be provided for managers and colleagues • briefing managers and colleagues before the member returns to work in order that management stress the need for proper treatment of the worker • negotiating with the employer to allow for a flexible dress code to be adopted during the period of transition.

3.2.3

Differences in discrimination Many studies still tend to group together the experience of LGBT people rather than tease out specific issues, although this is perhaps hardly surprising given that this is a relatively new legislative area. However academics and campaigners for LGBT issues emphasise the importance of not treating LGBT people as a homogenous group and to acknowledge the differences that lesbian, gay, bisexual and trans people may experience in the workplace.

Research on the pay gaps of lesbian and gay workers found that gay men in couples earn 6% less comparable to heterosexual men but that lesbian women seem to be paid around 11% more than heterosexual women living in a couple (Arabsheibani et al, 2006). This research on gay pay is supported by qualitative evidence from a study of lesbians in the workplace1 which found that some participants felt that being open about being a gay woman was empowering and had raised their profile and helped them to feel more equal with men in their organisation (Miles, 2008: 6).

Arabsheibani et al, state that as there are more graduates among lesbian women than among heterosexual women, this could help explain why there appears to be a large pay premium for women in a same sex couple (2006: 19).

1

Miles (2008) The double glazed glass ceiling: lesbians in the workplace. London: Stonewall

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Furthermore, having children is also a significant factor in reducing women’s career progression so this could also account for the difference, although further research is needed to qualify this assumption.

Lesbian employees have also spoken about the relative invisibility of lesbians compared to the strong identity of gay men in the workplace, which has led to some women finding it more difficult to come out. This issue was felt to an even greater degree by bisexual respondents (Miles, 2008: 8).

Trans people may also suffer different forms of discrimination depending on whether they have had gender reassignment and on how visibly they can be recognised as 'trans' or not. Whittle et al.

(2007) explain that those people who appear to the onlooker as 'more trans' are more likely to experience prejudice and/or discrimination (8). In addition, trans people may also suffer different forms of discrimination depending on whether they are a male to female (mtf) or female to male (ftm) trans. Whittle et al. explain that whilst the social problems experienced by ftm trans men will often fade away as they quickly come to look physically very masculine (at least whilst clothed), many mtf trans women will face difficulties for many years of their life as they struggle with the limitations of medicine and surgery to facilitate their passing as a woman in their day to day life (7).

3.2.4

Multiple Discrimination People have multiple identities and this can lead to multiple discrimination. Older LGB people can for instance face double discrimination in the workplace based on ageism as well as discrimination on the grounds of sexual orientation. A study of Muslim lesbian, bisexual and trans women has found that LGBT women struggle to reconcile their sexual orientation with their religious identities and often encounter Islamaphobia or racism as well as homophobic attitudes (Safra 2003).

Furthermore, LGBT people may also experience discrimination from within an LGBT network or group due to prejudice or conflicts in values between LGBT and other identities. Taylor’s study (2005) highlighted the conflict in the discourse that promotes the empowered lesbian employee to that of the experiences of working class lesbian women in the workplace. In particular, LGBT social networks or events that involve drinking and/or networking in gay pubs or bars could exclude groups for whom this type of activity conflicts with the values they hold (e.g. prohibition of alcohol).

These types of events may also risk excluding older LGBT groups who may not feel comfortable in this environment.

3.2.5

LGBT Employment in the North West Geographical location can heavily influence the work and career choices of LGBT people who seek a ‘work/life’ balance by moving to ‘gay friendly’ cities where they felt more comfortable both living and working as LGB people (see Colgan et al. 2006). As noted by Collins (2004) ‘the movement of gay men to an often-distant and large urban metropolis offers great scope for the more explicit exploration of their sexuality’ (1793).

16

The North West has established and vibrant gay villages in Manchester’s gay village in Canal Street and in Liverpool, and an established gay community in Blackpool, with a gay community also emerging in the newly revamped Deansgate and Salford Quays areas. Whilst these areas are likely to attract and retain an LGB workforce, this may prove a harder challenge for smaller towns and rural locations across the North West which may be perceived as isolating and hostile for LGB people. The same could also be said for trans people, who may feel that an urban environment that welcomes diversity provides a safer and more supportive haven for them to live out their trans identity. However the LGF also point out1 that older and established LGB couples migrate to rural areas and so these experiences may not be true for an older LGB workforce who may chose to live in more rural areas.

3.3

Enterprise Discrimination on the grounds of sexual orientation not only affects the economy in terms of the economic participation of LGBT people in the workforce, but also in terms of their participation as customers, users of services and as entrepreneurs. Findings from Stonewall highlighted that some LGB people will not bestow business on organisations that they are aware fail to support lesbian and gay people (Stonewall, 2007) therefore potentially have significant consequences for the economy and individual businesses in the North West.

Collins (2004) suggests based on a review of existing evidence that gay businesses or households might prefer the services of other gay businesses not only as part of trying to support their own community but also for more functional reasons relating to deliberately minimising the likelihood of encountering homophobic behaviour (Collins, 2004: 1792). This may particularly be the case when the service is needed in the home or at the business premises, where the use of gay or gay friendly service not only limits the chance of homophobic incidents but also ‘assists in minimising the effort to ‘de-gay homes in order to make a heterosexual person more at ease’ (1792-3). Gay services therefore provide a means for sustaining an ‘out’ gay lifestyle.

Furthermore, Collins argues that gay services add to the growth and influx of gay communities in an area, which can potentially lead to the regeneration and repopulation of an entire area (see Section 3.3.3). Again, Collins notes that ‘high levels of amenities are not an absolutely necessary pre-requisite for high lesbian/gay household densities, but their presence is certainly likely to help facilitate the take-off’ (1791). Therefore there is a commonly articulated argument that attracting and supporting enterprise amongst LGB people is likely to lead to further growth of these communities in an area.

1

Comments from an LGF steering group member, July 2009

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The business case for supporting gay enterprise and promoting gay friendly services is therefore clear. It is also reasonable to assume that trans people will also be more likely to bestow business and set up businesses in environments where they feel that their identity is not threatened or discriminated against. It should, however, be noted that some commentators have recently argued that anti-discrimination legislation enacted in the last few years could now mean that the LGBT community has less need for gay-specific businesses.1 However, as the LGF and Stonewall have made clear in their key priorities,2 LGBT communities continue to be treated unequally despite changes in legislation and therefore the need for LGBT focussed services remain. This is somewhat similar to the existence of 'ethnic' specific services which are aimed at various ethnic minority communities and have been in existence in spite of a plethora of race relations legislation.

3.3.1

Supporting LGBT Enterprise In terms of establishing or setting up LGBT enterprises, there is little evidence on the barriers faced

by LGBT people and no specific research of this kind. However there is evidence that LGB people face discrimination in accessing financial services which could greatly impact on business start ups. According to Stonewall, gay men and lesbians expect to be discriminated against in the provision of financial services and there is a reluctance and anxiety amongst lesbian and gay men to declare their sexual orientation when applying for a mortgage or insurance; which means that gay people are more likely to seek financial services from gay service providers even if this is more expensive (Stonewall, 2007: 33). This situation is likely to be emphasised for trans people in approaching financial services. Research for the London Development Agency also suggests that accessing start up capital from banks may be difficult for the LGB community as this has been the case for BME communities who have faced discrimination from the financial sector and as a result have to rely on informal sources of finance (Gavrielides, 2007: 6).

The LGF strategy for the North West ‘Breaking the Cycle’ also points to evidence that LGBT voluntary and community sector groups (VCS) have not attracted the investment and support that other equality based groups have (LGF, 2009: 12). This indicates that LGB groups face challenges when applying for VCS funding, and therefore are also likely to encounter the same challenges when applying for non-VCS funding, such as tendering for NHS contracts, that are not experienced by other equality groups.

1

See article by Gay Business Association, Director of Business Support, Stephen Coote in Outnorthwest (April 2009) ‘Has the bubble burst for the pink pound’ 2 For a discussion see Your Guide to the LGF 2008 /9 available from http://www.lgf.org.uk/uploads/pdf/campaigns/lgfguide2008.pdf and http://www.stonewall.org.uk/about_us/2534.asp

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3.3.2

The Pink Pound Discourse on the purchasing power of the gay community in the UK – often referred to as the ‘pink pound’ – has suggested that gay men and women have more money to spend on goods and services in the UK compared to heterosexual people due to lack of dependants.

Whilst some researchers have shown a higher spending power amongst gay and lesbian groups1, it should also be noted that researchers and campaign groups have challenged the theory of the pink pound as a myth perpetuated by market researchers (see Stonewall 2007 and more recently a study of LGB poverty in the USA by Albeda et al 2009); and suggested that in some instances gay and lesbian people are as likely to be in poverty because of, for instance, discrimination and inequality in the workplace2. Stonewall advocate that LGBT people come from all socioeconomic backgrounds and can therefore also experience social exclusion (Stonewall, 2007). This is no doubt the case for those LGBT individuals who experience multiple discrimination as a consequence of their age, gender, faith, disability and/or race.

The exact spending power of the LGB community in comparison to the heterosexual community is therefore both unclear and highly contested. Discourse on the spending power of the gay community does not extend to include trans people.

3.3.3

Links between LGBT communities and regeneration Various studies have linked the presence of gay communities to economic and urban regeneration – and London’s Soho, Manchester’s Canal Street and Brighton’s Kemptown are often used as examples of the success of gay villages in physically regenerating and repopulating once neglected or deprived areas. A key advocate of this position is American Professor Richard Florida, whose ‘creative class theory’ insists that cities with more gay people and ethnic minorities will attract highly skilled ‘creative’ professionals3 and so will out-perform other places4. However, Florida’s position together with other advocates, that link gay villages to urban regeneration have been contested by those that feel that urban regeneration depends on other factors and, moreover that gay villages can sometimes attract the wrong type of urban regeneration for these communities.

1

See discussion of results of a survey by Out Now consultancy at http://www.guardian.co.uk/uk/2006/jan/23/money.gayrights 2 See ‘Pink Pound – Reality or Fiction’ in Outnorthwest, April 2009 available at http://www.lgf.org.uk/news/outnorthwest/ 3 Broadly speaking, the creative class includes scientists, engineers, actors, poets, novelists, high-tech service professionals, legal and health care professionals (Nathan, 2005: 2) 4 See Florida (2003) The Rise of the Creative Class

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Alan Collins in his article Sexual dissidence, enterprise and assimilation: bedfellows in urban regeneration (2004) contends that for a number of relatively mature urban gay villages1, the areas have thrived to such an extent that they have become ‘the chic cultural and urban centres of the city - the place to be seen… regardless of sexual preferences’ (Collins, 2004: 1793). As a result, property developers and retail chains have moved into the area to take advantage of the assumed value of the pink pound, and the ‘tourism’ that the area attracts, thus breathing ‘new life’ into otherwise relatively unpopulated urban centres (see Lipman 2001). In his article The Rise of the Creative Class (2003) Florida argues that creative people seek cultural and sexual diversity and openness to other experiences, and therefore contends that cities that can attract these creative types will do better in the economy compared to those that do not. Both these positions highlight the benefit and potential economic value in supporting the development of gay villages in urban centres.

Both these positions have also been disputed and challenged. Firstly, Florida’s argument is challenged by Max Nathan’s examination of creative class theory in the British context (2005).

Nathan’s study, which draws on evidence of economic growth in British cities, found that whilst diversity and creativity are linked to economic growth in cities, these factors do not necessarily lead to these cities ‘out-performing’ others as professionals will ultimately go to where the jobs are.

Furthermore Nathan points to research that finds that over the past 20 years in the UK, population, jobs and output growth has generally been highest in small, Southern, service-driven cities which are relatively homogenous and uncreative, and that these locations have seen the biggest growth in high-end financial and business service jobs (Nathan, 2005: 5)2. Nathan concludes therefore that there are many routes to success, not just the creative class approach (5).

Next, some commentators have also warned that gay villages are not always successful in attracting the right type of businesses and visitors, with complaints that breweries are only keen to cash in on ‘niche marketing with no gay commitment’ and that the structural development of such areas is pursued purely on commercial grounds3 which in turn means that they are unlikely to survive economic recessions. It has also been reported that in some areas such as Manchester’s Canal Street, the interest that the location has generated as Manchester’s ‘chic cultural and urban centre’ has lead to the area becoming ‘too straight’ (Collins, 2004: 1794). This in turn has resulted in changes in the sexual ambience and sense of personal safety in the area for LGBT individuals; where heterosexual males come to search out heterosexual females who are using the area as a ‘safe space’ for socialising (Collins, 2004: 1794).

1

For example, London’s Soho and Manchester’s Canal St As examples, Nathan references the growths in Milton Keynes, Reading, Warrington, Brighton, Crawley, Northampton, York, Cambridge and Worthing 3 Lipman (2001) ‘Glad to be gay’ in New Start magazine, April 2001 2

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To summarise, whilst it is clear that the emergence of new gay villages have brought with them new business opportunities and the regeneration of run-down areas, the view that this regeneration could only have happened with the influx of the gay community is contested by some researchers.

Furthermore, some gay groups have challenged the exploitation of gay areas for commercial pursuits and for ‘ghettoising’1 an area for the gay community rather than encouraging the establishment of a diverse population.

3.3.4

LGBT Enterprise in the North West Research and evidence of LGBT Enterprise and business opportunities in the North West is limited. The LGF report ‘Breaking the Cycle’ reports that of the 68 registered LGB charities in the UK, only five are based in the North West. Director of Business at the LGF has also commented that the LGBT voluntary sector is experiencing a significant reduction in traditional fundraising and that competitions for funds from other sources are becoming more intense2.

3.4

Health Services As discussed above, high levels of gay-friendly amenities can help encourage the growth of gay communities which in turn can bring economic benefits to a region (discussed in Section 3.3.3).

The presence, availability and quality of health services for LGBT people are therefore essential for economic growth in an area. Added to this, poor health can greatly impact on a person’s ability to work and therefore participate in the economy. The benefits of high quality healthcare that meet the needs of LGBT people are therefore two-fold.

Various research in recent years has highlighted the experience of discrimination in health services

by LGBT people (see Hunt and Fish 2008; Hunt and Dick 2008; Meads et al, 2007; Elford et al 2007; and Hinchliff et al, 2006). This includes homophobic attitudes, reactions and responses from health care staff, assumed heterosexism and even in some severe cases being refused treatment by a health care professional on grounds of their sexual orientation or trans identity.

In their 2008 study on lesbian and bisexual women’s health checks for Stonewall, Hunt and Fish found that half of the women interviewed were not out to their GP3. Seven in ten who were out said that healthcare workers made inappropriate comments when they came out and; one in ten were ignored when they tried to come out to their healthcare professional (Hunt and Fish, 2008). On the other hand, the research showed that positive experiences when accessing healthcare made a difference to how lesbian and bisexual women felt about themselves and their relationship with the health sector (Hunt and Fish, 2008: 17). This is significant in light of recent findings from consultations with LGB communities by the LGF4 that LGB people are not accessing primary services and have poor health outcomes, as it could be inferred that this is due to negative experiences or perceived homophobia in the health care service.

1

Lipman ‘Glad to be Gay’ in New Start magazine, April 2001 'Charities feel the pinch' Outnorthwest, April 2009 3 Based on a survey of 6178 lesbian and bisexual women in Great Britain, of which 85% live in England 4 Breaking the Cycle: LGBT Strategy for North West 2009 - 2014 2

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Research by Press for Change and London Metropolitan on Trans and Transsexual People’s Experiences of Inequality and Discrimination (2007) found that 21%1 said that their GP did not want to help with gender transition, and in 6% of cases actually refused to help (Whittle et al, 2007: 16). 29% felt that being trans adversely affected the way they were treated by health care professionals (16). The LGF strategy for the North West also reports concerns that there is a lack of timely health care services for trans people going through gender reassignment both before surgery and in terms of after care (LGF, 2009).

Research has also found that LGBT people are not getting the appropriate service that they need from health workers. A study of health services in the West Midlands (Meads et al, 2007) found that some health care providers have suggested that women who do not have sex with men are at low risk of cervical cancer so do not need to attend for cervical smears. The researchers suggest that this may be the reason for approximately 40% of non-attendance by lesbians (Meads et al, 2007: 7). Campaigners have also noted that sexual health policy and provision for LGB people has focused heavily on HIV and the sexual health needs of men who have sex with men but that the sexual health needs of lesbian, bisexual women and trans people, as well as the wider health issues of all LGBT groups must also be adequately addressed and resourced (see Lesbian and Gay Foundation Strategy for the North West 2009).

A large survey of trans people conducted by the NHS Audit, Information & Analysis Unit in 20082 also found that accessing available and appropriate health services was a problem for trans people. Whilst almost two thirds of respondents (62%) felt that their GP addressed their needs appropriately, less than a fifth (19%) said their GP was knowledgeable about treatments and only 12% said their GP was able to explain to them what treatments were available (Gardner, 2008: 4).

A survey of trans people living in Calderdale West Yorkshire conducted by Calderdale NHS Trust3 also found that a accessing appropriate services was a key concern for trans people, including problems with accessing hormone treatment due to inconsistency between health professionals as to whether this could be provided and a perceived lack of post-operative (GRS) hormone monitoring (Calderdale, 2009: 11). This lack of available and/or appropriate services for trans people is also highlighted in a 2002 report of services available for the treatment of transsexuals in Great Britain which found that from a survey response of 98 health authorities/boards, only 20%4 had a complete trans service available locally, although not all of these centres had facilities for surgery (Murjan et al, 2002: 211). Furthermore some health authorities did not have an established policy for referral to other centres. The authors conclude that specialist treatment for the majority of trans people in Great Britain will ‘involve long distance travelling to appointments that are likely to be scheduled over a fairly lengthy period of time’.

1

Based on an online survey of 872 self-identified trans people. n = 647 3 n = 38 4 n= 20 2

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Discrimination on grounds of sexual orientation may be in some cases due to lack of knowledge on the part of the practitioner of the sexual practices which lesbians, gay men and bisexual people engage in and/or uncertainty regarding the terminology to use. This was a finding from a 2005 study on general practitioners’ perspectives on discussing sexual health issues with lesbian and gay patients (Hinchliff et al, 2005). However the study also found that a minority of practitioners held negative perceptions of homosexuality which caused difficulties when discussing patient’s experiences and needs (Hinchliff et al, 2005: 348). Whilst this research did not extend to a discussion of trans people, it is likely that the same uncertainty around how to address trans issues and the terminology used, together with personal prejudices, are also factors that impact on the services provided to trans people.

Research by Sigma, who specialise in HIV and sexual health research, also indicates that people living with diagnosed HIV experience multiple forms of discrimination when accessing health services on the basis of their HIV status and their sexual orientation. Between 2007 and 2008 Sigma conducted a national survey of people with diagnosed HIV which included responses from 1154 gay and 60 bisexual men (71% of the entire sample); and 7 lesbians, 3 women who identified as gay and 6 bisexual women (1% of the entire sample). As well as exploring the day-to-day needs of people living with HIV1, the ‘What do you need?’ survey investigated the ways in which HIVrelated discrimination was compounded by other forms of discrimination such as age, ethnicity or sexual identity related discrimination. Whilst the survey found that the majority of respondents who reported having experienced discrimination from doctors and/or other health care professionals said that this was on the basis of their HIV status (83% or 252 out of 317), over a quarter also stated that they had experienced discrimination from health care professionals on the basis of their sexual orientation (27% or 83 out of 317). This was significantly higher compared to other equality groups, where 7% of respondents said that they had experienced discrimination on the basis of their disability and ethnicity, and 6% on the basis of their gender. The two most common problems encountered involved a lack of respect, and significant (often unnecessary) restrictions in access to high quality health and care provision.

A study of people living with HIV in London by Elford et al. also found that discrimination experienced by people living with diagnosed HIV was higher amongst gay men and Black African heterosexual men compared to Black African heterosexual women (Elford et al, 2007: 260-262).

There was also a high association between those showing signs of their HIV status and HIV discrimination (255). In some cases, respondents had been refused treatment by a medical practitioner. This is again significant in light of evidence that HIV discrimination may contribute to an increase in HIV risk behaviours (255).

1

As well as health needs, this included housing, employment, skills and training. Other challenges such as with family life and relationships were also explored.

23

3.4.1

Health Care Services in the North West There is currently limited research or evidence available on the experiences of LGBT people accessing health care services in the North West. Further to the research undertaken in this study, one possible solution to closing this evidence gap would be to review the provision available across all PCT services1 in the region and assess whether the provision is fit for purpose – for example are dedicated LGBT services provided? Is confidentiality/anonymity afforded to individuals?

In a national study of lesbian and gay people’s expectations of discrimination, regional analysis showed that expectations of discrimination in the North West was fairly low compared to other regions in the UK. In the North West 6% of gay and lesbian people expected to be treated worse than a heterosexual if they were admitted to hospital for an emergency and were known to be gay compared to 14% in Wales; 10% in the Yorkshire and Humber and only 2% in the South West. In relation to routine procedures, this figure was also 6% among lesbian and gay people living in the North West; the lowest rate across the regions (Hunt and Dick, 2008 14-15). However regional analysis of the ‘What do you need?’ survey by Sigma indicated that the level of discrimination experienced by those living with diagnosed HIV in the North West2 from health care professionals, was similar to the national picture (80% compared to 83% nationally). The regional analysis does not provide a specific breakdown of discrimination encountered by diagnosed HIV patients on the basis of their sexual orientation.

3.5

Education and Training A number of studies have linked homophobic bullying and discrimination in secondary, further and higher education with poor attendance rates and lower achievements levels, which ultimately lead to lower success or underachievement in adult life (see for example Rivers 2001, Valentine 2009; LGF 2008; Hunt and Jensen 2007; Breitenbach 2004). Research by ECOTEC of the learning opportunities for lesbian, gay and bisexual people in Derbyshire (2006) found that being LGB had most effect on experiences at school, as opposed to college or in the workplace.

A survey of 1145 young people at secondary school by Hunt and Jensen found that almost two thirds (65%) of young lesbian, gay and bisexual people experience homophobic bullying in Britain’s schools and that 30% felt that adults are responsible for homophobic incidents in their schools (Hunt and Jensen, 2007: 3). Half of these students had skipped school because of it and seven out of ten pupils who experience homophobic bullying state that this impacts on their school work (10).

1 2

E.g. through reviewing online service finders and publicity/information leaflets from PCTs. This includes heterosexual people as well as those that identify themselves as gay, lesbian or bisexual

24

However, in an earlier and smaller scale study of 190 LGB adults, Rivers (2001) found that the majority (82%) had experienced name-calling at school, and 72% reported a regular history of absenteeism at school due to homophobic harassment. In addition, Rivers and Cowie (2006) found that over half of LGB people who were bullied at school (53%) contemplated suicide, with 40% attempting once and three quarters of those making second or subsequent attempts1. In the North West, research with 1800 pupils from schools across Manchester found that half of the pupils felt that their school is not a welcoming and safe place for LGB pupils, and 2 in 5 felt that it is not a welcoming place for LGB staff (LGF, 2008: 2).

University or college is generally considered an environment where LGB people can be themselves and establish their individual identity – ‘a space for coming out’ (see Valentine et al 2009). The research referred to earlier by ECOTEC found that some interviewees that had suffered negative experiences at school were looking forward to college as an opportunity where they could ‘start again’ in a different environment (ECOTEC, 2006: 27). The research found only a few incidents of bullying or discrimination in college or work settings (19). The study by ECOTEC did find that some LGB people chose, or avoided, particular subjects on the basis of gender stereotypes; although this was not commonly seen as a major factor for choosing particular subjects (ECOTEC, 2006: 30). For instance, some interviewees said that they avoided subjects considered overtly 'masculine', such as woodwork and metal work (29).

3.5.1

Experiences of discrimination within higher education However a recent report of the experience of lesbian, gay, bisexual and trans staff and students in higher education (Valentine 2009) showed that LGBT people still experience discrimination in an adult learning environment. Furthermore, the evidence of discrimination and harassment experienced by LGBT in the workplace outlined in Section 3.1 supports the argument that discrimination continues into adult life. Almost half of LGB students involved in the study by Valentine reported negative treatment on the grounds of their sexual orientation from fellow students and just over 10% reported negative treatment from tutors/lecturers. Trans students encountered higher levels of negative treatment than LGB students and higher levels of threatening behaviour, physical abuse and sexual abuse - particularly from other students (24).

Earlier qualitative research identified halls of residence as a place where LGB students can be particularly vulnerable (Taulke-Johnson & Rivers, 1999). Evidence suggested that students were regularly subjected to torment or abuse by peers and that hall tutors and administrators were illprepared to deal with issues relating to sexual orientation. The evidence also suggests that policies relating to discrimination in university accommodation did not address instances of homophobia2.

Valentine argued that the discrimination experienced by LGB students may explain why so many (20% of LGB students and 29% of trans students) have taken time out of their studies – a higher proportion when compared to the national average.

1 Rivers, I. & Cowie, H.A. (2006). Bullying and homophobia in UK schools: A perspective on factors affecting resilience and recovery. Journal of Gay and Lesbian Issues in Education, 4, 11-43.

2 Taulke-Johnson, R.A. & Rivers, I. (1999). Providing a safe environment for lesbian, gay and bisexual students living in university accommodation, Youth & Policy, 64, 74-89.

25

This research suggests that whilst discrimination against LGB students is lower compared to the reported incidents of bullying or discrimination in schools (outlined above), homophobic bullying and discrimination can continue after school into adult learning environments.

Whilst the level of discrimination and harassments on grounds of sexual discrimination in post-16 learning environments is unclear, a common theme throughout all the research cited above was that LGBT people have limited or no access to information or formal support channels at school or college about lesbian and gay issues (Hunt and Jensen, ECOTEC and Valentine).

3.6

Hate crime and the LGBT community There is no standard definition of hate crime. An example definition recognising the different groups that can be affected by hate crime is provided by GALOP1: "…crime committed against a person or people because of a particular group they belong to – such as women, lesbians, gay men and bisexual people, trans people, black and minority ethnic people, Jewish people, Muslim people and so on…" 2 Alongside the concept of different groups of people, the Association of Chief Police Officers (ACPO) recognises the importance of the concept of individual perception, as well as the lack of official categorisation of 'hate crime': "…Any hate incident, which constitutes a criminal offence, perceived by the victim or any other person, as being motivated by prejudice or hate…" 3 The Crown Prosecution Service (CPS) provides the definition of a homophobic or a transphobic incident as: "…Any incident which is perceived to be homophobic or transphobic by the victim or by any other person…" 4

1

Galop is London's lesbian, gay, bisexual and trans (LGBT) community safety charity (http://www.galop.org.uk/home.html) 2 http://www.casweb.org/galop/file-storage/download/What%20Is%20Hate%20Crime.pdf?version_id=75435 3 P.9 ACPO, Hate crime operational guidance and practice manual, 2005, available at http://www.acpo.police.uk/asp/policies/Data/Hate%20Crime.pdf 4 Guidance on Prosecuting Cases of Homophobic Crime, available at http://www.cps.gov.uk/publications/prosecution/hmpbcpol.html

26

More recently, definitions have been agreed by the Crown Prosecution Service and ACPO that are used in the Cross Government National Action Plan (which will be published in September 2009), as follows: Hate incident “Any non-crime incident which is perceived by the victim or any other person, to be motivated by a hostility or prejudice based on (a person’s sexual orientation or perceived sexual orientation)*.”

Hate crime “A hate crime is any criminal offence which is perceived, by the victim or any other person, to be motivated by a hostility or prejudice based on (a person’s sexual orientation or perceived sexual orientation)*.” *The same definition is applied to transphobic hate incidents/crimes, where sexual orientation is replaced by "against a person who is transgender or perceived to be transgender."

This definition widens the focus to include how incidents or crimes are perceived by 'any other person' as well as by the victim themselves.

3.6.1

Recording hate crime As the various definitions above might suggest, there is no formal Home Office offence category relating to hate crime. This has implications for the recording of hate crime. GALOP (2008) describe how: "…Nationally, Home Office data such as the British Crime Survey does not record figures on levels of homophobic or transphobic hate crime… [however, from April 2008 the Home Office required all police services to] collate figures on hate crime, including homophobic and transphobic incidents…"1 Hate crimes and incidents are identified through 'flags' on standard offences that highlight a hate crime motivation. There are five main 'motivation types' for hate crime: race, religion, sexual orientation, gender and disability.

The LGF argue that there is a lack of media attention or campaigns challenging hate crime demonstrating a lack of priority given to it in general (Breaking the Cycle, 2009: 48). This is compounded by the suggestion that transphobic and homophobic are the lowest priorities (ibid).

Also, hate crime refers to the motivation behind the crime which can be very difficult to prove, as highlighted by the recent Michael Causer trial.

1

http://www.galop.org.uk/downloads/fillingintheblanks.pdf pg 14.

27

Under reporting of hate crime and hate incidents in LGBT communities is high so any increase in the levels of reporting are generally welcomed. Traditionally increases in crime are seen as a negative trend, however increases in recorded hate crimes can demonstrate increased propensity to report; effectiveness of measures put in place to encourage recording; and officer understanding and awareness of the issue.

3.6.2

Nature of hate crime As hate crime is defined by motivation and not necessarily offence, hate crime can take on the form of any crime type. The CPS expand: "…homophobic or transphobic incidents go beyond the typical examples that may immediately come to mind, such as physical assaults, sexual abuse or public disorder. Homophobia or transphobia may lie behind crimes of criminal damage; arson; blackmail; robbery; theft; burglary; and indeed almost any other crime…"1 Despite this the evidence presented in the reviewed literature presented a picture of primarily personal crime as typifying the nature of the hate crime. This included domestic violence (Hunt and Dick 2008: 4); physical assaults; threats of violence harassment; or unwanted sexual contact (Stonewall, 2008, see next section).

The particular issue of domestic violence has been explored by a recent seminar in the North West run by '4NW'2 and incorporating speakers from a range of agencies including Government Office North West, local authorities and police forces3. An LGBT specific workshop produced the following recommendations: • a specialised regional service for lesbian, gay, bisexual or trans victims of domestic violence, with access points in major cities of the North West • two points of referral after reporting of an incident – police and health professional • GPs could become more involved in data capture and exchange as this is currently very poor.

1

Guidance on Prosecuting Cases of Homophobic Crime, available at http://www.cps.gov.uk/publications/prosecution/hmpbcpol.html 2 4NW is the Regional Leaders Forum for the northwest that has responsibility for housing, planning, transport and economic development and accountable for signing off the single regional strategy.

3 4NW (2008) Hidden domestic violence: report of seminar at Blackburne House, Liverpool, 4NW

28

Common circumstances surrounding hate crime are described by the Home Office (20081). These are that a significant proportion of homophobic hate crime occurs: between 3 pm and midnight; near home, in the streets or in local areas; and, more than once to the same victim. Perpetrators tend to be: • • • • • •

local youths/neighbours under 24 especially under 20 male likely to commit other hate crimes likely to escalate in seriousness if behaviour remains unchallenged act with other perpetrators - so victim(s) is/are outnumbered.

Knowledge of this type is useful in addressing crime as awareness of the circumstance surrounding criminal events can help inform preventive strategies.

3.6.3

Extent of Hate Crime Measuring the extent of hate crime nationally is difficult for the reasons stated above. For this reason GALOP describe how most studies have focussed on either local communities or specific sections of the LGBT community (2008:14). The first attempt at measuring the picture nationally was conducted by Stonewall (2008) in the, 'Homophobic Hate Crime: The Gay British Crime Survey2. Key findings from this include: •

a third of lesbians and a quarter of gay men have experienced a hate incident in the last three years • one in eight lesbian, gay and bisexual people have experienced a hate incident in the last year • over one in ten lesbian and gay people think that there is a ‘big problem’ of homophobic hate crimes and incidents in their local area • three in five lesbian and gay people have been a victim of any crime or incident in the last three years (Stonewall, 2008:5).

The North West regional picture was explored via police force area websites. The findings are shown below.

1 2

http://www.homeoffice.gov.uk/rds/pdfs08/hosb0708.pdf http://www.stonewall.org.uk/documents/homophobic_hate_crime__final_report.pdf

29

3.6.3.1

Greater Manchester Of the five hate crime motivations Greater Manchester Police (GMP) report that in 2007/08 just under 10% of all hate crimes/incidents were related to sexual orientation. This was 533 crimes.

This was an increase of 40.3% (153) since 2006/07 (when they made up nearly 7% of all hate crimes/incidents)1. Furthermore, reported levels of hate crime relating to sexual orientation were second only to hate crimes relating to race.

3.6.3.2

Cheshire Homophobic incidents and crime data are available from 2000 via an existing Freedom of Information request2. This indicates that for the full year 2007 80 homophobic incidents were recorded. For January to September 2008 the figure stood at 41.

3.6.3.3

Cumbria There are no crime data available. Public perception data for Cumbria indicate that over 50% of the public are confident in the Criminal Justice System's ability to deal with hate crime3. This does not control for different populations though.

3.6.3.4

Lancashire No data are available.

3.6.3.5

Merseyside No data was available from the constabulary website. However analysis of LGBT in Liverpool specifically4 indicates that well over half of a sample of 210 LGBT people have been a victim of hate crime (6). Over half the survey participants feared being victims of specifically homophobic or transphobic crime and there was a general view that homophobic and transphobic crime was on the increase in Liverpool or, at least, was not getting any better (5-6). In many cases this lead to, 'preventative measures to maximise levels of safety within the city, which commonly precluded the use of general public facilities' (6). Although these findings cannot necessarily be considered representative they do begin to indicate the extent of crime, and the fear of crime and its implications.

1

See http://www.gmp.police.uk/mainsite/pages/hatecrimediv08.htm http://www.cheshire.police.uk/showcontent.php?pageid=1643 3 p.14 http://lcjb.cjsonline.gov.uk/area6/library/Research%20and%20Consultations/CCJB_Citizens_Panel_Survey_2006_Web.p df 4 Stormbreak Research and Consultancy (2006) Lesbian, Gay, Bisexual and Trans Safety in Liverpool - A Report on the Research Findings, London: StormBreak 2

30

3.6.4

Effects of hate crime The effects of hate crime can be wide-ranging. The LGF report an impact on self esteem and behaviour and fear of repeat attacks/fear of hate crime (Breaking the Cycle, 2009: 48). This is added to by Victim Support (2006: 50-2) who identify: • • • • •

anger depression worsening of existing physical ailments trauma in children financial burden (e.g. replacement of windows).

Extremes include homelessness and victimisation by neighbours, agoraphobia, loss of their home or business contrasted with experiencing no effect, or accepting abuse as part of daily life.

As part of their research into the support needs of victims of all types of hate crime Victim Support also identify how the effects of hate crime vary but this does not appear to relate to the type of hate crime, e.g. homophobic or racist. Instead variations may relate to the perceived severity of the crime (50).

3.6.5

Reporting of hate crime Compounding the issues of recording outlined above is the fact that reporting of hate crime is not widespread. Stonewall (2008:20) suggest that three in four victims of homophobic hate crimes and incidents did not report them to the police (in comparison to three out of five of all crimes which were reported). Victim Support (2006:45) and others suggest reasons for not reporting hate crimes including; • • • • • • •

negative perceptions of the police/lack of trust negative experience of reporting incidents to the police negative experience of the police in countries of origin a sense that reporting is futile: nothing will change difficulties involved in reporting to the police confidentiality/not wishing to be outed embarrassment (where incidents are 'low-level' but frequent, Home Office, 2006).

The various issues of confidence around reporting incidents to police forces has led to the development of third party reporting systems where victims can report offences. However Stonewall suggest that nationally only 6% of victims utilise this option (2008:22). Additionally, lesbians may be more prepared to use this option than gay men (ibid: 20). Again these findings may have implications for service delivery.

31

Related to non-reporting is provision of evidence in court. Again Victim Support outline some of the reasons for not doing so: • • • • • • •

3.6.6

Fear of retaliation/repeat victimisation Fear of court process Lack of motivation Concern for privacy End of victimisation Physical and mental stress Fear of lack of proof and consequent disbelief on the part of the jury (Victim Support: 52).

Prosecuting hate crime Nationally, the CPS report that in the three years ending in March 2008, over 2,400 defendants were prosecuted for homophobic or transphobic crimes. In this period, convictions rose from 71% to 78% in 2007-08. Backing up evidence detailed above they also state that the majority of defendants were men (87%) and that offences against the person were the most common offences1.

In the North West region, 2007/08 data, taken from the CPS Annual Hate Crime Report (p.47) are as below (Table 3.1).

Table 3.1 Hate crime (all hate crime) prosecution in the North West region, 2007/08 Area

Convictions

Unsuccessful

Total

Volume

%

Volume

%

Cheshire

17

73.9

6

26.1

23

Cumbria

9

52.9

8

47.1

17

Gtr Manchester

62

86.1

10

13.9

72

Lancashire

33

89.2

4

10.8

37

Merseyside

24

70.6

10

29.4

34

The data show how in all areas there were more successful convictions than not. As a rough trend the data also show that the proportion of unsuccessful cases increases the smaller the total number of cases brought is.

1

http://www.cps.gov.uk/publications/docs/CPS_hate_crime_report_2008.pdf

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4.0

Estimate of the region’s LGBT population

4.1

Introduction This chapter provides an 'indicative' estimate of the region's LGBT populations. Given the lack of data about LGBT people or communities this analysis is based on an analysis of a range of existing data sets on sub-sets of the population which are used as proxy indicators. The chapter provides a brief background and context (Section 4.2). It then looks at sources of data that estimate the LGBT population nationally (Section 4.3) and regionally (Section 4.4). It then presents an indicative estimate of the regional and sub regional populations in the North West (Section 4.5).

4.2

Background and context There is no reliable data about the size of the LGB population in the United Kingdom, and extremely limited data on the number of transsexuals or the wider trans population in the UK. This is because it is not typically collected in national or regional research or surveys. From 2009 ONS have introduced a sexual identity question to all ONS social surveys,1 but this data will take several years to become available at a local authority level.

According to the Government’s Actuaries department, lesbian, gay and bisexual people constitute 5 to 7% of the total adult population: so currently between 3.05 million and 4.3 million individuals2.

Treasury actuaries produced the estimate when analysing the financial implications of the new Civil Partnerships Act3. This figure is based on analysis of a collection of research rather than on any primary research. The UK government produced the Employment Equality (Sexual Orientation) Regulations (2003) which quoted this estimate. The Equality Act (2007) also for the first time suggested the figure was 6%.

The most comprehensive study of the trans population in the UK covered only the transsexual population.4 It estimated that in 2000 there were around 5,000 transsexual people in the UK, based upon figures from the Home Office on numbers of those who had changed their passports via gender recognition certificate. The ratio of male-to-female to female-to-male transsexual people is estimated to be between 3:1 to 4:15.

1

http://www.statistics.gov.uk/pdfdir/siug0509.pdf Based on an overall population estimate of 60,975,000 taken in mid-2007 by ONS, available at http://www.statistics.gov.uk/cci/nugget.asp?ID=6 3 Final Regulatory Impact Assessment: Civil Partnership Act 2004 4 Whittle, Turner and Al-Amani (2007) Engendered Penalties: Transgender and Transsexual People’s Experiences of Inequality and Discrimination 5 Ibid, page 28 2

33

The study acknowledged the shortfall in data to provide a significantly robust estimate and it has recently been argued that the transsexual population (as well as the wider trans population) is likely to be much higher as the current figure is estimated on those with a gender recognition certificate and does not include those who are not seeking gender recognition1 or those at other stages of gender transition. Furthermore a recent survey by Calderdale NHS Trust identified prevalence in the local authority area of at least one in 5,0002, which is significantly larger than any previous formal population study.

Based on the available evidence we can broadly estimate the population of LGBT people in the UK to be between 3.05 million and 4.3 million LGB with an additional 5,000 transsexual people. For the North West, our calculations suggest that the LGB population is likely to approximate 430,000 in 2009 assuming a population growth of +0.23% for 2008 and 2009 respectively. The number of transsexual people in the North West by the end of 2009 is likely to approximate between 600-700 however other contextual evidence3 suggests this may be much higher.

A further aim of the study was to provide a statistically viable demographic profile of the LGBT communities in the North West (e.g. in terms of gender, age, income, education, ethnicity, etc) however due to the complete lack of population or demographic data at regional or national level it was impossible to do this.

The following sections provide an overview of what proxy data is available that enables inferences to be made about LGBT communities. The chapter looks at methods used to arrive at estimates for the LGBT population in the UK, followed by an exploration of data sources for the North West, and across the five sub regions. The last section provides analysis and estimates of the LGBT populations in the North West and its sub regions.

4.3

National LGBT population estimates The Treasury Actuaries department drew on a range of pieces of research to arrive at their estimate of 5-7% to inform the roll out of the Civil Partnership Act, including research studies from the UK, the United States and the Netherlands.4 In the UK, it drew mostly from the findings of the 2000 National Survey of Sexual Attitudes and Lifestyles (Johnson et al, 2001) of 16-44 year olds, which found that 5.4% of men and 4.9% of women had ever had a same sex partner. Interviews were completed with 11,161 respondents and after applying the non-response weighting, the distributions of age, sex and region for the NATSAL 2000 sample closely reflect the general population (Johnson et al, 2001: 33).

1

See LGF, Breaking the Cycle 2009 Caderdale NHS (2009) Survey of Trans Population in Calderdale, page 3 3 Such as the Calderdale study mentioned above.

4 Final Regulatory Impact Assessment: Civil Partnership Act 2004 2

34

Significantly, the focus of the NATSAL 2000 survey is sexual behaviours and practices and the survey did not ask questions about sexual (or gender) identity or orientation. When drawing on data sources such as this to estimate the LGBT population, it is important to consider that questions or variables that have been used to identify the person as LGBT. Furthermore data should be considered in light of the purpose for which it was originally collected, as a key issue with current estimates is the reliance on secondary data that were not originally designed to collect data on sexual identity, sexual orientation or gender identity. For instance a person’s sexual behaviour or practice does not necessarily tell us whether that person considers or identifies themselves as LGB; and conversely, a person may identify themselves as LGB without necessarily engaging in sexual practices or showing signs of sexual behaviour towards the same sex.

A number of large national surveys, including the General Household Survey, the British Household Panel Survey and European Social Survey include questions on same sex cohabitation, but by definition this excludes a large proportion of LGB people who are not living with a same sex partner. No major random ONS survey has ever asked questions on sexual identity or sexual orientation. Currently Census 2001 also holds data on same sex households but as well as excluding LGB people who do not live with a partner, this data is widely felt to be a lot lower than the actual number of same sex couple households and so rarely used by researchers1.

For instance, census data shows that there are 8,346 people living in same sex couple households in the North West, compared to an estimated population of the whole LGBT community by LGF of over 600,000 (1.6%). The census does not collect data on sexual orientation or sexual identity.

Campaign groups such as Stonewall and the LGF have argued for a question on sexual orientation to be included in the census. In response, the ONS established a feasibility study known as the ‘sexual identity project’ to explore this. ONS, as a result, introduced a sexual identity question to all ONS social surveys as of January 20092, and this data will become available over the next few years, including at a local authority level. However it was decided that a sexual identity question would not be included in the next census. ONS had significant concerns surrounding the issues of privacy, acceptability, accuracy, conceptual definitions and the effect that such a question could have on the overall response to the census3.

1

Based on a conversation with Stonewall, April 22nd 2009 http://www.statistics.gov.uk/pdfdir/siug0509.pdf 3 ONS (2006) Information paper: T2011 Census: Assessment of initial user requirements on content for England and Wales Sexual orientation Available at http://www.statistics.gov.uk/about/consultations/downloads/2011Census_assessment_sexual_orientation.pdf 2

35

It is also important to note that the ONS social surveys will collect data on sexual identity rather than sexual orientation. The ONS contend that although legislation refers to sexual orientation, their research during question development1 deemed sexual identity the most relevant dimension of sexual orientation to investigate through social surveys. They state that no single question would capture the full complexity of sexual orientation – such as attraction, behaviour and identity – and it would be difficult to examine consistency between them at the individual level. Their testing also showed that respondents were not in favour of asking about sexual behaviour in a social survey context, nor would it be appropriate in general purpose government surveys.

4.3.1

Other LGBT estimates: young people Two projects involving young people exist that have asked questions both about sexual behaviour and sexual orientation. As part of a national sexual health initiative in Scotland (SHARE Project), the MRC Social and Public Health Sciences Unit at the University of Glasgow gathered data from 5,854 pupils from 25 schools in Scotland (mean age 16.2 years; 2,735 young men and 3,119 young women) and asked them about their same sex sexual behaviour and future potential sexual partners. They found that 4% reported same sex sexual behaviour (ranging from kissing to sexual intercourse) and that 3.2% ‘strongly agreed’ or ‘agreed’ with the statement, ‘I could see myself having a sexual relationship with someone of my own sex’. A further 4.9% reported that they were ‘unsure’ (see Rivers and Duncan, 2002)2.

In England, a more recent study conducted in 2004 (see Rivers and Noret, 2008) asked a representative sample of 2,002 secondary school pupils (mean age 13.8 years) living in a rural county about their home life (with whom they lived), and also about their attraction to members of the same- and opposite-sex. Overall, they found that 55 young people (2.8%) reported being attracted to members of the same sex, with 31 reporting being raised by same sex couples (1.6%)3.

Thus, among young samples, rates of same sex attraction have ranged from 2.8% (in rural areas) to 3.2% (in the central belt of Scotland). However both these studies explored sexual attraction or behaviour rather than sexual orientation specifically.

1

See ONS (May 2009) Press Release: New guidance on measuring sexual identity in social surveys. ONS Rivers, I. & Duncan, N. (2002). Understanding homophobic bullying in schools: Building a safe learning environment for all pupils. Youth and Policy, 75 (Spring), 30-41.

3 Rivers, I. & Noret, N. (2008). Well-being among same sex and opposite-sex attracted youth at school. School Psychology Review, 37 (2), 174-187.

2

36

To summarise the data available nationally, estimations of the LGB populations vary across different research reports and furthermore rely greatly on same sex cohabitation or same sex sexual behaviours. As discussed above, the key UK data source that was used by Treasury Actuaries in their estimate of 5-7% was the 2000 NATSAL survey. Whilst the survey collects data on sexual practices and behaviours only, this data provides the basis for a more reliable estimate compared to existing ONS survey data on same sex couple households, as it incorporates a larger proportion of the LGB community. Furthermore the NATSAL survey used a representative sample that closely reflected the general population in terms of distributions of age, sex and region (Johnson et al, 2001: 33). Our review therefore concluded that data from this survey continues to provide the most accurate estimate of the LGB population in the UK for a study of this kind.

4.4

North West LGBT population estimates To estimate the LGBT population of the North West we have explored the available regional data to provide a broad estimate of the regional variations for the LGBT populations in the North West.

Data has been drawn from a range of available sources, however none have collected data on sexual orientation or gender identity, nor is the LGBT population the original focus of these studies.

We therefore present these findings with caution and emphasise that the purpose of this exercise is only to provide an indicative summary of the regional variations in LGBT population in the North West and not an estimate of numbers in the region or sub regions per se. This exercise aims to inform the extent to which the current population estimates can be applied in the North West region, and its sub regions. That is to say, if data suggests that the North West population estimate is similar to the UK population estimate and/or that there is a higher prevalence of LGBT people in the Greater Manchester region compared to Cheshire then this variance can be modelled for when calculating our estimate.1 In the North West region, the LGF have estimated the LGB population as being 612,000. This is based on indicative data from the Government Actuaries department that 6% of the population are lesbian and gay and their own estimation that 3% of the population in the North West are bisexual.

This is slightly higher than the 5-7% estimate for the LGB population used in other government reports. The transsexual community in the region take caution in using the estimate that there are 5,000 transsexual people in the UK estimating that it is in fact much higher, but acknowledge that this is the only source of data available at present (LGF, 2009: 23). The LGF estimate is based on the overall estimate of LGB population in the UK and therefore does not, due to lack of available data, take into account any regional or sub regional variations for the North West.

1

Of 4.7% taken from the 2000 Natcel survey

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Whilst the national estimate for the LGBT population has been widely accepted as 5-7%, research has shown that there are significant variations in the population of LGBT people across different regions and cities in the UK (see published findings from the NATSAL survey 2000). Furthermore, research has suggested that sexual minorities are likely to migrate to larger cities, especially cities that have well established gay communities such as London, Brighton and Manchester. The 2000 NATSAL survey found that 3.9% of women and 5.5% of men aged 16 to 44 and living in London had a same gender sex partner in the last five years; compared to 2.4% for women and 2.1% for men in other areas of the UK (Johnson et al. 2001). It is therefore likely that the population of LGBT people in the North West will vary considerably across sub regions – particularly in more rural areas. Therefore any population estimation must take into account the regional variations of the population of a specific region or sub region.

Not all men who have sex with men (MSM) identify themselves as gay or bisexual. Data on diagnosed HIV infections from sex between men only focuses on a small subset of the male gay and bisexual population who have sex with men and who have been diagnosed as HIV infected.

There are concerns with using HIV data since not all men are willing to declare MSM transmission of HIV to their GP. Men in rural areas are also likely to travel to urban areas to access services, meaning data on service usage can be misleading. However in the absence of reliable data, we have used data sources on the prevalence of diagnosed HIV infected patients from sex between men to provide an indication of the possible regional variations in the UK LGBT population but not in estimating the size of that population. This is done by comparing the prevalence of cases within the study population1.

Regional Trends is a comprehensive regular source of official statistics for the Statistical Regions of the UK2 covering a wide range of demographic, social, industrial and economic statistics.

Regional trends data provides data of diagnosed HIV infected patients which are from the Health Protection Agency's Centre for Infections; the Institute of Child Health (London) and; Health Protection Scotland (formerly SCIEH). The data presents the number of diagnosed HIV-infected patients who were exposed through sex between men in 20063. The figures above show that there were 2,363 cases of HIV infected patients in the North West from sex between men in 2006. This closely corresponds to the figures from the HIV & AIDS in the North West of England 2007 study, which show 2,719 cases of HIV from sex between men.

The Regional Trends data suggests that a higher proportion of diagnosed HIV patients who have contracted HIV by sex between men accessed treatment in the London and North West region.

Over half (50.6%) of the overall study population had accessed treatments in London and 10.9% had accessed treatment in the North West. A full regional breakdown is provided in Annex 2 (Table A2.1). Prevalence in other regions ranges from 8% (in the South East Coast) to 1.6% (in the North East).

1

Results can not be generalised beyond the population of the study Scotland, Wales, Northern Ireland and the Government Office Regions within England 3 Taken from the National Trends dataset 2008 - Available at /www.statistics.gov.uk/downloads/theme_compendia/Regional_Trends_40/RT40_Chapters_3_to_13.pdf 2

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Data from Regional Trends is similar to that presented in the Survey of Prevalent HIV Infections Diagnosed (SOPHID); a survey of all individuals with diagnosed HIV infection who attend for HIVrelated care within the NHS in England, Wales, and Northern Ireland within a calendar year1.

SOPHID provides the most comprehensive picture of the UK population of people with diagnosed HIV2. Survey data from SOPHID also shows that the highest proportion of HIV infected patients from sex between men are based in London (48.8% of the UK population based in London) followed by the North West (10.7% of the UK population based in the North West).3 The North West HIV/AIDS Monitoring Unit provides an annual report on the number of HIV positive individuals accessing treatment and care in the North West Region (Downing et al, 2007). The report is based on data collected twice a year from over 40 statutory treatment centres including genito-urinary medicine (GUM) clinics, infectious disease units, haematology clinics and a number of other specialist units and clinics including voluntary agencies, social services and drug agencies.

The findings show that the North West has a higher proportion of HIV infections among men who have sex with men (MSM) compared to the overall population in the UK (53% or 3,384 compared to the national figure of 45%) (15). This figure is significantly higher than those quoted in other studies indicating the difficulties in quality with the data sets.

Overall, data from these large scale data sets indicate that after London, the North West has the highest number of diagnosed HIV infected patients through sex between men, and furthermore that the number of cases in the North West is higher than the UK average.

It is important to consider that data relating to HIV infection among MSM may not include those men who live in the region but seek treatment or testing outside the North West. Similarly the data may not take into account the fact that trusts sometimes subsidise other trusts that border the region in order to provide the best local care for those affected by HIV. Taking the limitations of the sample into consideration, it is not feasible to provide an exact level of variation of the LGB population in the North West region compared to overall UK estimates. However we feel that it is reasonable to hypothesise that that the number of gay and bisexual men in the North West region is likely to be higher than other regions in the UK (with the exception of London) and higher than the UK average. We have therefore used these findings as an indication that the size of the LGBT population in North West is likely to correspond or be higher than UK population estimates, and therefore that it is reasonable that the current UK-wide estimates can be applied to the North West region.

1

See http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1195733790666 And includes each centre/NHS trust providing HIV treatment or care services in England, Wales, and Northern Ireland.

3 A full regional breakdown is provided in Annex Two. 2

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4.4.1

North West sub region population estimates In 2004, ONS released the first figures pertaining to same sex couples in England and Wales. Data was provided on the number of people living in same sex couple households recorded in the North West in 20011. As mentioned above these figures are considered by academics and campaigners to be particularly low and so are rarely used. However they do provide an indication of the sub regional variation in relation to the number of same sex couple households across the North West region. This in turn can be used to indicate how a regional LGBT population estimate might vary across each of the sub regions.

Data from Census 2001 shows us that of the 8,346 same sex couples in the North West, almost half (3,936 or 47.2%) were based in the Greater Manchester sub region. Conversely only 366 were based in the Cumbria region (4.4%). High prevalence of same sex couple households in the sub regions of Greater Manchester and, importantly, Lancashire (Blackpool and Preston in particular) are mainly due to the established gay communities in this region together with a high number of urban towns and cities. In Lancashire, 28% of the population of same sex couple households reside in Blackpool (516 of the 1,826) and in Greater Manchester almost a third resided in the city of Manchester (32.8% or 1,290 out of 3,936). The high number of respondents from Manchester is indicative of the fact that a number of LGB people migrate to the City because of the ‘gay village’, and also the large number of services and resources available to the community. Full regional and sub regional variations are provided in Annex Two and can be summarised as follows: • • • • •

Greater Manchester = 3,936 (or 47.2% of the total study population for the North West) Lancashire = 1,826 (or 21.9%) Merseyside = 1,270 (or 15.2%) Cheshire = 948 (or 11.4%) Cumbria = 366 (or 4.4%)

1

http://neighbourhood.statistics.gov.uk/dissemination/LeadHome.do;jessionid=ac1f930d30d5b057a99a298c4c70b8e0d4 e2370ca101?m=0&s=1240481895740&enc=1&nsjs=true&nsck=true&nssvg=false&nswid=1260

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Data from the North West HIV/AIDS Monitoring Unit also presents Greater Manchester, Lancashire and (to a lesser extent) Merseyside as the sub regions of the North West with a higher prevalence of diagnosed HIV infections from sex between men. Again Manchester and Blackpool were highlighted as the city and town with the highest prevalence of diagnosed HIV infected patients form sex between men, and Liverpool and Chester were also identified as cities/towns with a high prevalence. A full breakdown by region and local authority areas is also provided in Annex Two and can be summarised as follows: • Greater Manchester = 1600 out of 2558 (or 62.5% of the total study population for the North West) • Lancashire = 468 (or 18.2%) • Merseyside = 256 (or 10%) • Cheshire = 180 (or 7%) • Cumbria = 54 (or 2.1%) Regional variations relating to HIV infection among MSM are even wider when compared to the data collected on same sex couple households. This could be because some patients seek testing or treatment from outside of their regional area (particularly Manchester were more services are available). However the findings still indicate a higher prevalence in the Greater Manchester and Lancashire regions in particular, which is in line with current research that a number of LGB people migrate to urban areas or areas with established gay communities (such as Manchester and Blackpool1). Overall, findings from available data sources relating to LGB populations indicate that a higher proportion of LGB people in the North West reside in Greater Manchester and Lancashire, and to an extent Merseyside. These sub regional variations will be taken into account when modelling an estimate of the LGB population across the sub regions. Whilst it is not possible due to the inadequacy of available data to provide an exact level of variation across the sub regions, these findings will be used to decide whether to calculate for the population based on a higher estimate or lower population estimate.

1

For more information see the Literature Review in Chapter Three.

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4.5

Estimate of the LGBT population of the North West In the absence of Census data, other than that on same sex couples in England and Wales in 2001, providing an estimate of the LGBT population is not possible. However by drawing upon a variety of studies and acknowledging the limitations in sampling proxy data can be used to provide an indicative figure. Our review of limited data sources relating to LGB communities in the UK, the North West and its sub regions has indicated that it is reasonable that national estimates (for the UK) can be applied to the North West region and that a higher estimate can be applied to the sub regions of Greater Manchester, Lancashire and Merseyside and a lower estimate applied to Cheshire and Cumbria. We have modelled based on these findings.

Currently actuarial statistics suggest that the LGBT population of the UK is between 5-7%. An average of 4.7% (5.5% of men and 3.9% of women) is recorded among 16-44 year olds in London, Brighton and Manchester by the National Survey of Sexual Attitudes (Johnson et al, 2001).

However, in the North West, based upon ONS Mid-2007 population projections, the 15-44 age group represents 40.4% of the population1, with 41.6% of the population aged over 44 years, and modelling for this, a figure of approximately 5% (5.6% for men and 4.4% for women) of the population can be derived for adults in the North West (excluding those under the age of 16 years).

By including those under the age of 16 years, the approximate population rises to 7% (7.9% for men and 6.1% for women) which reflects the higher band figure estimated by Government actuaries. The higher band LGB population estimate for the North West is therefore 7%.

This figure can be expected to be lower in rural areas, as outlined in Section 4.1.2 above. In other areas of the UK, Johnson et al. found that approximately 2.3% of the population reported a same sex relationship in the past five years. Using the same rubric as before, in smaller towns and rural areas of the North West the LGB population may be estimated at approximately 3.4%.

If we accept that the population of transsexual people in the UK is approximately 5,000 based upon the 2000 study (and this excludes those not seeking gender recognition or reassignment), this group represents 0.009 of the population (based upon the 2001 Census). Again extrapolating from projected population changes since 2001, the transsexual population of the North West is likely to be approximately 600-700. This is a conservative estimate in the absence of available data, and the real figure is likely to be higher.

1

ONS (2009) Key Population and Vital Statistics. Available at http://www.statistics.gov.uk/downloads/theme_population/KPVS34-2007/KPVS2007.pdf

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In calculating the current population estimates for the region, the percentage change in the population over time (2001-2007) has also been used to allow for a projection for 2009 (see Table 4.1 below). Other than Merseyside there has been stable growth in the population of the region since 2001. Our estimates of the LGBT population of the North West are based upon four assumptions: • In Greater Manchester, Merseyside and Lancashire the LGBT population will be significantly higher due to migration to the cities and established gay communities than in Cheshire and Cumbria • The percentage change in the LGBT population estimates for the region and sub regions mirror those for the general population • The LGBT population mirrors the general population of the North West in terms of age • The LGBT population mirrors the general population of the North West in terms of gender.

4.5.1

Sub regions

4.5.1.1

Cheshire Cheshire’s population by mid-2007 was estimated by the ONS to be 688,700. In addition Halton and Warrington Unitary Authorities’ estimates (which were calculated separately) were 119,500 and 195,200 respectively. This makes a total population estimate of 1,003,400 by mid-2007.

Presuming a population percentage growth of + 0.36% for Cheshire and +0.13 and +0.35 for Halton and Warrington respectively, the population of this sub region by Mid -2009 can be estimated to be approximately 1,010,100 (693,700 for Cheshire, 119,800 for Halton, and 196,600 for Warrington). Assuming that the LGB population equates to approximately 3.4%, the number of LGB people living in the sub region is likely to be around 34,500.

The number of transsexual people in Cheshire is likely to be around 100, assuming that the distribution of transsexual people mirrors the distribution of the population in the North West.

4.5.1.2

Cumbria Cumbria’s population by mid-2007 was estimated by the ONS to be 496,900. Presuming a population percentage growth of + 0.31% per annum for Cumbria, the population of this sub region by mid-2009 can be estimated to be approximately 500,000. Assuming that the LGB population equates to approximately 3.4% (however this is a largely rural population and thus a margin of error is likely), the number of LGB people living in the sub region is likely to be around 17,000.

The number of transsexual people in Cumbria is likely to be around 50, assuming that the distribution of transsexual people mirrors the distribution of the population in the North West.

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4.5.1.3

Greater Manchester Greater Manchester’s population by mid-2007 was estimated by the ONS to be 2,562,000.

Presuming a population percentage growth of + 0.30% per annum for Greater Manchester, the population of this sub region by mid-2009 can be estimated to be 2,577,400. Assuming that the LGB population equates to between 7% (the higher end of the Government’s actuarial estimate), the number of LGB people living in the sub region is likely to be approximately 180,500.

The number of transsexual people in Greater Manchester is likely to be around 250, assuming that the distribution of transsexual people mirrors the distribution of the population in the North West.

4.5.1.4

Lancashire Lancashire’s population by Mid-2007 was estimated by the ONS to be 1,168,100. In addition Blackburn & Darwen and Blackpool Unitary Authorities’ estimates (which were calculated separately) were 140,900 and 142,500 respectively. This makes a total population estimate of 1, 451,500 by mid-2007. Presuming a population percentage growth of + 0.46% for Lancashire and +0.26 and +0.02 for Blackburn & Darwen and Blackpool respectively, the population of this sub region by mid -2009 can be estimated to be approximately 1,464,200 (1,180,000 for Lancashire, 141,600 for Blackburn & Darwen, and 142,600 for Blackpool). Assuming that the LGB population equates to approximately 7% (primarily as a result of the larger than average LGB populations in Blackpool and Preston), the number of LGB people living in the sub region is likely to be around 102,500.

The number of transsexual people in Lancashire is likely to be around 150, assuming that the distribution of transsexual people mirrors the distribution of the population in the North West.

4.5.1.5

Merseyside Merseyside population by mid-2007 was estimated by the ONS to be 1,350,000. Presuming a population percentage decline of - 0.21% per annum for Merseyside, the population of this sub region by mid -2009 can be estimated to be 1,344,500. Assuming that the LGB population equates to 7% (we have not controlled for the absence of a ‘gay village’), the number of LGB people living in the sub region is likely to be between 94,000.

The number of transsexual people in Merseyside is likely to be around 120, assuming that the distribution of transsexual people mirrors the distribution of the population in the North West.

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4.5.2

Total estimated LGBT population in the North West For the North West, our calculations suggest that the LGB population is likely to approximate 430,000 in 2009 assuming a population growth of +0.23% for 2008 and 2009 respectively. This equates to a population the size of the city of Liverpool. However this may underestimate the bisexual population as it uses a proxy based on same sex partnerships.

As noted previously, the number of transsexual people in the North West by the end of 2009 is likely to approximate between 600-700. Again this may be a conservative estimate as it is based only on those with gender recognition certification and does not include those not seeking recognition or the wider community of trans individuals at other stages of transition.

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Section B: Research Findings

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5.0

Employment

5.1

Introduction This chapter considers the key issues around experiences of employment and economic participation as reported by members of the lesbian, gay and bisexual population, as well as transgender people (LGBT) in the North West. It presents the qualitative evidence on LGBT communities’ experiences of work and employment including both positive and negative experiences (Section 5.2) and then looks at the impacts of workplace experiences on LGBT groups and individuals and how these affected outcomes (Section 5.3). The final section (5.4) identifies the implications for the regional economy of the research findings. The chapter draws upon feedback from the interviews and focus groups with LGBT communities living in the North West.1

5.2

Experiences at work

5.2.1

Being out and open at work People's experiences of being LGBT in employment and work were incredibly varied, with workplace culture playing a key role in determining how comfortable and open people felt they were able to be at work about their sexual orientation or gender identity.

Some respondents reported that they are totally open at work, that they have always been out to colleagues and had never experienced any difficulties in doing so.

“I would just describe my general experiences as positive, in the sense that I have never had negative reactions to being open about being gay. It has not held me back in my career or caused any difficulties in my every day working life. Nor has it created any particular advantages for me” (Gay male) “I've been out in all my jobs and my colleagues have all been fine” (Lesbian female) For those who felt able to be fully open at work about their sexual orientation or gender identity, this was predominantly because they felt able to do so because of an accepting company culture and attitudes of colleagues, team members or managers or because they worked in a diverse working environment where differences were accepted and valued.

Some noted that coming out at work was a 'revolving door' and that LGBT people had to continually come out to people at work, for example every time they changed jobs or teams or encountered new people in the workplace. This applied to trans individuals as well as to LGB individuals.

1

It does not draw on feedback from businesses, as this is explored in the following chapter.

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“Having to explain myself to each person I work for, its always me that has to explain… yes I'm male, I know I don't look it right now but I am. Just qualifying things.” (Trans male) On the other hand, some LGBT individuals were not open about their sexual orientation or gender identity to any extent in their workplace or with colleagues. Some reported that this was through personal choice because they did not wish to be out to colleagues; they saw this as a personal issue that they wanted to keep private; or because they felt that their seniority of position meant they wanted to keep a professional distance from colleagues.

“I am not completely out because I don't see the point; I am a private person so I don't want to shout from the rooftops about who I like, male or female.” (Lesbian female) "I am not out at work and never have been so it doesn't really affect me. I've not been out because my position is quite high and I don't want to bring life into work so I keep a distance with work colleagues." (Gay male) Conversely, other respondents in senior positions felt that being senior made it easier for them to be out within their organisation. Those individuals reported they had received feedback that having managers who were 'visibly gay' made it easier for other staff to be out in a workplace and fostered a more open workplace culture.

Some individuals reported they were out selectively, and who they came out to depended on their perceptions of people's attitudes towards them and the level of acceptance they expected. Several said they were out with colleagues but not with clients partly because they felt it was inappropriate to reveal personal information to clients or because they anticipated homophobic or transphobic comments from clients; and some respondents gave examples of where they had experienced homophobia from clients personally.

For those individuals who reported that they were not out at work this was for a number of reasons.

Primarily it was because they did not feel comfortable enough to do so; they feared the workplace culture in general or specific individuals they worked with would not be accepting of them. Some respondents said they would often 'let people assume' they are heterosexual and would 'conceal by omission' in order to hide their orientation or gender identity, for example by referring to a partner in a gender neutral way. Many respondents cited examples of heterosexism (the assumption everyone is heterosexual) for example assuming people are married.

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Some respondents said they expected or feared a negative response if they were to come out and that being open was not worth the risk. For some this was based on their own expectations alone; because of a masculine atmosphere at work; and for others it because they had witnessed anti-gay attitudes that had been voiced in front of them or towards other members of staff, for example homophobic jokes or comments about trans people's appearance. While some feared at the least, to experience negative attitudes, others feared bullying and some even feared they would lose their job if they came out.

"No [I am not open]. I do not want to lose my job. I think my manager is okay and most people on my shifts but I don't know the boss and I don't know other shift people, it is not worth the risk."

(Lesbian female) "I generally feel the pressure to conform and be 'girlie'. I work in a predominantly male environment and sexuality is often a subject used to 'bully' or annoy people in a discriminatory way.

Homophobic jokes and comments often come up in daily conversations." (Lesbian female) Respondents working in some sectors said they were less likely to be out because of the nature of the sector or the workplace they worked in. Generally speaking, those interviewees working in the public or voluntary sector felt more able to be open than those working in the private sector.

However there were exceptions and some interviewees working in the private sector such as in sales or law firms said they were able to be open – this appeared to vary according to the workplace culture and staff attitudes. Those who were not able to be open tended to be working in a very masculine atmosphere at work such as in factory or manual labour settings; they reported they felt it safest not to be open because they feared an adverse reaction.

"I was never openly out at work. I worked in very male environments like factories and the military and there were very anti gay attitudes." (Gay male) “Because of the very masculine atmosphere, I felt that being open about myself could potentially lead to being treated in a discriminatory or homophobic manner� (Gay male) Also some working in education felt it was not appropriate to be out at work because they felt they might be questioned by other staff or parents. This particularly applied to LGBT people working in faith schools. Company size was also an issue. Some LGBT people in smaller companies did not want to come out at work because they did not want undue attention focussed on them or did not want to be singled out because it was a small company or small team.

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There was also evidence of a link between outward appearances and whether people were out in the workplace. Those who fitted with perceived 'gay stereotypes' in relation to appearances or behaviour were less able to keep their sexual orientation or gender identity private. Others who felt their sexual orientation or gender identity was less self evident did not have to come out at work, and chose not to do so to avoid experiencing difficulties. Outward appearance was particularly an issue for trans people who transitioned while at work. In some cases trans people felt forced to be open about their gender orientation even if they didn't want to, because it was outwardly more obvious. Many reported feeling uncomfortable having to explain their often complex personal situation to colleagues or bosses.

Some respondents were ‘outed’ against their will, i.e. illegally, while at work. It is against the law to share info about a trans person's gender status if that information was received in a formal capacity – but examples were stated where this had been done in the workplace and trans people were ‘outed’ illegally. This also happened to people in relation to their sexual orientation, where they were outed by a colleague or boss. In one instance, one respondent who worked as a welder was outed by his boss, when he downloaded photographs of him in a gay bar from a social networking website, photocopied and distributed them around the office.

For some bisexual individuals, being open about their sexual orientation had been challenging due to negative reactions from colleagues including implying that it being bisexual was seen as 'fashionable' or that they were 'keeping their options open'. Feedback from several bisexual individuals was that work colleagues were less tolerant or understanding towards them as a bisexual person, or they found it harder to be open because they felt bisexuality was generally less well understood.

Overall LGBT people's willingness to be open and out at work depended partly on the individual’s attitudes (for example towards what level of personal privacy they desired) but predominantly on the workplace culture, particularly perceived or real attitudes, as well as company size and sector.

5.2.2

Positive experiences at work Many respondents from across all groups interviewed, reported that their sexual orientation had had no negative impact on their experiences of work and employment. For example they reported that their sexual orientation or gender identity had not influenced their decisions about where to apply for work, their career opportunities and progression whilst in work or on their overall experiences of being in employment. The sample included many LGBT individuals who had had successful and rewarding careers. These types of positive experiences spanned a variety of sectors and workplaces including third sector, public sector and private sector roles, including clerical work, factory work, arts, law, health and social care and sales/retail. Many reported that their sexual orientation had not negatively impacted on them, and that they had chosen the career they desired, enjoyed promotions at work where they had deserved them and had not felt the need to consider whether or not a role/employer would be appropriate for them during their career.

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Many respondents reported that they felt protected in the workplace by strong and visibly enforced diversity policies. For instance, some respondents cited experiences where potentially difficult situations such as examples of workplace bullying had been dealt with extremely effectively by their employer and where they felt their sexual orientation or gender identity had been taken account of and their needs met.

Structures for ensuring equality is actively promoted for LGBT employees “[My employer] promotes equal opportunities in the workplace. This includes clear anti bullying procedures and safeguards to prevent discrimination in promotion. We have an LGBT group that sits on the Council of Governors. Their role is to ensure that any new policies introduced take into account the potential impact on LGBT members of staff. They also assist the [public sector organisation] in recruiting from the LGBT community, particularly if any areas find themselves underrepresented by LGBT people” (Gay male, public sector employee)

Example of good handling of situations such as cases of bullying "I emailed [a lady in the office] her to tell her about a complaint we had received and gave her direction about how to correct it. She emailed back and swore in the mail at me [saying] if I had the time to write the mail, I had time to sort it out. I went to try and speak to her quietly about it and she flew off the handle, swore again in my face and called me an [swear word] poof. It was in an open plan office in front of lots of people. I decided it was best to walk away at that point. The management response was swift! I was asked how I wanted to pursue it and specifically said that I did not want the focus to be on the 'poof' statement. The lady in question was given a final written warning for her behaviour and the company followed up with me afterwards to make sure that the experience had no adverse effect on me. It was very effective and very public so it was a strong statement to say that this type of behaviour is entirely unacceptable." (Gay male) There were also examples where employees had demonstrated best practice approaches around equality in the application of employment rewards and benefits. This was common in the public and third sector but was also in evidence in the private sector.

Employers ensuring equality of access to HR policies such as maternity benefits “I am a gay parent and my son was born as the result of a surrogacy pregnancy. The organisation [I work for] was very supportive throughout the pregnancy and also I was treated fairly when applying for maternity leave. The circumstances in which I became a parent were not what the organisation was used to dealing with, but still they were very understanding and applied the relevant policies in the same way they would be applied to heterosexual parents. I felt that they valued me as an individual and made a real effort to understand my situation” (Lesbian female)

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Some trans individuals had experienced very open and accepting attitudes from employers and gave examples of positive role models, for example an occasion where their boss had transitioned at work and supported other staff to feel able to do so. Other employers had been accommodating towards people who were transitioning for example giving them access to a private toilet, which was welcomed and ensuring that other members of staff treated them fairly.

“An email was sent round informing everyone of the bosses name and pronoun change and request to be polite and respectful. I thought that was a great way of doing it. The email said that you could ask any questions in a personal email… This means everyone knows so you don’t have to come out to each person individually, just one time and it's done.” (Trans male) Other respondents cited examples where they perceived their sexual orientation had benefited their job or career, for instance where they had been able to provide diversity awareness training to fellow staff or take responsibility as a diversity lead within the workplace and had been able to help others in that role.

5.2.3

Negative experiences at work However a significant amount of interviews revealed cases where LGBT people’s experiences of the workplace were negative. Examples ranged in nature and severity. There were some respondents for whom 'just being tolerated' was viewed as being enough, however this was indicative of low expectations around being tolerated versus being completely accepted.

There were examples of homophobia or transphobia (and of inbuilt heterosexism) which were not explicitly directed at that individual but that contributed to making LGBT people feel uncomfortable at work, for example using 'gay’ as a derogatory term for anything and everything ('that's a bit gay'), discussing other LGBT staff, or acting and joking inappropriately.

There were cases where LGBT individuals were ignored or given the ‘cold shoulder’ by colleagues or where cruel jokes were made. There were a significant number of clear cases of bullying by colleagues and by line managers. For example one respondent was off sick with a stomach bug and when they returned to work their boss shouted offensive sexually based jokes across the office while simulating oral sex. In another case a colleague refused to be served food by their LGBT colleague saying they 'did not want to catch AIDS'. Others were regularly insulted by line managers.

“One staff member used to talk about gay people every morning, would bring it into the conversation, make [me] feel different. [There was] constant joking around in work situations. Two male members of staff used to pretend to be a gay couple in front of [me]. My line manager made the comment in monthly supervision that ‘it’s all about sex, it’s filth’…” (Lesbian female)

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There was also evidence of employers giving inadequate protection to LGBT employees against the general public/customers attitudes (which could be viewed as part of an employer’s duty to protect its staff).

“I was carrying out a safety demonstration and a passenger began to shout out discriminatory comments. I had to ignore the comments at the time and carry on with the demonstration.

Afterwards I told the senior flight attendant who told me to forget about it and that someone else would serve that passenger during the flight.” (Gay male) As well as multiple examples of workplace bullying and homophobia or trans phobia, there were other workplace experiences which contributed towards making LGBT people feel uncomfortable in their workplace.

There were particular issues for gay and trans people around using workplace bathrooms, with these being the object of bullying and humiliation. For instance one guy overheard colleagues saying he was a 'nice guy, but they wouldn’t want to follow him into the bathroom'. This was also a particular issue for trans people who were made to feel uncomfortable about which bathroom they used, or were bullied in the bathrooms out of sight of the main workplace.

“That was pretty bad, I got harassed a lot and followed to the toilet.” (Trans male) There were also examples where even though diversity policies, monitoring or training were in place to protect LGBT staff, experiences were still negative because of them not being implemented in line with best practice, as the example below illustrates.

“My manager asked the team to complete a compulsory equality and diversity monitoring spreadsheet. It had information about each team member including race, religion and sexual orientation. It was saved on the shared drive so everyone on the team could access and see each others information. When we complained the manager said we could just put ‘rather not say’ as an option for anything we did not want to disclose. The problem is if you put that in the column for sexual orientation everyone will suspect you are not straight.” (Gay male) In the case of collecting sexual identity or gender identity monitoring data, trans people in particular reported that trans status was rarely asked or recorded appropriately on monitoring forms. LGBT people also reported that diversity training often skipped quickly over LGBT issues or missed it out all together. Or while LGB issues were covered, trans issues were often missed out. The impacts of these positive and negative experiences are discussed in next section.

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5.3

Impacts on LGBT individuals The qualitative evidence suggested a range of impacts on people’s economic participation caused by their experiences in the workplace. These included impacts at all stages of working life including on LGBT people’s choice of job or career; their ability to progress and develop whilst in employment; and around level of economic engagement. There were also impacts around equality of access to workplace benefits and personal impacts including stress and mental health issues.

All of these contribute to poorer outcomes for LGBT people in the workplace. These are described in turn below.

5.3.1

Impacts on choice of sector and entering a career There was a significant amount of evidence around LGBT people reporting that they were selective about the sectors they want or felt able to work in. There was strong evidence to suggest that LGBT people in the region tended towards what they perceived to be more ‘accepting’ or ‘open’ sectors. Some of those included a clear bias towards the public sector (for example social care, nursing, local authorities and government departments), and towards third sector and charities, the arts & creative sector, and customer facing services and hospitality. Trans individuals in particular said they would opt towards jobs or careers that they felt would be more open and accepting of them. Conversely, there was evidence that LGBT people tended to avoid sectors which were seen as less open and accepting or where they perceived they might encounter homophobic or transphobic attitudes. These particularly included the armed forces, the police and the fire service, and also parts of the care sector such as childcare or social work where LGBT people did not feel they would be accepted or valued.

There was also significant evidence around LGBT people being selective about the types of companies or workplace settings they want or felt able to work in. This included evidence that some LGBT people would avoid factory settings or manual labour which was associated with very ‘masculine’ atmospheres and where they would not feel comfortable being open about themselves.

Some reported avoiding office settings in order to avoid office gossip and possible bullying. Some reported they avoided small businesses so that they would not be subjected to scrutiny and would err towards large and busier environments, such as call centres. There was also evidence to suggest that a small proportion of LGB people, and trans people in particular tended towards self employment as this gave them the flexibility to choose the workplaces and sectors they interacted with. Some of this pre-selection of companies or careers was through choice (i.e. LGBT people actively de-select particular sectors or types of business) and some was subconscious and identified during reflection within the interview process. Some respondents also recognised that career choice was bound up with their identity and found it hard to isolate the impact of their sexual orientation on their decisions.

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There was also evidence that some LGBT individuals actively prefer and seek out LGBT friendly companies to work in, for example LGBT sector voluntary organisations and charities and gay owned or gay oriented businesses (for example bars and hotels) reflecting the findings discussed in the review of existing evidence (Chapter Two). Some individuals actively checked if an employer had diversity policies in place and if it is ‘gay friendly’ before applying. In one case an individual rejected a job offer because they believed the employer would not be LGBT friendly.

“If I had any doubts about an organisation and their attitude to gay people I wouldn’t work there.”

(Lesbian female) “I always check the equality statement.” (Bisexual female) “Due to my experiences in my current role, I know that from now on this will definitely be something I consider. I am looking for a new job and have been checking the reputations of organisations on the ‘Proud Employers’ list and making enquiries to find out if they value their LGBT workforce.”

(Gay male) When applying for jobs, LGBT people reported they were sometimes hesitant to mention their sexual orientation in a job application, on their CV or at interview because they feared it would impact negatively on their chance of being selected, and during staff induction or probationary periods LGBT staff said they ‘kept quiet’ about because they felt it was easy to get rid of someone at that early stage. In a handful of cases, LGBT individuals felt they had not been offered a job because they were open about their gender identity or sexual orientation at the interview stage or because employers preferred to select a heterosexual or non transgendered individual. For trans people the interview process could be especially daunting, particularly for those who were trying to ‘pass’ and were worried about people’s perceptions of their appearance and some reported they would decide not to take a job if they encountered difficulties around their trans status at the interview stage.

Together this evidence suggests that some sectors and workplaces were perceived are more likely to be open and accepting, and therefore more likely to be benefiting from having a diverse workforce that includes LGBT people. For those workplaces that are not vocal about supporting equality in the workplace this may be a missed opportunity.

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5.3.2

Impacts on economic participation and career progression Some individuals in the sample of LGBT interviewees were currently, or had experienced, periods of unemployment, or had worked in a range of temporary jobs and were unable to find permanent employment. They partly attributed this to being cautious about employers’ attitudes towards LGBT employees or because of previous bad experiences. It was not possible to isolate from the evidence the extent to which other factors may also have affected their level of economic participation. However some trans people said they had struggled to find work during or since transitioning, due to a fear of transphobia or discrimination, or had been signed off long term sick as a result of their situation.

There were several cases in the sample where LGBT individuals reported they had either left a job because of the way they were treated as an LGBT person, or where they had been given the sack or made redundant from a role because of this. For example this included cases where people were let go after coming out as gay or where harassment and bullying contributed towards making it impossible to continue working somewhere.

“I once worked in a café and got on well with the boss and other employees. I decided to be open about my sexuality and about a week later I was fired. The reason given was that business was slow and they didn’t need as many staff. About two weeks after leaving they employed someone else. I didn’t do anything about it as I thought I couldn’t. I am currently unemployed. ” (Gay male) “I used to work at a factory and I would describe the atmosphere there as tolerable but uncomfortable. It was definitely a contributory factor for leaving the factory” (Lesbian female) “I was the shift manager [in a children’s home] and they used to undermine me and not do the tasks I allocated them because they said it was women’s work. I used to go off shift crying, so I left.

[In another job] the [manager] gave me homophobic verbal abuse in front of the [clients]. She let all the other staff go early on a regular basis but would never let me… I’ve recently moved.” (Lesbian female) “One employer was overtly homophobic. They were treating me differently from other employees, this was also noted by other employees. I left abruptly.” (Lesbian female)

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Having to leave a job or company because of poor treatment or attitudes was particularly common among the trans people interviewed. People who were transitioning while at work often found that their employer struggled to understand or deal with their situation appropriately, and many reported that it was often easier to leave work, perhaps returning once they had transitioned.

“Whenever someone judged me on my gender or thought that I was lying about it HR said I was bringing it on myself because I looked androgynous… I even forwarded them copies of their equality policy and they don’t get back to you… I left that job.” (Trans male, gay) “Not having worked for two years… I am planning in the next few months to get a job as a man having changed my documentation, looking the part more, so it should be easier to apply for a new role rather than transitioning in your current job” (Bisexual trans male) Another individual was given their notice while transitioning and felt this was as a direct result of their transitioning. In many cases, this had led to gaps in employment history and lower levels of economic participation.

For LGBT people in work, there was evidence that many LGBT staff were underemployed, i.e. not given the chance to optimise their full skills and capabilities. For example there was evidence that LGBT staff perceived they were given less demanding, more menial or less prestigious tasks than other staff members. There was also a common perception that fewer LGBT people worked in senior or managerial roles.

“I had one incident in a nursery and the manager said ‘people like you shouldn’t change nappies’ and as the other students were allowed to change nappies I knew she wasn’t talking about me being inexperienced… I was outed as a lesbian which isn’t what I identify as… after I was outed the jobs I got given got worse and the comments got worse. I was cleaning toilets and not having contact with the children. I think it was because of them knowing - because before it was fine.”

(Gay female) “One thing in the workplace my experience has taught me is that no one likes to take orders from a gay person. It’s more easy to be accepted in a more menial role.” (Gay trans male) Many respondents felt being LGBT had negatively impacted on their ability to progress in their careers or on their personal development in the workplace, either because they had to hide their sexual orientation in order to progress or that being out as LGBT prevented them from getting promotion or being given extra responsibility. For instance one teacher said they did not feel they could be open at work because it would be detrimental to their career and had to change jobs and keep their identity private in order to progress in their career. Individuals also reported that they had turned down opportunities to progress within a company if they felt that the team or office they would have to move to was not accepting of LGBT people. This fear was also mirrored with regard to moving job or company to progress, with some individuals saying they would rather stay where they were rather than risk moving somewhere new and having to face possible difficulties or have to ‘come out’ all over again. This reflected findings from the literature review in Chapter Two.

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For trans people there were specific issues around ability to progress within the workplace, with some respondents reporting that their trans status had impeded their ability to progress and that their company did not know how to make the most of their talents.

“When I joined [the company] I was ambitious and was promoted quickly. After undergoing gender reassignment surgery my experiences at work changed dramatically. It is as if the organisation has no idea what to do with me now. I have moved from one secondment to another without ever being given a stable secure job. I earn less than I used to and feel I have reached career stagnation because I am not moving forward any more. I feel trapped in my role with no prospects for promotion or a pay rise. I feel humiliated and belittled. My employer no longer takes any notice of me for my abilities knowledge or qualifications.” (Bisexual trans female) Overall this evidence suggests that LGBT people can often feel unable to progress and fulfil their potential within the workplace, indicating that there is under-utilised capacity and skills that could be more fruitfully employed within the North West as a whole. This also indicates that indirect and direct discrimination still occur – particularly in some sectors and workplaces – that needs to be addressed.

5.3.3

Impacts on access to work rewards and entitlements There was clear evidence of unequal treatment of LGBT people in the region with regards to fair access to in-work related benefits, rewards and entitlements. This included unequal access to death in service benefits for example where these was not applied equally to same sex partners; and unfair application of rules about time off to care for same sex partner compared with how rules were interpreted for other employees. For trans people there were issues around sick pay where respondents perceived they were treated unfairly in being told they had to use annual leave to recover from gender reassignment surgery or for gender clinic appointments.

Some LGBT individuals felt that while provision was made for equality and diversity activities, they could not access them in practice without outing themselves and were not given adequate access to time away from their desk by their line manager to access those facilities or services.

“When equality and diversity events are advertised by the LGBT group in my workplace you have to ask your manager for permission to attend if the event is in shift time. So as not to have to be ‘out’ the rule is you don’t have to give your manager the details of the event you wish to attend.

However in practice a manager will not honour those requests without knowing the reasons why it’s needed. If I did tell my manager it was an LGBT event he would assume it is a social event and turn it down anyway. So whether I have told my manager the reasons or not I have never been allowed to go to an LGBT event.” (Gay male) In relation to making a complaint or taking up a grievance (even where procedures were in place) many LGBT people expressed wariness about this, saying they felt unable or unwilling to take a claim or complaint forwards for fear of being labelled a ‘troublemaker’ or being seen as using their sexual orientation or gender identity as an ‘excuse’.

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5.3.4

Impacts on personal, social and health issues For many LGBT individuals the difficulties experienced in the workplace led to a series of personal, social and health impacts which negatively affected their quality of life, their personal relationships and in some cases, their mental health.

For instance some individuals reported that harassment or bullying at work or the pressure of trying to keep ones identity or relationship secret placed enormous pressures on them personally and in family relationships. Not being able to be open meant their entire working life was spent expending energy keeping up a pretence or keeping to oneself. This created undue pressure on personal relationships and family life with some respondents reporting strained relationships at home.

Dealing with constant homophobic attitudes and covert and overt bullying was also emotionally and physically draining.

“This guy basically started to pick on everything I did and would constantly question me about my work. Also every morning he would come in and say good morning to everyone except me and the same going home. It made me feel very vulnerable. I felt I couldn’t approach him about it because it was very subtle and he would just deny it. Also my confidence was already suffering. One day I just burst out crying. I went to my GP and he told me to take some time off and gave me anti depressants. Eventually I made a complaint to HR about the bullying but they said they investigated and couldn’t find any evidence of it. I didn’t discuss my sexuality because I was unhappy and lacked the confidence. HR moved me to a new job where I wouldn’t be managed by this man, so I agreed. About six months later I was made redundant as my job was not seen as essential. I was devastated.” (Lesbian female) These types of experiences impacted on LGBT people making them feel stressed and under pressure. For many individuals it affected them personally in terms of reducing self esteem and causing a lack of self confidence. In extreme cases, this affected LGBT people’s health, for instance it led to being placed on anti depression medication or to substance misuse problems.

Ultimately, this contributed to limiting their ability to participate fully in the workplace.

“I suffered long term homophobia in my private life and from some people I have worked with which in turn created some serious personal issues with me… I had no confidence and no self esteem, I did not feel worthy to apply for jobs…I did not seek promotion” (Gay male)

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5.3.5

Impacts specific to trans people In addition to the above, there were a series of issues in the workplace specific to trans people which affected their ability to participate fully in employment. These included difficulties around employment documentation, for example not being able to provide employers with all relevant documents because some are in an old name (e.g. university degree certificates) and issues around staff toilets including complaints about trans individuals sharing facilities with non trans employees. Finally, there were issues around job with uniforms, where trans individuals were given no say in what uniform they preferred and were randomly allocated a ‘male’ or ‘female’ uniform depending on how they appeared on any given day or depending on the attitude of the manager giving out the uniforms. In one case this led to the individual taking fewer shifts because they did not want to face the situation every time they went to work.

5.4

Implications for the regional economy The above evidence of poor experiences in the workplace, bullying and harassment, and indirect and direct discrimination towards a swathe of LGBT individuals suggests significant implications for the North West regional economy. There is significant qualitative evidence that LGBT individuals face difficulties or even actively avoid their preferred career or sector choice and that many are underemployed and marginalised within the workplace, therefore unable to contribute economically. For instance LGBT individuals are not able to access the same opportunities or benefits as others, and fear of discrimination prevents them from applying for new roles or progressing within a company. These challenges led to impacts on individuals' mental health and wellbeing – and the associated costs of time off from work and days lost to sickness. For trans individuals there were specific barriers and a lack of acceptance or support. Overall there is significant evidence of employers failing to capitalise on individuals' skills and experiences, suggesting there may be significant skills and capacity that remains untapped within the region's workforce. Given the current economic circumstances it should be hard for employers and policymakers to ignore this untapped potential.

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6.0

Enterprise

6.1

Introduction This chapter explores the experiences of the region’s LGBT entrepreneurs and LGBT individuals who are self employed, including both the challenges and benefits of starting and running their own businesses (Section 6.2), and their experiences of accessing business support (Section 6.3). This chapter goes on to look at the support, policy and guidance that is in place to support LGBT-led businesses (Section 6.4) and finishes by looking at the attitudes of employers in the North West region towards LGBT employees (Section 6.5). This chapter draws upon the primary data collected through interviews with LGBT entrepreneurs, LGBT individuals who are self employed, and interviews with employers in the region1. This included employers accredited as 'LGBT friendly'2 and other employers who were not accredited. It also draws on a small number of interviews with business support organisations3.

6.2

Experiences of enterprise and self employment LGBT individuals in the sample ran a range of different enterprises and services. The majority of entrepreneurs or self employed people who took part in the study ran businesses that had either a focus on LGBT issues or targeted LGBT customers, albeit to varying degrees. Only two entrepreneurs did not specifically target the LGBT sector or LGBT individuals in the work that they did4. The size of the businesses also varied, some were sole traders, and some had a workforce of 60 staff, most ran small enterprises that employed less than 25 people. While some businesses had been in operation for less than two years, others had run their businesses for over a decade.

Entrepreneurs participating in the research, therefore, had different business experiences, and had faced a range of different issues and challenges.

6.2.1

Reasons for becoming an entrepreneur Very few LGBT entrepreneurs reported negative experiences of being in employment prior to them starting their own business, but those that did cited this as a key factor in their decision to start their own business. For example, one gay entrepreneur who previously worked in the manufacturing industry described the attitude of their previous employer and colleagues as ‘19th Century’. Negative attitudes or potential going unrecognised appeared to be key factors that ‘pushed’ LGBT people into starting their own business.

1

Sample size = 6 entrepreneurs, 33 self employed LGBT individuals and 13 employers With either a national accreditation such as Stonewall Diversity Champions Employer Index or a regional accreditation such as Navajo accreditation which is available in Lancashire.

3 Sample size = 4 business support organisations 4 Although both entrepreneurs had provided services to LGBT organisations.

2

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“Certainly, the business was set up initially because I was a lesbian, and I had found it hard to find a job that would be suitable for me and that would maximise my potential. Opportunities to advance weren't there previously, and I felt that my sexuality was a barrier to get to a higher level.

I'd get to the final two when applying for new jobs but never further. The only way forward was to set up my own business which would suit my working style, and where I could be myself.” (Lesbian entrepreneur) Other entrepreneurs said that they started their own business as a result of a personal interest in supporting or working directly with the LGBT community. For example, one entrepreneur that an LGBT focussed organisation was personally motivated to set it up to remove discrimination in their sector. Some LGBT entrepreneurs felt this their businesses were more sustainable as they were interested in supporting LGBT communities in the long term rather than 'cashing in' on the LGBT sector for commercial gain. Other entrepreneurs mainly saw the value of operating a business targeted at an LGBT market as being able to work in an LGBT environment or to raise the profile of LGBT issues. For example, one gay entrepreneur working in hospitality had always worked within a majority gay workforce and wanted to continue to work within this community in their own business.

6.2.2

Coming ‘out’ as an LGBT entrepreneur While many LGBT entrepreneurs felt that a clear advantage of being self employed was that they could be open about their sexual orientation in the workplace, some still chose not to be open about their sexual orientation or gender identity to clients and customers they worked with, particularly those not working with or for the LGBT community. For example, one gay entrepreneur who worked with LGBT and non LGBT clients, said that he was not open with his clients about his sexual orientation, although he would be honest with people if they asked.

“I am not someone who goes around ‘flying the flag’ but if someone asks then fine.” (Gay male entrepreneur) This was reinforced by another gay entrepreneur who said they were not always open with clients about sexual orientation if this was not of particular relevance to the work they were doing. Now, the area of work has changed to focus on LGBT clients and they are much more visible as an LGBT business person.

Another entrepreneur said that while they make it a policy to be open to staff and potential recruits about sexual orientation, they do not always actively promote this to clients or customers as they feel they could be ‘put off’. For this entrepreneur, being open and out about sexual orientation was incredibly important to the way that they ran the business, yet they still felt unable to be open in business world outside of the LGBT community. LGBT-led businesses feared discrimination when dealing with non-LGBT business providers, clients or customers. The evidence suggests that some LGBT entrepreneurs felt they needed to be discrete about their sexual identity so it did not impact negatively on their commercial success.

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Some entrepreneurs were open about their LGBT identity, and felt that it was an integral part of the business that they ran or services that they provided, for example in running a bar targeted at the gay community or in being an equality and diversity adviser.

At the same time, there was also a sense that being an openly LGBT-led business can help win business. One entrepreneur reported securing business from major LGBT businesses as a result of being an LGBT-led business. This has also been the case for one entrepreneur who has a major contract for an LGBT campaign group. These examples support the findings in the literature review that LGBT communities are likely to give business to LGBT-led or LGBT-friendly businesses in order to support their own community.

6.2.3

Experiences of staff working in an LGBT-led workplace All entrepreneurs that employed staff or volunteers said that they are aware of the proportion of LGBT staff working in their organisation, and generally, they tended to employ LGBT staff.

However, none of the entrepreneurs said that their organisation had formal procedures in place to monitor their LGBT workforce, although one entrepreneur said that they were looking to put procedures in place to monitor the sixty volunteers they employed. Another entrepreneur collected monitoring information on gender, race and disability but not on sexual orientation or gender identity. Others said that because they were fairly small they tended to know the proportion of LGBT employees without monitoring.

"All staff members are known intimately as it is such a small organisation so there is no need to formally collect data. Around 75% of our staff are LGBT." (Gay male entrepreneur) Typically entrepreneurs felt that a key benefit for LGBT staff working in their company compared to other non-LGBT-led companies was that LGBT staff were aware that they could be ‘out’ in the workplace and would be accepted. Another entrepreneur added that because recruitment is so expensive, they make it their priority to create a supportive and positive environment for staff in order that in return staff feel loyal to the business and want to stay.

“There is a clear benefit for LGBT staff, in that due to our own sexual orientation they know that they will get total acceptance within the work place and will be supported. They are aware of our sexuality so we encourage a supportive environment.” (Lesbian female entrepreneur) “I like to ensure staff are happy, and want good staff to stay a long time.” (Gay male entrepreneur)

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All entrepreneurs that employed staff said that their business offered a supportive environment for LGBT staff, although only two organisations had formal equalities policies or an equalities statement in place to support LGBT employees. These policies tackled all forms of discrimination in the workplace including sexual orientation or gender identity. A ‘zero tolerance’ approach to homophobia or transphobia was a consistent view amongst entrepreneurs. With regards to internal HR policies, entrepreneurs felt that clear standards of non-discriminatory behaviour should be put in place by the employer, with two entrepreneurs saying that in failure to act in accordance with standards should result in legal action.

“They need to make it clear to staff that kind of behaviour is not tolerable and will be viewed on a par with racial and sexual harassment… failure to take proactive steps to ensure the safety of employees would leave them liable to legal action.” (Trans female entrepreneur) Furthermore, a number of entrepreneurs felt that these standards should apply to not only how employers treat their staff, and staff treat each other, but also to how a business communicates with customers and the outside world and to tackle discrimination from clients, customers and users of services.

“There should be an emphasis not only on treating customers with respect, but also on how to tackle harassment by customers towards members of staff.” (Lesbian female entrepreneur) One entrepreneur reported having policies in place to support and protect LGBT subcontractors who work with members of the public, often young people. In particular, this involves establishing clear boundaries with young people that they are contracted to work with to show that they do not tolerate homophobia and to inform young people of what constitutes homophobic behaviour.

6.3

Experiences of business support Both mainstream business support and LGBT focussed support was available in the region, provided by both public agencies and the third sector. LGBT entrepreneurs and self employed individuals accessed a range of different business support services, although a minority had accessed very little or no support at all. Generally those that had not accessed business support said that they did not need feel they needed it or were not aware it existed. Only one respondent did not access business support because they felt they may be discriminated against. This interviewee said that when they started their business twelve years ago with their partner, they tried to be self reliant so as to avoid exposure to discrimination. (However this respondent also felt that attitudes had now changed so if they were setting up a business now they may ask for assistance.)

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Many individuals that had accessed business support had done so via Business Link or via other business support services including Chamber of Commerce, Inland Revenue1, Prince’s Trust, New Entrepreneurs Scheme (NES), and banks and private business solutions providers. Respondents had also accessed support from specific sector organisations, such as the National Association of Children’s Homes or the Creative Industries Development Services.

Generally the mainstream organisations reported that they aimed to offer business support services that were inclusive and open to all groups and had worked with LGBT-led businesses, whilst one mainstream provider said that they were not explicitly aware of any LGBT businesses or employees that they supported as they do not distinguish between members, although undoubtedly this had been the case.

Indeed, most individuals who had accessed mainstream business support said that they were generally not out about their sexual orientation or gender identity to these services. This was mainly because the question had not come up and individuals did not feel that it was necessary or relevant to disclose it. There was limited evidence of someone in the sample experiencing discrimination on grounds of sexual orientation when accessing a public sector service; this individual feared they would receive the same treatment from any business support service.

“The people providing the employment service and other people accessing it made me feel uncomfortable as a lesbian, muttering ‘lesbian’ under their breath and they took the piss because I wore a tie. When I complained about the comments that other people accessing the service were making the staff just told me to go and sit elsewhere. I wrote a letter after this and didn’t get a reply – so I stopped taking up the support”. (Lesbian female) Of those entrepreneurs who were open about their sexual orientation or gender identity to business support services, some said that this was because of the nature of their business where it was obvious that they were LGBT. One trans entrepreneur said that they had always been open about their gender identity but again this was because of their appearance.

Only one entrepreneur thought they had been asked about their sexual orientation or gender identity when accessing business support and very few entrepreneurs had been asked questions relating to other equality strands. There were mixed views as to whether business support services should be asking monitoring questions on sexual orientation or gender identity reflecting wider public opinions on the pro's and con's of doing so.

1

E.g. training on PAYE or VAT.

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Commonly, those that had accessed business support had accessed some type of course or training event related to financial aspects of starting up a business, such as accessing finance and tax and VAT issues. A number had also received support in developing business plans, which tended to be through a one-to-one advice service. A few had received business support on specific issues, such as IT training or training on competitive tendering. One said that they received ongoing support via the phone from a business support organisation which was useful in helping them address basic issues as they arose.

Overall, LGBT individuals had found business support services to be accessible and useful in addressing their needs, and very few had experienced any difficulties or challenges in accessing business support on the grounds of their sexual orientation or gender identity. However one entrepreneur said that they had found the business support they received ‘alienating’ because the training course on offer was geared towards what they perceived to be a heterosexual 'norm', and another was disappointed with the service that they received from a mainstream business adviser, as they felt that the adviser did not have any knowledge of LGBT issues and was unable to put them in touch with other LGBT businesses in the area that could offer support.

One entrepreneur had experienced barriers to accessing finance for their business start up because of the nature of their business. They had found it difficult to obtain funding from a bank even though they had developed a sound business plan because of the ‘new’ and ‘different’ nature of their business which was targeting the LGBT market. Another entrepreneur said that accessing funding and business grants was a key problem area that LGBT businesses needed support in tackling, as often LGBT businesses are small and target niche markets and so it can be difficult to convince funders of their business plan. These challenges are linked more to the small and ‘niche’ nature of the business, rather than discrimination directly on the grounds of sexual orientation or gender identity. However, these experiences indicate that support is needed for LGBT businesses in helping them develop and sell their business plan and overcome barriers that they face in relation to the nature of their business.

Very few entrepreneurs had accessed support from LGBT focussed business support services, however, those that had said that this had helped them in developing their business. One entrepreneur had worked closely with the Lesbian and Gay Foundation’s Rainbow Partnership.1 They felt the partnership had provided excellent strategic input into the development of their business in its early stages, providing useful signposting as well as advice on LGBT issues.

Another entrepreneur who owned a bar had found the Village Business Association to be particularly helpful because it offered access to all the available LGBT support organisations in the area, and addressed relevant issues that local businesses faced, for example community safety issues.

1

The Lesbian and Gay Foundation’s Rainbow Partnership operates a membership group made up of individuals, organisations, businesses, voluntary and community groups and statutory bodies with the aim of increasing capacity in the LGBT sector.

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Whilst respondents perceived there to be good availability of business support for LGBT entrepreneurs in Manchester, this was not perceived to be the case across the whole of the North West. Respondents believed there was often a lack of provision for LGBT businesses outside of major urban centres.1 Overall, the LGBT business community was keen to access mainstream services as they felt that specialist knowledge in their area of business was more important and helpful for their business than accessing an LGBT focussed service. However some said that they would look to use services that were non discriminatory in all aspects of equality and that promoting this message was key to engaging the LGBT community. They suggested this could be achieved by advertising in the gay press; more actively promoting services to LGBT groups and looking to become Stonewall accredited or be willing to be audited as part of the Stonewall equality index in order to demonstrate that they are supportive of LGBT businesses. Finally in terms of accessing business support, one entrepreneur felt that there was a lot of support available for LGBT businesses in Manchester but that there was a poor level of services across the rest of the North West region.

6.4

Business support in the region The extent to which business support services specifically engaged and supported LGBT employees and businesses varied greatly.2 Organisations that were not specifically LGBT focused emphasised the wider policy initiatives/methods that they had in place for ensuring that their services were responsive to all individuals and businesses. One organisation felt that it was better to offer a service that was inclusive to all groups rather than to try and ‘compartmentalise’ their services for specific equalities groups. This representative organisation had also recently applied for the Navajo charter mark3 as they felt that this outwardly demonstrated their commitment to supporting LGBT groups.

“Our service is available to all, and there is no need to compartmentalise [our support], we cannot do this. A holistic approach is better than trying to offer specialist advice to LGBT people” (Business support organisation) “We wanted to demonstrate our commitment to the LGBT community and to make LGBT people feel comfortable coming to us. We wanted to promote the message that services are available to all.” (Business support organisation)

1

For instance another entrepreneur said that they had looked at the website for the National LGBT forum which provides networking opportunities for LGBT businesses across London, but noted there wasn’t an equivalent across the North West.

2 This section is based on feedback from interviews with 4 business support organisations, two targeted at LGBT business and two mainstream services.

3

The Navajo charter mark is awarded to employers in Lancashire that take positive steps to welcome and encompass LGBT issues.

See http://www.navajoonline.org.uk/charterMark.aspx

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This provider also said that they offer one-to-one training and support sessions, and so if a person did not feel comfortable talking openly about the business plan or issues that they faced, that these could be done privately and in confidence. They felt that in this way, they can be responsive to a range of groups who may feel uncomfortable approaching a ‘mainstream’ service.

In terms of the type of support, mainstream business support organisations generally offered advice on accessing finance, employment law and other legal advice, guidance on developing business plans and in some instances finance. LGBT-focused representative organisations offered advice specifically on LGBT issues or provided networking services for LGBT-businesses. In relation to general business needs, the LGF would often signpost businesses and individuals to appropriate mainstream support. The ‘additionality’ offered by the LGBT-focused support services for LGBT businesses and individuals was therefore in providing an environment in which LGBT people felt comfortable accessing support, and as a result could go on to access other services that had been tried and approved by LGBT businesses. Furthermore, as highlighted above, LGBTled businesses may employ a majority LGBT workforce and so may require additional information on supporting and catering for the needs of their employees.

Business support organisations also felt that the profile of existing mainstream and specialist business support services needed to be raised amongst LGBT groups, specifically by promoting these services as being LGBT responsive and accessible for all. It was felt that some LGBT individuals may have previously experienced discrimination from mainstream services so be reluctant to access them. One organisation described this as ‘opening up the mainstream’ by showing LGBT individuals that they will not be discriminated against if they were to access a mainstream service. This included positive promotion in LGBT press or amongst LGBT networks and community groups. One organisation felt that visibility of these services was higher in Manchester, Blackpool and Liverpool but more needed to be done to promote these services to those outside of the Manchester region.

“Publicity and visibility is the biggest area for improvement, there are plenty of support services and events however these aren't advertised anywhere. Usually things are known about through word of mouth but this isn't enough. Some people in areas with poor service provision would struggle.” (Lesbian female entrepreneur)

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6.5

Employer’s attitudes towards LGBT employees Employers in the North West were in a wide range of positions regarding to the extent to which they identify and support LGBT communities and the types of policies, provision and initiatives they have in place to support their LGBT workforce.1 This varied depending on whether they were accredited as an LGBT friendly employer or not.2

6.5.1

Policy, guidance and monitoring for LGBT employees All the accredited employers3 interviewed had equality and diversity policies in place that covered all the equality strands including LGBT, although some referred only to sexual orientation and it was not clear that these policies covered gender identity. A few employers had already put in place a single equality scheme and one was in the process of doing so. All employers operating in the public sector had equality and diversity policies in place that covered sexual orientation (in line with the legal framework), and this was also the case for the majority of private sector employers, although some had generic ‘equal opportunities’ policies that did not specifically refer to any equality strands4.

Employers commonly reported that they had policy and guidance documents that specifically addressed potential issues faced by LGBT employees. Many of the accredited employers specifically addressed LGBT issues as part of their action plans for equalities or as part of an equalities impact assessment framework. However, only one public sector employer said that they had a policy in place to support transgender staff that were in the process of transitioning. Other employers that did not specifically address LGBT issues said that they dealt with sexual orientation and gender identity in the same way as other equality strands and, therefore, did not have separate policies for dealing with these issues. Private sector employers were less likely to have policies that addressed the specific challenges and potential issues faced by LGBT employees.

In terms of monitoring the number of LGBT staff, only two accredited employers collected data on sexual orientation as part of the induction process and another was in the process of consulting with staff on a monitoring system. No employers collected monitoring information on gender identity, although two said that they were looking into how to collect data on this. Interestingly, some private employers did not feel that it was necessary to collect this data, with one employer stating that they treat everyone equally anyway so felt they did not need to know which employees were LGBT.

1

This section is based on evidence from 13 short qualitative interviews with businesses or employers from private, voluntary and statutory sector.

2 With either for example, Stonewall Diversity Champions or Employer Index or Navajo accreditation which is available in Lancashire.

3 I.e. those that were accredited with either Stonewall Diversity Champions or Employer Index or Navajo accreditation.

4 Equality strands include: age, faith or belief, disability, sexual orientation, race, gender and gender identity.

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As a result, very few employers were aware of the proportion of their workforce which were LGBT and one employer that did collect monitoring information on sexual orientation said that the data included a lot of ‘unknowns’. A few private sector employers said that they were aware that some people in the company were LGBT but this was through informal processes or disclosure by the employee.

6.5.2

Engaging and supporting LGBT employees in the workplace There was varying levels of activity undertaken by employers focused on engaging and supporting LGBT employees, with accredited employers typically demonstrating the greatest level of activity.

Employers that had policies in place to address LGBT related discrimination were mainly led at senior management level or by the HR department. Initiatives were funded by either HR or through an equalities budget. One employer said that networking events for LGBT staff, whether inside or outside of the workplace, where funded through this mechanism.

Employers that were accredited1 identified various ways that they supported or engaged their LGBT employees. The most common form of support was LGBT staff networks or LGBT staff support groups which were operating in three of the five accredited employers. However, one equalities officer working for a University felt that the workforce was not big enough to form an LGBT staff support group within the company and another said that although they had a support group, not many staff were on it. This employer had worked to boost participation by providing a virtual group and as a result more staff members had joined. Another employer that did not have an internal support network said that they linked into external support services such as the Northern Gay Men’s Network. Some accredited employers also felt that LGBT staff were supported as a result of the equalities training delivered to their entire workforce which covered LGBT issues.

Non-accredited employers, likewise, demonstrated positive activity to support LGBT employees.

There were examples of public sector organisations which had equality ‘task groups' for each of the equality strands including sexual orientation (LGB) that consult with human resources (HR) on key issues. One employer said that representatives in these equality groups were experts in these areas and formal meetings are planned bi-monthly to discuss any issues or new challenges, such as changes in legislation or best practice.

One local authority had taken a number of additional measures to support their LGBT workforce. In addition to an LGBT support network and an LGBT equalities task group, the local authority also had a support page on their intranet for LGBT employees and had also been involved in Manchester Pride by having an employer float. They felt it was important as a public sector employer to outwardly demonstrate their commitment to tackling LGBT issues and to support LGBT staff, particularly as the public sector employer is based outside of Manchester in an area that may not be viewed as gay friendly. They were also looking to develop a buddy system to help LGBT people who want to come out in the workplace.

1

With for example either nationally recognised (e.g. Stonewall) or sub-regionally recognised (e.g. Navajo) accreditation.

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Other non-accredited employers, particularly in the private sector, felt that their staff were ‘generally’ supported by an ‘open and inclusive’ workplace culture, though none had specific initiatives in place. Again, smaller employers felt that they lacked a critical mass to be able to set up LGBT staff networks, suggesting that virtual groups as described above may be a plausible alternative for smaller companies or where staff do not wish to ‘out’ themselves. Employers also noted that whether staff were out or not at work affected their ability to access such networks, even where they were provided.

Very few employers were considering positive recruitment campaigns to improve the diversity of their workforce. One said that they were currently looking in to taking ‘positive action’ in their recruitment processes in order to increase the representation of LGBT staff in higher bands in the organisation and cited this as an example of good practice.

6.5.3

Tackling homophobia and transphobia Most employers said that they would tackle homophobic and transphobic discrimination in the workplace through their grievance and/or harassment procedures which staff should be aware of.

Feedback from employers demonstrated that most employers have ‘reactive’ systems in place for dealing with direct instances of discrimination which extended to homophobic and transphobic discrimination. This was the case for accredited and non-accredited employers regardless of whether they had specific policies in place to support LGBT employees.

Some public sector employers had put in place ‘proactive’ measures to tackle homophobic and transphobic discrimination. One employer said they had alerted their staff to the Hate Crime Reporting Centre set up by the region’s police force for reporting LGBT related hate crime. A number of public sector employers also felt that they directly addressed homophobic and transphobic discrimination through ‘Dignity at Work’ policies that outlined clear guidelines on the responsibilities of employees and employers in tackling all forms of discrimination.

Employer’s opinions varied in how effective they believed their policies were in addressing the needs of their LGBT workforce. Some felt that their policies worked well and were very useful in enabling them to address LGBT related discrimination. However one public sector employer said that they were not confident that all staff would be aware of the policies and support systems in place, particularly newer members of staff. Key to the success of these initiatives was maintaining employees’ awareness of them.

Very few employers had sought external advice or had their equalities policies and initiatives evaluated. Two employers had sought advice and been evaluated as part of Stonewall’s Diversity Champions award. One employer had received consultancy support in conducting an Equality Impact Assessment, had received advice from the Lesbian and Gay Foundation and sought information from Stonewall publications.

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None of the employers felt that there were any particular ‘unmet needs’ in their company in relation to the support that LGBT employees may need, although several felt that they could be doing more but would need to consult with staff to specifically identify areas of need which is difficult without monitoring data. One employer said that they had advertised support services to staff and made staff aware that they could receive funding to start up an LGBT support network, but as yet no staff member had been in contact with them to talk about setting this up. Whilst this could indicate a genuine lack of interest from staff in accessing a support network, it could also suggest that staff need to be further supported and empowered to establish these networks rather than just being allocated funding to do this themselves.

6.5.4

Challenges and support for employers in addressing LGBT issues in the workplace While a range of support services are provided in the region for employers wishing to engage and support their LGBT workforce, such as those provided by the Lesbian and Gay Foundation,1 employers still faced a number of issues when trying to identify and address the needs of their LGBT workforce. A key challenge was the absence of monitoring data which limited knowledge of the existence of LGBT employees. This led to a feeling that there were no ‘visible’ LGBT employees to engage with. Other employers had struggled to set up LGBT networks and easily gave up when they hadn’t received a significance response to their emails; not acknowledging that more effort would be needed. Feedback suggested that employers were often looking for a ‘quick and cheap fix’ to addressing issues and did not have adequate funding available to support initiatives.

6.6

Implications for the regional economy The above evidence suggests the significant and previously unrecognised contribution of LGBT individuals in terms of enterprise, entrepreneurship and self employment within the region. In a period of economic uncertainty, providing business support to LGBT-led enterprise as a means of supporting individuals to stay in work is worth further exploration. It was clear that business support does not need to be tailored specifically to LGBT communities' needs, but that current support should be readily accessible and more widely advertised to raise awareness within LGBT communities. There may also be specific issues about the nature of LGBT businesses (e.g. the 'niche' nature of the services they may provide and how to attract funding) or the appropriateness of current services to their need which could be addressed to enhance LGBT-led enterprise in the region.

1

LGF works directly with frontline services and employers to offer advice and guidance on LGBT workplace issues: such as equality legislation and LGBT employee’s rights. They offer advice and consultancy to LGBT & mainstream organisations on how to improve the experiences of LGBT employees in their organisation, including advice on developing LGBT networks, training staff on LGBT issues, or helping employers to develop their own LGBT policies.

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7.0

Education

7.1

Introduction This chapter considers the issues around LGBT communities' participation in education. It presents the evidence on LGBT people's experiences primarily of post-16 education and training (Section 7.2) and then looks at the impacts of those experiences on LGBT groups and individuals and how these affected people’s outcomes (Section 7.3). The study focussed on post-16 learning since this was the remit of the research funders. It also explores the perspectives of colleges, universities and work-based learning providers from across the North West region in relation to the support they provide for LGBT learners (Section 7.4). The chapter draws upon interviews with educational institutions and interviews and focus groups with LGBT people, who had completed different levels of education.

7.2

Experiences in education LGBT people within the sample had a wide range of learning and training experiences, covering schools, apprenticeships, post-16 routes, degrees and postgraduate qualifications, as well as ESOL, evening classes and volunteer and work-based training. Some of those interviewed had left school without qualifications. Whilst some of this included a few young people, the majority of this group were aged between 60 and 85, for whom the emphasis had been on finding a job as soon as possible.

7.2.1

Being open and out in education and training Many interviewees reported that they had not been out at all during their studies, for a variety of reasons. While some had not yet been out to themselves at the time of their education or training, many others avoided the topic of their sexual orientation or gender identity either because they saw it as irrelevant. Some people had not felt ready to come out during education/training, because they did not identify as LGBT at the time or because they did not understand or have the language to explain their sexual orientation or gender identity. Some described not yet having engaged with this question, or felt that it was a personal matter or that it simply never arose as an issue. In some cases participants felt that their sexual orientation/gender identity had nothing to do with their course, and was therefore irrelevant. However, others put considerable time and energy into maintaining their privacy for fear of prejudice. More often, however, people did not come out in education due to direct experiences of homophobia and transphobia in the learning environment.

Heterosexism meant that staff and students often assumed participants were heterosexual, and therefore did not ask any questions, but there were mixed responses to this 'invisibility'. Reflecting findings of employees described in Chapter Four, some people who felt that they do not 'appear gay' believed that this protected them from prejudice, for example, a bisexual male who was sporty at school.

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"The reason I don’t have any overly positive or negative experiences is that I don’t come across or look gay so by the time they find out I’m gay they already know me." (Gay female) When one participant, with longer hair, was discussing her research about lesbian parents, the tutor asked whether 'as a heterosexual' she had consulted any lesbian parents. She told him she was a lesbian bringing up children and that she was offended by his comments. In another example, a gay man felt vulnerable and uncomfortable when asked in class to discuss what they wanted from their own relationships, and the provider changed the training approach as a result.

“I left university because I didn’t get the support I needed as an LGBT person... My doctor asked if I had ‘boy trouble’. I had just come out of a relationship with a girl. Because of that assumption, I felt like I couldn’t come out. I felt like my issue wouldn’t be taken seriously. I’m used to getting dismissed, my sexuality getting dismissed very easily.” (Bisexual female) A bisexual man described joining in the laughter about gay people at school, where he felt unable to discuss his feelings for men and women. The difficulties of reconciling sexual orientation with a personal Muslim faith or being part of a Christian institution also prevented people from coming out. One participant challenged homophobic language from other students, but without coming out herself, by saying 'if you want to finish that conversation you need to know my daughter is a lesbian'.

Many LGBT people seemed to assume that they would not be accepted and that there should be silence about their sexual orientation or gender identity, perhaps because of past experiences of homophobia from school or from a previous era. Some participants believed that 'any talk about being gay' was a criminal offence, which could apply to the period before homosexuality was legalised, or to Section 28. There were suggestions that some teachers still feared legal action or being sacked if they mentioned LGBT issues, despite Section 28 banning 'promotion of homosexuality' by public authorities being repealed. Older participants discussed generational differences, between a world where homosexuality was never mentioned and viewed as a disease, and greater openness today. However, they felt that even when the laws change it takes time for society to 'catch up'.

"When you are brought up to be in the closet, you can be too nervy to come out of it. Not everyone is gay friendly even nowadays, you need to be careful." (Gay male, aged 85) Experiences of being out differed according the learning sector. For instance it was clear that traditionally 'male-dominated' areas such as construction and engineering were seen as less welcoming to LGBT people, and perhaps because of the weight of this perception, there were few direct experiences of training in these areas. While some who had trained in childcare or teaching felt that these settings did not allow LGBT people to be open and accepted, there were both positive and negative experiences from arts subjects, youth work, nursing and counselling. Film and media studies were felt to provide a welcoming and comfortable learning environment for LGBT people.

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Of those who did come out, there were positive experiences of openness and acceptance from staff and students, as well as examples of bullying and discrimination. There was evidence that both positive and negative reactions had a significant impact on their wellbeing and self-esteem, as well as on their motivation and further participation in education, explored below.

7.2.2

Negative experiences of being out during education A number of participants reported having left a course because of homophobia or transphobia.

One interviewee was expelled from a Catholic order and had to leave religious training for the priesthood when their intersex status1 became known. Another left teacher training when a tutor told her not to mention her sexual orientation, and because she was afraid of being put on the 'List 99'2 which she perceived to be the equivalent to Criminal Record Bureau checking, for being gay/lesbian or a sex offender.

"It was hard for [me] to feel like [I] had a place to fit and accepted that [I] would not have a place in the staff room amongst staff and would never mention it to the students." (Focus group interviewee) There were other numerous examples of LGBT people leaving learning due to homophobia or transphobia. One gay man left university because of difficulties making friends, which he tried not to blame on being gay, although he felt it would have been easier if he was heterosexual and keen on football. He finished his degree at college where he had done his HND, which he felt was more welcoming. A 49 year old woman left a photography course because the tutor said her work was too 'gay' and wanted her to be more conservative. Another was asked to leave an NVQ level 3 youth work course, apparently because she had a girlfriend and subsequently felt she had been blacklisted by local educational institutions. Another young woman was 'outed' at school and received no support, then subsequently dropped out. A lesbian young woman's bad experiences from school continued into her apprenticeship, as students from school were in the same class.

This was compounded when a nursery manager prevented her from changing a baby's nappy, saying 'people like you shouldn't clean children' (Focus Group SM1).

Other participants reported experiences of homophobia and transphobia, which though serious, had not caused them to leave their course. This included failure to challenge use of inappropriate language, for example, when someone was out as a lesbian on a mountain leadership course, and despite this, everything that was 'off the mark' was derided as 'gay' without any concern about causing offence.

1

Intersex status refers to intermediate or atypical combinations of physical features that usually distinguish male from female. This is usually understood to be congenital, involving chromosome, morphologic, genital and/or genital ambiguity, sex developmental differences.

2 List 99 is a register of people barred from working with children by the Department of Children Schools and Families (Source: teachernet accessed 20.07.09).

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LGBT refugees and asylum seekers reported feeling very uncomfortable in adult education colleges, for example when a tutor had said that civil partnerships and equal rights were wrong, or when a tutor said a label on one participant's laptop looked lesbian and students laughed. Some felt judged and isolated by other students from their home countries, but enjoyed the provision of gay magazines in college, and an LGB university support group. One interviewee had endured two years of bullying from a university supervisor in a female college, which he felt was related to his female to male trans status.

LGBT learners highlighted financial dependency on parents, and the reliance of funding decisions on parental support as an issue. LGBT learners risked becoming estranged from their parents due to homophobia; and had difficulties completing the necessary paperwork to prove this and access alternative funding and resources. One woman had been evicted by her parents when she was 17, and received no support from her sixth form college to find accommodation to enable her to continue her education. Despite having hoped to go to university, she became homeless and had to leave education, in order to receive benefits. There were participants who reported on experiences in education and training that they did not see as particularly positive or negative.

Some were quite dismissive of inoffensive 'friendly banter' and even bullying in hindsight, or 'just got used to' being asked continually about their sexual orientation or gender identity.

7.2.3

Positive experiences of being out in learning There were more positive experiences of being out among LGBT people who had attended further and particularly higher education, as well as training as volunteers for LGBT organisations, and Equality and Diversity training. Other learning opportunities that people were able to access because of their sexual orientation/gender identity included training to volunteer in LGBT organisations, taking part in conferences and being active in the students union at college or university.

One gay individual felt that he had 'very good experiences' of being open during his Masters and PhD, although, like others, he reported not volunteering or broadcasting the information. Where people felt that they were able to be out and were accepted; they were more likely to report that their sexual orientation/gender identity was not an issue and had no impact on their education.

However there is a clear difference between this scenario, and the feeling that it is not an issue because it must be kept private. " Everyone who knows me personally knows I am gay but I don’t go around shouting about it‌ I was totally out in my undergrad and masters, it totally wasn't a problem. I haven't been treated differently because I'm gay. In my undergrad it probably helped, because I researched lots of gayspecific theories, that other students wouldn't have, so I learned more." (Gay female)

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7.3

Impact of experiences in learning The impacts of some of the negative experiences of LGBT learners were predominantly around people feeling uncomfortable and unable to be open in education; people leaving and not completing their course or studies and ultimately associated impacts in educational underachievement. There were also significant impacts on people personally and in terms of wellbeing.

Many interviewees reported that they had left their course and ceased to participate in learning entirely, due to a lack of support related to LGBT issues. Others put up with difficulties of not fitting in, attempting to hide their sexual orientation/gender identity, for example by joining in homophobic name calling, and so completing their course 'despite it'. Some individuals felt that they underachieved in education as a result of these experiences.

Others believed that their experiences had not affected their attainment, but had a serious impact on their self-confidence or personal wellbeing. In some cases there was evidence that indirect discrimination caused them to lack the confidence to apply for further educational opportunities (this was particularly the case in older people's experiences of barriers to education in the era before sexual orientation was ever mentioned or even legalised). One interviewee described how he became introverted and unsure of himself and therefore avoided applying to university, instead entering work. Some classified such experiences as discrimination from society and universities, while others internalised the blame for this and felt that there were no barriers except those located within themselves.

"The barriers we faced were not concerned with being refused opportunities because other people knew we were gay. It was the day-to-day pressure of not being allowed to be yourself that ground you down over time. You lost the confidence to take what opportunities arose, (‌) for me society’s attitudes meant that I wouldn’t even bother applying." (Gay man) One interviewee said they would have left after facing homophobia from a tutor, if it was not a short course, and warned that allowing an environment where discrimination can breed will cause learners to leave. When there was no support available, people reported that the only way to deal with their experiences was to keep it to themselves or leave. There was evidence in extreme cases, of severe impacts on people's social and emotional wellbeing.

"I turned to self harm, suicide attempts. I felt alone." (Focus group interviewee)

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7.4

Supporting LGBT learners

7.4.1

Experiences of support Many LGBT learners said they had never accessed any support from educational institutions related to their LGBT status. While some felt there was none on offer, or that homophobia prevented them from accessing it, others felt no need (for example if they had a supportive network of friends or felt comfortable with their sexual gender identity). Many participants did not know whether any support had existed but thought not, particularly but not exclusively among older respondents whose educational experiences were a long time ago, and those at pre-university level. One further education student set up LGBT support through the student's union to fill the gap in her college.

There were a few experiences of accessing LGBT support that seemed inappropriately delivered, for example, an LGBT student society that seemed only interested in getting drunk, or a youth group that felt 'cliquey and patronising'. This is often suggested to be the case in the LGBT sector, where groups focus on socialising and the 'scene' without addressing the support needs of individuals.

“I went to the LGBT society meeting but was not made to feel very comfortable. It was very much a 'clique'. I felt like everyone was looking down at me. I was not one of the cool kids. We had different lifestyles – I wasn’t interested in going to the bar every night and getting wasted which is what you have to do to be accepted within the LGBT community these days. I didn’t feel welcome there just as I don’t within a lot of lesbian/gay spaces, and there aren’t any bisexual/trans spaces – it’s very much gay dominated!” (Bisexual female, age 26) Some reported very positive experiences of supportive responses from individual staff and students, rather than formal LGBT-specific support. For example, a lesbian came out on first day of university, 'to get it out of the way', and felt very supported when lecturer said she was brave, and asked her what terminology was best to use when discussing lesbians. There were also experiences of college and university staff in particular, doing 'a great job', offering support when students were dealing with issues related to coming out, in contrast with their experiences in school. This included an example from a trans participant who was offered guidance and counselling when starting his gender change. In another case, a participant was open about their sexual orientation with staff, who dealt swiftly with a bullying incident, and described the whole experience as very positive.

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Good practice example During some NHS training about mental health awareness, one gay man had found acceptance, inclusiveness and empathy. The trainers let him know they could put him in touch with support if necessary and gave him the space he needed due to previous experiences of 30 years of homophobic victimisation in the workplace and his associated mental health problems. This involved giving him time off for counselling, and removing pressure to enable him to cope with the course, by extending deadlines during difficult times.

Others were less able to access the support they needed. Some were afraid of the reaction if they asked for support, and others reported that they would have turned against any available support in attempt to fit in and hide their sexual orientation. One person had their support request refused by a community college, as staff reportedly felt it was not their responsibility to help LGBT students and told them to find support them self. Another learner had struggled to access support regarding asylum issues and his English wasn't good enough to pursue it.

7.4.2

Challenges and support needs All types of educational institution interviewed were concerned about the risk to student retention and access to learning of not supporting an LGBT friendly learning environment. Institutions recognised that addressing the needs of LGBT learners was a way to give everyone the opportunity to succeed. They also recognised the importance of preventing the negative impact on self-esteem and studies of not being out.

Rather than seeing sexual orientation/gender identity as irrelevant or a private matter, educational institutions recognised the role of a college or university in supporting students to be able to be themselves, feel at home and see learning as a safe haven, particularly at a time when they may be exploring their sexual orientation. Even those that didn't share such a positive view recognised the need to invest in pastoral care to keep students on the courses, as retention is a measure of the success of their business. There was therefore a clear wish to raise awareness of what restricts access for LGBT learners, their experiences of oppressive conditions and how to adopt lifelong learning approach. Some educational institutions also identified the negative impact on learning outcomes of previous (bad) experiences in school, which impacted on learners coming to them, and this reflected the findings above from LGBT interviews and focus groups. “Frequently LGBT learners either do not participate or do not achieve as a result of prior experiences within school. Therefore there needs to be an appreciation of the pressure on learners.

Marketing certainly needs to be improved as well as staff training to create a welcoming message...

LGBT issues appear to be missing from standard teacher training for new teachers. Therefore it is missing from student teachers experience. Therefore external organisations should be engaged to address this key area.� (Interview with educational institution)

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However, educational institutions identified particular challenges to supporting LGBT students effectively, including problems with homophobia from students and staff affecting attendance and motivation, and homophobia at home whether from family or flatmates making it harder to study at home. Other challenges were around the need for positive action, as well as preventative and reactive work around bullying/harassment or dealing with incidents. Some participants working in education highlighted the gap between policy and practice. They felt that the policies in place were generally fine. However, it was the organisational culture more generally that prevented them from providing a welcoming open environment for LGBT learners, plus the feeling of believing they were not encouraged to discuss certain issues with staff or students. One LGBT student argued that universities do what they have to do by law, but still fall short of actively encouraging LGBT students to study there. For example, by not supporting LGBT groups and events or not reflecting LGBT experiences in course content1.

There were some specific challenges around gender in relation to subject areas. Two work based learning providers in the area of engineering believed that they were likely to miss out on good learners coming into the engineering sector because of negative perceptions of the openness of their sector. There was a strong perception that male-dominated courses may put off LGBT learners, more so than female dominated courses such as childcare, education, health and hairdressing. There were some examples of attempting to make males feel welcome on traditionally 'female' courses, for instance one college had strategically decided to use positive images for males doing hairdressing/healthcare however it was not clear if this was targeted at gay males or just to redress a gender imbalance more broadly. In another, the construction course tutors were on the equality and diversity committee and therefore fully versed in potential issues. In this institution new initiatives were always tested in challenging areas and their curriculum was designed to embed equality and diversity issues, including LGBT. While one construction-related provider identified only 'a couple of girls' on their 'lighter' courses, another acknowledged 'we are a stereotypically male organisation'. The latter however did have positive female role models among staff. One city campus with art-related courses was seen as much more LGBT-friendly than other campuses of the same institution with other subjects or more rural locations.

Interviewees felt that other challenges to supporting LGBT learners included a lack of positive visible LGBT role models and a perception that tackling LGBT issues was more challenging than other equality strands. Some institutions reported that their staff were not confident in handling learners' strong opinions on the topic, for example. Some felt that there was a need for a more visible message for non-LGBT learners, in line with Stonewall's slogan, used in schools "Some people are gay. Get over it."2

1

Encouragingly, these suggestions coincided with the feedback from several Equality and Diversity Advisors and Student Support Officers who took part in interviews which stated they were now aiming to provide these types of support.

2 Stonewall, 2007. See http://www.stonewall.org.uk/education_for_all/news/current_news/2043.asp

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A major issue that educational institutions raised repeatedly was their relationship with employers, in relation to student placements. Some framed this as treading a fine line, when negotiating a balance between their duty of care and support to LGBT students, and their dependence on employers. There were experiences of failure to provide the required equality policies, and apparent discrimination against their learners on grounds of sexual orientation or gender identity.

Problems in this regard occurred with different types of employer; small and medium sized enterprises sometimes lacked the policies and documentation, while private sector employers (for example a nursing home) were seen to view equality requirements as a problem, rather than being about enhancing experience of learners in their care. In contrast, schools were perceived as easier to work with as they understood their equality obligations. However, some faith schools (generally Catholic and Muslim schools) had warned directly that they would not accept student teachers who were openly LGBT. This put the college in a difficult position because challenging them would risk losing student placements which were hard to find. Instead they supported LGBT learners taking up those placements to make informed choices about how to handle the situation. In one case a transgendered student was very nearly forced to abandon a counselling degree, because employers were not willing to provide them with a placement. Staff supporting this student were distressed by the situation, and got it around by providing an internal placement.

7.5

Current approaches to LGBT equality and support in educational institutions Educational providers generally viewed promoting a positive message about an institution's support for LGBT people as an important aim, which involved going beyond merely ensuring there was no discrimination in terms of course entry and access to pastoral care and student support.

All institutions stated that their general pastoral and support services were open to LGBT students, including personal tutors, student mentors and a PCT nurse in college for sexual health and other issues. One institution highlighted the enormity of the step of asking for support regarding LGBT issues, when you may be questioning your sexual orientation or gender identity, and suggested that generalist services should avoid heterosexist language and look out for LGBT people presenting with other issues, as well as being aware of cross-diversity issues and rarely-discussed topics such as domestic violence in same sex couples.

Many educational institutions interviewed also had specific support in place for LGBT learners including anti-bullying policies or support services. An equality and diversity support network and equality and diversity advisors were also available in some, although access was limited on the sub sites of some institutions. One college was training staff to tackle young people's use of the term 'gay' as a negative adjective. Other activities included 'Respect week' focusing on all minority groups, poster campaigns and positive images and thinking about how language contributes to the feel and culture of a learning environment. Staff and student LGBT group sometimes linked up, for example, to attend Pride on behalf of the institution.

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Two work based learning providers, that had fewer provisions in place than most other institutions in the study, were explicit in their wish to learn more about what would make LGBT people feel comfortable in the learning environment and were interested in dialogue with LGBT groups.1 Some institutions provided LGBT equality training for staff. In one case, the training was being delivered by the Equality Coordinator who was a Navajo-trained2 lesbian, reflecting suggestions from the LGBT interviews and focus groups that high quality training should be delivered by LGBT people or by external experts.

Many colleges and work based learning providers covered some LGBT issues in the student induction process; but this was not mentioned by any universities. These included information about avenues of support/queries as well as equality and diversity, anti-bullying and complaints policies. An interesting example was a mandatory equality and diversity 'passport' including citizenship, sexual health, drugs and alcohol as well as sexual orientation and gender identity. One work based learning provider gave extremely positive feedback on using role play and scenario building to explore homophobic bullying3.

It appeared that institutions often found including trans issues in support for LGBT learners to be challenging. For example the 'Visible and Valued' DVD was highlighted by one institution as a strong resource; they were starting to add trans issues to it but saw this as incredibly challenging for some staff. Another emphasised how high quality training had increased staff confidence in dealing with LGBT issues, although there were still difficulties with challenging young people's homophobic language.

Almost all participating colleges and universities were in the process of preparing a Single Equality Scheme. Where equality impact assessments were embedded, institutions were checking for potential disadvantages, as well as opportunities to celebrate LGBT people in course provision.

Many had begun a process of consultation with LGBT students, staff and/or community groups, through a range of methods. These included a study of LGBT students, a 'critical friend' group who were not out to each other so were consulted separately, an equality forum involving community groups and local authority and LGBT student groups including in 6th form colleges. Such groups had successfully influenced equalities policies, for example, colleges had responded to their comments by ensuring that unisex toilets were identified on estates maps. Other institutions said that some support groups were not well attended, perhaps because of the public nature of the group (which was intended to normalise it) or because potential members said it was not needed.

1

Nevertheless, one was very clear that their focus was determined by what the building industry wanted and would change in response to employers.

2 The Navajo charter mark is awarded to employers in Lancashire that take positive steps to welcome and encompass LGBT issues. See http://www.navajoonline.org.uk/charterMark.aspx 3 Via theatre in education delivered by Rugrats via an LSC funding stream.

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Many educational institutions had established contacts with LGBT organisations across the region1. These partners were involved in various activities including: reviewing draft priorities for Single Equality Schemes, providing posters/leaflets/signposting, supporting individuals, attending fresher's fairs, and providing tutorials for staff and learners.

Some institutions had started collecting monitoring data on LGBT status among staff and/or students. Others recognised that there were steps necessary first to build confidence in the confidentiality and positive use of such data for improvements. They noted that a lack of data or unwillingness to disclose information makes it difficult to identify needs and achieve dialogue – a finding that mirrored the concerns of employers in the region (see Chapter Five).

Overall, the picture given by those institutions who agreed to take part in the research suggests there are certainly increasing amounts of support available and a growing impetus to improve openness and welcome LGBT learners than has been the case previously.

7.6

Implications for the regional economy The above evidence suggests that LGBT people's experiences of education, particularly negative experiences, can have a knock-on effect in terms of the level of education that people complete and their educational attainment. This then has impacts in terms of LGBT people's ability to contribute to the regional economy, their ability to fulfil their potential in the workplace and their choice of career. There is evidence that from an early age LGBT individuals are deterred from entering particular career paths or sectors because of a fear of discrimination or because of bad experiences in educational settings (for instance being unable to get an appropriate work placement or being treated badly in employer placements).

1

Such as Transyouth, LGF, BLYSS, PINC, Outreach Cumbria, Stonewall and Outrite.

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8.0

Health services This chapter considers the key findings and issues around health services for the lesbian, gay, bisexual and transgender community in the North West. This chapter presents the evidence collected on LGBT people's experiences of health services (Section 8.1) and then looks at the effects of these on the individuals concerned (Section 8.2). The chapter draws on the data captured from interviews and focus groups with the LGBT community. Given that health services are central to experiences within the transgender community, some of which are clearly distinct from issues of sexual orientation, these are described separately within each section unless relevant to previous findings.

8.1

Experiences of health services

8.1.1

Being out and open when accessing health services There was wide variance among the LGBT community about their ability or willingness to be open about sexual orientation or gender identify when accessing health services. Some were totally open because they felt free and able to do so, either because the felt it was important to be open and honest with health practitioners in order to get appropriate treatment, or because of the supportive attitude of the health practitioner. There were many examples of where a positive initial experience had encouraged individuals to fully engage with health services.

“My GP reacted well, in a low key way with no fuss. He did ask if I had any issues with sexuality. I felt he was supportive….times are changing and they can’t get away with treating you differently because of your sexuality.” (Lesbian female) “I am open with my doctor, as I generally only go to see them for female health related things (the pill) anyway. My doctor is a gay lady as well, but I would be open whether they were gay or not, and if they seemed weird about it I would change doctor straight away. If you can’t feel comfortable talking to your doctor about things then how can you expect them to give you the proper treatment?” (Lesbian female) The attitude of health practitioners at the outset was consistently highlighted as a major contributory factor in individual's overall experiences within the health sector. Many from the LGBT community highlighted only positive experiences with health professionals. "[My GP] has been fantastic and very supportive with me and this makes me feel I can be totally open with him." (Gay male)

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There were others that were not open at all, and did not wish to be, for a variety of reasons.

Because they saw this as a private or personal issue that they wanted to keep private; because of a lack of trust in the health practitioner that this information would remain confidential (a view that especially holds true where the health practitioner also treats other family members); because of health practitioners' uncomfortable manner or because some did not see it as being relevant.

“My GP doesn’t know that I am gay, this is because he is the family GP and although I know he cannot tell my parents I still wouldn’t want to take that risk.” (Gay male) Older members of the LGBT community interviewed appeared to be less comfortable being open due to their age, and the historical attitude that homosexuality was a criminal and moral offence.

Some LGBT individuals were selectively 'out' and found this unnecessary unless it was relevant to their treatment. A prevalent view within the gay and bisexual male community, though not exclusive to this group, was that individuals were unwilling to be open about their sexual identity or sexual health related issues to their GP, but felt more comfortable about being open about their sexual identity at sexual health clinics, Genito-Urinary Medicine (GUM) clinics, or outreach programmes run by external LGBT organisations. Others concealed by omission or let people assume they are heterosexual; this was particularly prevalent within bisexual communities; some expected or feared a negative response if they were to come out; had experienced negative responses previously or were aware of existing poor attitudes towards LGBT people.

“It’s none of their business. I did tell one doctor once and he said 'the world is full of evil people'. I assumed he meant me.” (Gay male) "My partner had an STI [sexually transmitted infection] and so I went to the GP [In Manchester] to get checked to see if I had it. I used the word partner and he was really frustrated and said ‘you shouldn’t come here’ he was very angry [that] I went there and he assumed as I used the word partner that I was gay". (Gay male)

There was a perception by several of a 'gay shutter' in some medical settings; that once individuals announced they were gay, the shutters would come down on the conversation. The interview process detailed a number of examples describing negative initial experiences which had had a detrimental effect on individuals' opinion of health services. Occasionally participants who had HIV felt that they were treated differently by some health practitioners particularly with regard to dental treatment, some refused to book appointments or would be inflexible with appointments and only allowed patients to attend at the end of the day after all other service-users had left.

Some gay men felt that if their sexual orientation was known by practitioners there would often be an assumption made that they were promiscuous and that health practitioners would assume that their symptoms must be as a result of sexually transmitted infection.

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“The doctor who was doing my exam commented that my wife's name was spelt wrong on the forms, after I corrected him that my 'wife' was male and the name spelt right, he carried out the exam. He found some white material in my throat and went to get the consultant, they examined my throat then had a discussion, then started asking personal questions assuming that it was a sexual transmitted infection, I don't think they would have asked those questions if I was straight.”

(Gay male) Likewise for some bisexual individuals, being open about their sexual orientation had been challenging due to health practitioners' negative reactions. Bisexual interviewees commonly perceived that it was harder for them to be open because practitioners were less understanding and some felt that health practitioners tended to view them as promiscuous.

“Sometimes if you’re talking about sexual health and you come out as bi some people then assume you must be promiscuous. It could be that I’m being paranoid but I feel my GP does look down on me a bit since knowing about my sexuality.” (Bisexual female)

8.1.2

Positive experiences of health services There were many supportive comments about the treatment of the LGBT community in health situations, where people felt that they were treated with due respect and professionalism and were treated exactly the same as heterosexual patients.

"My partner came to visit [me in hospital] and introduced himself to nursing staff, there were no problems and he was always made to feel welcome. As a gay patient, I think I was treated no better or worse than anyone else, it was all very professional." (Gay male) Genito-Urinary Medicine (GUM) clinics were frequently noted as positive examples of how a health service could support the LGBT community.

Good practice example Though the occasional negative experience was mentioned, GUM clinics were widely perceived to be supportive of individuals irrespective of their sexual orientation, very inclusive and accepting in their language and approach.

"My experience of the GUM clinic was particularly good. I liked the confidentiality and they were friendly, encouraging and easy to talk to." (Gay male) Similar positive experiences were expressed with regard to outreach programmes and support services and walk-in clinics run by organisations such as the Lesbian and Gay Foundation, Body Positive, Queer Notions and the Armistead Project. LGBT people perceived the staff to be friendlier, more relaxed and non-judgemental. In addition they felt these were geared up to helping the LGBT community by providing direct support in the form of one-to-one advice and meeting groups for LGBT people with related issues, as well as acting as an initial point of contact for LGBT people who may need more specialised or in-depth health services.

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"There are LGBT support services in the region which are doing an incredible job…

Without these services and the people who run them, I may not have been helped on the road to recovery…I would really advocate that more of these services were set up across the region to ensure that LGBT people have this support regardless of where they live."

(Gay male) Frequently LGBT people accessed either these organisations or GUM clinics for their health requirements rather than access services through their GP, this was particularly prevalent with gay or bisexual male community. Sometimes this was for reasons of discomfort, with others this was because of prior negative experiences.

"I'm not open about my sexual orientation with my GP…I rarely see him and there is no relationship between us that I would feel comfortable talking about my sexuality. I would prefer to use an STD [sexually transmitted disease] clinic at the hospital to find out this information. They are geared to providing this service, rather than advice on general health… [and are] less oppressive than announcing it directly at your GP." (Gay male)

8.1.3

Negative experiences of health services A common concern among same sex couples within the LGBT community was with their ‘next of kin’ status. Many interviewees perceived that some practitioners would not accept same sex partners as next of kin, highlighting direct and indirect experiences of this.

“There was one time I was in hospital and my partner wasn’t allowed on the ward with me because she wasn’t deemed as next of kin and it wasn’t necessary for them to be there according to the ward sister.” (Lesbian female) LGBT communities frequently highlighted examples of homophobic experiences within hospitals.

There was a perception that staff treated LGBT couples different from heterosexual couples, again predominantly with regard to same sex partners being present. Though there were also supportive comments of hospitals in general, there were more than a few examples given of openly homophobic remarks or behaviour made by some hospital staff to same sex couples. In some cases, staff refused to recognise same sex partners, with some instances of nursing staff unwilling to allow same sex partners to stay with the patient, and some refusing to give details of important medication or treatment advice to same sex partners.

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“My son goes into hospital quite a lot and when I was with my ex-girlfriend, the sister on the ward wasn’t happy that …. both of us were staying with him, although at the time I classed her as [his] other parent and I still do. The sister wasn’t happy about that and just because I was his birth mother, she wouldn’t acknowledge my girlfriend or anything that she said. If I was out of the room and [my son] needed his medication the sister wouldn’t give it to him if only she was there, she would insist that I was there for her to do it, even though I had given full permission for her do it. …

They wouldn’t talk to her about what was going with his treatments or medication with her…. they would only talk to me about things. I didn’t challenge it at the time, I just wanted [my son] to get better and to get him home. I am sure that a man and a woman would be allowed to stay with their child. On the first night we were in a big room with a double bed in it for us, but then when this sister came on she moved us into a smaller room with a single bed and said that we couldn’t share it 'cos it could only hold a certain amount of weight! If we had been a heterosexual couple, we would have been allowed to stay in the double room.” (Lesbian female) Mental health services were an area that generated more negative than positive experiences from the LGB community. Though some acknowledged that this perhaps was a result of an inadequate mental health service for all people regardless of gender identity or sexual orientation. LGB people commonly perceived that often complex issues were not dealt with adequately and sexual orientation frequently wasn’t taken into account within treatment. Furthermore many people had found provision for substance and alcohol misuse for LGB people difficult to access.

"I tried to kill myself a fortnight ago and a suicide counsellor told me I was a lost cause, there was nothing for me ([name of] hospital) and that I should just go to A and E but I’m bipolar and you get into a vicious cycle between doctors and A&E. [Name of NHS centre] has a dreadful reputation for dealing with gay people." (Bisexual female) LGBT users of mental health services frequently noted negative experiences around not having the predominant causes for their condition addressed within treatment, and the link to their sexual orientation or gender identity were inadequately understood by medical professionals.

“I was told by the medical ‘experts’ that my sexual orientation had no relevance to my mental health issues. This was despite the fact that I had been a victim of homophobia for over 30 years.

The doctors were very insensitive in how they dealt with my history of victimisation and completely blind to the sexual orientation component of my alcohol addiction. They were too concerned trying to find a way of treating the outward symptoms without showing any interest in diagnosing the complex underlying condition, of which my sexuality was an intrinsic part. I was promised a lot of support services while spending a period in hospital for this condition, including community care and counselling. I received none of this support despite feeling that I really needed it, and completely lost confidence in the medical staff who had been looking after me as a result.” (Gay male)

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Some gay and bisexual men raised concerns about giving blood. Their sexual orientation meant they were unable to give blood and left them feeling very embarrassed, and uncomfortable. The Blood Service continued to send letters about donating, which were never explicit that being gay would preclude individuals from donating. There were also objections raised to the association within the blood donation form between being gay, using prostitutes and using intravenous drugs.

"I felt terrible, I went to donate blood in the hope I could save someone's life and here I was being associated with drug-users and prostitution…I could not understand why they had not made things clearer [when they asked for donations]. It would have saved me going along in the first place and having to find out in such an upsetting way." (Bisexual male) Many lesbian women interviewed suggested a lack of understanding among practitioners in their dealings with health services. Many interviewees reported that practitioners initially assumed that any symptoms of ill health in women were automatically due to pregnancy. There were numerous examples given of confusion of practitioners if lesbian women stated that they were sexually active but didn’t use contraception and there was also incidence of lesbian women being refused contraception because of their sexual orientation.

“Once I was experiencing a lot of pain with my stomach and they insisted that I had to a pregnancy test. I told them that it was impossible for me to be pregnant as I had never slept with a man, and the response was 'yes but you’re sexually active'. They didn’t seem to get the fact that it was with women.” (Lesbian female) The reasons behind poor attendance of lesbian women to cervical smears suggested in the Meads study of health services in the West Midlands (see Chapter Three), were echoed by the experiences of lesbian women in the North West. There were widespread examples of confusion as to the appropriateness of cervical screenings for lesbian women; furthermore there were instances described of lesbian women being denied cervical screenings because of their sexual orientation. Interviewees noted that information leaflets on smear tests often highlighted the main reason for needing them was because of heterosexual activity which implied that the lesbian community did not need them. Indeed many lesbian women perceived Well Women’s clinics to be for heterosexual women only.

“My girlfriend was told that she didn’t need a smear…..as she has not had sex with a man. We found this insulting and demanded that she had a smear. The assumption that cervical cancer only occurs with connection to how many times/how many men you have slept with is wrong and insulting.” (Lesbian female) LGBT individuals raised concerns about the low standard of sexual health advice offered regarding sexual activity between women, with a common perception that sexual health advice largely covered either heterosexual activity or sex between men, and that there was subsequently little information provided about safe sex with other women.

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“I’m not sure I’ve been provided with the right information. When using sexual health services I am not given any advice about sex with women, whether is what I can or can not get in relation to STD [sexually transmitted diseases]. I was also told to use condoms with sex toys and my long term partner, which made me wonder if the individual understood the nature of my relationship. I did not feel comfortable disclosing this information however I did not receive any negative feedback but I did not feel they were prepared nor had an understanding of my sexual risks as a gay women.”

(Lesbian female) Interviewees perceived there to be difficulties in accessing fertility treatment for same sex couples.

Some lesbian interviewees perceived that they were ineligible to access NHS treatment because they did not have a health problem that would affect conception, and so were obliged to pay for this treatment privately. There were some misconceptions about the extent to which NHS treatment was free of charge to different groups of potential parents. Private treatment unaffordable for some couples, and there was also a perception of a lack of private provision in the North West.

“I think that this part of their policies is about homophobia…as it runs counter to the principle of equal access to treatment for all. If you are a heterosexual woman with a partner who has say, a low sperm count, you get treatment for free whereas we have to pay.” (Lesbian female) The study highlighted numerous examples of heterosexism within North West health services.

Female interviewees detailed common experiences that in undergoing treatment such as cervical smear tests or requesting medication such as the pill, practitioners frequently assumed that the individual was heterosexual. Members of the LGB community who had children frequently were assumed by the health services to be heterosexual. GPs frequently assumed that their patients were heterosexual during consultations and rather than the practitioner asking, often the individual had to volunteer this information. There was also often an assumption that individuals would rather be treated for more personal examinations by a practitioner of the same gender, even though this would make some patients uncomfortable.

“I had a pain in my abdomen and so went to the doctor….he said to just get a girlfriend and have sex with her and this would make me better. This was in central Manchester.” (Gay male) LGB individuals also highlighted that when they did complain about heterosexist, homophobic or transphobic treatment by health practitioners rarely was any discernable action taken. This could have a profoundly negative effect in the long run, because it fails to address this form of abuse and normalises this behaviour. “…When I first moved to Manchester I registered at the nearest surgery only to find that my doctor was an extremely homophobic Indian guy, he tried to give me a moral lecture about being gay once and we ended up in a stand up row. I tried reporting him to the practice manager but nothing came of it.” (Gay male)

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Finally, one of the key experiences of the LGBT community was the inconsistency of healthcare provision throughout the region. Though not exclusively positive, Manchester was held up by many as a beacon of good practice with regard to services geared to the lesbian, gay and bisexual community, and though there was a more mixed response in Liverpool there were many positive experiences of health service provision in this area.

“My partner had a brain tumour and was referred to Christies hospital in Manchester, [they] were absolutely wonderful. They were just so welcoming and lovely and treated me as her partner and fully respected that and it wasn’t an issue at all. I think is probably because it is in Manchester and in general it is a much more diverse and open city to be in. Also there is probably a more proportionate representation of gay people on the staff so seeing a same sex couple on the wards etc wouldn’t be such a big deal as it is here [Cumbria].” (Lesbian female) Blackpool also had a strong reputation for good practice in treating and advising the LGBT community. There were however many negative examples highlighted certainly in rural areas, but also elsewhere in the region in smaller urban areas where services were often perceived negatively, whether due to the attitude of practitioners to the LGBT community or poorer access to LGBT specific services.

“The [STI] testing place in Blackpool you get your results back very quickly. In Preston it can take up to 14 days which is such a long time. And they don’t tell you if you’re clean, you’re on constant alert for 14 days, and you only get a text if you’ve got something nasty.” (Gay male)

8.1.4

Trans people's experiences The trans community had quite separate experiences of the health services in the North West. In most cases transgender people were open about gender orientation because they were reliant on the medical establishment for gender reassignment treatment. However, where it was not relevant to access health services some said they would not disclose for fear of discrimination, due to concerns about the accessibility of health records within the health services and confidentiality under the Gender Recognition Act 2004. Many trans individuals also highlighted that though gender orientation was often known by health practitioners, their sexual orientation was rarely requested.

“Excluding services specifically related to gender reassignment I am never explicitly out when accessing health services for fear of discrimination or being treated differently.” (Trans individual) One of the main concerns expressed by the trans community was the lack of timely healthcare for trans people. There were time implications with the initial referral process, going through the gender reassignment process, as well as accessing mental health services all of which were essential to completing the transition. A prevailing perception was that this length of treatment time was a deliberate attempt to deter trans people from going through with the procedure. Indeed many trans interviewees reported that they had had to be proactive and persistent in dealing with the issue or they would not have succeeded in getting the appropriate treatment.

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“At the moment having trouble…applying for funding for chest surgery, and it’s ten months and counting and I still haven’t had a letter back from the PCT, despite five letters going their way from my GP and numerous phone calls by their staff. They seem to be incredibly hard to get hold of, these people. Otherwise, mental health, I am in the queue for therapy, which is going to be 12-18 months before I get seen…” (Trans male) Trans people gave numerous examples of transphobia among health practitioners. Some highlighted incidents where they had either been refused medical treatment or had not been referred for appropriate examinations. Some trans individuals had experienced health service staff either who refused to acknowledge their gender or were confused by the individual's appearance.

This was disconcerting, disempowering and upsetting when it had occurred in a public area. On some occasions trans people had been questioned on using disabled toilet facilities.

[Interviewee described an incident when trying to access emergency hospital treatment, the reception staff delayed access to treatment until their confusion about his gender had been sorted out. Individual felt disempowered as he was unable and unwilling to argue the point in public]. 'I was so unwell that I couldn’t cope with it just standing there having this really long discussions…she refused to give me access to treatment until she had resolved the anomaly. I was more upset because this was a medical emergency. I would be more happy to deal with the situation if I had been physically up to it. I feel that at that time I was indirectly discriminated against as a transsexual [person] and would have received treatment quicker if I had been ordinary” (Trans male) There was a widespread concern that trans issues were not taken seriously because of the relatively small population, and some blamed the proportionally high suicide rate among the trans population on the detrimental effect of poor services.

“Trans people are not taken seriously. We have a paradox – we’re reliant on health services yet there are relatively few of us to make a fuss in order for things to change.” (Trans male) In relation to mental health services, experiences for trans people were also of very mixed quality.

There were incidences where some within the trans community were not confident about being honest about mental health issues for fear of this would have a negative impact on their gender reassignment treatment.

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“Mental health stuff I’ve found really difficult… firstly because I don’t want it on my records, I’ve got to be really careful about getting any diagnosis on my records as I wouldn’t want it to be a reason why I might be seen as too crazy to know my own mind enough to make a decision regarding surgery and other things…they say that you can’t really be suitable for trans treatment if you have any contributing psychiatric conditions that might be the cause of you wanting to transition; it goes far beyond that, not just including someone who says ‘I’m a man, but not just any man, I’m Napoleon!’ sort of delusions, but it can also include self harm…I’ve been told that I can’t have any healthcare treatment until that’s been taken care of and managed…if you’re trans what you can actually say to your mental health team is often quite limited because you can’t risk the fact that agencies will talk to each other…” (Trans male) Despite strong evidence of negative experiences of health services, there were some who had had positive experiences, giving examples of understanding hospital staff, or supportive GPs. Furthermore there was an acknowledgement by some of how far health services had travelled over the last 10 to 15 years. “[I] had [an] excellent experience with my GP. Total respect by everybody….He has been involved in all issues. I have been attending a gender identity clinic for about ten years and in my opinion they have become better and better. I can see clear progress there…the last few years I have felt respected and supported and helped in a way that was good for me.” (Trans male) Trans communities also expressed major concerns with the lack of provision in the region. People had to travel to London or further afield to undertake gender reassignment and acquire hormones.

There was a perception that this process was a 'postcode lottery', and that equal access was not guaranteed for all. Many of the trans community perceived a lack of adequately trained staff in this area, and that this was not part of standard medical training which did not support an adequate service.

“A lot of the health services for Trans people are located in London. I have to travel to Charing Cross for a 30 minute appointment sometimes. I have to use public transport and it is costly to travel. Because of the time and distance, family and friends cannot take the time off to come with me for support. This also raises the question whether it is ethical to allow someone to travel back to the North West from London unaccompanied after they have had treatment or surgery.” (Trans individual)

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8.2

Impact on LGBT individuals The perception among LGBT communities of a lack of quality provision in some areas of the region impacted on some who had the added time and costs of travelling to these areas to access the services. This suggested an impact on those services being able to maintain a high standard of provision to the LGB community. It also means patterns of demand based on usage are most likely inaccurate as the evidence suggests some centres were having a 'honeypot' type attraction.

“Manchester has some good sexual health services and I feel much more confident accessing services in Manchester than in Liverpool. They’re much more geared toward my sexuality. They had understanding of the issues that I may face as a gay man. Any education that was done around sexual health was done in a non-patronising way.” (Gay male) However some within one of the focus groups discussed how they sought out a particular GP in the Manchester area because he was gay and had a good reputation for working with the LGBT community, only to be refused access due to coming from outside the catchment area.

For LGB individuals who felt unable to be open about their sexual orientation with health practitioners, this lack of openness also obstructed them from fully accessing health services; and individuals were put off from accessing health services they needed because of the negative experiences described above. These types of incidents made it extremely difficult for LGBT people to access services that others had little difficulty accessing and suggests that LGBT people may be presenting later at health services as a result.

Furthermore many individuals both in the trans and LGB community said they had to be proactive and forthright to get the health services they wanted and that practitioners where often less forthcoming with options. This had a big impact in terms of unmet need and exposes the risk that there may be others, lacking this self confidence or assertiveness, who as a result will not be getting the health services that are required. This particularly applied in asserting the rights of a same sex partner. The evidence highlighted that LGBT individuals had to challenge some health practitioners on negative reactions to their same sex partner usually in moments of distress.

“Just being invisible has been a barrier.” (Bisexual female) There were impacts in terms of safe sex education, particularly for lesbian and bisexual women.

The lack of safe sex education for lesbians, alongside the information leaflets covering same sex sexual activity for women, often implied that those women didn’t have sex with men. This can have a profound impact on the health risks of the lesbian and bisexual community. There were incidences within the study where women were given inappropriate sexual health advice which in some cases could have impacted on the wider community. It appeared that safe sex education for women was a clear area of need.

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“Recently [at] family planning clinic and GUM clinic, no one has ever asked about [my] sexuality.

As a HIV positive woman, no one has ever spoken to [me] about safe sex with women because they have assumed [I am] straight [she was married and has children].” (Bisexual female) The impact of conflicting messages regarding cervical smear tests was that a large section of the female lesbian community does not go for cervical smears, either because they have been refused previously or due to confusion as to whether sexual orientation prevents them from accessing this important health service.

“There is much confusion as to whether having sex with a woman qualifies you for a cervical smear. When I first went for a cervical smear, I had had sex with a woman but not a man before.

When the nurse detected that I had not been penetrated, she refused to continue. Different medical professionals give different advice. The leaflets advertising smears are unclear.” (Bisexual female) The lack of appropriate mental health services for LGBT populations described above was a key issue with significant impact. A lack of appropriate mental health advice could have a severely negative impact especially when the advice is inadequately tailored to individuals’ issues, leading to wider social impacts such as other health issues and an inability to participate economically.

There were two key areas where health practitioners’ lack of awareness was potentially preventing some from accessing health services: lack of knowledge about same sex couples attempting to access fertility treatment; and lack of knowledge with the wide-ranging needs of the trans community. Often same sex couples encountered ignorance of options open to them, and numerous examples were given where individuals were required to bring information with them for appointments in order to be referred. With the trans community this also held true, however there was a strong perception that throughout the health service there was not enough adequately trained professionals to address the needs of the transgender community, and that their treatment was therefore inadequate.

“As a trans person I have definitely not been able to access appropriate health services. I have been battling for 15 years to try to access services which have been denied to me and without which I am prevented from completing my journey to achieving my female identity outwardly. I have never been offered the option of a full range of appropriate health services following my surgery. I have only found out about these services through my research and by obtaining reports from professional medical bodies into the adequacy of services for trans people….I was speaking with a nurse who specialised in training staff how to insert catheters. She was completely unaware that, where a trans patient had undergone gender reassignment surgery, the catheter could be inserted incorrectly and could cause serious damage. She had only ever trained in how to apply catheters to people who were the same gender as birth, and was passing this advice to other people in the profession….I feel that I am a second-class citizen and whenever I try to ask for help from the medical profession, I am turned down as an inconvenience.” (Trans female)

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There was a consistent perception within the trans population that persistence was essential if they were to be taken seriously by health practitioners and that trans people were kept waiting in the hope that they will give up. This leads some to pursue a route into private health provision to ensure their needs are met, with some travelling abroad for such treatment. For others however the perception of inadequate health service provision (and an inability to pay for private treatment) has deterred them from accessing health services. There was also mention by interviewees of the high suicide rate among the trans community linked to a lack of understanding or adequate provision for their needs.

"To be honest I don’t access health services very much. I find it intrusive. It scares me. I prefer to self-medicate, Homeopathy, the black market for hormones etc. I don’t like doctors. I distrust the medical world." (Trans individual)

8.3

Implications for the regional economy The above evidence indicates that LGBT people have very varied experiences and perceptions of health services in the region. Availability of good quality and appropriate health services for LGBT people varied considerably by sub region, particularly in relation to provision for trans individuals.

Lack of understanding of LGBT people's health needs and inappropriate health advice may be having an impact on the health of the region's LGBT population and ultimately on their quality of life and ability to contribute to the region economically. For instance poor perceptions of health services may lead to LGBT individuals presenting with health problems later, when problems can be more serious or difficult to deal with and may contribute to poorer health outcomes for LGBT people. This can impact economically in terms of days lost through sick leave and related health and well being issues such as poor mental health outcomes. Supporting the LGBT community to access good quality, appropriate medical care will be vital in support of their contribution to the region's success and prosperity.

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9.0

Hate crime This chapter considers the issues around LGBT communities and crime. It presents findings on LGBT communities’ experiences specifically of hate crime; the prevalence and nature of hate crime and their experiences of reporting it (Section 9.1) and then looks at the effects and impacts of hate crime on LGBT groups and individuals (Section 9.2). The chapter draws upon feedback in interviews with LGBT people.

9.1

Experiences of hate crime As highlighted previously in Chapter Three, there is no single standard definition of hate crime but it is commonly defined in this context as an incident perceived by the victim to be homophobic or transphobic. 1 This definition was used in interviews to explore LGBT people's experiences of hate crime.

9.1.1

Prevalence and nature of hate crime experiences The evidence from LGBT communities revealed that being a victim of hate crime as a result of sexual orientation or gender identity was a fairly common experience across LGBT groups in the North West. There were clear examples from LGBT people that they had experienced hate crime themselves, or in more isolated examples reported knowledge of crimes committed against a friend or partner.2 The interviews revealed examples of LGBT individuals who had experienced more than one incident of hate crime. Although the interviews did not explicitly collect information on the number of incidents, there were clear examples of LGBT individuals who referred to hate crime incidents in the plural. This again confirmed published literature which found that a common characteristic of hate crime was that it would happen more than once to the same victim.

There was however a recurrent view from some older LGBT people, typically those over the age of 50, that hate crime occurred more frequently in the past than today. While in all cases there wasn’t confirmation of the exact timing of this experience it appeared to be several decades ago, prior to specific legislation and greater acceptance and awareness of LGBT groups which would account for this perception. In one exceptional case, the abuse occurred before homosexuality was legalised. However, examination of the ages of other interviewees who reported having experienced hate crime suggests that hate crime was a more recent experience and, therefore, is indeed a current issue for LGBT groups in the North West.

1

See Section 3.6.

However given the qualitative focus of the interviews it is not possible to use these findings to ascertain specific figures on the incidence of hate crime.

2

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LGBT groups experienced hate crimes representing a spectrum of incidents from verbal abuse and attacks on property to serious physical and sexual assault. This again echoes the evidence from the literature that hate crime can take on the form of any crime type and include both personal and property crime. Furthermore, certain incidents that LGBT people experienced were not perceived to be a ‘crime’, suggesting a tolerance threshold among LGBT people where such abuse was almost ‘normalised’. "[I haven’t experienced] crime as such; just harassment, intimidation, threats, the usual." (Gay male) As a result, there is a possibility that the experience of this type of ‘crime’ was under reported in the interviews and potentially also in any published figures on the prevalence of hate crime across the region. For the purposes of this study the lower level incidents such as verbal abuse are reported on here as a hate crime.

Most commonly, LGBT people reported experiencing homophobic and transphobic hate crime in the form of verbal abuse or derogatory gestures. Verbal abuse was typically experienced in a public place, for example, while walking in the street, waiting at a bus stop, in a bar, or entering the home. In a smaller number of cases, it was also experienced in the workplace. The perpetrators of the verbal abuse varied depending on the situation, but included both individuals known to the LGBT person, for example teachers, workmates or neighbours but most commonly perpetrators were unknown, for example ‘local kids,’ a ‘gang of youths’ or even individuals driving past in a car.

A further form of hate crime, LGBT communities commonly reported was attacks on property. This included car tyres being slashed, wing mirrors being smashed and vandalism on people’s homes, such as broken windows and homophobic graffiti. The instances involving homophobic graffiti made it clear these attacks were hate crimes, in other examples, however, there was no direct evidence but they were perceived to be a homophobic or transphobic crime.

"Once my car window was smashed outside my house and I thought it was the local kids being homophobic but I had no proof." (Lesbian female) Although less commonly reported than verbal abuse, there was also evidence that LGBT people had experienced hate crime in the form of both threats of and actual physical attacks. This included where verbal abuse had escalated into physical assault or violence as well as direct unprovoked violence. The violence was reported exclusively to have been experienced in a public place, most typically when out socialising or in the street. In most cases, the assailants were unknown to the victim. In isolated examples, assumed triggers for the violence were identified, such as couples being affectionate in public or individuals being seen leaving a gay venue.

Overall, experiences of hate crime were reported by LGBT people from all orientations but it was rarer for bisexual people to report they had experienced incidents. Where they did, it was perceived to be due to an assumption on the part of the attacker that the individual was gay rather than directly related to their bisexuality.

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"No-one has ever committed a crime against me because they thought I was bisexual, but I’ve been attacked twice because they thought I was gay. I think that bisexuals suffer from homophobic crimes on the basis of perceived sexuality." (Bisexual individual) The physical violence was most typically reported by gay men and trans people, and this was also acknowledged by individuals from other groups.

"I think the situation is worse for gay men." (Lesbian female) It was acknowledged in these isolated examples, that trans individuals were more likely to be targeted because their gender identity was more outwardly obvious but the interviews revealed little further evidence as to the factors behind different LGBT groups' experiences of hate crime.

9.1.2

Reporting hate crime and seeking help There was clear evidence that LGBT communities were not routinely reporting hate crimes to the authorities. LGBT people were more likely to report physical attacks to the police rather than verbal abuse or property crimes.

"It would take being knifed or something really serious for me to go to the police with any kind of homophobic attack." (Gay male) LGBT people commonly felt that verbal abuse was not a 'crime' and as such they did not routinely report these incidents to the police or seek help for the issue. Similarly, there were other examples of LGBT people who perceived that the police themselves would not take it seriously, or that the police had ‘more important’ things to be dealing with; this served as a disincentive for reporting their experiences.

"Verbal abuse isn’t really seen as anything is it, by the police so I didn’t bother [to report it]."

(Lesbian female) Additionally where the hate crime was perpetrated by people unknown to the victim, LGBT people felt there was insufficient evidence to report it as they perceived that the police wouldn’t be able to help in any way. For other LGBT individuals, there was a perception that they had to just tolerate verbal abuse so reporting it was not necessary. "[Verbal abuse] is just a part of daily life." (Lesbian female) In other examples, across all types of hate crime, LGBT people suggested that the experience was not reported as they did not want to make things worse and provoke additional attacks if the perpetrator found out it had been reported. In exceptional examples, there was a concern that any record of reporting a hate crime might be available to other agencies which could have negative consequences. For example, it was perceived that social services might become involved after reporting a hate crime, if it was felt that any children were in an unsafe environment.

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LGBT people's perception of the action the police could or would take was a common factor in making the decision to report a hate crime. There was a recurrent perception of a lack of faith in the police to take positive action for LGBT people. In isolated examples, LGBT people explicitly reported that they felt the police would not take any action as the police themselves were homophobic. This view prevailed among LGBT people who had experienced hate crime during a period longer ago, when there was less understanding of the issue of hate crime. The introduction of legislation would have encouraged some of these LGBT people to report their experience, had it happened more recently.

"I know things have changed now and there is new legislation that makes it illegal. If it happened now, I think I would report it." (Lesbian female) However, the perception of the police being unsympathetic to reporting hate crime was not restricted to older LGBT people. Other LGBT people who had experienced an incident more recently also held this view, suggesting a potential lack of understanding on the part of LGBT people as to procedures and actions police forces have now adopted for dealing with hate crime.

There was an isolated perception from lesbian women that the police would take attacks on gay men more seriously than attacks on lesbians, although there was no further evidence as to why this view was held.

Alternatively, there were more exceptional examples where LGBT people explicitly suggested that they would report hate crimes so as to ensure that the prevalence of these incidents is known.

"In the past I would not report every incident because back then it was lumped in with crime generally. I think that it is important to report homophobic crime now so that it is reflected in the national statistics properly and gets the recognition it deserves." (Gay male) Where hate crimes were reported to the police, the subsequent experience of LGBT people was relatively positive. Some LGBT people reported very positive experiences where the police were perceived to have listened to the complaint and taken it seriously. And for most LGBT people who reported a positive experience in reporting their incident to the police, this experience was more positive than they were expecting.

"They seemed comfortable talking about LGBT issues and seemed to want to listen about that aspect of the crime, and they explained about it being a hate crime." (Gay male) The development of specialist hate crimes units, such as the 'Sigma' hate crime unit within Merseyside Police, were viewed as particularly positive.

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Good practice example LGBT individuals gave positive feedback about new specialist hate crimes units, such as the 'Sigma' hate crime unit within Merseyside Police, these were viewed as particularly positive examples. For those who had used these to report a crime, the specialist unit were key to their positive experience in reporting a hate crime. The specifically trained officers within these units were perceived to be more understanding and therefore more supportive when hate crimes were reported. LGBT communities felt that these units also encouraged LGBT people to report hate crimes as they demonstrated that hate crime is taken more seriously.

Additionally, there were exceptional examples of LGBT people focusing on a particularly positive aspect of the support received. For example, the reassurance received from the police was a key factor in the positive experience of some LGBT people. In one case, a victim of vandalism was visited by a neighbourhood police officer every night in the week following the attack which provided significant reassurance for the individual involved. For others being kept up to date on the investigation's progress was an important factor in their positive experience.

There were, however, also examples of LGBT people who had more negative experiences of reporting incidents of hate crime to the police. Typically, the negative experience related to reluctance on the part of the police to treat and investigate the crime as a hate crime. In exceptional examples, interviewees reported that they perceived homophobic behaviour on the part of the individual police officers who were dealing with a complaint. There were examples where the police were perceived to be homophobic by implying that the incident was brought on the LGBT persons themselves because they were gay. In other cases, explicit homophobic behaviour was exhibited, for example, the following inappropriate remark was made to a trans individual after they reported an incident of verbal abuse.

"Its not surprising that sort of thing happened to you going around like that." (Trans individual) There was limited evidence from the interviews to robustly suggest that LGBT people's experience of reporting hate crimes was more negative or conversely positive depending on whether the incident was being reported in a rural or urban area, as positive and negative experiences were reported by LGBT people living both types of area. However, there was an explicit recognition by some LGBT people that reporting hate crime in smaller, less cosmopolitan communities was more difficult.

"The police have changed in recent years but I think it is still really daunting to go to the police this may be even more difficult in small communities." (Lesbian female) "I would report incidents to the Police yes, Manchester Police I’d feel safe with, and it’d be less of a trauma if I were to speak to a LGBT liaison officer. You couldn’t expect the same service if you were in Cumbria or abroad though." (Lesbian female)

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Despite the negative experiences of some LGBT people, there was, however, a recurrent view that progress had been made by the police in their recognition and response to dealing with hate crimes.

"The police used to have a shocking reputation, but from my understanding it's all turned around now. It's good to see the police allowed to march in their uniforms at Pride. From speaking to colleagues it seems more is being done for the victims of specific LGBT crimes which is absolutely brilliant." (Gay male) Beyond reporting the hate crime to the police, there were limited examples of LGBT people seeking help from other agencies. Where this did occur, it most commonly involved a social housing provider, as the hate crime attacks were focused on an LGBT person's home and/or they were perpetrated by a neighbour. Generally housing providers were considered helpful and reporting the incidents led to the installation of CCTV at the property or in more serious cases to the LGBT individual being re-housed.

In one isolated example, there was evidence that an LGBT person had had contact with Victim Support but it was not clear whether they had been referred to this agency by the police or whether it was a self referral. In any case, their experience of this agency was not overly positive as they felt this agency couldn’t understand the extent of anxiety the victim was feeling after repeated verbal and physical homophobic attacks.

9.2

Impacts on LGBT individuals The evidence from the interviews demonstrated that experiencing hate crime incidents can have a significant impact on LGBT individuals in terms of psychological effects and changes in lifestyle.

There were several examples of LGBT people reporting that their experience of hate crime, most typically where verbal abuse had been experienced, had led to hurt feelings and affected their confidence. For others, typically those who were subject to more severe verbal abuse or physical attacks it had impacted on them in terms of their sense of security and fear of future crime. In more severe cases, the experience of hate crime has led to significant mental health issues, which has in turn affected other dimensions of their life, form example their ability to work. The following example described the emotional effects of a long running incident of hate crime experienced by a trans individual: "It's taken a toll on my mental health - I've become a wreck, lost a lot of confidence, the old fears about being a victim come back. I've lost a relationship and work because I've been in such a state." (Trans individual) There was evidence that experiencing hate crime has subsequently led to LGBT individuals making adjustments to their behaviour while out in public. This included not being affectionate with a partner while in public, which was perceived to be a likely trigger for hate crime.

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Other LGBT people reported having made other changes to their lifestyles as a result of their experience of hate crime including no longer going out at night or having to relocate to a new area following abuse by neighbours.

Where LGBT people had experienced a negative response from the police following an attempt to report a hate crime incident, this discouraged these individuals from potentially reporting incidents in the future. This may lead to LGBT individuals experiencing continued impacts of hate crime without the opportunity to access support that is available.

9.3

Implications for the regional economy The above evidence suggests that experiences of both lower level, as well as more serious hate crimes are a regular and current experience for LGBT communities in the region. Sub regionally, service provision varies in its appropriateness and relevance to LGBT communities. Living in fear of hate crime can impact on LGBT individuals' self confidence and ability to be open and out, even leading in severe cases to mental health issues which potentially affect people's quality of life and their ability to contribute to the region economically as well as socially and culturally.

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10.0 Rural areas 10.1

Introduction This chapter considers specific issues for LGBT communities living in rural areas of the region, including rural areas and small towns across the North West. These are presented separately because the evidence suggests there are specific issues around the experiences of LGBT individuals living outside of major urban centres which require a specific policy response. This section looks at evidence from the research on whether being geographically located outside of major urban centres (such as Liverpool or Manchester) affects LGBT communities' experience of employment, education and health services. This chapter presents the evidence on LGBT communities’ experiences of education, employment and health including both positive and negative experiences (Section 10.2) and then looks at the impacts of these experiences and how these affect outcomes for LGBT people (Section 10.3). The chapter draws upon the interviews and focus groups with LGBT communities.

10.2

Experiences of being LGBT in a rural area There was some evidence that the experiences of LGBT people living in a smaller or more rural communities differed from those living in more urban or major urban areas.

A key issue for LGBT people in rural areas was around protecting their identity in a close knit community. Interviewees in rural areas noted that they felt they had to keep their sexual identity private, in the workplace and in education and they reported a keen awareness of being careful about what information they revealed about themselves and to whom. Several interviews highlighted the perception that ‘everyone knows who you are’ and commented on the huge differences between living in a city, such as Manchester, compared to living in rural Cumbria or Cheshire, as the latter lacked the diversity present in larger communities.

"I wasn’t out with my little jobs that I did outside college…I just kept myself to myself …I grew up in a small Cheshire town so you’ve got to be careful because people talk, you know." (Gay male, Cheshire) "I stick out like a sore thumb and issues around identity in the work place that makes me feel uncomfortable." (Lesbian female, Cumbria) "If it [being gay] was mentioned at all it was always in a very negative way. I didn’t even realise it was a possibility, I lived quite a sheltered life I think, growing up in Carlisle." (Lesbian female, Cumbria)

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LGBT individuals felt they had to make choices about whom they could be open with as they did not want issues around their sexual orientation to impact on their professional career. This meant individuals expended energy protecting their identity and often felt isolated as other LGBT people were not 'visible'.

"The area that I work in is not broadminded. I think if I was working in Manchester or a bigger city then I don’t think my sexuality would be an issue and I don’t think I would be quite as closed as I am about it.” (Lesbian female, Cumbria) Generally speaking, rural areas were less likely to recognise or cater for the LGBT community and there was a lack of positive LGBT role models or services.

"A lot of it comes down to the local community not catering for LGBT people, socially, politically or just on a cultural basis. There’s no positive enforcement of the gay identity in the local area. I don’t know if they gay community shy away from trying to include themselves in the wider community or if it’s the wider community that prevents that from happening." (LGBT individual, Cumbria)

10.2.1

Experiences of employment There were issues around accessing support in rural areas for LGBT individuals in the workplace.

For those working in rural areas in the private sector, in both large and small sized companies, many lacked faith in organisations to act upon any equal opportunities policy that might be in place.

There were various reasons put forward for this – some did not feel anyone locally would actually know what to do if someone brought up an issue regarding inappropriate or offensive language, others commented there was a lack of training for all staff on equality and diversity. While this was also an issue for employees more generally it appeared to be heightened for those in rural areas who lack alternative support mechanisms.

"Although the Equal Opportunities Policy is there, it’s very hard to enforce it. The training is there, around differences, but I don’t know how it could be made more of because there is a cost implication and for voluntary organisations it’s a real issue. It could become a part of the induction, a specific section of training about equality and diversity.” (Rural focus group participant) Other respondents were either unaware of Equal Opportunities Policies or felt the organisation they worked in did not have one. This left them feeling that they had no support structure to deal with direct or indirect discrimination in a rural community.

Living in a rural area also affected the type of job opportunities and employment sectors that were available to LGBT people. In rural areas these were often perceived to be more outdoor focussed and often seen as 'male dominated' and therefore less likely to be open and accepting of LGBT individuals.

"Working in conservation tends not to be an open environment with regards to diversity.” (Rural focus group participant)

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“I am … going into outdoor pursuits and that is very daunting and feels very different as it is a very male dominated profession. I have just been on a six day training course and I felt uncomfortable probably for the first time in my working life, coming out, because I wasn’t sure about it. I had a slight hesitation about being myself.” (Rural focus group participant)

10.2.2

Experiences of education The qualitative evidence suggested members of the LGBT communities attending post-16 learning felt that LGBT learner support and policies were not always in place in rural areas, though this was not solely a rural issue.

"I think there should be support groups within universities. The [education institution] here seems very reluctant to support LGBT people through groups and societies. They can't say, we support equality and diversity but they don’t want anything to do with LGBT people. It's ridiculous." (Trans female, Cumbria) In particular to rural areas, the geographical settings of the educational institutions, for example being split over several different – and remote – sites, meant that students lived in small communities compared to the majority of other universities where students form part of a large campus community. This meant that LGBT people were more isolated and less able to access support networks.

10.2.3

Experiences of health The responses of the LGBT community to health provision in rural communities demonstrated both positive and negative experiences and appeared to be highly dependent on experiences with individual practitioners. On the positive side: "I have had extremely positive experiences of NHS services. My previous partner was diagnosed with cancer in 2004 and died in 2006 and all the way through I was treated with respect as her partner, included in all the decision making and I was there when all the tests were done. The district nurses were incredible… I came up here [Cumbria] assuming there would be some prejudice but we have not experienced any." (Rural focus group participant) However other experiences respondents showed a lack of understanding in respect of same sex partners and family in hospital situations. Again, these experiences related mostly to the attitudes of a few individuals. The lack of health provision in rural areas particularly for individuals wishing to transition was highlighted.

"When I transitioned in 2007 there was not a Gender clinic in the North East or Cumbria so I had to go to Edinburgh to see my gender psychiatrist… I had to do the ‘Life Test’ where you life in your new gender for two years, and by that time a gender clinic had been set up over on the North East so I was referred there to see another psychologist to get my second opinion for surgery. I was then referred to my surgeon who is based down in Leicester." (Trans individual, Cumbria)

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10.3

Impacts on LGBT individuals Living in a rural area and the potential isolation that goes with it can impact on LGBT individuals.

For instance, where individuals felt that there was no effective support structure representing equality and diversity, they felt pressure on them individually to change people.

"It seems that the onus is always on you to tell volunteers that the language they use is homophobic or inappropriate, and it would be really nice for your straight counterparts to take that responsibility on. Until more of us come out [in rural areas], the changes are not going to happen.

Individuals putting themselves on the line, taking the battering and sometimes literally a battering, and being out there normalising it…" (Rural focus group participant) Having positive local examples of proactive employers can have a beneficial impact in rural communities. A positive example showed how change had taken place over recent years in their rural community through the work of one committed individual.

"Since I have been here, our manager … has worked very hard to learn how to make the place accessible and friendly towards LGBT people. We seem to have a number of trans people in this community who are now able to volunteer within our community centre and our non-LGBT staff and volunteers volunteer on LGBT nights and events that we put on! It’s fantastic." (Lesbian female, Cumbria) A key impact on LGBT communities in rural communities was the lack of support services available and the impact of this in relation to feelings of isolation. Interviewees perceived there to be a gap in terms of provision of support networks either through work or more community-based avenues.

Some individuals interviewed had helped set up LGBT support groups in their local area as there had been nothing available. Some groups were identified, for example, Pride in North Cumbria (PInC) and Connexions in Carlisle run a youth group for LGBT people. However where groups did exist there were difficulties accessing them given travel time distances and costs, or because there was not enough of a critical mass to support groups for specific age groups or with common interests (e.g. parents). Many participants said they were unable to access a relevant support group in their specific local area.

"I do feel isolated, all my friends from school are straight so the only gay friends are at PInC and they are all younger than me so it gets a bit frustrating… I would like there to be a social group set up because currently there is nothing for people over 25.” (Lesbian female) “Isolation is an issue - I don’t know of any gay parent support groups or anything but I think it would be really useful, especially when [my son] starts school because parents will have an issue with it and I think some of the kids might have an issue with it, so I think it would be good. I don’t know of anyone else with kids so there is nobody else to talk about with it. I live in a village outside of Carlisle and it is full of people who are homophobic idiots. If you're gay you're basically out of the village.” (Lesbian female)

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Feelings of isolation, combined with direct and indirect discrimination, led to some participants feeling they needed to leave rural communities in which they have grown up and move to larger urban areas to find work, to learn and to fulfil their potential.

"One of the boys in my nephew's class found out I was gay and has been picking on him because of it. I kicked off about that but I don’t think anything has been done. That is one of the main reasons that I want to move into Carlisle 'cos it’s a bigger place and it's more anonymous."

(Lesbian female) For some participants, the internet has provided access to services unavailable in their local rural community.

"As I live in a rural village with no gay pubs close by, I did feel isolated until I got the internet. I now use websites like [name] to chat with other gay men and through this I have built up a good social life. I think that the internet has changed a lot of things for gay men. You no longer have to go to cruising areas just to find someone to talk to." (Gay male)

10.4

Implications for the regional economy The above evidence suggests that LGBT people living in rural areas of the region experience isolation and feel unable to access the same opportunities as their counterparts in more urban areas. Some feel compelled to move to major urban centres in order to feel better supported, be open and accepted, and to find appropriate work opportunities. This implies a missed opportunity where skills and talent are being lost from rural economies.

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Annex One: More details on our methodology

A1

More details on the methodology This annex contains further details about the methodology for the study.

Literature review A review of current and recent literature (dated 2007 onwards) was undertaken in relation to the issues being explored by the study around work and employment, business support, education and health issues, and experiences of crime looking at issues, barriers and opportunities for LGBT people. This element of the research helped to identify data sources available on the LGBT population, inform the study on current thinking and guide the topic guide design for the community research element. Findings were summarised and form Chapter Three of this report.

Population estimate A review of data sources and literature was undertaken to provide a population estimate of the LGBT population in the North West region. This included reviewing estimates of the UK’s LGBT population developed by government departments, including those developed by Her Majesty Treasury Department in 2006 and extrapolating those to the NW region and sub regions. This review also looked at available data on HIV, sexual activity reviews and data on same sex households – all at the regional or sub regional level within the North West. This data was analysed and combined with other contextual research to provide a working estimate of the LGBT population for the North West region.

Recruiting researchers and the peer research approach A key aspect of the study was to ensure that the LGBT community participated in the study as a Community Research Group, to work alongside researchers from ECOTEC. In total thirty individuals were recruited to participate in the study as community researchers. Individuals were recruited via a targeted marketing campaign in tandem with the LGF which included advertising on the web and Facebook, through viral email and through the 'OutNorthWest' magazine. Significant work was done to promote the project through contacting university LGBT groups, LGBT community groups, third sector and public body organisations, and other appropriate community organisations located via web search and snowballing sampling, with advice from the Research Reference Group. Individuals interested in the study received a project outline and person specification and were invited to complete an application form and submit a CV.

A2

The thirty community researchers were selected from the pool of applicants to reflect the diversity of the region's community in terms of geographical location/sub region, gender, sexual orientation and gender orientation, age, and ethnicity. Community researchers received a training manual and small group training session and were supported to do the work through mentoring via telephone and email. Community researchers were each given a quota of interviews to achieve and collectively targeted to complete a series of focus groups. Researchers were paid on the basis of numbers of interviews achieved and focus groups completed. All interviewees received a £20 voucher as a thank you for their time.

The interviews were conducted using a topic guide which was piloted by the community researchers during the training sessions and also validated by the Reference Group. The interviews and focus groups were written up using a common structure in word and excel.

Feedback was given on initial write ups to ensure the quality and all interviewees signed a receipt form to confirm the research and to acknowledge receipt of the £20 incentive.

Fieldwork: interviews and focus groups The main element of the fieldwork was a programme of in depth interviews lasting around an hour each, and focus groups with LGBT individuals and groups from across the region. The thirty community researchers were supported to deliver this programme of peer research. This included: • 303 in depth interviews with LGBT individuals; and • 19 focus groups, representing 158 LGBT people’s views.

The focus groups and interviews were profiled broadly by: sub region, urban/rural, to cover LGBT groups, age, BME groups and to include people with a disability. A breakdown of the sample profile achieved is available below.

Sample profile of all interviewees The sample profile consisted of 428 individuals in total, which included interviewees in both depth interviews and focus groups. From this total, 56% were female and 44% were male.

Table A1.1 Gender of interviewees Category Number % Male 197 43% Female 257 55% Other 8 2% Total 462 100 Source: ECOTEC Research & Consulting (2009)

A3

In terms of gender identity, the sample consisted of 42 transgender individuals (10%) that had transitioned from the gender assigned to them at birth to live their lives as the opposite gender. A further 11% of interviewees (46 individuals) lived and worked full time in a gender role opposite to that assigned at birth.

The sample was also profiled by sexual identity/orientation, with the largest proportions of interviewees describing themselves as lesbian (40%) or gay (39%), followed by those who identified as bisexual (11%), straight/heterosexual (1%) and other (3%).

Figure A1.1 Sexual orientation of interviewees

17 4%

51 11%

3 1%

26 6%

184 39%

181 39%

Straight/heterosexual

Gay

Lesbian

Source: ECOTEC Research & Consulting (2009)

A4

Bisexual

Other

No reply

The age range of participants was fairly evenly spread between the ages of 18 and 59, with a smaller proportion of those aged over 60 (4%).

Table A1.2 Age range Age Range 18-24 25-34 35-44 45-59 60+ No reply Refused Total

Number

% 95 123 116 79 17 28 4 462

21% 26% 25% 17% 4% 6% 1% 100%

The profile of interviewees included representation from all ethnic groups listed below. They were predominantly White: British (86%); Irish (3%) or another white background (4%). They also identified as: Mixed White and Asian (2%); Black Caribbean or Mixed White and Caribbean (1%), Indian (1%) or having another ethnic background (1%).

Table A1.3 Ethnicity Category White British White Irish Any other white background Black African Black Caribbean Mixed - White and Black African Mixed - White and Black Caribbean Indian Pakistani Pakistani British Asian or Asian British Indian Any other Asian background Mixed - White and Asian Any other Mixed background Any other ethnic background No reply Total

Number

% 397 10 15 2 3 2 6 3 1 1 1 2 7 2 6 4 462

Source: ECOTEC Research & Consulting (2009)

A5

87% 2% 4% 0% 1% 0% 1% 1% 0% 0% 0% 0% 2% 0% 1% 1% 100%

The disability profile of the sample illustrated that around a fifth of interviewees (21%) identified as having a disability.

Table A1.4 Disability Number

Percentage Yes 95 21 No 361 78 No reply 6 1 Total 462 100 Source: ECOTEC Research & Consulting (2009)

In terms of level of education, just over half of the sample (51%) was educated to either first degree (37%) or higher degree (14%) level. Around a fifth (19%) had either A Levels or BTEC qualifications and 15% had obtained GCSEs or O Levels. A small percentage of the sample left school without any formal qualifications (6%) and one in ten (9%) recorded other education/qualifications.

Figure A1.2 Level of education reached

Level of education reached Left school without formal qualifications GCSE/ O level

66 14%

43 9%

4 1%

24 5%

69 15%

A Levels / BTEC Degree 89 19%

Masters Other

167 37%

No reply

Source: ECOTEC Research & Consulting (2009)

A6

The sample profile's work status can be divided into the majority (72%) that either worked full or part time (53% and 19% respectively), and those economically inactive that included: students (10%); long term sick/disabled (4%); short term sick/disabled (3%) and those who had retired (3%).

8% of the sample were unemployed.

Figure A1.3 Work status Work Status Working P/T Working F/T 6 1%

36 8%

17 7 14 3 4% 2% 3% 1%

87 19%

Student Looking after home/family Unemployed

43 9%

Long term sick/disabled Temporarily sick/injured Retired 249 53%

Source: ECOTEC Research & Consulting (2009)

A7

No reply

The household income of interviewees was divided almost equally amongst most income bands.

Almost equal proportions earned between £1501 to £2500 (19%) and £951 to £1500 (18%) per month, and equivalent proportions (14%) earned less than £320 per month or over £2501 per month. 10% earned between £321 to £650 per month and 9% between £651 to £1500 per month.

Figure A1.4 Household income Household income

A: Less than £320 per month (£74 per week) B: Between £321 and £650 per month (£75 – £150 per week)

83 18%

61 13%

42 9%

63 14%

40 9% 79 17%

94 20%

C: Between £651 and £950 per month (£151 - £219 per week) D: Between £951 and £1500 per month (£220 - £345 per week) E: Between £1501 and £2500 per month (£346 - £576 per week) F: More than £2501 per month (£577 per week) G: Prefer not to say

Source: ECOTEC Research & Consulting (2009)

A8

In terms of the geographical distribution of interviewees, the below map illustrates the regional spread. This is based on only the first part of postcodes (e.g. M1, L5) as supplied by all individuals in order to protect anonymity.

Figure A1.5 Geographical spread

A9

Locating the sample of interviewees Interviewees were located through a number of mechanisms including: • advertising through LGF's network, on their website, by email and on Facebook • contacting LGBT community groups • through the personal networks of the community researchers and via their own snowball sampling.

The in depth interviews and focus groups covered a range of topics determined by the Research Reference Group and project funders. The key themes were: • • • • • • • •

Employment and enterprise Education and training (post 16) Health and access to health services Rural issues Youth issues, family and partnership rights Transgender issues Crime Effects of multiple disadvantage.

Throughout, the study maintained a focus on access to, and experiences of services and how these relate to economic participation. For example how do workplace experiences affect economic participation; how do health factors affect economic participation? A series of demographic questions were also asked to collect statistics.

Stakeholder interviews with entrepreneurs and employers In addition to the primary research above, a series of in depth interviews were completed with stakeholders including educational institutions and employers, to establish the level of support and guidance that they provide to LGBT students or employees and how they tackle discrimination.

This included: • 13 interviews with educational institutions across the region, including training providers, further education colleges and universities • 23 interviews within the business sector including: • 4 interviews with business support services like Business Link/Chambers of Commerce and LGBT specific organisations • 6 interviews with business leaders or entrepreneurs running LGBT-led businesses • 13 with employers.

A10

Entrepreneur interviews Interviews were conducted with six LGBT entrepreneurs in the North West to explore in depth their experiences of starting their business, the business support they had received and their views on the challenges that LGBT communities face in business and in the workplace. This evidence was supported by shorter interviews with 33 LGBT individuals who were self employed from the main sample of 300 individuals, to focus on the type of business support that they had received and the barriers that they faced in starting up their businesses.

Employer interviews Interviews were conducted with 13 employers in the North West to explore the level of support and guidance that they provided to LGBT employees and how they tackle homophobia and discrimination in the workplace. This included interviews with five organisations accredited for their work with LGBT groups, three of whom were public sector organisations, one university and one third sector organisation. Three organisations were accredited through Stonewall’s Workplace Equality Index which is a national benchmarking exercise showcasing Britain’s top employers for lesbian, gay and bisexual staff1. A further two organisations had received the Navajo Charter Mark which is awarded to organisations in Lancashire that take positive steps to welcome and encompass LGBT issues within their organisation or service provision2.

Of those eight companies that were not accredited, three organisations were public sector and the remaining five were private sector. Private sector organisations included recruitment firms, a biomedical organisation and an industrial services company.

These interviews were conducted using an agreed topic guide and written up using a common structure.

Analysis All of the incoming qualitative and quantitative information was collated and secondary analysed using a thematic gridding technique to extract themes and evidence to support those themes. A team debrief was held to share common themes emerging and identify issues for the report.

Demographic data collected from the interviewees was collated and analysed in excel and SPSS.

1 2

See http://www.stonewall.org.uk/workplace/1477.asp See http://www.navajoonline.org.uk/charterMark.aspx

A11

Annex Two: Data tables from population estimate

A12

Data tables from population estimate This annex contains data tables to support the population estimate in Chapter Three of the report.

Table A2.1 Regional Trends Data: Diagnosed HIV-infected patients: sex between men Diagnosed HIV-infected patients: sex between men Number North East 355 North West 2,363 Yorkshire and The Humber 684 East Midlands 523 West Midlands 977 East of England 792 London 10,968 South East Coast 1,729 South East Central 622 South West 964

Percentage 1.6% 10.9% 3.2% 2.4% 4.5% 3.7% 50.6% 8% 2.9% 4.4%

19,978 92.2% England Total Wales 454 2.1% Scotland 965 4.5% Northern Ireland 157 0.7% Not known 107 0.5% Other/Abroad 9 0% United Kingdom Total 21,670 100% Source: Health Protection Agency's Centre for Infections; Institute of Child Health (London); Health Protection Scotland (formerly SCIEH).

A13

Table A2.2 SOPHID 2007: Number of diagnosed HIV-infected individuals seen for care in the United Kingdom (UK) by Strategic Health Authority (SHA).

Diagnosed HIV-infected patients: sex between men Number

Percentage

East Midlands

610

2.5%

East of England

944

3.9%

London

11716

48.8%

North East

407

1.7%

North West

2564

10.7%

South Central

734

3.1%

South East Coast

2008

8.4%

South West

1091

4.5%

West Midlands

1109

4.6%

Yorkshire & Humber

808

3.4%

England (SHA unknown)

30

0.1%

England Total

22021

91.8%

Wales

534

2.2%

Scotland

1123

4.7%

Northern Ireland

186

0.8%

Other/abroad/no fixed abode

126

0.5%

United Kingdom

23990

100%

Source: SOPHID 20071

1

Available at http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1221482342808.

A14

Table A2.3 Census 2001: Number of people in same sex couple households Local Authority

No. of people in same sex couple households

Cumbria Total

366

Carlisle

100

Allerdale

54

Eden

26

Copeland

42

South Lakeland

100

Barrow in Furness

44

Lancashire Total

1826

Lancaster

186

Wyre

92

Fylde

88

Blackpool

516

Blackburn with Darwen

138

Ribble Valley

46

Pendle

60

Hyndburn

78

Burnley

66

Rossendale

74

Preston

190

South Ribble

116

Chorley

108

West Lancashire

68

Greater Manchester Total

3936

Wigan

286

Bolton

290

Bury

218

Rochdale

204

Oldham

170

Salford

482

Manchester

1290

Tameside

302

A15

ECOTEC

Local Authority

No. of people in same sex couple households

Trafford

360

Stockport

334

Merseyside Total

1270

Sefton

210

Liverpool

484

Knowsley

92

Wirral

330

St Helens

154

Cheshire Total

948

Halton

92

Warrington

146

Ellesmere Port and Neston*

56

Chester*

174

Vale Royal

106

Macclesfield

154

Congleton

102

Crewe and Nantwich

118

TOTAL NORTH WEST

8346

Compiled from http://neighbourhood.statistics.gov.uk/dissemination/LeadHome.do;jessionid=ac1f930d30d5b057a99a298c4 c70b8e0d4e2370ca101?m=0&s=1240481895740&enc=1&nsjs=true&nsck=true&nssvg=false&nswid=1260

A16

ECOTEC

Table A2.4 Population Prevalence of HIV by local authority of residence and infection route, 2007

Cumbria

Local Authority of Residence

Carlisle Allerdale Eden Copeland South Lakeland Barrow-inFurness Unknown Cumbria Total Lancaster Wyre Fylde Blackpool

Infection Route MSM

13 (50%)

Injecting Drug Use 2 (7.7%)

Hetrosexual 9 (34.6%)

8 (50%)

7 (43.8%)

11 (84.6%)

(215.4%)

6 (46.2%) 10 (41.7%)

1 (4.2%)

5 (38.5%)

Blood / Tissue

Mother to Child

1 (3.8%)

Undetermined 1 (3.8%)

1 (6.3%)

26 16 13

4 (30.8%)

1 (7.7%)

11 (45.8%)

1 (4.2%)

1 (7.7%)

1 (7.7%)

13

1 (4.2%)

24

8 (61.5%)

13

1 (100%) 54 (50.9%)

Total (100%)

1 3 (2.8%)

41 (38.7%)

17 (48.6%)

18 (51.4%)

36 (78.3%)

9 (19.6%)

3 (2.8%)

2 (1.9%)

3 (2.8%)

106 35

32 (69.6%)

1 (2.2%)

9 (19.6%)

2 (4.3%)

237

4 (1.4%)

44 (15.1%)

4 (1.4%)

3 (4.3%)

45 (64.3%)

3 (4.3%)

1 (2.2%)

46

2 (4.3%)

46

2 (0.7%)

291

Lancashire

(81.4%)

Blackburn with Darwen Ribble Valley Pendle Hyndburn Burnley Rossendale Preston South Ribble Chorley West Lancashire Unknown Lancashire Total

15 (21.4%) 6 (42.9%) 10 (62.5%)

7 (50%) 1 (6.3%)

5 (23.8%)

4 (25%)

1 (6.3%)

13 (61.9%)

1 (4.8%)

1 (4.8%)

1 (3.7%)

1 (3.7%)

8 (29.6%)

1 (3.7%)

16 (59.3%)

20 (83.3%)

1 (4.2%)

3 (12.5%)

42 (43.8%)

1 (1%)

47 (49%)

13 (44.8%)

1 (3.4%)

12 (41.4%)

11 (64.7%)

6 (35.3%)

15 (57.5%)

10 (38.5%)

1 (16.3%)

4 (66.7%)

468

4 (5.7%)

70

1 (7.1%)

14 16

1 (4.8%)

21 27 24

4 (4.2%) 1 (3.4%)

2 (2.1%)

2 (6.9%)

96 29 17

1 (3.8%)

26 1 (16.7%)

6

13 (1.7%)

247 (32.3%)

14 (1.8%)

11 (1.4%)

11 (1.4%

764

38 (36.2%)

1 (1%)

60 (57.1%)

2 (1.9%)

4 (3.8%)

71 (34.1%)

8 (3.8%)

117 (56.3%)

5 (2.4%)

6 (2.9%)

1 (0.5%)

208

91 (60.3%)

3 (2%)

49 (32.5%)

3 (2%)

2 (1.3%)

3 (2%)

151

50 (37.6%)

5 (3.8%)

68 (51.1%)

4 (3%)

4 (3%)

2 (1.5%)

133

37 (33.6%)

4 (3.6%)

65 (59.1%)

2 (1.8%)

2 (1.8%)

315

11 (2.5%)

107 (24.2%)

1 (0.2%)

2 (0.5%)

7 (1.6%)

443

29 (1.9%)

661 (43.9%)

2 (0.1%)

32 (21.1%)

16 (1.1%)

1505

4 (3.7%)

43 (39.8%)

2 (1.9%)

1 (0.9%)

108

Greater Manchester

(61.3%)

Wigan Bolton Bury Rochdale Oldham Salford

105

110

(71.1%)

Manchester

765 (50.8%)

Tameside

58 (53.7%)

A17

ECOTEC

Local Authority of Residence

Merseyside

Trafford Stockport Unknown Greater Manchester Total Sefton Liverpool

Infection Route MSM

Injecting Drug Use

Hetrosexual

Blood / Tissue

Mother to Child

Undetermined

Total (100%)

93 (52%)

6 (3.4%)

67 (37.4%)

4 (2.2%)

3 (1.7%)

6 (3.4%)

179

78 (63.4%)

1 (0.8%)

34 (27.6%)

3 (2.4%)

5 (4.1%)

2 (1.6%)

123

4 (40%)

6 (60%)

10

1600 (52%)

72 (2.3%)

1277 (41.5%)

26 (0.8%)

62 (2%)

33 (39.8%)

4 (4.8%)

41 (49.4%)

4 (4.8%)

106

2 (0.5%)

247 (65.9%)

6 (1.6%)

9 (2.4%)

15 (51.7%)

1 (3.4%)

11 (37.9%)

63 (50%)

4 (3.2%)

52 (41.3%)

2 (1.6%)

3 (2.4%)

36 (81.8%)

7 (15.9%)

1 (2.3%)

3 (42.9%)

3 (42.9%)

38 (1.2%)

3075

1 (1.2%)

83

5 (1.3%)

375

2 (6.9%)

29

2 (1.6%)

126

(28.3%)

Knowsley Wirral St Helens Unknown Merseyside Total

256

11 (1.7%)

44 1 (14.3%)

7

11 (1.7%)

664

361 (54.4%)

13 (2%)

12 (1.8%)

14 (46.7%)

1 (3.3%)

1 (3.3%)

30

23 (35.4%)

1 (1.5%)

1 (1.5%)

65

4 (12.1%)

33

2 (2.7%)

75

Cheshire

(38.6%)

Halton Warrington Ellesmere Port & Neston Chester Vale Royal Macclesfield Congleton Crewe & Nantwich Total

14 (46.7%) 39 (60%)

1 (1.5%)

10 (30.3%) 44 (58.7%)

19 (57.6%) 2 (2.7%)

19 (70.4%) 30 (58.8%)

1 (2%)

25 (33.3%)

2 (2.7%)

6 (22.2%)

1 (3.7%)

1 (3.7%)

27

17 (33.3%)

2 (3.9%)

1 (2%)

51

8 (80%

2 (20%)

10

16 (55.2%)

13 (44.8%)

29

180

4 (1.3%)

119 (37.2%)

7 (2.2%)

8 (2.5%)

2 (0.6%)

320

103 (2.1%)

2045 (41.5%)

63 (1.3%)

95 (1.9%)

65 (1.3%)

4929

7 (3.7%)

8 (4.2%)

8 (4.2%)

(56.3%)

North West Residents Isle of Man Out of Region

2558 (51.9%) 9 (42.9%) 110

12 (57.1%) 2 (1%)

56 (29.3%)

21 191

(57.6%)

Abroad Unknown* Total

1 (33.3%)

2 (66.7%)

41 (60.3%)

3 (4.4%)

22 (32.4%)

2719

108 (2.1%)

2137 (41%)

3 70 (1.3%)

103 (2%)

2 (2.9%)

68

75 (1.4%)

5212

(52.2%) Men who have been exposed through sex with men and who are also injecting drug users are included in the MSM category. * Includes four people of no fixed abode and four who declined to give any residential information.

Source: Downing et al (2007) HIV & AIDS in the North West of England 2007

A18

ECOTEC

Table 10.1 Regional and sub regional population estimates since 2001 per thousand (percentage change)

Sub region

Mid-2001

Mid-2002

Mid-2003

Mid-2004

Mid-2005

Mid-2006

Mid-2007

Cheshire

674.3

675.3 (+0.15)

678.6 (+0.49)

681.7 (+0.46)

684.4 (+0.40)

686.3 (+0.28)

688.7 (+0.35)

-- Halton

118.6

118.4 (-0.17)

118.4 (0.00)

118.9 (+0.42)

119.2 (+0.25)

119.5 (+0.25)

119.5 (0.00)

-- Warrington

191.2

191.4 (+0.11)

192.1 (+0.37)

192.4 (+0.16)

193.3 (+0.47)

194.0 (+0.36)

195.2 (+0.62)

Cumbria

487.8

488.5 (+0.14)

491.1 (+0.53)

494.4 (+0.67)

495.6 (+0.24)

496.2 (+0.12)

496.9 (+0.14)

Greater Manchester

2,516.1

2,518.1 (+0.08)

2,527.8 (+0.39)

2,533.5 (+0.23)

2,543.3 (+0.39)

2,553.8 (+0.41)

2,562.0 (+0.32)

Lancashire

1,136.5

1,140.4 (+0.34)

1,148.2 (+0.68)

1,155.8 (+0.66)

1,162.2 (+0.55)

1,165.7 (+0.30)

1,168.1 (+0.21)

-- Blackburn/Darwen

138.5

139.3 (+0.58)

140.0 (+0.36)

140.8 (+0.57)

141.2 (+0.28)

141.2 (0.00)

140.9 (-0.21)

-- Blackpool

142.3

142.3 (0.00)

142.7 (+0.28)

142.9 (+0.14)

143.1 (+0.14)

142.7 (-0.28)

142.5 (-0.14)

Merseyside

1,367.8

1,364.4 (-0.23)

1,361.6 (-0.21)

1,359.2 (-0.18)

1,357.4 (-0.13)

1,353.6 (-0.28)

1,350.2 (-0.25)

TOTAL

6,773.0

6,778.1 (+0.08)

6,800.5 (+0.33)

6,819.6 (+0.28)

6,839.8 (+0.30)

6,853.2 (+0.20)

6,864.3 (+0.16)

Average change in population estimates: Region: North West, +0.23 Sub regions: Cheshire, +0.36; Cumbria, +0.31; Gtr Manchester, +0.30; Lancashire, +0.46; Merseyside, -0.21.

Unitary authorities: Blackburn & Darwen, +0.26%; Blackpool, +0.02; Halton. +0.13; Warrington, +0.35

A19

ECOTEC

Nicola Hall and Demetrious Panton

ECOTEC Research and Consulting Ltd Vincent House, Quay Place, 92-93 Edward Street, Birmingham, B1 2RA Tel +44 (0) 0845 313 7455 Fax: +44 (0) 0845 313 7454

Email: nicola.hall@ecotec.com demetrious.panton@ecotec.com

www.ecotec.com

ECOTEC ECORYS in the UK

Improving the Region's Knowledge Base on the LGB&T population in the North West Draft Final Report to NWDA and partners

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