1. Good practice examples of “preventative” services with lesbian, gay and bisexual and transgender communities Lucy Wilkinson

2. The Care Quality Commission is the regulator of health and adult social care in England What is the Care Quality Commission?

3. What are the issues for LGB and T people who may need social care? From CSCI “Equality and diversity matters” bulletin (2008): Feeling safe and not being discriminated against Opportunities to “come out” when and if you chose – so services must have a culture where it is OK to talk about sexual orientation and gender identity Workers who are positive about sexual orientation – for some people this means being supported by staff who are also LGB Support to live the life you choose – including contact with LGB and T communities Services to take any discrimination that you face seriously – and to have choice in how this is handled

4. What are the issues for LGB and T people who may need social care? From “Rainbow Ripples” report: LGB disabled people’s experience of service provision in Leeds (2006) Few services specifically consider LGB disabled people Problems of homophobia in services aimed at disabled people Problems of disablism in services aimed at LGB people Interrelated misconceptions about LGB and disabled people impact on service provision LGB disabled people sometimes have to deal with homophobia and disablism at the same time – combination can make the overall experience more than twice as bad as either experience on its own LGB disabled people have their own culture and sometimes respond creatively to discrimination +

5. …so “prevention” of what? “Preventative” services should… Prevent LGB or T people from experiencing discrimination – both from within services and from others in society Prevent isolation and disconnection from LGB and T communities These concepts should be embedded in all social care: from direct access services through to services needing assessment, such as Direct Payments/Individual Budgets and provided services; for example, home care, day care, care homes Is “prevention” the right word for direct access services? We are talking about “direct access services that promote social inclusion of LGB and T people” Where these provide specific services to LGB and T people, should be available to people across the spectrum of assessed need?

6. Good practice – initiated/led by LGB and T people Rainbow Ripples www.rainbowripples.org.uk A self-initiated group of LGB disabled people in Leeds working to improve services Uses a social model of disability approach Research project with University of Hull published in 2006 looked at a broad range of social inclusion issues e.g. housing, transport, advocacy, employment, social life and safety (as well as social care and health) In 2008, published booklet on “housing alternatives for LGB disabled people” Primarily an involvement group – but this led to information sharing and peer support between members A local group which developed a national reputation for innovation Illustrates how fragile sustainability of work with LGB groups can be – due to changes in staffing and the support provided by the host organisation, the group are not now physically meeting but maintain some email contact

7. Good practice – led by the voluntary sector Age Concern regional “Opening Doors” initiatives A number of Age Concerns around England are developing work with older lesbians‚ gay men and bisexuals‚ often in partnership with local lesbian‚ gay and bisexual organisations See: http://www.ageconcern.org.uk/AgeConcern/regional- initiatives.asp Examples include: Age Concern Manchester: Out in the City : “a social/support group for older LGBT people. The members take part in a varied programme of artistic and cultural events as well as enjoying a valuable social outlet.”

8. Good practice – led by the voluntary sector Age Concern regional “Opening Doors” initiatives cont Age Concern Central Lancashire: The Friends of Dorothy Project – “Helping to make a difference to the lives and wellbeing of senior members of the Lesbian, Gay Bisexual and Transgender Community through befriending and support.” Also works in partnership to manage the Navajo Chartermark –a loose network of LGBT friendly organisations with strong links with the LGBT Community. Private and public sector organisations that take positive steps to welcome and encompass LGBT issues within their organisation or service provision can apply for the Navajo Charter Mark. Age Concern Oxfordshire: Home Improvements: “Looking at how the needs of LGBT people with dementia (and their carers) are met in care homes. We expect to have awareness raising, training, engaging with clients and carers”

9. Good practice – led by the voluntary sector Age Concern regional “Opening Doors” initiatives Small survey of regional initiatives, carried out for this presentation: Main successes Reducing isolation of LGBT older people Increased physical and mental well-being Developing a reputation among some LGBT groups for inclusivity Raising awareness of issues Making successful partnerships Becoming visible Main barriers Lack of funding (most had not applied to statutory funders for LGBT specific work) Gaining trust from older LGB or T people – when they have faced discrimination in the past and may fear “coming out” Sustainability on time limited funding: needed to maintain trust with LGBT communities

10. Good practice by councils London Borough of Hackney: Participation of social care in “Open Space” event for the LGB and T communities (March 2009) – entitled “How can we make Hackney a great place to grow old?” Followed by specific report to the Transforming Adult Social Care Board on LGB and T issues Leading to an action plan which includes working with the local Age Concern “Opening Doors” Project to develop Support for LGBT older people Training on LGBT issues A help desk A chartermark for providers

11. The council role – links between this milestone and the Equality Framework for Local Government (EFLG) EFLG priorityDeveloping direct access, social inclusion (“preventative”) services Knowing your community/equality mapping Does development takes account of corporate equality mapping? Place shaping, leadership and partnership Partnerships to deliver “preventative services” with user-led organisations, health and the third sector (including LGB and T, BME groups) Community engagement and satisfaction Development of “preventative” services underpinned by equality impact assessments (EIAs) including consultation with diverse people who may need them Responsive services and customer care Delivery of “preventative” services and respond to needs of diverse people using services through delivery of actions in EIAs and ongoing feedback Modern and diverse workforce Development takes account of the diverse workforce needed to deliver equality for all in direct access services

12. How are councils performing? – a snapshot From 25 CQC/ CSCI council inspections in 2009 (“service inspections”) Engagement with and/or commissioning for LGB and T communities reported in 13 inspections: 6 councils: not considered any work on engaging LGB or T people covered by the inspection (e.g. older people) 4 recognised the need to engage but had not carried out any work yet 1 using corporate LGBT engagement mechanisms (for example “Pride” events) - unclear how these specifically related to LGB and T people who may need social care 1 had developed specific engagement for older LGBT people, but needed to evidence the extent to which LGBT communities were aware of and using the range of targeted advice and support available and what their experience and outcomes are. 1 council involves LGB and T older people regularly in service planning and gives meeting the needs of diverse communities, including LGB and T people “a high priority in commissioning”

13. Finally…Development of regulation on commissioning for equality Visit our consultation page on our equality and human rights and scheme: (and consider putting in a response) http://www.cqc.org.uk/getinvolved/consultations/equalityandhumanrights scheme.cfm

14. My contact details Lucy Wilkinson Equality, diversity and human rights regulatory policy manager (from 1 st Feb.) lucy.wilkinson@cqc.org.uk 07789 925 478