Casting a queer lens on the 10 Year Health Plan

Launched last summer, the government’s 10 Year Health Plan sets out its vision to tackle health inequalities, stating: ‘social justice runs through this plan.’ But what does it mean for LGBTQ+ people? Despite the NHS’s commitment to universal care, LGBTQ+ people face persistent disparities in accessing the care they need, how they’re treated when they do receive it, and in their overall health outcomes.

With LGBTQ+ history month well underway, and this year’s theme celebrating science and innovation, it feels like the right moment to cast a queer lens on the 10 Year Health Plan, and how the three shifts (from hospital to community, treatment to prevention, and analogue to digital) could change LGBTQ+ people’s experiences of health and care.

A brief stocktake makes clear the scale of inequality facing LGBTQ+ people in the UK.ⁱ

When trying to access care, one in eight LGBT people report unequal treatment from health care staff, and trans and non-binary people report negative experiences at the GP ‘front door’, leading many to avoid seeking care altogether.

Those who make it through the front door face lengthy waiting lists, with waits for some types of gender-affirming care like gender-reassignment surgery stretching up to 20 years, in sharp contrast to the government’s headline priority of reducing waiting lists, where the target for elective care is 18 weeks.

Patients must also navigate a system designed without their needs in mind, with sexual orientation and gender identity data continuing to be inconsistently captured in NHS systems leading to missed or inappropriate care, and undermining efforts to address inequalities at scale. Our own research shows patients are frequently ‘lost in the system’ when it comes to poor NHS admin, and there’s an extra layer of bureaucracy for LGBTQ+ individuals, with trans and non-binary people often reporting problems with GP registration, fragmented records and repeated disclosure of personal information.

These barriers have huge implications for LGBTQ+ people’s overall health outcomes. Recent ONS data uncovered the shocking statistic that LGB+ people have around 1.3 times greater risk of death from any cause compared with those who identify as straight, and more than double the risk of suicide or self-harm.

While the forthcoming NHS England LGBT+ health evidence review will be an important contribution to understanding how best to meet the health needs of LGBTQ+ people, these challenges have long been known, raising the question of how the government’s health plan will genuinely tackle the inequalities facing the queer community.

Shift one: moving care from hospitals to local communities

Community-based services, including primary care, mental health support and sexual health clinics, are often the first point of contact with the health service for patients, and as such are a critical opportunity for building trust and overcoming stigma. If designed inclusively, these services can offer a more accessible space for LGBTQ+ people. Partnerships with voluntary and community organisations can extend reach to individuals who have previously avoided the NHS due to negative experiences or fear of discrimination.

Let’s demonstrate this with a hypothetical case study. Gemma is 16 and thinks she might be gay. She has questions about relationships and staying safe, but doesn’t feel comfortable discussing them with her GP, especially if her parents attend her appointments. Instead, she turns to a health care professional she already knows and trusts – her school nurse. Because this support is embedded in the community, Gemma can easily access inclusive information and advice without fear of judgement. Under the principle of the 10 Year Health Plan, increased focus on community services in areas like school nursing have the potential to increase access to vital community services.

Shift two: preventing illness, not just treating it

Prevention-led approaches have already demonstrated impact in the LGBTQ+ community. The successful opt-out approach to HIV testing in A&E, which is leading the way on earlier prevention, also increases access for people who are straight and people who may not openly identify as LGBTQ+.

Again, let’s illustrate this with a hypothetical case study. Neil, a 40-year-old gay man who prefers not to reveal his sexuality openly, arrives at his local A&E department with shortness of breath. As part of his routine assessment, a doctor runs a standard set of blood tests. Because Neil does not opt-out of testing for HIV, hepatitis B and hepatitis C, these checks are carried out automatically, removing the burden of disclosing his sexuality.

Thanks to this routine, stigma-free approach to testing, Neil – like many people across England – receives a diagnosis quickly and begins treatment without delay.

The 10 Year Health Plan could provide the mandate to roll out similar initiatives that would especially benefit those facing health inequalities.

Shift three: realising the potential of digital technology

Shared patient records, remote consultations, and the growing use of AI in clinical decision-making have the potential to significantly change the way we access and receive personalised care.

Imagine Alex, a 50-year-old trans man, who was assigned female at birth. He recently updated his NHS record, changing his gender marker from ‘F’ to ‘M’. But once registered as male, Alex stops receiving automatic invitations for cervical screening, even though he’s still at risk of cervical cancer. To stay up to date, he must contact his GP and actively opt in, adding another layer of admin to an already sensitive area of health care.

Now imagine the NHS introduces a functionality through the NHS App that automatically flags when someone still requires cervical screening based on their patient record, not just the gender marker on their file. With this new system, Alex continues to receive routine invitations without having to opt in manually. This smooth and inclusive process supports Alex in attending his screenings on time without extra burden. This is just one example of how extra focus and investment the 10 Year Health Plan promises on the NHS App could support LGBTQ+ patients.

Idealism must be tempered with realism

These examples offer just a glimpse of what successful implementation of the 10 Year Plan could mean for queer people. But there are many hurdles that must be overcome along the way.

Digital transformation brings up legitimate worries about deepening discrimination. AI systems are trained on existing data – and incomplete or biased data risks reinforcing existing inequalities we’re trying to solve.

And even when you have an effective prevention-led approach, like PrEP – a highly reliable way of preventing HIV – it’s still a complex (but essential) challenge to reach different communities that may be overlooked. There are no quick fixes, and you still need to listen to people’s voices as well as ‘technical’ solutions.

Tackling these deep-rooted inequalities is no small task against the wider backdrop of worsening public attitudes towards trans and non-binary people.

Despite these challenges, there’s lots of room for hope. The ‘curb-cut effect’ is a powerful example: lowering curbs was originally introduced to support disabled people, but it ended up benefitting everyone, including parents with prams and people recovering from injuries. When systems are designed to support the most marginalised people, the ripple effects are far-reaching and indeed life changing.

The same principle applies here. If the three big shifts deliver reforms that truly meet the needs of those at the sharpest end of health inequalities, everyone benefits.