Exploring LGBTQ+ disadvantage within health and social care service pathways in North East England
Projects
‘It’s not what we would class as the front of our priority’: a qualitative, intersectional perspective on LGBTQ+ disadvantage within health and social care service pathways in North East England
Background
Despite increased awareness of the significant health and healthcare inequalities experienced by minoritised groups, limited research considers the interaction of multiple factors of social disadvantage.
Scoping review
A qualitative scoping review aimed to identify and explore how LGBTQ+ adults’ experiences of homelessness, substance use disorder, and criminal justice involvement impacted upon their access to and use of health and social care services in the UK and Ireland.
Review themes were clustered around ‘normativity’ and its impact upon LGBTQ+ adults facing multiple disadvantage, who were seen to be ‘other than’ and moved out of the way so that normal working practices could continue.
Discrimination and anticipation of stigma then acted as barriers to service access and use.
Study aim
To explore the health and social care pathways of LGBTQ+ people in North East England who had experienced disadvantage, to identify barriers and facilitators within these pathways, and use these findings to inform future service provision.
Methods
A qualitative study design was underpinned by its ethos of community involvement, with knowledge co-created by the researcher alongside community members.
The North East was chosen because it has the highest percentage of heterosexuals in England and Wales (ONS, 2023) and a lack of LGBTQ+ specialist services.
There were 13 months of recruitment and a total of 72 interviews with people aged above 18 years: 39 with LGBTQ+ people who had experienced disadvantage and 33 with professionals, totalling 66.5 hours of data.
Findings
Finding 1: The majority is the priority
Politics, policies, funding, and commissioning all contribute to normative processes that privilege core groups of service users at the expense of stigmatised ‘others’.
Recommendation: Reflect upon organisational processes that may establish or reinforce core groups. Conduct Joint Strategic Needs Assessments in partnership with local organisations and communities.
Finding 2: At the interface of guidance and practice
The disconnect between policy and practice highlights the powerful influence of workplace cultures.
Recommendation: Involve staff in new workplace processes relating to LGBTQ+ issues and those relating to marginalised groups, and build in evaluation of how these are implemented.
Finding 3: Oblique angles rendered invisible
A focus on economic disadvantage can render invisible the impact of social inequalities on marginalised groups.
Recommendation: Widen the field of vision – include greater consideration of the impact of intersectionality within health and social care services and research.
Discussion
The normative framework of services designed to support people facing disadvantage rendered invisible the disadvantage experienced by LGBTQ+ people and other minoritised groups.
LGBTQ+ people experiencing multiple disadvantage within the study and scoping review were stigmatised, marginalised, or excluded – not only from mainstream services, but also from those services designed to support people excluded from mainstream provision.
Data and research drawn solely from these services may implicitly assume equitable access and thereby further the marginalisation of ‘others’.
However, when there was genuine concern, interest, and awareness, marginalised LGBTQ+ people who had been stigmatised and othered now began to engage – a ‘ripple effect’ of benefits could be seen across the wider system of health and social care services.
The study supports a utilitarian position (which encourages actions that lead to the greatest good for the greatest number of people), and recommends that conversations across the system consider ‘all of us’ rather than ‘us and them’.
Dissemination event
An online event hosted by local voluntary, community and faith sector (VCFS) organisations was held in September 2024, with 43 attendees taking part in exercises designed to check the relevance of the study’s findings, and explore how we can best reach people on the margins of care.
Two plain language reports have been created from the study and this event and are in the design stages. Given the enthusiasm for continuing this work, a second event is currently being planned which aims to develop practical tools to support services in this work.
Publications in progress (Open Access)
Adley, M., O’Donnell, A., & Scott, S. (2025). How LGBTQ+ adults’ experiences of multiple disadvantage impact upon their health and social care service pathways in the UK & Ireland: a scoping review [under review]. BMC Health Services Research.
Adley, M., O’Donnell, A., & Scott, S. (2025). ‘The majority is the priority’: a qualitative, intersectional perspective on LGBTQ+ marginalisation within health and social care service pathways in North East England [final co-author checks]. Social Science and Medicine.
Adley, M., O’Donnell, A., Scott, S., & Yolles, M. (2025). Bounded, relational, and relative: an innovative application of phenomenological relationality within cross-cultural qualitative social science research [submitted for review]. International Journal of Qualitative Methods.
A further paper is in progress that explores the discrete experiences of the LGBTQ+ people of colour who participated in the study. These interviews are being revisited by Mark and two of the study’s Public Advisors whose combined analysis will form the basis of the paper.
Book chapter
Adley, M. (2025) ‘A queer engagement: navigating the twists and turns of public involvement and multiple marginalisation’, in McGovern, W., Bareham, B., Alderson, H. and Lhussier, M. (eds.) Public Involvement and Community Engagement in Applied Health and Social Care Research: Critical Perspectives and Innovative Practice. Emerald Publishing Group (Accepted)
References
Office for National Statistics (2023) Sexual orientation, England and Wales: Census 2021
Read more
How could we improve care for LGBTQIA+ people who experience disadvantage, in our region? – ARC
Lead researcher: Mark Adley (funded via an NIHR ARC NENC PhD studentship)
Supervisors: Prof. Amy O’Donnell, Dr Stephanie Scott, Newcastle University
Public Advisors: Kassim Ali, Livv Evans, Ellie Lowther, Karl Whillis