FROM MARGIN TO MAINSTREAM: CHALLENGES
IN CONSIDERING THE VIEWS OF ALL OLDER
PEOPLE IN THE EVALUATION OF THE NATIONAL
SERVICE FRAMEWORK FOR OLDER PEOPLE IN
ENGLAND
Jo Moriarty (KCL)
Jill Manthorpe (KCL)
Michelle Cornes (KCL)
Roger Clough (Independent researcher)
Les Bright (Independent consultant)
Steve Iliffe (UCL)
Older People Researching Social Issues (OPRSI)
Outline
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Context
Methods
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Results
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Challenges in recruiting LGBT participants
Shared and unique issues
Discussion
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IAGG July 2009
Background
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Healthcare Commission, Commission for Social
Care Inspection and Audit Commission
undertook joint inspections of services for older
people 2005-6
Aimed to measure progress in implementing
National Service Framework for Older People
(NSFOP)
Produced report: Living Well in Later Life. A Review
of Progress against the National Service Framework for
Older People (2006)
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Themes of the review

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Tackling ageism and promoting equality
Involving older people
Designing and delivering services around
older people
Living well in later life
Leading organisations through change
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Role of research team

Research team asked to obtain the views
of:
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Older people (defined as those aged 50
and over)
Their caregivers
Local voluntary and community sector
(VCS)
Views to be used in informing inspections
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Methods (1)
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Rapid appraisal approach

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Listening events
 Large public events
advertised locally
Focus groups
 Shared interest or
characteristic
Individual interviews
 Face to face or telephone
Postal survey
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Methods (2)

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Multidisciplinary
Older People
Researching Social
Issues (OPRSI)

Collective of older
people actively
involved in research
(Clough et al. 2006)
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What was new

National Service Framework referred to age
discrimination and racial discrimination

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Silent in relation to sexuality (Clover 2006)
Review was first time that English regulatory
bodies had made an explicit attempt to tackle a
wider span of diversity issues

Context of heteronormativity in gerontology (Cronin,
2004)
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Exemplified in…….

Discrimination can have profound and far
reaching consequences on the lives of older
people. They may experience discrimination and
disadvantage for a variety of reasons apart from
their age. It may be on grounds of faith or sexual
orientation, because they are black or disabled,
or combinations of these (Living Well in Later
Life, p24)
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Results

1839 people took part in
listening events, focus
groups or interviews


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More diverse ethnically
Older
4170 people returned
questionnaires

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Less ethnically diverse
Younger
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LGBT participants
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Specifically recruited via:
Older gay and lesbian group

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Six individual telephone interviews
Specialist centre for LGBT people

Two focus groups and one interview (15
participants) and discussion with staff
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Discrimination

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HIV+ status affecting ability to find NHS
dentist
[Rights worker] Similarly the guys I’ve
spoken to have experienced homophobia
in terms of if they’re homosexual they
must have AIDS and therefore, you know,
skull and crossbones, stay away from me
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Some improvements noted

Some noted change in attitudes
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Younger doctors are more understanding
My partner’s pre transsexual and my GP is very good
My GP came out and visited me ‘as a bereaved person’ and I
was treated ‘the same as heterosexuals’
But
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on hospital ward treatment was not good but not because of
sexuality – everyone was receiving same poor level of care!
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Intersectionality

Looks at inter relationships of gender, class,
race and ethnicity and other social divisions

One man described how he was sexually assaulted
and robbed of his disability living allowance (DLA) but
did not feel he could complain to police

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People take advantage of you because they know you are on
DLA
One transgendered person felt being a mental health
service user was more stigmatising

I have problems with people’s definitions of me but it’s more
of a stigma to have mental health problems
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Integrating LGBT issues
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Two examples where ‘blanket’ approaches
fail to take account of whether LGBT
people have different needs, wants and
preferences:
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Social networks and leisure
Caregivers
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Social networks and leisure
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Increasing recognition of role played by
social networks and leisure in maintaining
wellbeing
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Us older ones don’t like going to pubs and
clubs and we want something else to do with
our (time), you know, we want to socialise in a
different way
[Our centre] is not so much body conscious –
there’s no backstabbing’
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Recognition of caregivers’ needs
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Rights agenda for caregivers fails to
recognise inequalities among different
carers (Manthorpe & Price, 2006)
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Pre civil partnership legislation
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[I] was told [my partner] needed residential care,
but this would have meant having to fund the care
by selling our house and home and business
because of the lack of clarity around the status of
gay and lesbian couples. I wanted her home
anyway.
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Discussion 1
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Need to recognise that some issues will
be common to almost all older people

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Transport & mobility problems
Fear of crime
Reliable and accessible services
Some issues will be different

Role of specialist versus generic provision?
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Discussion 2
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Need to acknowledge difficulties in recruitment
in research studies
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Extent to which older LGBT people self-identify or
wish to be identified (Langley, 2001)
Overcoming mistrust of authorities
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One man described being sent to a mental health unit before
the Sexual Offences Act 1967
‘[Mental health units are] terrible. They drag you in and inject
you. Nurses can treat you bad’.
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Discussion 3
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Extent to which professional training
addresses homophobia & heterosexism
and equips professionals with skills and
confidence to address them (Hardman,
1997; Langley 2001)
Applies to regulators/inspectors
And to researchers as well !
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