When we registered as a care provider with the Care Quality Commission in 2017, we realised that the independent regulator did not have a category or guidelines for LGBT service users or companies.
This signified a vital issue to us; that the LGBTQI+ community remains invisible within the care industry, something that we wanted to change.
It was at that time that we contacted the folks at the CQC to see how we could effect change and ensure LGBTQI+ service users are acknowledged and offered a choice.
Two years later we are thrilled to see that the CQC has released new guidelines on the importance of enabling people to manage their sexuality needs.
The report titled “Relationships and sexuality in adult social care services” looks at how providers can help people develop their understanding of sexuality and relationships among many other things.
Being the first company of its kind in the UK, we have come across many aspects of the care industry that we believe could be improved – particularly when it comes to working with the ageing LGBTQI+ community.
So we are thrilled the CQC are now addressing the LGBTQI+ community and their needs when in the care industry.
Our Managing Director Ramses Underhill-Smith’s thoughts on why shame erodes our mental health wellbeing
I was recently at an event where a 6-year-old, in a confused state, asked me if I was a boy or a girl? This was an odd question because I’ve known this child since birth and my gender has never been in question.
The comment its self was not disturbing, but what I understand from this question is, the moral shame of being LGBT+ has been pointed out as a lesson for a six-year-old.
For me, it was a positive question. There was a time when I would have left the event because of the anxiety I would be feeling.
And that got me thinking about the way my own mental health had been affected over the years by very vocal cultural shaming.
So in this post, I want to point out that LGBT+ people from all walks of life are impacted by shaming from the main stream because of their gender or sexuality.
Thankfully, today because of the support I have and the work I do to support my mental health, I can stay at these events, withstanding the stigma of being Transgender out loud.
I think it’s important to be visible and although I’m not always able or willing to take on every battle, I’m thankful that I can at last be myself and be more comfortable.
CQC praises UK’s first LGBTQI domiciliary care company and its ‘kind and caring staff’ after finding the ‘service promoted an open and honest culture’
Alternative Care Services , the UKs first LGBTQI+ focused care service to provide exceptional support to aging and vulnerable members of the community, recently underwent a CQC inspection.
In its report the CQC said the new specialist care provider and its” kind and caring staff promoted an open and honest culture”, bolstering Alternative Care Services’ aim to ensure no one ever has to ‘go back into the closet’ when receiving care.
Clients receiving support from the company told inspectors that the services provided by the company have been “transformative”.
One client to the CQC: “They have an understanding of the LGBT community, they understand us, they respect us. This makes it more comfortable compared to other agencies.”
Another told inspectors: “Having this support has been transformative and very helpful”, “I was specific about what I wanted and they were open and honest with me on whether they could meet our needs, and they have been able to do this”, “Compared to previous agencies, it has been a seamless transition and is working well.”
“The care workers are very competent and know what they are doing. I can see that they have lots of experience.”
While another Alternative Care Service client said: “We need consistency, it is really important and this is what we get. They have been able to accommodate this for us.”
The CQC report said staff told inspectors they were well supported, trained and spoke positively about the values of the provider.
“They are a great agency, they always listen to us” and “I think I’m lucky and feel I’ve hit the jackpot as I know that I have chosen a great company to work for.”
Despite being a small and relatively new company, the CQC report on Alternative Care Services also found that:
• Staff were aware of their safeguarding responsibilities and were confident the registered manager would take the appropriate action if they had any concerns.
• People and their relatives had been actively involved in decisions about their agreed care and support. We received positive comments about the kind and caring nature of care workers and how positive relationships had been developed at the start of the care package.
• People were provided with information on how to make a complaint. Relatives told us they would feel comfortable getting in touch with the provider if they had any concerns.
• The service promoted an open and honest culture. We received positive feedback about the management team and staff felt well supported. Staff were confident they could raise any concerns or issues, knowing they would be listened to and acted upon.
• Staff spoke positively about the values of the provider and the direction the organisation was going in. The registered manager was passionate about the rights of people who needed support from the LGBTQI+ community. He had been involved in campaigning for people’s rights at workshops and national conferences.
• There were arrangements in place to assess and monitor the quality and effectiveness of the service and use these findings to make ongoing improvement.
When reporting his findings on the five questions the CQC asks about care service providers, the inspector had this to say:
Is the service safe?
“There was a safeguarding policy in place and staff were confident any concerns brought up would be acted upon straight away. Staff had received training in safeguarding and knew their responsibilities to report any signs of abuse and protect people from harm.”
Is the service effective?
“Relatives told us that care workers were aware of people’s health and well-being and knew how to respond if their needs changed.
“Care workers completed an induction and training programme to support them to meet people’s needs. There were no formal records of supervision but care workers confirmed they had one to one meetings with the management team.”
Is the service caring?
“We saw that people and their relatives were involved in decisions about the care and support they received, and encouraged to express their views.
“People and their relatives were happy with the care they received. Relatives spoke positively about the caring attitude of the care workers that supported them.
“People were introduced to care workers to help them feel comfortable before the service started. New care workers were developing positive relationships with people they were getting to know and understand and treated them with respect.”
Is the service responsive?
“Care records were discussed to meet people’s individual needs. Staff knew how people liked to be supported. Although people and their relatives had no complaints about the service, they said they would be comfortable in contacting the management team if they had any concerns.”
Is the service well-led?
“Relatives told us that they were happy with how the first few months of the service had been managed. Staff felt supported to carry out their responsibilities and spoke positively about the management team.
“The management team were in regular contact with people using the service and their relatives to monitor the quality of care and support provided.
“The registered manager worked in partnership with a range of organisations in relation to care and support for people in the LGBTQI+ community.”
You can read the full report here:
Alternative Care Services is a care agency providing support and social care for older LGBT people in their own homes.
Founded by Ramses Underhill-Smith, the company was created after Ramses saw a HIV-positive friend risk his health by rejecting care in his own home, over concern that the care workers might be homophobic.
Some of our staff are trans, gay, bisexual, and from the LGBT community, some aren’t, but all get training in treating patients with dignity.
“If you’ve had surgery and you’ve got scars, you don’t want people looking at them in a certain way. We’re so used to it in the LGBT community – it’s not even the words people say, but the fact that everybody stares. You don’t want to have to explain when you get undressed for personal care.”
“It’s about knowing that whoever comes to your door is going to understand who you are, that in conversation you’re going to be able to say things openly.” Some frail older people, he points out, barely see anyone but health professionals; if they can’t talk to them honestly, they are completely isolated.”
We are proud that we help provide dignity, support and comfort to our clients and thrilled that our work has been featured in The Guardian.
As a care provider it is very important to us to provide excellent services to our clients.
It’s also important for us to share our experiences and best practices as care providers to other providers in the UK.
Proudly, as the UK’s first (and only) LGBTQI+ adult care provider we also love to share our innovative thinking and unique approach to care.
So when our Managing Director Ramses Underhill-Smith was asked to join the National Care Forum Managers Conference, he naturally jumped at the chance.
Speaking to leaders and managers from around the country, Ramses eloquently discussed the status of the homecare industry, the challenges facing small businesses and the provision for LGBT+ seniors in the healthcare system.
Ramses’ workshop was extremely well received and enabled managers to gain detailed insight into running an LGBT+ focused organisation, drawing on his expertise and knowledge.
As an organisation we were all thrilled to be a part of the NCF Managers conference, which allowed us to spread a vital message from many who normally do not have a voice.
We believe that everyone in our care has the fundamental right to:
Be regarded as an individual and given individual respect
Be treated equally, and no less favourably than others
Receive respect and understanding regarding their sexual, cultural, religious and spiritual beliefs
Be safe, feel loved and always know that someone cares
Be afforded personal privacy and security
Have the opportunity to think independently, and make their own choices and be listened to
Today (Thursday October 11th) is National Coming out day. It’s a day when people of the LGBTQI community can celebrate the occasion they told their family, friends and the world about who they are.
It’s a day many celebrate with pride and happiness, being able to be open and honest with all. But it’s also a day to show solidarity and support to others who may not have had the chance or the courage to come out.
And we at Alternative Care Services want to say, to all far and wide, we hope you are proud to be who you are, and live your life the way you want to.
We want you to know that you are worthy, valid and deserve happiness. Happpy #NationalComingOutDay
September marks the start of World Alzheimer’s Month. So here are a few things you should know about the disease.
1) September 21st is World Alzheimer’s Day
2) There is a difference between Alzheimer’s and dementia. Dementia is a brain disorder that affects communication and performance of daily activities. Dementia is an umbrella term for a set of symptoms including impaired thinking and memory loss. Alzheimer’s disease is a form of dementia that specifically affects parts of the brain that control thought, memory and language. In different types of dementia there is damage to different parts of the brain.
3) Alzheimer’s disease is a common cause of dementia causing as many as 50 to 70% of all dementia cases. Alzheimer’s is not a reversible disease. It is degenerative and incurable at this time. Some forms of dementia, such as a drug interaction or a vitamin deficiency, are actually reversible or temporary.
4) Dementia is not a natural part of ageing and it doesn’t just affect older people. Over 40,000 people under 65 in the UK have dementia.
5) Dementia is not just about memory loss, someone with dementia may also experience difficulties concentrating, problems planning and thinking things through, struggling with familiar daily tasks, issues with language and communication, problems judging distances, mood changes and difficulties controlling emotions.
6) People can still live well with dementia. You can find out more about this on the Alzheimer’s Society website.
So much can happen in a year.
Last year, we marched with Opening Doors London during the 2017 Pride, it was a fantastic day.
One year later, we are so very excited that Pride 2018 is here, and it’s going to be a scorcher of a day!
This year we’ll be there, marching alongside F2M London and will be handing out cake pops, water and leaflets at stall A09, come find us and have a chat,
Here’s to many more.
The care and health industry is a challenge to say the least, and at the end of a never-ending day, you sigh in relief when you get one more thing done because you care.
We know how hectic running a health and social service business can be, but imagine if you were the 5th largest employer in the world with 1.2 million staff.
Really caring can make all the difference.
So as the NHS turns 70 years old, everyone at Alternative Care Services wants to thank the staff (past, present and future) for their tireless hard work and dedication to keeping us all healthy, for free!
Thanks to the thousands of people who give their all every day, and who make all of our care services fantastic services, you know who you are.
Pride, No Shame – Ramses
We have been asked on many occasions why we think there’s a need for LGBT care.
At Alternative Care Services we believe it’s about creating safe and respectful spaces for older LGBTQI+ people, especially when they’re at home.
The need for (and lack of) safe spaces for the older LGBT generation is an issue that has been discussed by many organisations for many years.
In fact, there have been multiple studies (Marie Curie Hiding Who I Am being one) that have revealed that senior LGBTQI people live in fear of discrimination when receiving care.
Another report, conducted by Stonewall (Unhealthy Attitudes 2015) shows that a large proportion of healthcare staff are not confidently equipped with the necessary skills to provide thorough care for LGBT people, elderly or otherwise.
We believe that traditional models of care in Britain are letting down the older generation of LGBTQI+ people, and this is where we are taking a stand.
What Alternative Care Services does:
At Alternative Care Services we offer the very best, non-discriminatory care and support for all of our service users.
We employ staff from the LGBTQI+ community, in fact 90 percent of our staff identify as LGBTQI+.
That’s important as we believe that they are more likely to be able to respond to the specific care needs of an older generation of LGBTQI+ people.
We also make sure they are fully equipped to meet all needs of all our clients. Ultimately, we’ve employed people from the community to serve their community.
The Alternative Care Services teamWe believe there are fundamental issues within a care system that simply doesn’t acknowledge the existence of the LGBT community.
This ‘invisibility’ happens at the outset of the care process as all the referral forms are heteronormative, so social services doesn’t even know how to offer LGBT-focused services. There is no way of offering it.
What can be done to end the discrimination against the LGBTQI+ community?
We think there needs to be a change within the care system at large to futureproof the services for younger generations.
In an ideal world, everyone would live together in harmony, there would be no phobias, discrimination or bias.
Why choose LGBTQI+ care?
This may one day be a reality, but until then, Alternative Care Services will provide the very best personally-centered care and support to all with kindness, dignity, respect and understanding, regardless of sexual orientation or gender identity (SOGI).
Our aim is to enable all to live satisfying; independent lives while maintaining values and identities.
Providing exceptional care to the LGBTQI+ community is what we do, because you’re not an afterthought, you’re our first thought.
Here’s a list of our full unique services and all of our costs are transparent.
On June 13th Opening Doors London (ODL) hosted a national ‘Pride in Care’ conference.
ODL (the UK’s biggest charity supporting the older LGBTQI+ population) brought together leading experts and members of the LGBTQI+ community to discuss how improvements in the social care industry.
Our Managing Director Ramses spoke alongside Senior Lecturer in Health at The Open University, Dr Rebecca Jones and Oral Historian Dr Jane Traies on LGBTQI+ identities ageing in the social care system.
Alternative Care Services Managing Director Ramses speaking at the Pride in Care ConferenceThroughout the day there were numerous fantastic talks on various subjects ranging from Dementia and cancer within the LGBT community, housing advice, improving mental health, living longer with HIV and how best to cope with social isolation.
Other speakers on the day included Alice Wallace, Director of Opening Doors London, Dr Ben Thomas, Professor of Mental Health and Learning Disabilities in the School of Health and Social Care at London South Bank University and Anna Kear, CEO of Tonic Housing.
This entire event was fantastic, giving real insight into development of care services and the importance of staffing and culture in delivering excellent care designed specifically for # community
At Alternative Care Services we do things a bit differently, we have to as we are the UK’s first and only LGBTQI+ at-home care provider.
It is our mission to make sure all of our clients are provided the very best, discrimination-free service, as we believe dignity and respect is paramount to providing fantastic care.
Being the first company of its kind in the UK, we have come across many aspects of the care industry that we believe could be improved – particularly when it comes to working with the ageing LGBTQI+ community.
When we registered as a care provider with the Care Quality Commission, we realised that the independent regulator did not have a category for LGBT service users or companies.
This signified a vital issue to us; that the LGBTQI+ community remains invisible within the care industry, something that we believe must change.
We therefore contacted the folks at the CQC to see how we could effect change and ensure LGBTQI+ service users are acknowledged and offered a choice.
After months of discussions, the regulator agreed that its registration process needed to change and confirmed to us that it would now redevelop the entire CQC registration process!
We are thrilled to have been a catalyst of change and to have worked directly with the CQC to make sure LGBTQI+ people are no longer invisible when it comes to the industry.
It is worth noting that this is still a work in progress, and there is still much to do to, but with the help of fantastic organisations like the CQC, and its staff, we can improve services for all.
It was bright and warm June morning that Ramses, our MD was invited on LBC radio to challenge the protests of Man Friday, a Feminist group that opposes the 2018 Gender Recognition Act.
Speaking on the popular Nick Ferrari radio program, Ramses discussed the possible changes in law and explained to the audience and protestors why the new changes were a positive step for the trans, non-binary and non-gender community.
He argued that these protests signify that it’s ok to hate the trans, non-binary and non-gender community. You can hear the full show here:
What is Man Friday and why are they protesting?
Back in March the female activist group called Man Friday attended a men-only swim session wearing just trunks and pink swimming caps to protest against proposed changes that would enable trans, non-binary and non-gender people to choose their own gender.
Man Friday aim “To raise awareness among men of the misogynistic and homophobic pro-self-ID policies that are allowing men to appropriate women’s spaces, services and positions,” one activist told The Independent.
The group also want to challenge the idea that sex and gender are interchangeable and for organisations to use the lawful exemptions in the Equality Act to protect the rights, safety, dignity and privacy of women.
What is the Gender Recognition Act?
The first thing you should know is that the GRA is not new. It was introduced to UK law in 2004 and officially let an adult register to change the gender assigned to them at birth.
However, the 2018 update of the Gender Recognition Act has been surrounded in much controversy. Why?
As new proposed changes would mean trans, non-binary and non-gender adults would be able to sign a self-identification form to register without the need for a ‘diagnosis’ of gender dysphoria.
The current legislation requires trans, non-binary and non-gender people to provide psychiatric assessments and proof of living for two years in the gender they wish to be officially recognised.
The new self-id would make it much simpler and less medicalised
Opposition to the change comes in the form of organisations like
There are already multiple countries (Portugal, Ireland, Malta, Belgium, Norway and Denmark) using the self-id process with, so far, no evidence of anyone abusing them for sinister purposes.
Why is it important for transgendered people to be able to self-refer?
“It’s important because the older systems that have been in place since the 2004 is woefully inadequate, people and if you can decide at any time in your life that you are heterosexual, you should be able to deice what gender you are,” explained Ramses.
We work with many fantastic organisations and charities at Alternative Care Services.
One of our favourites is Opening Doors London (ODL), the UK’s biggest information and support charity older LGBTQI+ people.
On June 13th ODL will host a national ‘Pride in Care’ conference, which aims to bring together leading organisations and members of the LGBTQI+ community to discuss how improvements in the social care industry can be made.
Who will be speaking at the ODL Pride in Care conference?
So we are excited and thrilled that our Managing Director Ramses Underhill-Smith will be guest speaker at the event.
Ramses will be speaking alongside the esteemed Dr Rebecca Jones (Senior Lecturer in Health at The Open University) and Dr Jane Traies (Oral Historian) on LGBTQI+ identities ageing in the social care system.
Alternative Care Services Managing Director RamsesWhat will be discussed at the Pride in Care event?
Throughout the day there will be numerous talks on various subjects ranging from Dementia and cancer within the LGBT community, housing advice, improving mental health, living longer with HIV and how best to cope with social isolation.
Other speakers on the day will include Alice Wallace, Director of Opening Doors London, Dr Ben Thomas, Professor of Mental Health and Learning Disabilities in the School of Health and Social Care at London South Bank University and Anna Kear, CEO of Tonic Housing.
When is the ODL Pride in Care Conference?
Pride in Care conference will kick-off on June 13th at 9:30am and is an all-day event, there are still tickets available if you’d like to go along to take part in any of these fascinating discussions.
Where is it being held?
The event is being held at the Roberts Building, University College London, Torrington Place, London, WC1E 7JE.
For more information on the Opening Doors London Pride in Care conference, click here.
There are many types of sexual orientations and gender identities, so we explain what they all stand for:
L – Lesbian: a woman who is attracted to other women
G – Gay: a man who is attracted to other men or broadly people who identify as homosexual
B – Bisexual: a person who is attracted to both men and women
T – Transgender: a person whose gender identity is different from the sex the doctor put down on their birth certificate
Q – Queer: originally used as a discriminatory term, more recently, the term is used by people who are not heterosexual and/or not cisgender and people who reject traditional gender identities and seek a broader and deliberately ambiguous alternative to the label.
Q – Questioning: a person who is still exploring their sexual orientation and/or gender identity
I – Intersex: a person whose body is not definitively male or female. This may be because they have chromosomes which are not XX or XY or because their genitals or reproductive organs are not considered “standard”
A – Allies: a person who identifies as straight but supports people in the LGBTQQIAAP community
A – Asexual: a person who is not attracted in a sexual way to people of any gender
P – Pansexual: a person whose sexual attraction is not based on gender and may themselves be fluid when it comes to gender or sexual identity
- CQC issue new guideline on dealing with relationships and sexuality in adult social care servicesMarch 8, 2019When we registered as a care provider with the Care […]
- Our Managing Director Ramses Underhill-Smith’s thoughts on why shame erodes our mental health wellbeingFebruary 15, 2019I was recently at an event where a 6-year-old, in a […]
- CQC praises UK’s first LGBTQI domiciliary care company and its ‘kind and caring staff’ after finding the ‘service promoted an open and honest culture’December 31, 2018Alternative Care Services , the UKs first LGBTQI+ […]
- Dignity in care: we understand more than most why it’s importantNovember 18, 2018Alternative Care Services is a care agency providing […]
- Alternative Care Services works with CQC to create registration breakthroughJune 5, 2018At Alternative Care Services we do things a bit […]