Monitoring Sexual Orientation, Gender and Trans Status

Over the last two decades, the lesbian, gay, bisexual and trans (LGBT) communities have seen legislative change which has led to greater acceptance. However, there is still a huge lack of evidence about LGBT people, our needs and experiences. Monitoring sexual orientation, gender identity and trans status is a proven way to address that lack of evidence. Championing sexual orientation and trans status monitoring for service users and staff across all public services is a key an organisational priority for LGBT Foundation. You can read more about our recommended approach and download our guidance to implementing monitoring here.


Sexual Orientation Monitoring

LGBT Foundation worked with NHS England and a number of stakeholders to make sure that healthcare services collect information on patient sexual orientation and use this to improve services.

What is an information standard for sexual orientation monitoring?

Information standards are used across the health and social care system to help collect and process information. This standard enables health and social care organisations to monitor sexual orientation in a way that is consistent with all other parts of the healthcare system. It is classed as a ‘fundamental standard’, meaning that it applies across all of health and social care.

What are the benefits of this standard for patients and service users?

By recognising that every patient has different needs and circumstances, healthcare services can deliver a personal form of care, which best meets those needs and improves outcomes for people. Monitoring sexual orientation as part of other equalities monitoring means that services are able to use this information to better meet the needs of their patients and service users.

Key benefits for patients and service users are:

· Equality of access to services.

· Improved services, more specific to your needs.

· Creating a culture of inclusivity and openness with the service provider.

We know from research that lesbian, gay and bisexual (LGB) people experience health inequalities compared to heterosexual people, such as being at higher risk of poor mental health, or missing out on routine health screening. If your healthcare service collects information on patient sexual orientation, they will be able to target specific health promotion and services to LGB patients: for example, promoting cervical screening to lesbian and bisexual women; or referring young LGB people experiencing poor mental health to a specific LGB young people’s service.

What do you need to know as a patient or service user?

As of October 2017, organisations are now able to use this standard to implement sexual orientation monitoring.

The standard sets out a consistent question and answer options for recording this data:

Which of the following options best describes how you think of yourself?

1. Heterosexual or Straight

2. Gay or Lesbian

3. Bisexual

4. Other sexual orientation not listed

U. Person asked and does not know or is not sure

Z. Not stated (person asked but declined to provide a response)

9. Not known (not recorded)

This is based on research into monitoring sexual orientation conducted by the Office for National Statistics and the Equality & Human Rights Commission, and on current practice by organisations which monitor sexual orientation.

Classifications 1-3 are those which people are most likely to be familiar with, and are intended to simplify the question and answer. Classification 4 allows patients to identify as other than heterosexual/straight or lesbian, gay or bisexual – for example queer or asexual.

Classification U allows recording where a patient does not know or is not sure, consistent with terminology in NHS Digital’s Data Dictionary. Classification 9 allows the patient not to disclose this information, as is their right. Classification Z will not be visible to the patient or healthcare professional but is needed to account for missing data in analysis (e.g. where there is no record of sexual orientation).

It's still your choice

As a patient or service user you will never be forced to disclose your sexual orientation – it is always your choice whether you disclose this information or not. Sometimes people can feel embarrassed to ask or to be asked about sexual orientation, but it needn’t be an embarrassing question. Asking someone their sexual orientation should be similar to asking if they are married or their age – it’s a part of their identity that affects their life but doesn’t define them, and it’s certainly not asking about their sex life.

Trans status monitoring

LGBT Foundation supports monitoring trans status as there is a significant lack of evidence about the needs and experiences of trans people. We believe that monitoring, sensitively implemented, is a clear way to address that lack of evidence and make our needs and experiences heard. Not counting trans people as part of wider equalities monitoring suggests that trans people’s needs don’t count, and we want to contest that.