Put simply, sexual orientation and trans status monitoring is asking people accessing health and social care services about their sexual orientation, trans status and gender identity and recording this information. When monitoring sexual orientation and trans status, it is important to ask questions in the right way so that communities understand how to answer in a way that ensures accurate and robust data is collected. When done appropriately, monitoring can demonstrate that services are culturally competent and can help LGBT people feel included.
If We're Not Counted, We Don't Count!
LGBT Foundation and NHS England have launched a new good practice guide to provide support for services to implement effective sexual orientation and trans status monitoring. If We're Not Counted, We Don't Count contains updated guidance, tips and case studies, and explains how monitoring plays an instrumental role in identifying and addressing inequalities. It also explains how monitoring is not a stand-alone step, it is only useful if the findings are used to better support LGBT patients and to underpin strategies to address LGBT health inequalities. This guide explains how to use the information collected through monitoring to improve services for LGBT people.
Why is sexual orientation and trans status monitoring important?
LGBT communities experience a broad range of health inequalities throughout their lives, including substantially higher instances of mental health issues and drug/alcohol dependency, lower rates of physical activity and higher rates of smoking. LGBT communities also experience higher rates of homelessness, domestic abuse and sexual violence which can lead to significantly worse health outcomes. Health inequalities arise at different stages of people’s lives, and LGBT people often experience specific further discrimination and marginalisation when accessing services to address these health inequalities.
All health and social care services should be taking proactive steps to improve care, provide equitable access to services and be working to reduce LGBT health inequalities. Monitoring sexual orientation and trans status is essential for services to understand the specific needs of their LGBT patients/service users and recognise the ways in which services need to be improved.
A 2017 primary care patient experience survey conducted by LGBT Foundation found that LGBT people who shared their sexual orientation with their GP were 21.4% more likely to feel their GP met their health needs than those who did not. Trans people who shared their trans status with their GP were 62.1% more likely to feel their GP met their health needs than those who did not.
Sexual Orientation Monitoring
LGBT Foundation worked with NHS England and a number of stakeholders to make sure that healthcare services collect information on patient's sexual orientation. The Sexual Orientation Monitoring Information Standard (SCCI2094) was published in October 2017 by NHS Digital and NHS England.
An Information Standard is a document used across the health and social care system to help collect and process information in a consistent way. This provides a consistent mechanism for recording the sexual orientation of all patients aged 16 years or over across all health services in England.
The Information Standard was commissioned by NHS England and developed by LGBT Foundation working with NHS Digital, the Department of Health, Public Health England and a cross-system group with representation from leaders across health and social care as well as organisations representing the workforce.
You can find out more about the Sexual Orientation Monitoring Information Standard in the If We're Not Counted, We Don't Count guide, and you can find the full specification here.
Trans Status Monitoring
There is currently no national trans status monitoring information standard, although there is ongoing work to develop a standardised approach and to update IT systems so that trans status can be properly recorded. However, this should not hold services back, there are ways to effectively monitor without an information standard.
Trans status monitoring is becoming more prominent and LGBT organisations such as LGBT Foundation and Brighton and Hove Switchboard have supported services to implement trans status monitoring effectively.
Services which have implemented trans status monitoring usually gain consent from the individual to place a note on their medical record to say that they are trans and/or to say that their gender identity is something other than male or female.
You can find out more about trans status monitoring in the If We're Not Counted, We Don't Count guide.
- e-Learning for Healthcare - Sexual Orientation Monitoring Information Standard module
- NHS England - Additional guidance on the Sexual Orientation Monitoring Information Standard
- LGBT Foundation - Sexual orientation monitoring guide (2017)
- Building Health Partnerships - Clinical rationale for sexual orientation monitoring
'If We're Not Counted, We Don't Count' Launch Event
Below is a recording of the launch event for If We're Not Counted, We Don't Count which took place on 12 July 2021. Panelists included:
- Dr Michael Brady, National Advisor for LGBT Health, NHS England and NHS Improvement
- Paul Martin OBE, Chief Executive, LGBT Foundation
- Patrick Ettenes, Co-founder of BringDementiaOut and community health champion
- Michelle Ross, Co-founder of cliniQ and Director of Holistic Wellbeing Services