Sexual orientation monitoring will help us tackle health inequalities

13 November 2017

The NHS has released new guidelines, which say all patients aged 16 and over in England will be asked about their sexual orientation.

The information will be used to:

  • check there is equal access to services for lesbian, gay and bisexual (LGB) people
  • improve understanding of the impact of inequalities on health and care outcomes for LGB people
  • enable policy makers to better identify health risks at a population level

What inequalities do LGB people face?

Research by the LGBT Foundation has shown that LGB people are disproportionately affected by health inequalities and experience significant barriers to accessing services.

  • LGB people are twice as likely as the general population to commit suicide
  • LGB people are seven times more likely to use drugs, twice as likely to binge drink, and show higher levels of substance dependency compared to their heterosexual peers
  • LGB people are more likely to experience many cancer risk factors including stress, smoking, problematic alcohol use and poorer diet and exercise
  • LGB people are less likely to access mainstream health services, including cancer screening
  • LGB people are more likely to rate their experiences of health and care services as poor, and fear that they will suffer unequal treatment as an LGB person
  • LGB people who have experienced or fear they might face discrimination can put off using health services until an emergency

What will I be asked?

You will be asked ‘which of the following options best describes how you think of yourself?’ and will be able to choose from:

  • Heterosexual or Straight
  • Gay or Lesbian
  • Bisexual
  • Other sexual orientation not listed

What if I don’t want to answer?

You might not want to tell your GP about your sexuality or you might be questioning your sexuality. You will be able to choose from:

  • Person asked and does not know or is not sure
  • Not stated (person asked but declined to provide a response)

Some people are concerned about the security of this information or the potential for it to be misused by future governments. These fears are understandable, given the discrimination that many LGB people have experienced in their daily lives.

It’s your choice whether to answer or not. You won’t be forced to tell your GP about your sexuality, and your GP shouldn’t make any assumptions about you if you choose not to answer.

Why is my sexuality relevant?

On an individual level, you might not feel your sexuality has anything to do with the problems you visit your GP about.

However, the NHS wants to examine the needs of LGB people as a group. This is because your sexuality makes you more likely to experience certain health problems or poor quality of care. The NHS needs to make sure it’s not treating people unfairly because of their sexuality, but it can’t do this without first asking people how they identify.

This is also why the NHS asks you about other demographic information, like your age, ethnicity or religion. The data means we can check everyone has equal access to services and tackle specific issues in certain communities.

How will this data make a difference?

There is currently very little data on NHS patients who do not identify as heterosexual. Most services do not ask patients about their sexuality, so they just don’t know about the experiences of LGB people. The data that exists hasn’t been collected on a large scale.

Asking patients about their sexuality allows the NHS and charities like METRO to investigate these inequalities and better identify health risks. The data will help us to provide services that are relevant and appropriate, particularly for high risk groups.

This will lead to targeted campaigns, early interventions and better services for LGB people. Improving access to services means people would be less likely to put off seeking help until an emergency.

What if my sexuality isn’t listed?

People identify in lots of different ways, including queer, pansexual and asexual. You can choose ‘other sexual orientation not listed’ or choose not to answer the question if you wish.

What about trans and non-binary people?

The new guidelines refer to sexual orientation monitoring, not gender identity. We urge the NHS to think about implementing a similar standard, as trans and non-binary people also face health inequalities and often experience a poor standard of care.

What does METRO make of these guidelines?

METRO is a member of the National LGB&T Partnership, which has welcomed the new standard as a significant game changer in the future health and social care provision for lesbian, gay and bisexual people.

The National LGB&T Partnership works to reduce health inequalities and improve access to health and social care for LGB&T people. We worked with NHS Digital, the Department of Health and Public Health England to develop these guidelines.

We believe this new standard is a vital step towards addressing health inequalities and improving access to care. Dr Greg Ussher, our CEO, said:

“We know from our service users that LGBT people still experience considerable health inequalities, especially when this coincides with poverty, which it frequently does.

We also know that one of the best ways we can start to tackle this issue is through effective and universal monitoring, which is why we are delighted to see this work moving forward.”

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