Sexual Orientation Monitoring Frequently Asked Questions

What is an Information Standard?

An information standard is defined in the Health and Social Care Act 2012 as: “a document containing standards that relate to the processing of information”.

The Data Coordination Board (DCB) assures the quality of information standards.

What is a Fundamental Information Standard?

A Fundamental Information Standard is one that can be applied across Health and Local Authorities with responsibilities for Adult Social Care that supports a general business need, for example recording sexual orientation. It will define at a high level what it is and how it should be implemented, used and or recorded.

A fundamental Standard may cross organisational, geographical, profession and / or specialty boundaries. Fundamental standards are used within other Information Standards, Collections and Extractions that will define a specific implementation.

What is the scope of this Information Standard for Sexual Orientation Monitoring?

The Sexual Orientation Monitoring Information Standard provides the mechanism for recording the sexual orientation of all patients/ service users aged 16 years and over across all health services and Local Authorities with responsibilities for Adult social care in England in all service areas where it may be relevant to collect this data. The standard may act as an enabler for the Equality Act 2010, supporting good practice and reducing the mitigation risk for organisations required to comply with the Act.

What question will be used to monitor sexual orientation?

Sexual orientation:

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
  5. Person asked and does not know or is not sure
  6. Not stated (person asked but declined to provide a response)
  7. Not known (not recorded)

The question set is based on research into monitoring sexual orientation conducted by ONS and the EHRC, 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 (LGB). Classification U allows recording where a patient does not know or is not sure, consistent with terminology in NHS Digital’s Data Dictionary. Classification Z allows the patient not to disclose this information, as is their right. Classification 9 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).

When will the standard come into effect?

The information standard was published on 5th October 2017. From this date, organisations will be able to use this standard to implement sexual orientation monitoring.

Organisations which must have regard to this Standard are defined within the Health and Social Care Act, 2012 and can be found here:

What will change as a result of this standard?

This standard will enable health and social care organisations to monitor sexual orientation in a way that is consistent with all other parts of the healthcare system. There are several expected benefits, listed below.

What are the expected benefits of this standard?

Implementation of this standard will deliver benefits across a number of areas:

  • Support health and social care bodies to be compliant with the Equality Act with regard to sexual orientation.
  • There is a strong evidence base that LGB people are disproportionately affected by a range of health inequalities, including poor mental health, higher risk of self-harm and suicide, increased prevalence of sexually transmitted infections (STI) including HIV, increased use of alcohol, drugs and tobacco with a higher likelihood of dependency; increased social isolation and vulnerability in old age. However, a lack of patient SOM means that these inequalities and related specific patient needs are often not acknowledged or addressed in mainstream service provision.
  • Recording sexual orientation across health and social care would allow policy makers, service commissioners and providers to better identify health risks at a population level. This would support targeted preventative and early intervention work to address health inequalities, which is shown to reduce expenditure linked to treatment costs further down the line.[2]
  • Health and social care organisations will be able to utilise the collected information to contribute to the improvement of health and social care providers’ understanding of the impact of inequalities on health and social care outcomes for different populations in England and thereby take steps to ensure the provision of equitable access for LGB individuals.

Is there a cost associated with implementation?

A solution has been chosen that is simple and fits with the research conducted to make implementation as easy as possible. We consulted with the owners of the three datasets which already collect this data and with organisations in the health and social care system which routinely monitor sexual orientation. This found that they had taken a phased approach to implementation.

What are the information standard requirements?

The information standard includes the following requirements for its implementation:

  • IT systems: where this data is recorded, IT systems MUST be adapted to use the question and response codes as set out in this standard
  • Health and social care organisations: where this data is recorded, health and social care organisations SHOULD provide adequate training for all staff involved in collection and recording of this data.
  • Health and social care organisations: where this data is recorded, health and social care organisations MAY wish to create briefing documents for staff and patients/service users explaining why this collection is necessary.
  • NHS Digital MUST be receptive to changes to data sets that may be impacted by this Fundamental Standard.
  • NHS Digital MAY wish to consider publishing data where it exists.

Is there public support for the Information standard?

LGBT Foundation has previously conducted research with LGB and heterosexual people to assess the acceptability of SOM. This indicates that 90-95% of people, both LGB and heterosexual, would be comfortable disclosing their sexual orientation as part of demographic monitoring if they understood why it was being collected.

During the development of the standard, engagement with the LGB community suggests that SOM is largely acceptable among LGB people providing that confidentiality policies are adhered to and that the data is used appropriately.

To support the implementation of the Standard, LGBT Foundation has developed a “Good practice guide to monitoring sexual orientation”. In addition, Stonewall has produced a resource called “What has it got to do with you” providing ten reasons on why people should complete sexual orientation monitoring forms.

Why does the standard not include gender identity?

Our engagement with the trans community and our work with trans organisations on equalities monitoring shows that gender identity and trans status should be kept separate from sexual orientation.

NHS England is working with the Department of Health and other partners on a scoping exercise which is evaluating options for the development of a unified information standard which would include gender identity. The initial scoping exercise is due to be completed by the end of winter 2017 when an options paper will be considered by NHS England and the Department of Health. This standard for SOM acts as the pilot for any future wider standard and the intention is that the SOM will become part of any unified information standard.

Which services are currently collecting sexual orientation information?

The following three NHS services collect sexual orientation monitoring:

  • Improving Access to Psychological Therapies Data Set – Version 1.5
  • Genitourinary Medicine Clinic Activity Dataset (GUMCADv2) Standard Specification
  • Deprivation of Liberty Safeguards (DoLS), under the Mental Capacity Act 2005, Data Collection.

Does the Sexual Orientation Monitoring Standard make it compulsory to collect this data?

No, the standard provides the categories for recording sexual orientation but does not mandate a collection.