The government recommendation that all NHS healthcare providers should ask patients about their sexual orientation during appointments has been welcomed by LGTBQ+ charities and campaigners.
The call comes in a report from the Women and Equalities Committee, which says monitoring is the best way to address the “deep inequalities” in care that LGBTQ+ people receive despite often facing poorer health than the general population.
LGBTQ+ people are more likely to attempt suicide and self-harm than the general population, and are more likely to smoke and drink alcohol at high levels. Gay men are more likely to have anal cancer and bisexual women more likely to have cervical cancer than the general population. Lesbian and bisexual women also have higher rates of obesity than heterosexual women.
Although NHS England says that all patients receive the same physical and mental healthcare, the report says “unacceptable” inequalities “glare out wherever you look” and, as a result, hospitals and care homes should now face financial penalties if they fail to collect this data from patients.
Currently doctors and nurses are encouraged by NHS guidelines, updated in 2017, to ask patients about their sexuality when they see them face to face, but are not required to do so. Many don’t – especially when facing the time pressures of short appointments and targets.
The report says that doctors not knowing a patient’s orientation means that LGBTQ+ people are often “expected to fit” into systems that assume a person is heterosexual and cis-gendered. At the same time, when LGBTQ+ people do choose to disclose, their sexual health often becomes the caregiver’s priority.
The report recommends all medical schools include LGBTQ+ content as standard, and LGBTQ+ case studies within the curriculum.
Laura Russell, director of campaigns, policy and research at Stonewall told HuffPost UK: “We welcome the call for all providers to implement sexual orientation and trans status monitoring, alongside training for frontline staff to collect this data.”
Laurence Webb, assistant director of inclusion at LGBT Foundation, which runs a ‘Pride In Practice’ programme to help clinicians feel more confident talking about LGBTQ+ health, agreed that effective monitoring could also highlight inequalities in the system. “It provides a better understanding of the potential barriers to accessing or using healthcare services, thus allowing for improvements to existing services,” he told HuffPost UK
“It is crucial that all healthcare professionals operate a practice of personalised care.”
Both noted that the way data was collected would be crucial to a positive patient experience. “As with all personal data, information on sexual orientation and trans status should be collected and recorded sensitively,” said Russell
“It is crucial that all healthcare professionals operate a practice of personalised care,” said Webb. “Speaking openly and respectfully about a patient’s sexual orientation and trans status allows healthcare professionals to understand the specific needs of their LGBT patients, and creates a culture of inclusivity and openness.”
Alex Leon, an LGBTQ+ activist and campaigner, while broadly supportive of the suggestions, shared some reservations. “I think mandating data collection on sexual orientation and gender identity is important – so long as people are also given the opportunity to choose not to disclose,” he told HuffPost UK.
“The community needs assurance that in divulging this information about us, which can and has been used as a tool for discrimination, we are protected within the healthcare system and our complaints are taken seriously.”
Disclosing this information would not detract from time available to talk about medical problems or mean LGBTQ+ people were given less time than the general population, he said. “It’s all part of normalising discussions around these parts of our life, rather than allowing them to remain taboo or unspoken.”
But Leon did want to see a more intersectional approach. “Yes LGBT people face distinct healthcare inequalities. But what if we’re talking about a black lesbian woman, or a disabled trans man? The way that multiple marginalised identities impact on access to and fair treatment within our healthcare service need to be taken into account when we talk about making our healthcare system more inclusive,” he said.