“By monitoring sexual orientation, you’ll be able to build an evidence base on the experiences of LGB people,enabling you to better understand your staff and service users,and provide for their different needs.” (Good Practice Guide, Sexual Orientation Monitoring Information Standard, 2017)


The sexual orientation monitoring information standard, introduced by the NHS in October 2017, is vital to ensuring we provide equitable services for all and that patients feel able to talk to their healthcare providers without fear.

There is considerable evidence that shows that lesbian, gay and bisexual people are:

  • more likely to have poorer health outcomes compared to heterosexuals
  • have fewer opportunities to voice their concerns about their health
  • are less likely to access services when they need to because of anticipatory discrimination
  • are more likely to have specific health problems as a group e.g. substance abuse, poor screening uptake, higher levels of smoking
  • are more likely to face discrimination when trying to access healthcare services.

That said, the launch of the standard resulted in considerable public debate – not all positive, and very little about health inequalities itself which led to a long period of campaigning by LGBT+ groups. Below are examples of some of the headlines from major news outlets in the UK.

News headlines.jpg

The value of public debate

However, public debate has been very useful and can inform training and raising awareness:

(a) It has helped organisations realise that the reasons behind collecting monitoring information needs to be communicated clearly, regularly and thoroughly.

(b) It has highlighted the level of socio-cultural discourse around sexual orientation, providing equality advisers and trainers the opportunity to see how minority sexual orientations are perceived (regardless of legal protections).

(c) It has alerted operational areas within healthcare to the need to update monitoring systems (e.g. patient administration systems, employee records) so that they reflect the diversity of people who use services and are employed by the organisation.

What does the standard say?

Collection of monitoring data in standard categories of:

  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)

What can you do?

“Monitoring sexual orientation of staff members will make sure that LGB staff members know they work in an inclusive and fair environment.” (Good Practice Guide to Sexual Monitoring Information Standard, 2017)

  1. Contribute to implementing the standard in your workplace. Take a phased approach guided by information from NHS England’s website. 
  2. The information standard will be reviewed in October 2018 by NHS England, make sure to have some idea of the pros and cons for your organisation so you can provide much needed feedback.
  3. Speak to your leads in Information Technology and managers of the patient administration systems and staff information systems. Ensure they are aware that the standard will eventually become mandatory (expected by 2020) since the NHS is committed to ensuring that services are monitored so that information can be used to demonstrate health inequalities and contribute to improved service deployment
  4. Communicate with leads in NHS England and NHS Digital for updates.
  5. Introduce training sessions on sexual orientation monitoring for all staff. Develop leaflets/booklets that can specifically be used in staff and patient areas.
  6. Communicate the importance of monitoring to service users through patient groups.
  7. Ensure your organisation has a sexual orientation monitoring information policy to show commitment to the standard.
  8. Ensure that the Communications Department at your organisation is aware of the standard and why it is necessary so that it can be written about in staff-wide bulletins.
  9. Hold an open session for all staff to come along so they can ask questions about the standard. Ensure wider questions about health inequalities, service provision and monitoring are covered.
  10. Ensure that senior staff in all areas are aware of duties under the standard. Ask them if front-line staff need additional training.
  11. Liaise with your organisation’s LGBT+ Network to ask for advice and help in getting the message out.
  12. Confidence in confidentiality will ensure confidence in your organisation, and increased disclosure rates among both staff and service users. Ensure you provide information on this when running training about the monitoring standard.
  13. All monitoring forms should include a brief explanation of why this data is being collected and how confidentiality will be maintained.

    When can you use monitoring for staff?

    1. job application
    2. selection process
    3. recruitment
    4. routine requests to update records

    5. promotion and appraisal process

    6. staff surveys
    7. exit interviews

    When can you use monitoring for patients?

    1. registering for the service

    2. delivery of service
    3. first record on patient administration system
    4. patient satisfaction surveys

    5. patient complaints


An essential read is the Good Practice Sexual Orientation Monitoring Information Standard 2017.

NHS England overview and specification

NHS Digital overview and specification

Equality and Human Rights Commission – Improving Sexual Orientation Monitoring

Health Education England e-Learning to Support Sexual Orientation Monitoring Information Standard