Sexual orientation

Sexuality and sexual orientation refer to who someone feels physically and emotionally attracted to, and this can be romantic or emotional attraction, or both¹⁸.

Research shows that that lesbian, gay, bisexual and trans (LGBT+) people experience greater health inequalities compared to heterosexual and cisgender people, such as being at higher risk of poor mental health or missing out on routine health screening. If a healthcare service collects information on a patient’s sexual orientation, they will be able to target specific health promotion and services to support LGBT+ patients: for example, promoting cervical screening to lesbian and bisexual women; or referring young LGBT+ people experiencing poor mental health to a specific LGBT+ young people’s service¹⁹.

LGBT Foundation and NHS England have launched a good practice guide to provide support for services to implement effective sexual orientation monitoring. The guide ‘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 is important to find the right time to ask these questions, as patients may not feel comfortable sharing at first but may feel comfortable enough to do so later on. This is important as an individual’s sexual orientation can change over time. If a patient wishes to know why you are asking for this data, you can inform them that the service collects this information so that they can appropriately provide for all their patients and ensure that it is inclusive of people of all identities.

The information standard for Sexual Orientation Monitoring (DCS2094) was published in October 2017 and provides the mechanism for recording the sexual orientation of all patients aged 16 years and over across all health services and Local Authorities with responsibilities for adult social care in England, for the purposes of compliance with the Equality Act 2010²⁰.

Further guidance and frequently asked questions on the Sexual Orientation Monitoring Information Standard can be found on the NHS England website.

Systemized Nomenclature of Medicine – Clinical Terms (SNOMED CT) is a structured clinical vocabulary for use in an electronic health record, it gives clinical IT systems a single shared language²¹. The Information Standards development team consulted with the national SNOMED CT team and the NHS Data Model & Dictionary Service at NHS Digital to ensure that SNOMED CT codes are compatible with the question set for this Standard. All NHS healthcare providers in England must now use SNOMED CT for capturing clinical terms within electronic patient record systems.

Table 4 identifies the data items required to record and flow this data to the MHSDS and IAPT Data Set, as referenced in the Sexual Orientation Monitoring specification. Classification 4 (Other sexual orientation not listed) allows for patients to identify as other than heterosexual/straight or lesbian, gay, or bisexual, including but not limited to asexual or queer. The SNOMED CT code specified for this “Other” grouping specifically relates to being attracted to neither gender. This code is under review to improve on this, but at this time is the most appropriate code available.

Table 4

Extract from the Technical Output Specification; MHSDS Table MHS011 and IAPT Table IDS011 - Social and Personal Circumstances

Data Item Name: SOCIAL AND PERSONAL CIRCUMSTANCE (SNOMED CT)

Intermediary Database (IDB) Element Name: SocPerCircumstance