Sexual orientation and gender identity leaflet

What is sexual orientation?

A person’s sexual attraction to other people, or lack therof. Along with romantic orientation, this forms a person’s orientation identity. 

Very generally, the main categories of sexual orientation are:

• Lesbian: Refers to a woman who has a romantic and/or sexual orientation towards women.*
• Gay: Refers to a man who has a romantic and/or sexual orientation towards men. Also a generic term for lesbian and gay sexuality. Some women define themselves as gay rather than lesbian.*
• ​​​Bi: An umbrella term used to describe a romantic and/or sexual orientation towards more than one gender. Bi people may describe themselves using one or more of a wide variety of terms, including, but not limited to:
  • bisexual
  • pan
  • queer
  • other non-monosexual identities. *
• Heterosexual/straight: Refers to a man who has a romantic and/or sexual orientation towards women or to a woman who has a romantic and/or sexual orientation towards men.*

The four orientations listed above are by no means exclusive, and some people may identify themselves as queer (often used by those wanting to reject specific labels of romantic orientation, sexual orientation and / or gender identity).

However, lesbian, gay, bi, transgender (LGBT) and heterosexual/straight are the orientations most commonly identified and the most commonly asked in sexual orientation monitoring practice within the NHS. Homosexual (someone attracted to people of the same gender) is generally considered an overly clinical and old fashioned term to use. Heterosexual doesn’t have the same connotations but is usually given as heterosexual or straight as the two terms are synonymous for most people. (LGBT Foundation)

* As defined by www.stonewall.co.uk

What is transgender identity?

An umbrella term to describe people whose gender is not the same as, or does not sit comfortably with, the sex they were assigned at birth. Trans people may describe themselves using one or more of a wide variety of terms, including (but not limited to):

• transgender
• transsexual
• gender-queer (GQ)
• gender-fluid
• non-binary
• gender-variant
• crossdresser
• genderless
• agender
• nongender
• third gender
• bi-gender
• trans man
• trans woman
• trans masculine
• trans feminine
• neutrois *

*As defined by www.stonewall.co.uk

What is homophobia, biphobia and transphobia?

Homophobia, biphobia and transphobia encompass a range of negative attitudes and feelings toward people who are identified as, or are perceived to be, lesbian, gay, bi or transgender (LGBT).

Supporting our LGBT+ community

The Trust is committed to ensuring service users receive the best possible health and social care and staff have the right skills and knowledge to respond effectively to individual needs. We recognise that our work around embedding appropriate policies and practices is a start to ensuring dignity and respect for the community we serve.

Supporting our LGBT+ staff

The Trust pride themselves in being an inclusive employer, valuing all our employees and providing a safe, non-judgemental working environment. 

Using visual symbols to show support

The rainbow flag is a traditional symbol which depicts support for the LGBT+ community. Acting on feedback from staff and patients that visual symbols are important, the rainbow flag is displayed in the organisations premises both to display support of LGBT+ issues and provide a welcome and reassurance to LGBT+ staff and patients. Staff are also able to wear a rainbow lanyard badge. This is a symbol that sends a message that “you can talk to me” about sexual orientation and gender identity issues.

Why do we ask patients and service users about their sexual orientation and gender identity and collect the information?

• It supports highlighting of inequalities between different groups. We know, for example, a disproportionate number of young LGBT+ people self-harm and complete suicide.
• It makes it easier to identify issues that affect LGBT+ people. For example many LGBT+ people experience discrimination and social isolation within their communities. There is a strong link between social isolation and serious self-harm and suicide.
• It makes it easier to monitor serious self-harm and suicide rates amongst LGBT+ people and to implement strategies to reduce these.
• It assists in accurately risk assessing and care planning with patients and service users. For example, there is some evidence that a disproportionate number of LGBT+ people have incidence of problematic substance use, including alcohol. There is a strong link between serious self-harm and suicide and substance use (including alcohol). When assessing a patient, being able to make the link between sexual orientation and gender identity and substance use may impact on the level the risk is assessed to be; and therefore the actions taken in response.
• It increases understanding of the potential barriers to our services, such as fears LGBT+ people may have that services will discriminate on the basis of sexual orientation or gender identity. To illustrate, ‘coming out’ as LGB or T is often stressful and it does not end, as an LGBT+ person has to make a decision each time they meet someone new, or accesses a new service, whether or not to come out.
• It supports staff in building confidence in asking questions about sexual orientation and gender identity. This gives a clear message of inclusion and understanding that sexual orientation and gender identity are relevant and do impact on social inclusion, on mental wellbeing and on physical wellbeing.
• It assists in improving our existing services as well informing the development of tailored services for LGBT+ people where these are appropriate.
• It makes it easier to monitor incidents of discrimination and prevent them from happening. For example, where an LGBT+ person feels safe to disclose their sexual orientation or gender identity, they are more likely to feel safe to report incidents of discrimination. These may be significant factors in their presentation within our services.
• It enables better measurement of equality and diversity performance and of related changes and improvements. How can you know your services are meeting the needs of LGBT+ people if you are not counting them?
• It gives a strong message about your commitment to recognising equality and diversity (as an individual and as a team/service). Remember, a person may not choose to disclose their sexual orientation or gender identity at the time you ask, but they will be observing how inclusive and safe your service is and may choose to disclose at a later time.
• It increases staff confidence in talking about sexual orientation and gender identity, which in turn increases patient/service user/carer confidence in disclosing sexual orientation and gender identity. Making the effort to understand LGBT+ patient/service user and carer needs will impact positively on their outcomes within our services.

Top 10 tips for engaging with our Lesbian, Gay, Bisexual and Transgender (LGBT+) community

1. Monitor: Collecting monitoring data for sexual orientation and gender identity can tell you a lot about who is, and who is not accessing your services.
2. Explain: Make sure people understand why you are collecting monitoring data. It’s not about ticking boxes, it’s about making sure services are fair and equal to all. And that any barriers to access can be identified and overcome.
3. Raise staff awareness: Make sure staff are trained in how to appropriately ask this information and understand why it is being collected.
4. Analyse and action: What is the data telling you? Are there any actions you need to take? If LGBT+ representation is low ask yourself why? Is it because people don’t want to declare or that they don’t feel it is a safe place to declare or are there any access barriers.
5. Feedback: This is a two way process. Communicate what you identify from the information and any actions that you are doing as a result. Listen and act on the feedback you receive from the community.
6. Engage: Find out who your local LGBT+ community are. Ask to meet with them and find out what issues they face accessing your services. You will probably find they match what your data is telling you.
7. Be confident: Get to know the issues. Be confident and comfortable talking to people about sexual orientation and gender identity.
8. Don’t make assumptions: Create an environment where the person is able to be themselves, this means no assumptions about anything! For LGBT+ people this includes making assumptions about someone’s sexual orientation or gender identity, the gender of someone’s partner or that a family with children is a family with heterosexual parents.
9. Display inclusive images: Making sure your imagery is inclusive really shows people that it is a safe place to be yourself.
10. Challenge: Actions speak louder than words! If you see or hear something that is discriminatory, unacceptable or offensive make sure that you challenge this.

Asking the questions - How to do it…

Learn through doing

If at first response rates are low for sexual orientation and gender identity you should not be discouraged. It takes time to embed successful sexual orientation and gender identity monitoring, and to build up a culture of openness.

Remember that monitoring is a process and it will take time for staff to become familiar with asking about sexual orientation and gender identity and for patients and service users to become familiar with being asked.

Set the questions on sexual orientation and gender identity in context

Briefly explain to patients and service users and carers why this information is being collected and how it will be used. Give examples of how individual services or the Trust has improved outcomes for LGBT+ patients/service users, carers and staff.

Ask questions about sexual orientation and gender identity alongside questions on other protected characteristics (such as ethnicity and marital/ civil partnership status)

Treating sexual orientation and gender identity in this way helps reinforce that these are normal questions to ask as part of a service monitoring process.

Ask about gender identity (trans or transgender) and sexual orientation in different questions

This avoids confusion about what sexual orientation and gender identity are.

Encourage patients and service users to understand they have an informed choice about whether they wish to answer monitoring questions or not. Ensure confidentiality is explained.

Confidence in confidentiality will ensure service users and patients and carers have confidence in a service, which will increase disclosure rates. Sexual orientation and gender identity information is sensitive.

Where possible, allow patients and service users to complete monitoring questions in private, making sure that the parameters of confidentiality are clearly stated alongside the monitoring questions.

In some situations staff may have to complete monitoring on a patient or service user’s behalf or by telephone. In such cases, make sure the service user or patient understands what they are being asked and that they are happy to disclose to you or the staff member. Sexual orientation and gender identity are always matters of self-identification and self-disclosure.

Consider the best point on a patient or service user journey within services to ask questions about sexual orientation and gender identify.

When would it be most appropriate, and most useful to monitor equalities information? Patients and service users may not disclose at first but may feel more comfortable later on. Also, a patient or service user’s sexual orientation and gender identity may change through their lifetime.

You Said We Did

Capture examples of how your services have been improved in response to all equality monitoring data, including LGBT+ related. Display these with other You Said We Did feedback. An example may be that you have an identified equality ally or champion who ensures initiatives to improve equality and inclusion are promptly implemented within your services.

Display LGBT+ inclusive information in waiting areas and on display boards

An example is displaying the Lincolnshire LGBT+ Resource Directory.

An example of improvements

The Trust attends Lincoln LGBT Pride each year. In 2015 the Trust surveyed people who attended Lincoln LGBT Pride (which included some LPFT patients/service users, carers and staff). They told us they didn’t feel staff were comfortable talking about sexual orientation and gender identity, or that they knew enough about LGBT support available across Lincolnshire. Trust staff have also told us they don’t feel comfortable talking about sexual orientation and gender identity.

We listened and have responded by developing this information brief guidance for staff and by publishing our first LGBT support resource list (available on the Trust’s internal and external websites).

Suggested wording

Suggested wording for asking the question on sexual orientation

Which of the following options best describes how you think of yourself?* (This wording reinforces the fact that sexual orientation is about identity rather than just who a person has sex with).

• Heterosexual
• Lesbian
• Gay
• Bi
• I prefer not to say*
• Not stated

* Ensure this same option is made for all questions about protected characteristics. Only offering this option for questions about sexual orientation and gender identity will reinforce the notion that sexual orientation and gender identity are somehow embarrassing to talk about.

Suggested wording for asking the question on trans status

Is your gender identity the same as the gender you were given at birth?:

• Yes
• No
• Prefer not to say
• Not stated

Suggested wording for asking about gender identity

Which of the following options best describes how you think of yourself?

• Female (including trans woman)
• Male (including trans male)
• Non-binary
• In another way
• I prefer not to say
• Not stated

Where to get further guidance, support, or to get involved in the Trust’s work around sexual orientation and gender identity

The Staff LGBT+ and Allies* Network is a proactive forum that welcomes new members of staff and also provides a resource for staff to raise questions about any issues related to LGBT+, including the option to request advice on cases (submitted without patient identifiable information).

*An Ally is a person who supports equal civil rights, gender equality, LGBT+ social movements; and challenges homophobia, biphobia and transphobia. (Wikipedia)

For further related information contact:

LPFT’s equality and diversity lead. Email equality@lpft.nhs.uk

The Trust has an intranet page on Equality and Diversity, which has helpful related information.

The Trust’s Executive Director Sponsor of the LGBT+ and Allies Network can be contacted via email equality@lpft.nhs.uk

Other useful resources are Stonewall  and the LGBT Foundation 

We have also developed LGBT Resource Directory with useful local contacts and web pages. The directory is available on Equality and Diversity section and on LPFT website.