Beyond just ‘ticking the box’: Switchboard calls for action on monitoring of sexual orientation, gender and trans status

A new consultation by the Brighton and Hove LGBT Switchboard’s Health and Inclusion Project (HIP) has highlighted the importance of equalities monitoring for improving health outcomes for LGBTQ+ people, and found that these communities face significant barriers to providing accurate monitoring information about sexual orientation, gender and trans status.

LGBT Switchboard, has called for the introduction of consistent, LGBTQ+ inclusive equalities monitoring of sexual orientation, gender identity and trans status in healthcare and council settings, following a consultation with healthcare providers and the LGBTQ+ community, which found that many barriers and challenges to proper monitoring for these characteristics continue to exist.

“Equalities monitoring might not be exactly the most exciting subject for many people, but understanding LGBTQ+ health needs all starts with effective monitoring,” says Switchboard’s LGBTQ Engagement Officer, Sophie Barnes. “Research has consistently shown that LGBTQ+ people continue to face significant health inequalities as compared with their straight and cisgender peers, but a lack of demographic data on our LGBTQ communities means that many of our health needs remain unknown.”

“This is particularly the case where LGBTQ+ identity intersects with other aspects of a person’s identity or experience that are marginalised, for example along lines of ethnicity, disability or immigration status,” she said.

However, while many services already routinely monitor characteristics like disability and ethnicity to ensure that their services are inclusive of a diversity of people, the research indicated that sexual orientation and trans status are not yet widely monitored, despite being protected characteristics under the Equality Act 2010.

In exploring why this is the case, consultation with healthcare providers revealed a concern that monitoring sexual orientation and gender identity will be considered intrusive or inappropriate. However, in stark contrast, research with the LGBTQ+ community found that nearly 3 in 4 LGBTQ+ people said they were currently either ‘somewhat’ or ‘very’ comfortable sharing information about their sexual orientation, gender or trans status in a healthcare setting.

In fact, for many LGBTQ+, it’s the service provider’s discomfort – not their own – that is the issue, the consultation found:
“When the person asked me about my sexual orientation they stumbled and seemed to find it hard to ask,” said one respondent to the LGBTQ+ community survey. “It wasn’t a problem for me, but it seemed to be a huge problem for them. There still seems to be a huge taboo around sexual orientation and gender identity and some people seem to find it hard to ask the questions, which doesn’t make it any easier for us when answering.”

However, the research suggested that LGBTQ+ people, and particularly those who are trans and/or non-binary, face many barriers to providing accurate monitoring information, due to a lack of monitoring, sometimes inappropriate question and answer options, and a lack of confidence in services to be LGBTQ+ aware.

“People get really confused about what straight and gay mean in relation to trans people,” said one participant in the LGBTQ focus group. “The understanding just isn’t there for a lot of people.”
A lack of the gender-neutral ‘Mx’ option on many patient intake and monitoring forms also means that non-binary people are forced to either choose an incorrect gender or decline to provide any response.

“Because there’s no data collected at all on non-binary people it’s very difficult to make statements about our needs,” said one non-binary focus group participant. “If you’re not acknowledged on the form at all, then where do you even start?”

While some healthcare providers surveyed expressed a view that monitoring sexual orientation, gender identity and trans status would equate to unfairly advantaging the LGBTQ+ community, the majority – around 8 in 10 – expressed enthusiasm about taking steps towards improving monitoring practices. Several also said they believe Brighton and Hove has a particular responsibility to its LGBTQ community:
“Brighton and Hove are areas where there is a high and visible community of [LGBTQ+] people and we as service providers have a greater responsibility to make an effort to meet their needs,” commented one healthcare worker in the online survey.

LGBT Switchboard’s hope is that the findings of the consultation will contribute to increased momentum on improving monitoring practices at a national – as well as a local – level.

“There is still a great deal of work to be done before sexual orientation, gender and trans status are monitored widely, consistently and well,” said Switchboard CEO, Daniel Cheesman. “But it has been very encouraging to see that healthcare providers are keen to learn how they can improve their monitoring practices to better understand and respond to the needs of people across the spectrum of sexual and gender diversity, and we will look forward to working to support them to help make this happen.”

“It’s not right that in 2018 we still do not have a reliable base of data about the health needs of LGBTQ+ people, and that all starts with monitoring,” he continued. “As the LGBT Foundation, has put it, ‘If we’re not counted, we don’t count’.”

Read the full report on the consultation into Monitoring Sexual Orientation, Gender and Trans Status here:

Press enquiries, please contact:

LGBT Switchboard CEO: Daniel Cheesman             [email protected]

LGBTQ Engagement Officer: Sophie Barnes          [email protected]