A practical guide for the NHS Sexual orientation DH INFORMATION READER BOX Policy Estates HR/Workforce Commissioning Management IM & T Planning/ Finance Clinical Social Care/Partnership Working Document Purpose Best Practice Guidance Gate Reference 9755 Title Sexual orientation: A practical guide for the NHS Author Department of Health/EHRG Publication date February 2009 Target audience PCT CEs, NHS Trust CEs, SHA CEs, Foundation Trust CEs, Directors of PH, Directors of Nursing, NHS Trust Board Chairs, Special HA CEs, Directors of HR, GPs Circulation list Description This document gives practical advice to enable NHS organisations to address their responsibilities relating to sexual orientation and employment or healthcare delivery Cross reference N/A Superseded Docs N/A Action required N/A Timing N/A Contact details Equality and Human Rights Group Department of Health Skipton House 80 London Road London SE1 6LH 020 7972 5097 for recipient’s Use Sexual orientation: A practical guide for the NHS Contents Foreword 2 Executive summary 3 Section One: Context 4 Part One – Legal requirements and policy implications 5 Part Two – How the legal requirements are the same as other equality strands, and how they differ 14 Section Two: Process – How to work with staff and patients 18 Part One – Understanding the needs of lesbian, gay and bisexual staff 19 Part Two – Assessing and implementing policies, practices and procedures for staff 24 Part Three – Involving lesbian, gay and bisexual staff 29 Part Four – Understanding the needs of lesbian, gay and bisexual patients 31 Part Five – Assessing and implementing policies, practices and procedures for patients 44 Part Six – Involving lesbian, gay and bisexual people 47 Section Three: Resources 50 Worksheet 1: Action planning framework for lesbian, gay and bisexual staff 51 Worksheet 2: Action planning framework for lesbian, gay and bisexual patients 56 Worksheet 3: Delivering inclusive services to gay men and men who have sex with men 62 Worksheet 4: Delivering inclusive services to lesbians and women who have sex with women 64 Worksheet 5: Delivering inclusive services to people who are bisexual 66 Worksheet 6: Getting everyone on board – frequently asked questions 67 Worksheet 7: Encouraging disclosure from service users and patients 69 Worksheet 8: Setting up a lesbian, gay and bisexual staff network 70 Worksheet 9: Monitoring staff 71 Worksheet 10: Working with lesbian, gay and bisexual staff – a ten point action plan 73 Worksheet 11: What help is available 75 Contacts 82 Contents 1 Foreword As an employer and a provider of healthcare services, the NHS should not only comply with the law but should also aspire to be an exemplar of good practice and seek to ensure that its services and employment practices respond to the needs of the whole of our society. This means that it is essential that we strive to take account of everyone’s needs, in the design and delivery of all our services – including people from the lesbian, gay and bisexual community. It is also essential that This guide is part of a suite of guidance we strengthen our role as an inclusive which seeks to equip NHS staff at all levels employer by removing barriers that might – whether as employers or employees, or as prevent us from attracting, recruiting, service providers, commissioners or planners developing and retaining people with the – to understand the needs of all people. best skills and aptitude to make their careers in the NHS. There is increasing evidence of the health inequalities experienced by patients and This guidance should create new work service users as a result of their sexual programmes and activities that will enable orientation and how this can be addressed NHS organisations to be more inclusive through better access and targeted workplaces, reduce health inequalities intervention. Increasing protection under the experienced by lesbian, gay and bisexual law highlights the rights of lesbian, gay and people and help us achieve the priorities set bisexual people to receive equal treatment in out in the NHS Operating Framework 2008/9. the same way as everyone else. Other existing public sector equality duties, ongoing reform towards personalised services and World Class Commissioning present a real opportunity for NHS organisations to reconsider the design of services to take full Surinder Sharma account of the equalities agenda. By National Director for Equality and Human developing expertise and implementing the Rights, Department of Health lessons learnt, we can embed equality at the heart of all functions and structures and contribute to a better understanding of our staff and more informed, personalised patient care. 2 Sexual orientation: A practical guide for the NHS Executive summary This guidance document, produced by the However, in developing an SES, it is Department of Health (DH), gives practical important to understand that there are advice to NHS organisations to help them significant differences between the legal comply with recent equality legislation, requirements for the different equality understand the role of sexual orientation in strands that must be understood in order the context of healthcare, and integrate this that they are complied with. This guidance is knowledge into single equality schemes (SES). designed to assist NHS organisations to Other guides in this series cover disability, implement and comply with the requirements gender, religion or belief, and trans people. of legislation on sexual orientation enacted Age Concern are producing a companion recently, and also provides general practical guide to age equality. The Race for Health guidance around the issues that fall out of programme provides extensive guidance and that for the NHS. support for the NHS on issues of race. The guidance will provide a workbook and a Many NHS organisations will already be one-stop shop for information about the working towards developing an SES. A single legislation and its impact. It will take readers equality approach helps to bring together through the steps necessary for equality parallel strands of key systems, for example impact assessment and planning for the equality impact assessment, data collection integration of issues of sexual orientation etc, needed to respond to the specific duties during the development of overall equality of the different equality laws. This helps to schemes. Many of the processes, such as utilise expertise and scarce resources more equality impact assessment and consultation, effectively. It also contributes to a better are similar to those described for the other understanding of staff and workforce issues equality strands, but the guidance will and encourages a personalised approach to highlight any areas that need special patient care, treating patients as individuals. attention for sexual orientation and will also A combined approach will help to minimise provide a handy reference for cohesive and the number of requests for information and collaborative working. ensure that key personnel, for example public health analysts, service managers, administrative and frontline staff, are encouraged to work together to ensure a co-ordinated approach to achieving equality of outcomes. Executive summary 3 Section One: Context 4 Sexual orientation: A practical guide for the NHS was decriminalised, people stopped using Part One – Legal these words. requirements and Some men may be in opposite‑sex relationships but engage in sexual activity with people of the same sex. Healthcare policy implications providers should not assume that men in this This part begins by setting out some situation are gay, but should instead discuss definitions. It then summarises the legislation behaviour. Healthcare providers should also which gives rights to equal treatment consider the impact that any disclosure may regardless of sexual orientation, and provides have on partners and therefore take steps to practical illustrations of how the legal be discreet. Men in these circumstances may framework impacts on health and social care not respond to preventive healthcare providers and commissioners. messages in the same way as openly gay men. This has long‑term implications relating to sexually transmitted infections and other What is ‘sexual orientation’? communicable diseases. Sexual orientation refers to the general Homophobia is defined as hostility or attraction a person feels towards one sex or prejudice based on a person’s status (actual another (or both). Most people are familiar or perceived) as a lesbian woman or a gay with the terms ‘heterosexual’ or ‘straight’, man, or someone who is attracted to where people are attracted to the opposite someone of the same sex even if they do not sex. Other people are attracted to people call themselves LGB. It can lead to who are the same sex as them (lesbian or discrimination, bullying, harassment and, at gay) or people of both sexes (bisexual). its worst, violent hate crime against LGB people or those who are thought to be LGB. Women who have a sexual orientation towards other women are often referred to There are two issues to note, which will be as lesbian, while men who have a sexual referred to again elsewhere in this guidance. orientation towards other men are referred to First, most lesbians, gay men and bisexuals as gay (although gay can also be used as a would consider that their sexual orientation is generic term for both lesbian and gay only one aspect of who they are. In addition, sexuality). Those people who have a sexual they will have a gender, an ethnic and orientation towards both their own and the cultural identity, possibly a disability, a opposite sex are usually referred to as religious or non‑religious belief, and of bisexual. These three groups make up what course they will have an age – in other is sometimes referred to as the LGB – lesbian, words, they will have ‘multiple identities’. gay and bisexual – community. Each of these other aspects may have an impact on how they are seen by people from Generally speaking, the worlds homosexual different groups, whether at work or when and homosexuality are outdated.