As one of its Equality Objectives, Central and North West London NHS Foundation Trust (CNWL) committed to improve the recorded data of its service users' sexual orientation by at least ten per cent within four years. This was prompted by a recommendation from the Trust's first LGB&T Health Conference, which involved discussions with LGB organisations including Stonewall and PACE. The need to improve recording rates for sexual orientation was also highlighted at the Trust's Sexual Orientation and Health event in Camden in December 2012.
To meet this objective the Trust communicated the importance of capturing accurate recording data through Equality and Diversity leads within each of its service lines. It also distributed Stonewall's What's It Got To Do With You? booklet, which explains to individuals why it's important to provide equality monitoring information. As a result the Trust has improved its recording rate in many services, meeting their ten per cent target in the first year.
To support the continuation of this good practice, the Trust has produced and distributed guidance to staff on collecting this information from service users who are under 18 years old. Reports on data collection rates are produced quarterly and progress is discussed by Equality and Diversity leads at the Trust's Equalities and Diversity Group meetings.
In order to meet the requirements of the public sector equality duty, NHS Greater Glasgow and Clyde committed to assess all new policies, service re-designs and efficiency savings to measure their impact on different protected groups. An Equality Impact Assessment toolkit was developed which explicitly requires staff to identify the needs of and impact on lesbian, gay and bisexual people.
In 2011 the health board undertook a review of completed Equality Impact Assessments to see if there were any trends or patterns that needed to be actioned and prioritised.
This review process identified that sexual orientation was consistently under-reported in Equality Impact Assessments and that, in comparison to the other protected characteristics covered by the Equality Act 2010, services were least likely to be proactively tackling homophobia.
This finding was supported by a review of the health board's first Equality Scheme which also reported lower levels of activity in understanding, identifying and removing barriers to services for lesbian, gay and bisexual people.
In response to these findings and in order to comply with the duty, the health board developed a Tackling Homophobia Campaign to improve attitudes and behaviours across the organisation. The campaign involved a microsite (www.nhsggc.org.uk/homophobia) that was promoted to all staff through the intranet, staff newsletters and the equalities e-bulletins, as well as via a roadshow to further engage employees in different teams and different areas.
The campaign included a good practice guide for employees on acceptable language and behaviour in the workplace. The campaign has received 10,000 website hits, 2000 email pledges and 800 photograph pledges, as well as public support from high profile figures including the Deputy First Minister Nicola Sturgeon.
Nottinghamshire Healthcare used the public sector equality duty as a means to justify updating its patient database, extending the collection of patient equality monitoring data to include sexual orientation.
Healthcare staff have received training on how to ask sensitive questions and the Trust has developed easy-read versions of the monitoring form for patients and service users who require them.
The data has been used to identify areas of service where lesbian, gay and bisexual people were under-represented in their accessing of services. The data has also been used to influence patient care plans, particularly where lesbian, gay and bisexual patients have been reluctant to discuss with clinical staff some of the underlying background to their mental health issues, especially those that relate to their sexual orientation. The data has also been used to identify the need for lesbian, gay and bisexual patient support groups, including in the Trust's secure environments, and to encourage people to attend Patient Pride events.
Nottinghamshire Healthcare updated its Procurement Policy in 2010 anticipating the introduction of the public sector equality duty. Contractors delivering services on behalf of the Trust are required to demonstrate that they have systems in place for assessing the impact of their practices on all of the diverse groups it serves, including lesbian, gay and bisexual people. Contractors are required to make sure that staff are trained in equality and diversity and that the training covers all protected characteristics, including sexual orientation.
Where suppliers are contracted to work in key areas of the Trust, they are required to undertake the Trust's own equality and diversity training. Contractors are also required to collect and report on the equality monitoring data of their staff, inclusive of sexual orientation, at all levels including Board level.
When questioned by suppliers about why the Trust requires such a high standard of performance on lesbian, gay and bisexual equality, the Trust has been able to refer to the public sector equality duty to push suppliers into improving their performance in this area. Accordingly the Trust plays an active role in educating, advising and enabling contractors as required.
In early 2012 Oxleas NHS Foundation Trust consulted with peer organisations about support for lesbian, gay and bisexual service users in Adult Learning Disability Services, to help the trust in meeting its obligations under the general duty to eliminate unlawful discrimination and advance equality of opportunity.
The consultation received over 100 responses and identified that there was a distinct lack of policies, procedures or good practice examples for lesbian, gay and bisexual people with learning disabilities.
In response the trust organised a national conference called 'Hidden Desires' in October 2012, attended by over 100 delegates from the health, local authority and voluntary sectors.
The trust has followed up this work by working in collaboration with local authority colleagues to draft a policy on supporting lesbian, gay and bisexual people with learning disabilities which it plans to share with other trusts around the country as an example for best practice. The trust is also producing best practice guidance and creating a website with information for health professionals that will also be accessible for service users.
In September 2011 Oxleas NHS Foundation Trust discussed using the new version of Rio (the electronic records system) to record sexual orientation so that the trust could collect monitoring data about the sexual orientation of service users. This was in order to support lesbian, gay and bisexual people's health needs and so that the trust could plan and design services appropriately. These actions were taken in order to eliminate discrimination, advance equality of opportunity and to demonstrate compliance with the public sector equality duty.
The trust piloted a monitoring form including all nine protected characteristics of the Equality Act 2010 with three teams across the trust and asked for feedback from staff. This identified a lack of confidence amongst staff about asking service users to disclose their sexual orientation.
In response the trust secured funding to build an e-learning package for staff. The e-learning covers why monitoring is important, raising awareness of lesbian, gay and bisexual health inequalities, the particular health needs of lesbian, gay and bisexual patients and developing services as positive, welcoming environments for lesbian, gay and bisexual people. There is a particular section on how to ask patients about their sexual orientation sensitively.
In 2008 Sussex Partnership NHS Foundation Trust amended its equality strategy to apply the equality duties for race, gender and disability across all equality strands (now protected characteristics). This was in recognition of the fact that the duties had led to improved performance within the trust in relation to race, gender and disability and in anticipation of the statutory duties being extended to other characteristics, including sexual orientation, in a consolidated Equality Bill.
This decision enabled the trust to amend its systems, policies and practices so that they would better promote equality for lesbian, gay and bisexual staff and patients. This included updating the trust's computer systems so that monitoring data about sexual orientation could be captured about staff and patients and used to identify areas in need of improvement.
Analysis of this monitoring data demonstrates that the proportion of staff willing to disclose their sexual orientation in monitoring exercises has significantly increased since this work began in 2008, with the proportion of staff leaving their sexual orientation undefined having reduced by 15.3%. This is an important measure of staff confidence in the trust's commitment to lesbian, gay and bisexual equality.