Sunday, 15 October 2017

Now, Miss Melford! Out with it! What is your sexual orientation?

I had hoped never to be asked that, as it would be an awkward question to answer. The NHS is however now making it mandatory for doctors and nurses to ask a patient what their sexual orientation is, if this information isn't already on record. No exceptions. No nonsense.

It'll be: 'Oh, do stop crying, Miss Melford! And stop that silly snivelling! Pull yourself together, woman. It's only a routine question. But we must have a definite answer! Your continued eligibility to treatment depends on it! Do you hear me?' [Impatient medic slaps Lucy's face, and forces a stammered, gulping reply. Later that day, they come for her. She is interned for three years, pending a Sexual Deviation trial. While in prison, her festering wounds and sores are not treated]

Actually, the announcement assures everyone that having one's stated sexual orientation on record won't make the slightest difference to the type or quality of care received under the NHS. In fact, it's all about avoiding any whiff of discrimination, in order to comply with the Equality Act 2010.

Yes, really. There's nothing to worry about. Keep calm and carry on.

It seems the NHS wants to be able to say - nay, prove from its meticulous records - that in (say) 2019 there were thirty-nine million patient consultations, and every person seen by a doctor joyfully declared their sexual orientation, with this interesting overall result:

Heterosexual, or straight 75%
Lesbian, Gay, Bisexual, or of other non-standard sexuality 15%
Not sure, not known, or not stated 10%

And that everyone - whatever sexuality they admitted to with such fervour - demonstrably received exactly the same standard of care, as can be proved by an analysis of patient records.

In fact a new government body, the Office of Sexual Statistics (OfSex) has lately been set up with that sole task - to extract figures that will reassure the general public that one's sexual deviation (oops, what an amusing slip! one's sexual orientation) is utterly irrelevant. It never matters. Not in any circumstance. The NHS is absolutely even-handed. A statement to this effect will be made in the House in due course, with a tribute to the staff concerned. A remarkable achievement.

I satirise to the hilt, of course. But apparently this sexual-orientation question really will be popped to patients coming in for a winter flu jab, or about their sore toe, or their inflamed tonsils.

'Just say 'aaaaah', Mr Simmonds. Hmm, those tonsils look jolly the way, what's your sexual orientation?' 

To which the responses might be various, such as: 'What?! Mind your own bloody business!!' or 'I'll ask my wife when I get home, and I'll let you know what she says' or even 'Why Doctor! I didn't know you fancied me! Well...I'm free Wednesday afternoons, you know...'

I picked up this story from the online BBC News - see I could hardly believe it, but apparently it's true. Even though some (perhaps most) doctors will think it an intrusive question, and they doubtless anticipate confusion and resentment on the patient's part, it must nevertheless be asked so that the patient's record is complete. Nobody will then be able to say that a doctor did this or that in ignorance (or defiance) of the patient's sexual orientation. (Aha, I sniff a legal defence being constructed against future compensation claims mounted against the NHS by disgruntled or badly-treated LGB patients!)

Let me anyway quote an important part of the BBC article:

NHS England said the data was already being collected in many areas but that the new guidance makes it standard, and that it expects sexual orientation monitoring to be in place across England by April 2019. 

Under the guidance, health professionals are to ask patients: "Which of the following options best describes how you think of yourself?". The options include heterosexual or straight, gay or lesbian, bisexual, other sexual orientation, not sure, not stated and not known.

NHS England said lesbian, gay and bisexual (LGB) people were "disproportionately affected" by health inequalities such as poor mental health and a higher risk of self-harm and suicide. It said public bodies had a legal obligation to pay regard to the needs of LGB people under the Equality Act 2010. "Collecting and analysing data on sexual orientation allows public sector bodies to better understand, respond to and improve LGB patients' service access," the guidance states.

Paul Martin, chief executive of Manchester's LGBT Foundation, which worked with NHS England and others to develop sexual orientation monitoring, said he was "so proud" of the new standard. He said earlier this week: "If we're not counted, we don't count." The launch of sexual orientation monitoring was a "hugely important step in the right direction" towards addressing LGB inequality in health and social care, he said.
I suppose that if I were lesbian, gay or bisexual in my personal orientation - and had problems with the NHS - and felt invisible, with my needs unrecognised and unprioritised, then perhaps I'd be cheering this new initiative.

But I'm not lesbian, gay or bisexual, and this presents me with a problem. What on earth am I going to say to my doctor when she asks me? And what might be the real-life consequences of a particular answer?

'It's like this, doctor. I haven't had sex since sometime in 2007. That's ten years ago. And since then my life has radically changed. I feel no desire now, I've got no libido. But that's fine, because I'm finished with sex. I really don't think I'll ever have sex again. Sex tends to go with having someone special in your life - and I have, for practical purposes, put myself out of the game by refusing to embark on any more relationships. In any case, I don't feel the need for even occasional sexual adventures. I don't need sex to convince me that I'm looking great, that I'm alive and kicking, and still a force. 

'It's not become impossible for me to have sex, but I'm not experiencing any internal urges or longings to indulge. And I won't let myself be seduced by any offers that may come my way. In fact I consciously avoid situations in which I might come under pressure to play the sex game. I need to keep things under control, and entirely in my own hands. I don't want to end up trapped in a bedroom with no way out. In any event, I dislike the messiness of sex, the physicality, and having to give myself up to an animal urge. Or worse, having to surrender (or submit) to another person. So I keep well away from all that. It's not for me. 

'In some very special circumstances I might give my consent and have a go - in the last seconds before a meteor strike destroys the planet, maybe. But, looking at my planned life to come, sex will play no part. That's a personal decision. It maximises my reasonable preference for autonomy and comfort, and continued good health (I don't want a sexual infection). I can still have a wonderful time in the years ahead, but without the physical and emotional stress - and corrosive regret - that having sex involves. 

'Besides, I need a lot of personal space, and I don't like it invaded. Sharing it intimately is a horrendous no-no - it's way over a personal red line. I can't handle close-up intimacy - and sex is pretty damned close-up as activities go. I accept that sex can be useful later-life exercise, but I can easily find substitutes. 

'So what am I, doctor? What's my orientation? I don't desire sex with either a man nor a woman. Nor, if a pill were offered to me that would increase my libido, and restore an urge to have sex, and presumably incline me decisively to one or the other - or indeed both - would I take it. I'm just not interested.   

'But if that pill were forced upon me, what might my preference be? 

'I really can't say, because there is no track record to draw inferences from. If a man ever gives me some attention, I enjoy it, but that doesn't mean I would ever want him physically. In fact I think that men's muscular and hairy bodies are most unappealing, and I've always thought that. I like the company of women, and most of my friends are women, but I can't imagine getting turned on by the offer of lesbian sex. I want a woman's friendship and sisterhood and empathy - not her body. I have no unusual sexual practices of my own invention. And I don't have sex on my own. I still haven't bought myself a sex toy to play with: I'd regard it as a waste of money.

'Well, that leaves 'not stated', 'not sure' and 'not known', doesn't it? 

'As I've been willing to discuss this with you - at great length, but I wanted to be clear - it can't be 'not stated'. 

'I don't want you to put me in the 'not sure' category, because that implies some experimentation, and there just hasn't been any. Nor will there be. 

'So 'not known' best fits. Shall we settle on that?'

Perhaps, when next at the surgery, I can simply plump for 'not known' and skip the long-winded explanation. Or perhaps they've already marked me down, on no evidence, and without discussion, as 'hetero'. If so, I'll let sleeping dogs lie.

Whichever category we settle on, it might have consequences. If they do have me down already as 'hetero' there is the small risk that a young male doctor will see in me a raving sex-crazed spinster who might compromise him, if there is any question of a physical examination. It's a ludicrous notion, but feasible.

And yet what might they really make of 'not known'? Does it imply a mental issue? I don't want to be shunted off into perpetual therapy, to explore why I don't know who to have sex with. And yet 'not sure' also suggests a background problem requiring therapy. The thing about NHS therapies is that they take ages to arrange, and go on for a long time because of the long gaps between appointments and sundry cancellations. And meanwhile they stop you being treated as an ordinary patient.

All this in the name of Equality. Huh.


  1. I read that news story this morning and wondered what my response might be. Probably I'll say "asexual" and if there isn't a tick box for it, that's their headache.

  2. I thought of 'asexual' too, but I'm not quite certain whether, with me, it's just a low libido, a great dislike of physical intimacy, or genuine asexuality. Not that these distinctions matter two hoots. They are the NHS's current preoccupation, not mine.


  3. Asexuality is far more complex a subject than people imagine... I would need a subset of boxes a page long.

    I seem to fall outside the standard deviation of the mean in every survey I have been involved in, I always warn pollsters then mess up their results if they wish to continue. Clearly this survey has not been thought through with enough relevant answers to make it useful so no surprise there.

    I would not let an erroneous answer be recorded, spent a lifetime with not being understood so would spend time getting a useful answer or show up the uselessness of their options.

    Sounds like we are not going to be snooped upon up here in Scotland then...


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