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Sexual Orientation: Core Training Considerations

Wendy Cree and Simon O'Corra / National Health Service (UK)

Is There An Ideal Model For Training?

It is hard to say that there is one model of training that should be applied in all agency contexts. Health and social care agencies have different structures and cultures, are different sizes, fulfill different functions and belong to both the voluntary/private and statutory sectors. A one size fits all would not be helpful. However, from the responses that we received from stakeholder, key agencies, training providers and participants, there are certain elements that seem to make training more or less effective depending on their presence or absence.

Diversity Strands Are Non Hierarchical

Responses in interviews indicate that a number of people within the health service feel that there is effectively a hierarchy between the diversity strands with sexual orientation holding a low ranking.

Why this should be the case can only be surmised. However, there is a strong correlation between belief in choice and disapproval of homosexuality. The practical result of this correlation can be the denial of parity of sexual orientation between LGB people and other diversity strands and the people who identify with those strands. This belief and the disparity it can engender must be noted and addressed to make sure that there is no hierarchy of oppression in the six diversity strands in relation to employment and service delivery.

It is important to make it explicit that the development of these standards has as a starting point that there is no hierarchy between the strands of diversity and the discrimination that is associated with them.

This research assumes that no one strand of diversity is ideologically or theoretically more important than any other, although practically in the delivery of a service one aspect may be more important than another at a particular point in time.

Individual Diversity Is Multi Faceted

In a world where none of us is defined by any one single aspect of diversity, a non hierarchical approach allows each one of us to identify with a number of aspects of diversity and to decide for ourselves which aspect of that identity is most important or prominent at any point of time.

The multi-faceted nature of diversity allows us all to acknowledge our own experiences of discrimination and to recognise that we all also have the potential to discriminate.

Standards And Good Practice

Some standards will have a general application that extends far beyond training and practice related to sexual orientation or general equality and diversity training. This is a reflection that the standards of practice and training relevant to equality and diversity and sexual orientation are very often about general good practice.


There was considerable reference throughout conversations with stakeholders, key agencies and training providers that part of the process of making services for LGB people inclusive is to mainstream both services and training on sexual orientation.

The term ‘mainstreaming’ is used in the context of countering the marginalisation that LGB people experience. However, it is apparent in these conversations that not all mainstreaming is seen as being effective and in some situations may be counter productive.

The Oxford Dictionary defines the verb ‘to mainstream’ as ‘to bring in line with the majority, the usual, the normal.’ In our view this has both benefits and disadvantages for LGB communities and there needs to be a distinction between ‘positive mainstreaming’ i.e. that which brings advantages to LGB communities and ‘negative mainstreaming’ that which continues to disadvantage.

An example of ‘positive mainstreaming’ would be to ensure that core funding for developments in services for these communities is available once special funding, which is often time limited, ceases. Another example is to include sexual orientation components, such as case studies, in non diversity training.

In contrast ‘negative mainstreaming’ with an emphasis on ‘normalising’ sexual orientation and LGB services may only lead to absorption/assimilation into an existing heteronormative culture in which the recognition of difference and increased visibility are lost. What is commonly referred to as ‘tokenism’ or ‘lip service’ frequently falls within this category as do gaps between policy and practice. For example a cervical screening clinic may encourage lesbian attendance but failing to ask inclusive questions on sexual practice will have the negative effects of forcing women into a position of coming out and reducing their attendance at these clinics. The inclusion of sexual orientation training within a general diversity training may have the intention of making the training inclusive of all strands of diversity but have the effect of ‘tokenism’ in which passing reference only is made to sexual orientation and the issues remain unaddressed.

Those developing these services need to be mindful of the distinction and always use as their base-line questions:

  1. How is this action decreasing the marginalisation of LGB communities and making services more inclusive?
  2. What else needs to happen to make this action effective?

The NHS Knowledge And Skills Framework (KSF)

A number of key stakeholders emphasised the importance of the KSF in the development of standards.

As one of the three key strands within Agenda for Change the KSF has been an important point of reference throughout this research. Two of the purposes of the KSF are to:

  1. ‘facilitate the development of services’.
  2. ‘promote equality for and diversity of all staff’.

Therefore in developing training standards for sexual orientation and service inclusion, this research has referred to:

  1. Core Dimensions 4: Service Improvement
  2. Core Dimension 6: Equality and Diversity

Elements of these core dimensions have been incorporated into the training standards where possible and appropriate.

The above article was extracted from a British NHS report, “Core Training Standards for Sexual Orientation”

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