NHS England (NHSE) has issued new guidance stating that transgender patients should be accommodated on single-sex hospital wards or bays that align with their biological sex, rather than their gender identity. The directive, released on Thursday, specifies that alternative arrangements should be made when such alignment is not clinically appropriate. Decisions regarding patient placement must also consider individual clinical needs, while ensuring the dignity and safety of both transgender patients and others.
This updated guidance replaces previous NHSE advice, which suggested that patients and staff could utilize facilities based on their gender identity. Under the former guidance, a transgender woman, identified biologically as male but identifying as female, could opt for a women's ward, and a transgender man, biologically female but identifying as male, could choose a men's ward.
The previous guidance was withdrawn following a Supreme Court ruling in April 2025, which determined that under equality law, the term "sex" refers to biological sex and "woman" refers to a biological woman. The judgment indicated that for a space or service to be considered single-sex, it must exclusively accommodate individuals of the same biological sex.
The new NHSE guidance also emphasizes that to avoid discriminating against transgender individuals, gender-neutral spaces should be offered. It further clarifies that clinical need takes precedence in certain circumstances, particularly in emergency units and urgent care settings.
In addition to patient accommodations, NHSE has provided advice to trusts regarding the organization of single-sex facilities for staff, including changing rooms and toilets. This advice also stipulates that these spaces should be used based on biological sex, not gender identity. The guidance encourages NHS trusts to conduct audits to ensure they offer sufficient alternatives to single-sex facilities, such as gender-neutral or single-occupancy toilets.
NHSE data indicates a rise in breaches of previous mixed-sex accommodation guidance, with the number of instances where individuals of opposite sexes were placed on single-sex wards increasing annually since 2021. The most recent figure for August 2026 reported 5,520 breaches, an increase from 3,853 in June 2025.
Sex-based rights charity Sex Matters has welcomed the new guidance as a significant shift, but has expressed concerns about its implementation, citing issues with NHS patient data potentially misrepresenting individuals' sex. Trans rights organizations TransActual and Trans+ Solidarity Alliance have voiced concerns that NHS staff may lack clarity on how to safely care for transgender patients, predicting operational challenges in under-resourced hospitals.
The NHS has been a focal point for debates surrounding equality law and workplace regulations. In January 2026, Darlington Memorial Hospital was found to have violated the dignity of nurses who objected to a transgender colleague using female changing rooms. The tribunal concluded that the trust had indirectly discriminated against the nurses, who are reportedly seeking substantial compensation for legal costs. Bethany Hutchison, president of the Darlington Nurses Union, welcomed the guidance but stressed that its effectiveness hinges on adherence by hospital trusts.
Another employment tribunal in Scotland in December 2025 found that NHS Fife had harassed a nurse, Sandie Peggie, over its interpretation of single-sex space rules after she raised concerns about a transgender woman using female changing rooms. An appeal in this case is currently underway.