NHS to Segregate Wards by Biological Sex After Court Ruling

NHS bosses are directing hospitals to house patients according to their biological sex, a directive that comes 18 months after a Supreme Court ruling clarified that the terms 'woman' and 'sex' in the Equality Act 2010 refer to biological sex. The new guidance, to be published imminently, marks a significant shift from a 2019 policy that instructed healthcare workers to accommodate patients based on their gender identity.

Critics had previously warned that the prior policy was unsafe, potentially placing women at risk of assault, as it stated that having male genitalia was not a barrier to placement on a female ward. Under the old rules, staff were advised to consider a patient's presentation, including their dress, name, and pronouns, regardless of whether they held a Gender Recognition Certificate. These rules applied to single-sex spaces such as wards, toilets, and showers.

The forthcoming guidance also specifies that staff must use single-sex changing rooms and toilets aligned with their biological sex. This follows reports of female nurses expressing discomfort with being required to undress in front of transgender colleagues.

NHS England will formally communicate these new directives to NHS trusts and integrated care boards, mandating action from chief executives and boards. The update is a response to the Supreme Court's 2025 ruling and subsequent guidance from the Equality and Human Rights Commission. Some NHS trusts had continued to house transgender women in female wards while awaiting national guidance, despite the court's decision.

Former health secretary Wes Streeting had previously committed to revising NHS guidelines by the summer of 2025. At the time, he stated the importance of biological same-sex spaces for women's safety while emphasizing the need for dignity and compassion for transgender individuals.

The previous guidelines for patient accommodation stated: "Trans people should be accommodated according to their presentation: the way they dress, and the name and pronouns they currently use." In cases where other patients objected, hospitals were instructed to balance the needs and rights of all involved, permitting transgender patients when deemed necessary and appropriate by staff.

However, the new guidance reverses this approach. Patients will generally be accommodated according to their sex as registered at birth, with exceptions only for rare clinical reasons. The expected wording indicates: "Trans people and others with the protected characteristic of gender reassignment should be accommodated in line with their sex as registered at birth, while also ensuring that: (i) clinical needs are met, and (ii) privacy, dignity and safety are maintained for all, including other patients."

In contrast to the new directive, Chelsea and Westminster Hospital NHS Foundation Trust had stated after the Supreme Court ruling that they would continue to respect users' right to self-identify and were committed to delivering safe and compassionate care. This stance highlights a period of varied practice among NHS trusts.

An employment tribunal previously ordered an NHS trust to pay £187,000 in damages after finding it harassed seven nurses by requiring them to share a changing room with a transgender woman. Judges determined that County Durham and Darlington NHS Foundation Trust created a "hostile environment" for nurses who objected to Rose Henderson, born male, using single-sex changing facilities. One of the nurses involved, Bethany Hutchison, stated that their concerns were raised to protect women but resulted in "pressure and intimidation."

Andrea Williams, chief executive of Christian Concern, welcomed the new guidance as "long-overdue," asserting that it returns biological reality to the core of NHS policy. However, she raised concerns that the guidance lacks clarity and protection for NHS staff regarding pronoun use, citing a case where a nurse faced investigation for declining to use preferred pronouns for a biologically male patient.