NHS England has published revised policies on single-sex spaces in hospital accommodation, with particular impact for the treatment of trans patients. Previous guidance took a trans-inclusive approach – now trans patients will be treated on the basis of sex assigned at birth, rather than their gender identity.
This was a planned publication following the updated Equality and Human Rights Commission (EHRC) Code of Practice, which advised public services how to interpret the 2025 Supreme Court Ruling that ‘sex’ in the Equality Act 2010 should be interpreted as meaning sex assigned at birth.
NSUN founded and convenes the Mental Health and Trans Solidarity Forum, a partnership of mental health and trans-led organisations working towards trans health justice. Along with our partners in the Forum, we met with NHS England twice throughout the update process, and on both occasions received confirmation that they did not want to take a trans-hostile approach, but felt they had no choice given changes in the law.
The update says that where services are provided on a single-sex basis, patients should be accommodated on wards that reflect their sex assigned at birth, or in individual side rooms where available. However, it states that trans patients can still be accommodated on wards that reflect their gender when there is ‘clinical need’ – and that clinical need overrides the single-sex requirement. It also emphasises that ‘all reasonable steps should continue to be taken to maintain the privacy, dignity and safety of all patients’.
While it will almost always be clinically justifiable to treat trans people either in separate spaces or on wards that reflect their gender, whether this happens will depend on individual staff members’ understanding of trans people’s clinical needs. We know that serious improvement is urgently needed in this area.
It will take time for these policies to be implemented, and it is unclear how different trusts and clinicians will interpret their competing legal and ethical obligations, particularly around ‘clinical need’. Nonetheless, the guidance threatens to worsen an already harmful and inaccessible health system for trans people and institutionalise transphobic rhetoric, further discouraging trans people from seeking medical care.
In mental health care, this policy is especially dangerous – the risk of psychological harm resulting from incorrect treatment is significant. Patients tend to spend far longer in psychiatric settings and face discrimination for self-advocacy. Many will now face long periods of detention in inappropriate and dangerous environments along with the additional pressure to explain themselves and their needs, putting them at further risk.
We encourage all who are working in the NHS to take this opportunity to advocate for the safety of trans patients. We urge all organisations, particularly well-funded charities with greater influencing power, to direct resources and energy toward trans health justice. We are all counting on you.
Trans patients deserve better – to be supported in spaces that align with their gender, to develop trusting relationships with healthcare staff, and to be free from medical discrimination.
We offer our ongoing solidarity to trans people today and every day. It is incredibly distressing to watch hateful rhetoric seep into the policies of public services that are meant to look after us. NSUN will continue to fight for trans health justice. We will continue to fund trans-led alternatives to the mental health system, fight misinformation, and work with partners in the mental health sector to lobby decision-makers via our Trans Solidarity Forum.
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