NHS England tells hospitals to place trans patients by biological sex

What the new guidance sets out

NHS England published updated guidance on Thursday, 15 October, saying trans patients should be accommodated according to their biological sex rather than their gender identity. The rules cover single-sex wards, toilets and changing rooms. The guidance says the privacy, dignity and safety of trans patients must be maintained, along with those of other patients sharing accommodation. Where clinical needs and same-sex accommodation cannot both be met, clinical needs take priority, including on emergency units and in urgent care settings. Where a biological-sex placement is not clinically appropriate, alternative arrangements should be made, with decisions taken case by case.

Ending the earlier approach

Previous NHS England guidance allowed patients and staff to be placed on wards or to use facilities based on their gender identity, so a trans woman, a biological male who identifies as a woman, could previously have chosen a women's ward. That guidance was withdrawn after the Supreme Court ruled in April 2025 that, under equality law, 'sex' means biological sex and 'woman' refers to a biological woman. The Equality and Human Rights Commission has already revised its code to state that a service must be used on the basis of biological sex to count as single-sex. La Vanguardia reports that the rules apply across NHS England facilities, including primary care clinics and private hospitals or clinics that receive public funding. Scotland, Wales and Northern Ireland run separate health services.

1. 2025-04Supreme Court rules that 'sex' in the Equality Act means biological sex
2. 2026-08NHS England records 5,520 breaches of mixed-sex accommodation rules
3. Oct 15, 2026Updated NHS England guidance on single-sex spaces published

Alternatives and staff facilities

Where a trust's facilities are mainly single-sex, the guidance says organisations should consider whether suitable and accessible alternatives can be provided, such as single-occupancy rooms or mixed-sex facilities with individual lockable rooms. BBC reporting says trans people should be offered gender-neutral spaces to avoid discrimination. NHS England has also published separate advice for trusts on changing rooms, toilets and other single-sex facilities for staff, which should be used by people based on biological sex. All organisations are asked to audit their provision to protect the privacy, dignity and safety of all staff. Trusts are asked to check whether hand-washing facilities are communal and whether privacy options exist, with findings expected to inform local policies and any capital investment needed.

Strain on single-sex wards

Hospital pressures mean many already struggled to keep wards single-sex. NHS England data show breaches of the previous mixed-sex accommodation guidance, where members of the opposite sex were placed on a single-sex ward, have risen every year since 2021. The latest figure, for August 2026, is 5,520 breaches, against 3,853 in June 2025. Sex Matters, a sex-based rights charity, welcomed the guidance but is concerned about how it will be applied.

2025-06

3,853

2026-08

5,520

2025-06

3853 breaches

2026-08

5520 breaches

Reaction from trans groups

TransActual and Trans+ Solidarity Alliance said in a joint statement that the guidance would not work in resource-strapped hospitals and would create unworkable operational challenges. The groups said the guidance leaves individual healthcare professionals unclear on how to care for trans patients safely.

This NHS guidance emphasises clinical judgment as the priority over blanket exclusion, but leaves individual healthcare professionals unclear on how to safely look after trans patients.

The groups argued that placing trans people in spaces for their sex assigned at birth would push them away from accessing care. They accused the government of putting politics over patient care while failing to resolve what they called a legal mess.