NHS England Tells Hospitals to Place Trans Patients on Wards by Biological Sex

NHS England published new guidance on Thursday, October 15, telling hospitals to care for trans patients on single sex wards or bays that match their biological sex, not their gender identity. The document replaces advice that let trans patients stay on a ward for the gender they identify with, and it follows the Supreme Court ruling of April 2025 that sex in equality law means biological sex.

The guidance says trans people and others with the protected characteristic of gender reassignment should be accommodated in line with their biological sex, and that all patients should be treated with respect, dignity, compassion, and care. Hospitals should not place trans women on female wards or trans men on male wards. Where that would not be clinically appropriate, the hospital should find alternative arrangements. Where clinical needs and same sex rules cannot both be met, clinical needs come first.

NHS England said decisions may still be made case by case, protecting the dignity and safety of all patients. To avoid discrimination, trans people should be offered gender neutral spaces. Cases where a trans patient was placed on a ward for their gender identity are likely to be rare, it notes.

Who the guidance covers

The patient guidance covers acute, mental health, and community NHS trusts, and NHS funded patients treated in private settings. It does not cover accident and emergency departments, urgent treatment centres, or paediatrics, where clinical need is the overriding priority.

A second document, published the same day, covers staff. It tells NHS staff working in hospitals and GP surgeries that single sex facilities such as changing rooms and toilets should be used according to biological sex. Trusts with mainly single sex facilities should think about alternatives, such as single occupancy rooms or mixed facilities with lockable rooms. Trusts must audit their facilities and cover the cost of changes. The staff guidance carries a foreword from Duncan Burton, the chief nursing officer for England.

The wider legal setting was set in two steps. In April 2025 the Supreme Court ruled that the word sex in the Equality Act 2010 means biological sex, and that a service counts as single sex only when it is used on that basis. Just over two months ago, the code of practice written by the Equality and Human Rights Commission on single sex spaces came into force on the same basis.

A split reaction

Nurse Bethany Hutchison, who won a claim against County Durham and Darlington NHS Foundation Trust after a trans colleague was allowed to use women changing facilities, welcomed the guidance as clear and necessary. She said the test now is whether NHS trusts will follow it.

Maya Forstater, chief executive of the charity Sex Matters, called the change a momentous shift back to reality. She warned that NHS patient records are in poor shape, with many trans people recorded as the opposite sex.

Campaign groups TransActual and the Trans+ Solidarity Alliance took the opposite view in a joint statement. They said the guidance leaves individual health workers unclear on how to look after trans patients safely. They said forcing trans people into spaces for their sex assigned at birth will never be the most clinically appropriate choice, and that it would push trans people away from seeking care.