NHS England says trans women won’t be placed on female-only wards

Trans women will no longer be placed on female-only wards under new NHS England guidance published on Thursday. The rules state that single-sex wards, toilets, and changing rooms must be used according to biological sex, not gender identity. Trans people should be “accommodated in line with their biological sex,” the guidance says.

Shift from gender identity to biological sex

NHS England’s updated guidance instructs all organisations to audit provision to protect the “privacy, dignity and safety of all staff.” Where clinical needs and same-sex accommodation requirements conflict, clinical needs take priority. In trusts with mainly single-sex facilities, “suitable and accessible alternatives, such as single‑occupancy or mixed-sex facilities with individual lockable rooms, can be provided.”

This marks a reversal of previous NHS England guidance, which allowed patients and staff to use facilities based on gender identity. The change follows last year’s supreme court ruling that “woman” and “sex” in the Equality Act refer only to biological woman and biological sex, not transgender women with gender recognition certificates. The Equality and Human Rights Commission has already revised its code accordingly.

Campaign group Sex Matters welcomed the move. Chief executive Maya Forstater said it represented “a momentous shift back to reality.” But she expressed concern that NHS England has not said how the rules will be implemented. She noted the guidance was published 18 months after the supreme court judgment, despite promises it would come “within weeks.” Forstater cited the case of nurses at Darlington memorial hospital, who won an employment tribunal in January after being forced to share single-sex changing rooms with a trans colleague. The tribunal found they faced “a hostile, intimidating, humiliating and degrading environment.”

TransActual and Trans+ Solidarity Alliance, in a joint statement, said the guidance would “not survive contact with reality in resource-strapped hospitals and will create unworkable operational challenges.” They argued it emphasises clinical judgment but leaves healthcare professionals unclear on how to safely care for trans patients. The groups said forcing trans people into spaces for their sex assigned at birth was never clinically appropriate and would push them away from accessing care.

Bethany Hutchison, the lawyer who led the Darlington claim, said: “The test now is whether NHS trusts will actually follow it. The Darlington nurses should never have had to take their own employer to court to secure privacy, dignity and lawful single-sex facilities.” She added: “Enforcement cannot continue to depend on the courage and personal sacrifice of individual nurses.”