NHS England has introduced updated guidance directing hospitals to assign single-sex ward accommodations, toilets, and changing rooms based on biological sex rather than gender identity. The guidance states that trans people should be accommodated in line with their biological sex while ensuring their clinical needs are met and their privacy, dignity, and safety are maintained alongside other patients.
An internal impact assessment obtained by the Guardian examined the consequences of this policy across multiple protected characteristics. The document acknowledged positive effects for certain groups, including benefits for women who are pregnant or breastfeeding, individuals with particular religious beliefs, and minority-ethnic populations. The assessment also noted that the policy would support privacy, dignity, and safety priorities and improve legal accuracy in guidance on single-sex spaces.
However, the report identified potential adverse effects for trans people. It warned of possible delays in care and increased risk of “corridor care”—temporary bedding arrangements outside standard wards—if dedicated side rooms are unavailable. The assessment noted concerns that trans people could experience or fear discrimination through being “outed” as trans or placed on wards misaligned with their lived gender. It also flagged the possibility that hospitals may lack sufficient capacity to provide side rooms when required, potentially placing trans people in distressing accommodation situations.
The report further cautioned that the policy might negatively affect relations between cisgender and transgender people, as staff balance competing group needs, and that some women not conforming to societal appearance expectations could face questioning to access single-sex wards. The assessment suggested that mitigation strategies could include prioritizing clinical need in placement decisions and noting that the policy does not apply in emergency or intensive care settings. It emphasized that same-sex accommodation delivery should not result in patients receiving corridor care and that decisions on trans patient placement should be individualized.
The new guidance was informed by a legal ruling and updated codes of practice indicating that biological sex designations apply to service access, with acknowledgment that trans people are likely to experience disadvantage compared to non-trans individuals.
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