NHS England has released updated guidance establishing that trans patients should be accommodated on single-sex hospital wards and facilities based on biological sex rather than gender identity, representing a change from its previous policy framework.
The new guidance permits alternative arrangements when placement by biological sex is deemed clinically inappropriate, with provisions for gender-neutral spaces and single-occupancy facilities to be made available. Staff facilities are similarly to be assigned by biological sex. The guidance acknowledges that clinical needs may override other considerations, particularly in emergency and urgent care settings. NHS trusts have been directed to conduct audits assessing the availability of alternatives to single-sex facilities.
This policy revision follows an April 2025 Supreme Court judgment determining that equality law defines “sex” as biological sex and that single-sex spaces should restrict access to individuals of the same biological sex. The previous NHS guidance, which had allowed patients and staff to use facilities corresponding to their gender identity, was subsequently withdrawn.
Data from NHS England indicates an increasing number of breaches of mixed-sex accommodation guidance in recent years, with 5,520 breaches recorded in August 2026 compared to 3,853 in June 2025. The Sex Matters charity has characterized the new guidance as a significant policy reversal, though raising concerns about implementation. Trans rights organisations have expressed worry that the guidance may create operational difficulties and uncertainty for NHS staff in providing appropriate care.
The guidance follows several high-profile employment tribunal cases involving NHS facilities and single-sex spaces, including a January 2026 case at Darlington Memorial Hospital where nurses were found to have experienced indirect discrimination, and a December 2025 case involving NHS Fife where a nurse filed harassment claims related to changing room access policies.
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