NHS England assessment warns new single-sex ward guidance could harm trans patients

An internal NHS England impact assessment has warned that new guidance on single-sex hospital wards could have adverse consequences for transgender patients.

Titled “Privacy, dignity and safety in hospital accommodation”, the new rules, published last week, state that trans women are no longer to be placed on female-only wards, where applicable.

Under the new rules, “women should not have to share toilet or bathroom facilities with men”

The changes follow an April 2025 Supreme Court ruling that the terms “woman” and “sex” in the Equality Act 2010 refer to biological sex. The ruling clarified that trans women, including those with gender recognition certificates, are not considered women under the Act for the purposes of its sex-based provisions, prompting NHS England to review its policy on single-sex hospital accommodation.

Under the new rules, “women should not have to share toilet or bathroom facilities with men” and “women should not have to walk through an area occupied by men to reach toilets or bathrooms, excluding corridors”.

However, these requirements do not need to apply in “urgent” cases and can therefore “override the need for complete segregation of sexes”. Such settings include A&E departments and urgent treatment centres, adult critical care units and active treatment areas such as chemotherapy units.

The impact assessment obtained by the Guardian considers the potential effects of the policy rather than reporting measured outcomes.

What are the key findings

It states that the new guidance could potentially delay treatment for trans patients who need to find suitable alternative accommodation, such as a private side room.

As a result, this could also increase the risk of corridor care, meaning that if side rooms are unavailable, trans patients could face a greater risk of being cared for in corridors.

The assessment also highlights the risks of discrimination and distress for trans people, including being involuntarily outed if they are accommodated on wards that do not align with their lived gender.

Potential impacts also include fears of discrimination which could deter trans people from accessing healthcare altogether.

Enhancing segregation

It also suggests that the segregation of transgender and cisgender patients could cause tensions between both groups, as well as create difficulties for staff balancing patients’ needs.

The assessment also raises concerns that women who do not conform to conventional expectations of how women look or behave could face questioning about their sex when accessing single-sex wards.

As a result, the internal assessment suggests that where to place trans people in NHS hospital wards should be made on a “case-by-case basis”.