The National Health Service (NHS) in England has implemented new guidelines requiring transgender patients and staff to use wards and restroom facilities according to their biological sex, marking a reversal of previous policies that aligned accommodation with gender identity. The guidelines, issued by NHS England in October 2026, come in response to a Supreme Court ruling from April 2025, which defined "sex" under the Equality Act 2010 as biological sex rather than gender identity.
Under the updated policy, transgender women will be placed in male wards and use male bathrooms, while transgender men will be accommodated in female wards and facilities. However, the NHS stated that in certain circumstances it may be appropriate to assign trans patients individual rooms instead of placing them on wards. This accommodation aims to protect the privacy, dignity, and safety of all patients.
The guidance applies across all NHS-funded services in England, including hospitals, GP surgeries, and private clinics receiving NHS funding. It also addresses staff facilities, recommending that hospitals provide alternative options such as mixed-sex areas with individual lockable rooms to promote inclusivity for transgender and non-binary staff. Hospitals have been directed to audit their facilities to ensure alternatives to single-sex spaces are available for these employees.
The policy shift has prompted varied reactions. Some campaigners and advocacy groups welcomed the move, describing it as a "momentous shift back to reality." Maya Forstater, chief executive of the sex-based rights charity Sex Matters, expressed support for the change but raised concerns about the lack of clarity regarding the implementation of these rules by NHS trusts.
Conversely, the British Medical Association (BMA), representing doctors, voiced apprehension about the guidance’s impact on transgender and non-binary people. Dr. Amit Kochhar, chair of the BMA’s representative body, cautioned that the changes could result in exclusion or disadvantage for these groups. The BMA emphasised the need for medical professionals to work in an environment that fosters inclusion and ensures comfort with available facilities.
The previous NHS guidelines, which permitted trans people to be accommodated according to their stated gender identity regardless of physical sex characteristics, had led to several high-profile disputes. Among these was a legal case involving seven nurses at Darlington Memorial Hospital who claimed they faced intimidation after raising concerns about sharing a single-sex changing room with a transgender woman. There have also been reports of sexual assault and harassment in NHS hospitals linked to ward placements, including incidents on psychiatric wards in Manchester and London involving transgender patients.
The 18-month delay between the Supreme Court decision and the issuance of the new NHS guidance has drawn criticism from some quarters. Other government departments, including education, justice, and defence, are expected to update their policies on single-sex spaces in the coming months to reflect the Court’s interpretation.
The NHS stated that patient allocation should continue to be considered on a case-by-case basis, balancing the needs and safety of all individuals, including those requiring single rooms for medical or personal reasons. The NHS also reaffirmed that men and women should not be required to share bathrooms, lavatories, or wards, consistent with the Supreme Court ruling and existing equality law.