Trans women will no longer be placed on female-only wards in NHS hospitals in England, under guidance that ties wards, toilets and changing rooms to biological sex. Where clinical needs cannot be met that way, those needs take priority.

The guidance follows a 2025 Supreme Court ruling that the terms 'woman' and 'sex' in the Equality Act refer only to biological sex. Earlier guidance had allowed patients and staff to be accommodated based on gender identity.

What Changes for Patients

In a letter to health bosses, NHS England HR director Danny Mortimer said trans people 'should be accommodated in line with their biological sex'. The guidance adds that 'privacy, dignity and safety' must be maintained for all patients sharing the accommodation.

The same rules apply to non-binary patients, who must use facilities for their biological sex. If that is not safe, patients may be given their own room or use unisex facilities, such as disabled toilets.

Staff are covered too. Every organisation should audit its provision to protect the 'privacy, dignity and safety of all staff', and trusts with mainly single-sex facilities can offer single-occupancy or lockable rooms.

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Clinical Needs Come First

Where clinical needs and same-sex accommodation cannot both be met, the guidance states that clinical needs are the priority. Mortimer said the responsibility was to provide care that is 'safe, compassionate, dignified, respectful and inclusive for all patients'.

Mortimer added: 'These are complex issues that require careful judgement.' Maya Forstater, from the charity Sex Matters, said NHS England had not explained how the rules would be implemented, adding that 'patient data is a mess'.

She called the policies 'a momentous shift back to reality', but criticised the 18-month gap after the ruling. She said the guidance had initially been promised 'within weeks'.

Campaigners welcomed the change after a string of high-profile incidents. These included a Manchester consultant's legal action against her employer over an alleged incident in which a trans patient exposed themselves to others on an all-female mental health ward.

Female nurses at Darlington Memorial Hospital won a tribunal case against their NHS trust in January over sharing changing rooms with a trans colleague. The tribunal found they faced 'a hostile, intimidating, humiliating and degrading environment'.

Nurse Bethany Hutchison, who led the claim, welcomed the 'clear and necessary guidance'. She said: 'Enforcement cannot continue to depend on the courage and personal sacrifice of individual nurses.'

Concerns Over Patient Care

According to a qualitative interview study on PubMed Central, researchers spoke to 20 health professionals working with young trans and gender-diverseAnother study, published in 2025, analysed 1,340 tweets posted by 652 US-based users of the #TransHealthFail hashtag.. They identified four barriers to care: structural, educational, cultural and social, and technical.

Another study, published in 2025, analysed 1,340 tweets posted by 652 US-based users of the #TransHealthFail hashtag. Researchers found negative experiences across health settings, including patients placed in the wrong room under policies based on sex assigned at birth.

The researchers said such experiences could lead patients to delay or avoid care and worsen their mental health. They cited research in which about 23% of respondents in one sample reported avoiding healthcare out of fear of discrimination.

The researchers recommended rooming by gender, not assigned sex, in areas that are usually sex-segregated. They cautioned that tweets reflect patients' perceptions, that timing is unknown, and that data came only from US accounts.

TransActual and Trans+ Solidarity Alliance said the guidance would 'not survive contact with reality in resource-strapped hospitals'. They said it prioritises clinical judgement but leaves health professionals unclear on how to care for trans patients.

They said the guidance would create 'unworkable operational challenges'. They added: 'Forcing trans people into spaces for our sex assigned at birth will never be the most clinically appropriate decision, and would push trans people away from accessing care.'

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