What do these policies mean?

Being a woman is not about clothes or makeup – it is a biological reality, and that reality matters in every corner of healthcare.

All the policies seen in the audit confirm that the NHS will affirm anyone who says they are a woman.

While the vast majority of the UK population know that it is not possible for humans to change sex, and don’t have their own gender identity, NHS policy writers seem to believe the opposite.

As a result, all of the policies in this audit conflate sex and gender. This seemingly small “confusion” makes the policies very difficult to understand. Most people would be surprised to learn that “single gender” accommodation is in fact “mixed sex”.

Since 2009, NHS Trusts have allowed any male who says that he is a woman (or claims a trans-identity) to access spaces that are advertised as female only.

Almost all Trusts advertise Single Sex Accommodation on their website, but the internal staff policy – usually hidden from public view – says:

  • Trans people should be accommodated according to their presentation: the way they dress, and the name and pronouns they currently use
  • A trans person does not need to have had, or be planning, any medical gender reassignment treatment

For female patients this means that if they complain about sharing toilets, showers or sleeping accommodation with a bearded male, NHS staff are instructed to variously:

  • re-educate the patient that their privacy/dignity/safety concerns are bigotry
  • deny that the person is male
  • consider reporting this as a hate crime
  • threaten to withdraw treatment from the woman for complaining

For NHS staff, recent employment tribunals have shown that female staff who do not agree to share their showers and changing rooms with males are subjected to harassment and victimisation to get them to comply. For example:

  • Bethany Hutchison and others v County Durham and Darlington NHS Trust
  • Sandie Peggie v NHS Fife and Beth Upton
  • Faye Russell-Caldicott v NHS England

In case you think that the green box is exaggeration, quotes from the policies speak for themselves:

Avon and Wiltshire Mental Health Partnership NHS Trust

“Providing education to other service users in a ward to prevent ignorant or transphobic comments is, if successful, a better solution than having to protect or isolate the trans service user, but please note that disclosing that someone is transgender without their consent may be unlawful.”

Supporting Trans and Non Binary People – Best Practice Guidelines (p26)

Great Western Hospitals NHS Foundation Trust

“Refusing to use a name, pronouns, or gender which the patient recognises or asking intrusive questions about a patient’s trans status when not relevant or pertinent to treatment is a form of harassment and a form of discrimination. If this is malicious in intent, this may be considered as a hate crime.”

Supporting Trans Patients Policy (p9)

Homerton Healthcare NHS Foundation Trust

“Examples of intimidation or behaviour that is not acceptable” “Derogatory or offensive racial, religious, political, disability, ageist or sexual remarks gestures or behaviour” and “You should recognise that abusive and violent behaviour could result in you being refused access to NHS services”

2021 Policy for the Management of Patients and Visitors, Who Are Violent, Abusive, Aggressive or Threatening (p6-7)

(NB Sandie Peggie was disciplined and suspended from work for using the word “man” which was considered abusive)