The NHS Constitution consultation
SEEN in Health welcomes the review of the NHS Constitution and the opportunity to make our views heard through the consultation process. Our response will highlight the vital importance of sex equality and equity in protecting the privacy, dignity and safety of patients and staff alike.
We are encouraged by the change in mood in England which recognises the need for spaces and services to be based where necessary on sex rather than gender identity and we will be clear about our support for this move.
According to the Constitution:
“The NHS is founded on a common set of principles and values that bind together the communities and people it serves – patient and public – and the staff who work for it…It is available to all irrespective of gender, race, disability, age, sexual orientation, religion, belief, gender reassignment, pregnancy and maternity or marital or civil partnership status…[and] it has a wider social duty to promote equality through the services it provides and to pay particular attention to groups or sections of society where improvements in health and life expectancy are not keeping pace with the rest of the population”.
This is important because we know that women with English as a second language – a large and growing group – are at a particular disadvantage when accessing healthcare. To reach this group and ensure that they have the essential information they need, we need clear sex-based language to promote equality and equity of access.
We note that the Constitution refers incorrectly to ‘gender’ rather than the actual protected characteristic of ‘sex’ as set out in the Equality Act 2010. This is confusing. While ‘gender reassignment’ is a protected characteristic, ‘gender’ and ‘gender identity’ have no legal status. One of our aims is to ensure clarity on this issue.
The Constitution also states that the NHS aspires to “… high-quality care that is safe, effective and focused on patient experience…” and that “Respect, dignity, compassion and care should be at the core of how patients and staff are treated… patient safety, experience and outcomes are all improved when staff are values, empowered and supported.” SEEN in Health believes that this is our opportunity to make sure that the conflict between sex-based rights and gender identity is considered thoughtfully and resolved to ensure protection for people who need it. This is often women, due to their sex-based vulnerabilities and health needs.
The NHS values outline how every patient counts, putting patients at the heart, respecting dignity, needs abilities and limits. The NHS ensures that “compassion is central to the care we provide and respond with humanity and kindness to each person’s pain, distress, anxiety or need.” Further, “everyone counts” so it is vital we remember that there is a need to balance the rights of all affected groups, including the sex-based rights to single-sex spaces and care.
But this isn’t purely about single-sex spaces and the provision of toilets or washing facilities. This is about correctly registering the sex of patients and staff. All health professionals need to know what sex someone is so we can provide appropriate and safe care.
Lives can literally depend on knowing a patient's sex – calculating drug doses, interpreting the results of blood tests or investigations, identifying sex-based patterns and presentations of disease, or even just knowing the right questions to ask.
There are conversations worth having around patient records accurately recording sex while also acknowledging that a patient’s preferred gender, title and name could be different from their registered details. Of course, while a Gender Recognition Certificate – commonly known as a GRC – does not change the need for accuracy, it should be recognised to help promote dignity for those who are recorded as such.
As important, though, are the rights of patients to know the sex of their health professionals. It is deceptive and potentially abusive for a person in a position of trust and power to declare themselves to be other than they are, whether a physician’s assistant or nurse allowing a patient to believe that they are a doctor, or a man insisting that a patient believe they are female.
We would encourage all people who are interested in strengthening the NHS Constitution, particularly in regards to sex-based rights, to take part in the consultation.