One year after a Supreme Court judgment clarified the meaning of sex under the Equality Act, concerns remain that public institutions have not yet aligned their policies with the ruling. While the judgment reaffirmed that sex in law refers to biological sex, institutions like the NHS are not updating policy or guidance in line with the judgement.

Single-Sex Spaces in the NHS

Mixed-sex accommodation in NHS wards and staff housing has been a longstanding issue. Although the Department of Health had previously stated that mixed-sex accommodation had been eliminated, guidance issued as far back as 2009 permitted transgender patients to be accommodated in wards corresponding to their gender identity, rather than their biological sex. That guidance also stated that such placements would not be recorded as breaches of mixed-sex accommodation rules, and therefore did not require reporting.

An audit conducted by citizen journalists examined NHS policies in force between July 2024 and July 2025. According to the journalists, the review found that no NHS Trust across Great Britain had updated its services, policies, or guidance for either staff or service users to reflect the Supreme Court judgment.

Further Freedom of Information requests indicate that, as of April 2026, NHS Trusts may still be operating under policies that are unlawful. In response, these citizen journalists, working with us at SEEN in Health, have published an online map detailing the audit’s findings, allowing members of the public to review policies specific to their local Trust.

We will continue to update the map as revised policies are received.