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New guidance from NHS England (NHSE) recommends that transgender patients should be accommodated on single-sex hospital wards or bays corresponding to their biological sex rather than their gender identity. The guidance allows for exceptions when this arrangement is not clinically suitable, stressing that decisions must be made on an individual basis with priority given to clinical needs, as well as maintaining the dignity and safety of both transgender patients and others.
This marks a departure from earlier NHSE advice, which permitted patients and staff to use wards or facilities aligned with their gender identity. Under the previous framework, a trans woman (biological male identifying as female) could choose a women’s ward, and a trans man (biological female identifying as male) could use a men’s ward. However, this approach was overturned following a Supreme Court ruling in April 2025. The court clarified that, for the purposes of equality law, the term “sex” refers to biological sex, and “woman” signifies a biological woman, requiring single-sex spaces to be restricted to individuals of the same biological sex.
Alongside the new patient-related directives, NHSE also issued guidance for NHS trusts about managing single-sex facilities for staff, such as changing rooms and toilets. Like the recommendations for patients, these staff areas should also be used based on biological sex rather than gender identity. The NHS encourages audits to ensure sufficient alternatives are available, including gender-neutral or single-occupancy toilets, to prevent discrimination against transgender individuals.
Hospital capacity issues have already made maintaining strict single-sex wards challenging, with NHSE data showing a rising number of breaches of previous mixed-sex accommodation rules since 2021. Most recently, in August 2026, there were 5,520 recorded breaches compared to 3,853 in June 2025. The guidance has received mixed reactions: sex-based rights group Sex Matters hailed it as a significant step toward reality but expressed concerns over implementation due to inaccurate NHS patient data, as noted by CEO Maya Forstater. Meanwhile, transgender advocacy groups such as TransActual and Trans+ Solidarity Alliance worry about the practical challenges faced by NHS staff in providing safe care within these new parameters
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