NHS England (NHSE) issued new guidance on Thursday stating that transgender patients should be cared for on single-sex hospital wards or bays that correspond with their biological sex rather than their gender identity. The policy also applies to staff facilities, directing that changing rooms and toilets be used based on biological sex.
The guidance follows an April 2025 Supreme Court ruling which determined that under equality law, the term "sex" refers to biological sex and "woman" refers to a biological woman. Previous NHSE guidance had allowed patients and staff to use facilities and wards based on their gender identity, such as a transgender woman—a biological male who identifies as a woman—choosing to be on a women's ward.
Under the new rules, NHSE stated that alternative arrangements should be made when following the biological sex policy is not "clinically appropriate." The document notes that decisions may be made on a case-by-case basis to ensure the safety and dignity of all patients, while specifying that clinical need remains the priority in emergency and urgent care settings. NHS trusts are encouraged to audit their facilities to ensure they offer alternatives, such as gender-neutral or single-occupancy toilets.
Transgender patients and staff may notice a change in how they are assigned to rooms or changing areas, though the guidance stipulates they should be offered gender-neutral spaces to avoid discrimination. The policy follows legal disputes involving NHS staff, including a January 2026 tribunal ruling that a trust indirectly discriminated against nurses who objected to a transgender colleague using female changing rooms at Darlington Memorial Hospital. Those nurses are currently seeking £400,000 in legal costs from the NHS. Transgender rights groups TransActual and Trans+ Solidarity Alliance stated the guidance could create "unworkable operational challenges" in hospitals with limited resources.
The next steps for the policy involve implementation across individual NHS trusts, which must now align their internal procedures with the national guidance. Bethany Hutchison of the Darlington Nurses Union stated that the test will be whether trusts follow the new rules. Meanwhile, legal precedents continue to develop, as an appeal is expected in a separate case involving a nurse in Scotland, Sandie Peggie, which is scheduled to reach the courts in 2027. The guidance is effective as of its publication on Thursday.