NHS bosses will finally tell hospitals they must stop letting trans women onto female wards 18 months after a landmark court ruling.
Under new guidance to be published later today, staff will be required to accommodate patients according to their biological sex.
It marks a complete U–turn from previous policy, published in 2019, which said healthcare workers should respect an individual’s gender identity.
Critics have warned that this was unsafe and placed women at risk of sexual assault as the document made clear that having male genitalia was ‘not a bar’ to being placed on a female ward.
Instead, staff were told to take account of the way an individual dressed and the name and pronouns they used, regardless of whether they had a Gender Recognition Certificate.
The rules applied to all single sex spaces, including wards, toilets and showers.
Separate new guidelines, also to be published today, will make clear that staff must use single sex changing rooms and toilets that align with their biological sex.
Female nurses have previously told of their unease at being forced to undress in front of transgender colleagues.
Darlington nurses Tracey Hooper, Annice Grundy, Lisa Lockey and Bethany Hutchinson
NHS England will write to NHS trusts and integrated care boards to inform them of the new guidelines and require chief executives and boards to take action.
The changes follow the Supreme Court’s ruling in April 2025 that the terms ‘woman’ and ‘sex’ in the Equality Act 2010 refer to biological sex, and subsequent guidance from the Equality and Human Rights Commission.
A number of NHS trusts have continued to allow trans women onto female wards in defiance of the court ruling while they waited for national NHS guidance.
Former health secretary Wes Streeting had promised to publish revised NHS guidelines by summer 2025 but it has been a year and a half since the court ruling.
He said at the time: ‘I do think biological same–sex spaces are really important, particularly for women and for women’s safety, but we also need to make sure that we’re providing dignity and care and compassion and respect for trans people.’
The old guidelines on patient accommodation said: ‘Trans people should be accommodated according to their presentation: the way they dress, and the name and pronouns they currently use.’
Where other patients objected, hospitals were required to balance the competing needs and rights of those involved, with transgender patients permitted when staff considered it necessary and appropriate.
But the new guidance reverses this position, with patients required to be accommodated according to their sex registered at birth, except for rare occasions when there is a specific clinical need to the contrary.
NHS briefing documents seen by the Daily Mail say: ‘Trans people and others with the protected characteristic of gender reassignment should be accommodated in line with their sex as registered at birth, while also ensuring that: (i) clinical needs are met, and (ii) privacy, dignity and safety are maintained for all, including other patients.’
Responding to the Supreme Court ruling, Chelsea and Westminster Hospital NHS Foundation Trust said: ‘We are proud to be one of the UK’s leading providers of gender affirming services.
‘As such, our unwavering commitment and support for trans+ and non-binary service users and staff remains the same.
‘We will continue to respect and uphold our service users’ right to self-identify and remain committed to delivering safe, compassionate care to every patient.’
An NHS trust paid out £187,000 in damages in June this year after an employment tribunal found it harassed seven nurses by requiring them to share a changing room with a transgender woman.
Judges ruled County Durham and Darlington NHS Foundation Trust created a ‘hostile environment’ for nurses who objected to Rose Henderson, who was born male and identifies as a woman, using the single–sex changing rooms.
One of the claimants, Bethany Hutchison, said the nurses raised their concerns to protect women but were instead subjected to ‘pressure and intimidation’.
Andrea Williams, chief executive of Christian Concern and the Christian Legal Centre, said: ‘This is welcome and long-overdue guidance.
‘It has taken a long-fought battle, led by courageous women such as the Darlington nurses, to put biological reality back at the heart of NHS policy.
‘But an important gap remains.
‘The guidance does not give NHS staff the clarity and protection they need over pronoun use.
‘Jennifer Melle was investigated, disciplined and referred to the Nursing and Midwifery Council after declining to use female pronouns for a biologically male patient.
‘She was eventually cleared, but no nurse should have to endure that ordeal for using biologically accurate language.
‘NHS England must now make clear that healthcare professionals cannot be compelled to use preferred pronouns or penalised for declining to express beliefs about gender identity that they do not hold.’
