NHS England has brought in new guidance which requires staff to accommodate patients according to their biological sex, rather than their gender identity.
It marks a complete U–turn from previous policy, published in 2019, which said healthcare workers should respect an individual’s gender identity.
The new rules, published on Thursday, come 18 months after the Supreme Court ruled that “sex” in the Equality Act means biological sex.
It will now mean the Norfolk and Norwich University Hospital, the Queen Elizabeth Hospital in King’s Lynn and the James Paget University Hospital in Gorleston will have to comply.
The Norfolk and Waveney University Hospitals Group – which has managed the three sites since May 2025 – had previously said its policies were under review.
That stance had prompted criticism from gender-critical campaigners, who have been calling on the hospitals to act upon the Supreme Court ruling, warning that their previous rules were unlawful.
James Paget University Hospital in Gorleston (Image: Google Maps)
The Norfolk and Suffolk NHS Foundation Trust (NSFT) – which manages mental health facilities in the county – will also have to follow the advice.
The guidance also covers Norfolk’s GP surgeries.
Hospital bosses have been told to review the guidance “at pace” and draw up a clear plan to tackle any areas where change is needed.
WHAT THE NEW RULES SAY
Under the patient guidance, single-sex hospital services “should be provided on the basis of biological sex”.
That covers sleeping accommodation, toilets and bathrooms in acute and community hospitals as well as mental health units.
Trans patients should be placed in line with their sex registered at birth.
Where that would not be clinically appropriate, hospitals must find alternatives, such as a single room.
Where a patient’s clinical needs and single-sex accommodation cannot both be met, staff have been told to prioritise care.
NHS England says this should happen only rarely, and every such decision must be recorded and reported nationally.
Queen Elizabeth Hospital in King’s Lynn (Image: Supplied)
The rules do not apply in A&E, critical care, cancer and dialysis units, children’s wards or end-of-life care.
STAFF FACILITIES
A second document covers staff.
It tells trusts to follow the EHRC’s code of practice, under which toilets and changing rooms should be single-sex.
Trusts must review their policies on changing rooms, showers, toilets and staff accommodation, and audit their facilities.
Where needed, they should provide single-occupancy toilets or lockable mixed-sex rooms so no member of staff is left without suitable facilities.
WHAT DO HOSPITAL BOSSES SAY?
Simon Nearney, Group Chief People Officer for Norfolk and Waveney University Hospitals Group, said: “NHS England issued updated guidance on single-sex accommodation and staff facilities on 15 October, and we will be following that guidance across our hospitals.
“We are committed to providing safe, dignified and respectful care for every patient and a working environment that protects the privacy, dignity and wellbeing of our staff.
“We provide single-sex accommodation and facilities in line with the law and the NHS Constitution’s same-sex accommodation pledge and take our responsibilities seriously to ensure patients and staff feel safe and that their privacy and dignity are protected.
“NHS organisations have been asked to review local policies, practices and facilities in light of the new guidance.
“We are now considering the implications for our hospitals and will implement any changes required as part of that process.
“Throughout this work, our focus will remain on ensuring all patients, staff and visitors are treated with dignity, respect and compassion.”
Anthony Deery, chief nurse at Norfolk and Suffolk NHS Foundation Trust, said: “We remain committed to providing the best possible care and support for all our service users, families, carers and staff.
“NSFT has received the latest guidance from NHS England and will review its policies in light of the updated Equality and Human Rights Commission Code of Practice, taking any appropriate action where required.”
‘WE WILL BE WATCHING’
The new guidance has been seen as a win for gender-critical campaigners, who have called on hospitals to comply.
Ermine Amies, a spokeswoman for Women’s Rights Network, said: “All the NHS Trusts working in Norfolk have prioritised gender identity over biological sex for too long, denying the rights of women staff and patients.
Ermine Amies, a spokeswoman for Women’s Rights Network (Image: Supplied)
“It is shocking that they have continued to refuse to follow the law, even after the Supreme Court ruling.
“Our members who work in the NHS tell us that transactivist staff have been working to defy the law for the last 18 months, so we expect some activists will try to override this new guidance.”
She called on the leaders of Norfolk’s hospitals, mental health trust, community health trust and ambulance service to “show strong leadership and robust management to ensure compliance”.
“We will be watching their actions closely,” she added.