NHS England has issued new guidance stipulating that transgender patients should be housed in hospital wards or bays aligned with their biological sex, rather than their gender identity. This directive, published on Thursday, aims to comply with a Supreme Court ruling from April 2025 that defined 'sex' under equality law as biological sex.

The guidance acknowledges that exceptions may be made if clinically inappropriate, with decisions to be handled on a case-by-case basis. These decisions must prioritize the clinical needs, dignity, and safety of both transgender patients and others.

This represents a significant shift from previous NHS England guidance, which allowed patients and staff to use facilities based on their gender identity. Under the old rules, a trans woman (biological male) could opt for a women's ward, and a trans man (biological female) could choose a men's ward. This policy was withdrawn after the Supreme Court judgment affirmed that single-sex spaces should be exclusively for those of the same biological sex.

Furthermore, the new guidance emphasizes the provision of gender-neutral spaces to avoid discriminating against transgender individuals. It also reiterates that clinical need can be the overriding factor, particularly in emergency and urgent care settings.

The updated advice extends to staff facilities, including changing rooms and toilets, which should also be organized based on biological sex. NHS trusts in England are encouraged to audit and increase the availability of alternative facilities, such as gender-neutral or single-occupancy options.

This policy update comes amid ongoing challenges for hospitals in maintaining single-sex wards. NHS England data reveals a consistent rise in breaches of mixed-sex accommodation guidance since 2021. In August 2026, there were 5,520 breaches, a notable increase from 3,853 in June 2025.

Sex-based rights charity Sex Matters has welcomed the guidance as a "momentous shift back to reality" but expressed concerns regarding its implementation. Maya Forstater, CEO of the organization, highlighted potential issues with NHS patient data accuracy, suggesting "thousands of trans-identifying people recorded as the opposite sex."

Conversely, trans rights organizations TransActual and Trans+ Solidarity Alliance voiced apprehension, fearing that NHS staff may lack clarity on how to "safely look after trans patients." They predict the guidance will face "unworkable operational challenges in resource-strapped hospitals."