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We all deserve to feel safe, respected and cared for in hospital. But new NHS England guidance could put the dignity and privacy of trans patients at risk. As women, we believe everyone deserves compassionate healthcare, without fear of discrimination. So why are we making exceptions?
Yesterday (16.10.26), NHS England published its long-awaited guidance on privacy, dignity and safety in hospital accommodation. It sets out how wards in England should operate following last year’s For Women Scotland ruling, and its central instruction is that trans patients should be accommodated in line with their sex assigned at birth.
Most of us are familiar with what it means to lie in a hospital bed, whether through our own experiences or those of a loved one. The thin gown. The curtain that never quite closes. Being frightened, in pain, and reliant on strangers for the most basic things. It is the moment in life when dignity matters most, and when it is easiest to lose. Privacy, dignity and safety during this time should be an absolute priority and yet the latest guidance seems to forget that we are all equally entitled to the same protections.
The guidance’s answer to protecting the dignity of trans patients is, largely, a single room. Yet, side rooms are one of the scarcest resources in any hospital. They are needed for patients with infections, for people who are immunocompromised, and for those at the end of their lives. On a busy ward, there may simply not be one. But even where there is, how exactly is that implemented in practice?
Imagine a trans woman who transitioned decades ago. Her colleagues, her neighbours, perhaps even some of her friends do not know her history, and that is her right. She is admitted for a routine operation and placed in a side room on a men’s ward. Every visitor and member of staff who walks past and sees a woman in a single room on a men’s ward may wonder why she is there, potentially revealing something deeply personal about her that she never chose to share.
Now imagine a trans man, presenting as male, and living as a man in every part of his life, placed on a women’s ward. How does that serve his privacy or his safety? How does it serve the dignity or privacy of the women in the beds around him who perceive him as male?
The law has long recognised that a person’s trans history is private information, and gender reassignment remains a protected characteristic under the Equality Act. It is unclear how a ward placement that announces that history to a room full of strangers can ensure that law is respected.
As is so often the case, the guidance places the hardest decisions with individual healthcare workers. Picture a nurse at 3am. The ward is full. There is one side room, and a patient with suspected norovirus waiting in A&E. A trans patient also needs a bed. Whatever the nurse decides, they are risking either a breach of the new accommodation requirements, or compromising the care of a patient. And this is on top of an already impossible workload. Clinicians came into nursing and medicine to care for people, not to police them. They should not be put in this position, and patients should not have to depend on which way an exhausted member of staff happens to call it.
Hospitals already struggle to keep wards strictly single-sex under current pressures, and even mixed-sex accommodation breaches have been rising. This latest guidance asks more of a system that cannot meet its existing commitments, without providing a single extra bed, room or member of staff to deliver it.
We know, as women, what happens when people stop feeling respected in healthcare.
Research from around the world shows that when women are dismissed, disbelieved or treated without dignity, the consequences are serious:
Many of us have lived some version of that ourselves. We would never accept a policy that made women afraid to go to hospital, whether they were assigned female at birth or not.
Trans organisations are already warning that this guidance will make trans people even less likely to seek help when they need it.
Many already delay care because of past experiences of discrimination. Every person who puts off a scan, ignores a symptom or avoids an admission because they dread how they will be treated, is a person whose health is put at risk. That is a health inequality – not a privacy policy.
And it is not only patients. It is their partners, parents and children, sitting by a bedside, already frightened, and now also watching the person they love be singled out.
Perhaps the hardest part to accept is that there is little evidence the previous approach was causing the problems this new guidance is supposed to address. TransLucent sent Freedom of Information requests to every acute and mental health trust in England responsible for adult inpatients. They asked how many complaints had been made about trans women on women’s wards in the year to August 2023. The answer was “one”, and it was minor enough that it was never escalated. Earlier investigations dating back to 2021 found none at all.
Under the previous approach, trans patients were cared for according to the best interests of all patients and the best care available. Curtains, side rooms when needed, and the judgement of experienced staff did the job, quietly, for years.
This guidance doesn’t fix a problem. It creates new ones: more segregation, more pressure on wards, more anxiety for staff, more people too afraid to come through the hospital doors. It is a waste of time, money and, worst of all, people’s health.
If you’re a woman in the UK who believes everyone deserves to be treated with dignity and respect, please add your name to our letter, ‘Not In Our Name: Women in support of the trans+ community’. Together, we can show that there are thousands of women who refuse to accept trans+ people being treated as less deserving of the rights and protections we all expect.