In April 2025 the Supreme Court made a landmark legal ruling that the terms “man” and “woman” referred to biological sex when it came to applying the 2010 Equality Act. Six weeks ago the Equalities and Human Rights Commission (EHRC) published a Code of Practice laying out how this should apply. , external
The EHRC Code of Practice specifically uses the example of a hospital ward as a place where this code applies. It says allowing trans women to use a service means it could no longer be classed as female-only, and could also be unlawful sex discrimination. Mixed sex wards are no longer allowed in the NHS apart from in limited circumstances.
The current NHS England guidance was originally written in 2019, external and states: “Trans people should be accommodated according to their presentation: the way they dress, and the name and pronouns they currently use. This may not always accord with the physical sex appearance of the chest or genitalia”.
The website was updated after the Supreme Court ruling in 2025 to say that revised guidance would be published “as soon as possible” but 17 months on hospital trusts still have no national NHS code and are having to formulate their own policies. GMMH follows the existing NHS England guidance.
Dr Michael Foran, an associate professor of law at the University of Oxford and an expert in equality law, said the NHS was struggling to implement the law because of long established practices.
“The NHS has very well-established policies for consulting stakeholder groups in a way that is maximally inclusive,” he said
“You can see the NHS is approaching this in the same way that it would approach any new policy. You consult with your stakeholder groups, you get legal advice, you think about how you might best engage this new change.”
“But the central problem the NHS is facing is that complying with the law is not a new policy to consult on,” he said.
“You don’t have a choice as to whether or not you comply with the law.”
Dr Foran said the priority was to follow the law and then to work out how to make adjustments so that trans people could properly be cared for.
The EHRC Code of Practice also states that the rights of trans people have to be taken into account when making decisions on single-sex spaces. If they are not properly accommodated then this could amount to discrimination.
But some trans rights groups feel changes to the current guidelines will inevitably lead to a substantially negative impact on trans patients.