NHS England has published new guidance that states that trans patients are to use wards and other hospital spaces on the basis of biological sex. According to an internal report, the changes could lead to delays and greater risk of “corridor care” for trans people. 

The updated guidance was released on Thursday, October 15. It states: “Single-sex services, such as hospital accommodation, should be provided on the basis of biological sex.” It further reads that trans patients “should be accommodated in line with their sex as registered at birth”.

The guidance also says that, in order to avoid discriminating against trans people, they should be offered gender neutral spaces. However, decisions regarding the facilities they use should be made on a case-by-case basis, ensuring clinical needs are met. 

According to an internal NHS England impact assessment seen by The Guardian, the updated guidance could lead to a “number of potential adverse impacts for trans people” in accessing healthcare. The document highlights that the possibility of facing discrimination could lead trans people to “avoiding accessing healthcare at all”.

Moreover, the document states: “There may be delays and a greater risk of ‘corridor care’ for trans people with a negative impact on their physical and mental health and wellbeing if side rooms are not available.

“Trans people may fear and potentially experience discrimination by being ‘outed’ as trans through not being accommodated in a ward that aligns with their lived gender or being placed in a side room.”

The report highlights the risk that hospitals might not have the capacity to provide gender neutral spaces, “forcing trans people into the potentially distressing situation of being accommodated on wards aligned with their biological sex”.

Furthermore, the report also states that cisgender women who do not “present in line with general societal expectations” could be subjected to invasive questioning around their sex to be able to access single-sex wards.

In a joint statement, TransActual and Trans+ Solidarity Alliance commented on the updated guidance, stating: “Forcing trans people into spaces based on our sex assigned at birth will never be the most clinically appropriate decision, and will push trans people away from accessing care. 

“Doctors and nurses need to be able to prioritise looking after the person in front of them, not juggling scarce side rooms and writing breach reports to keep trans people safe.

“This guidance will not survive contact with reality in resource-strapped hospitals and will create unworkable operational challenges. The government failing to get a grip of this legal mess is sadly putting politics over patient care.”

The updated NHS England guidance comes 18 months after the UK Supreme Court ruling regarding the 2010 Equality Act’s definition of ‘woman’. In April 2025, the Supreme Court ruled that this definition does not include trans women who hold gender recognition certificates.