The NHS has quietly pulled back its guidance allowing people to use toilets and changing rooms based on their gender identity rather than biological sex.
This comes after the UK Supreme Court confirmed that the term “sex” in the Equality Act refers specifically to biological sex, not gender identity.
This landmark ruling has forced NHS chiefs to rethink their approach and scrap the previous advice, which had been widely used across many public sector organizations, including hospitals.
What the Withdrawn Guidance Said and Why It Sparked Debate
The now-withdrawn NHS guidance told staff to let trans and non-binary people use facilities that matched their gender identity, not the sex they were assigned at birth.
It even urged NHS leaders to take a strong “zero-tolerance” stance on transphobia and encouraged policies that support this inclusive approach.
For example, one NHS trust in Leeds had explicitly allowed staff to use single-sex spaces according to their gender identity, and provided gender-neutral options for non-binary individuals.
However, this guidance faced fierce criticism from women’s rights groups and campaigners who argued that it endangered women’s safety and privacy.
They claim the policy created a hostile environment, and some say it contributed to controversial disciplinary actions against nurses who stood up for single-sex spaces, such as the case in Darlington.
Families and Campaigners Demand Accountability
Maya Forstater, chief executive of the campaign group Sex Matters, didn’t hold back in her criticism when speaking to The Telegraph.
She described the guidance as encouraging a “hostile, humiliating and unsafe environment” for both NHS staff and patients.
She called for a public apology from the NHS Confederation for “undermining women’s rights and the culture of care.”
Forstater also urged the NHS to reach out to all trusts to clarify that the previous guidance was flawed and that any policies based on it should be revoked.
The NHS Confederation’s Response and Next Steps
The NHS Confederation confirmed that they removed the guidance because parts of it were outdated following the Supreme Court’s decision and new interim advice from the Equality and Human Rights Commission (EHRC).
They explained that they plan to update and reinstate the guidance once the EHRC updates its Code of Practice, which then needs approval from the UK government, followed by revised NHS England guidelines.
A spokesman emphasized that removing the guide doesn’t mean the NHS is stepping back from supporting trans and non-binary staff and patients.
Instead, the aim is to keep fighting bullying, abuse, and discrimination in healthcare workplaces.
Initially, the NHS Confederation chose to flag the outdated parts on their website rather than removing the guidance entirely, but later decided that full removal was the best way to prevent confusion.
Ongoing Controversy and Calls for Clarity
Forstater was particularly critical of the former NHS guidance, saying it was among the worst she had seen and accused it of encouraging hospitals to break the law regarding workplace facilities.
She pointed out how this approach led to staff like Sandie Peggie and the Darlington nurses being disciplined for simply advocating for single-sex spaces and their right to safety and privacy.
She also criticized the NHS Confederation for delaying action after the Supreme Court judgment, saying hospitals should always have recognized that biological sex matters.
What This Means for the Future of NHS Policy
The NHS now faces growing pressure to issue updated guidance that aligns with the Supreme Court’s ruling.
Health Secretary Wes Streeting has made it clear he wants this new advice ready by summer 2025.
Meanwhile, other public bodies are already moving forward.
The Football Association recently announced a ban on trans women competing in women’s football, reflecting the broader ripple effects of legal rulings on gender identity policies across the UK.