Imported gender ideology is damaging the NHS

Activist-driven records are dangerous for patients – especially transgender patients

The NHS is losing essential data that keeps people safe

Everyone’s medical records should show essential information about them, including age, sex and medical history. But lobbying by the World Professional Association for Transgender Health (WPATH), a transgender ideology activist group, has led to confusion and obfuscation in the IT systems that record patient data in some NHS trusts. Across the country, the simple sex category for “male’ or “female” is being replaced by a bizarre range of options including “non-binary”, “man including transman” and “trans-female”. 

This is bad for all of us. And the people it’s most dangerous for are those with a transgender identity. 

Increasingly, patient records are held on computer systems, not on paper. Some NHS trusts are merging these records into a single electronic health record for each patient. To do this, they buy a specialist IT software system. The biggest provider of health-record software is an American firm called EPIC. Sex Matters wrote last year about how EPIC has built in contested ideas such as gender identity. In NHS Trusts using EPIC, a gender identity is assigned to every patient – even babies. In some cases biological sex is being conflated with the “acquired gender” stated on a gender-recognition certificate – which changes sex for some legal purposes – and in others, with self-identified gender identities.

Now we know that all this has come from WPATH, as explained here

Activist-driven records are dangerous for patients

How did a US-based activist group shape NHS medical records? Back in 2011, WPATH’s executive committee convened a working group of clinicians, specialists in medical-information technology and activists to make recommendations for developers, vendors and users of electronic health-record systems with respect to transgender patients. In 2013 those recommendations were published, and they included taking an “organ inventory” of every patient, asking whether they have a penis, testes, prostate, breasts, vagina, cervix, uterus or ovaries. WPATH also successfully lobbied the United States Department of Health and Human Services to mandate the inclusion of sexual orientation and gender identity (SO/GI) data fields for approved electronic health-record systems in the USA. 

When NHS England looked for a system, it selected the American company EPIC – whose systems already incorporated those US-mandated rules In 2023, several NHS England trusts launched EPIC systems software. More are expected to follow.

There are three problems with this. First, there’s the time wasted by NHS staff and patients in collecting and recording unnecessary data. You don’t need an organ inventory if you simply record whether people are male or female. 

Second, there’s a serious risk of recording false information. Asking about body parts instead of simply recording sex will lead to errors. It’s especially confusing for vulnerable patients, who may give wrong answers to questions like “Do you have a cervix?” (Research has shown that almost half of women do not know what a cervix is.) There may be language barriers or learning difficulties – or a patient may be too unwell to engage in a quiz about which reproductive organs they have. For those who can answer, being asked such questions is unlikely to inspire trust or confidence.

Third, it can lead to medical errors. Conflating sex with ideological terms like non-binary or trans-female is dangerous for patients. We know this because it’s already happening in the USA, which adopted this software several years ago. We’ve heard from a doctor who wasted crucial minutes in an emergency with a patient suffering chest pains because the system had incorrectly recorded him as transgender. Chest pains are symptoms of very different problems in men and women, so confusion about sex can mean misdiagnosis – which can be serious. That doctor realised something wasn’t right, and discovered the error. A more junior clinician might have been afraid to ask.

This is particularly dangerous for women. If someone presents in an emergency, the doctor has to check whether they might be pregnant before giving them an X-ray. If the doctor doesn’t even know that the patient is female, then a baby could be at risk. Pregnancy itself brings specific conditions that can be life-threatening. A woman can die from an ectopic pregnancy in the first 12 weeks, when she may not even know she is pregnant, or from pre-eclampsia later on. 

If the patient’s medical record says she is male, there is likely to be a delay before she gets the right treatment. This is not speculative. It has happened – a patient who looked like a man presented in the emergency room with severe abdominal pain. By the time the medical staff realised this was a pregnant female on testosterone, the baby had died in utero. 

This case was published in the highly ranked New England Journal of Medicine, but if lessons were learned they have not reached those who are implementing EPIC in the UK. In a London hospital using EPIC, the medical records of two very ill babies were missing crucial information like gestational age (which shows whether they were born prematurely) and ethnicity, which NHS trusts are legally required to record, but included the babies’ pronouns.

UK activists are pushing for this too

The push to remove sex categories and sex-based language from healthcare is woven into the NHS Rainbow Badge scheme. This was created by activist doctors; Stonewall and other transactivist groups were paid to oversee its roll-out. Although the scheme has now officially ended, the legacy remains, in policies and systems in which references to woman or female have been removed. Freedom-of-information requests by the Daily Express have revealed dozens of NHS trusts recording their own versions of gender identity, asking patients to answer whether they are “male (including trans man), female (including trans woman), non-binary, intersex, questioning/unsure or prefer not to say”. This despite the fact that a trans man is biologically female. 

It’s time to choose

There are two options here for NHS services across the UK. They can continue to obfuscate about sex, to make health records unreliable, and to make it difficult for clinicians to ask if someone is male or female. Over time, this will cost the NHS hard cash. For example, if clinicians cannot be sure if someone is male or female, they will have to order pregnancy tests on everyone being sent for an X-ray and half of those will go in the bin. Calls for sex-specific cancer screenings will go to the wrong people, who may even turn up; others will not be called who should have been, leading to late diagnoses.

There’s a simple alternative. Given that the software is customised for NHS England, it would be entirely feasible to tweak the system, remove elements based on WPATH recommendations and return to sex-based patient data. A simple, optional marker could be put in place for patients with trans identities for patients’ safety – in case their sex is not obvious from their appearance, for example.

Now is the time to fix this, before it goes any further and patients get hurt.