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NHS Hospitals: “single-sex” accommodation cannot be mixed sex

Reviewing Annex B: Briefing for policy makers

The NHS’s current policy places rapists who identify as women in “single-sex” hospital bays and mental health units for women.

Sajid Javid has promised to review this policy.

"It's not wrong to look at whether guidance is right, or how it's being applied, to reassure everyone." – Sajid Javid, Health Secretary

Sex Matters today publishes our policy proposal for how to do this.

As an NHS nurse told a panel at the Conservative Party Conference yesterday, the current policy prioritises inclusion of transgender patients over the safety and needs of female patients. Dr Sinead Helyar said that:

  • If patients question why there is a male-bodied person on a female-only ward, nurses are told to “reiterate… that there are no men present”.
  • Policy documents compare patients who ask for single-sex spaces to racists and label them “transphobes”, “offenders” and “perpetrators”.
  • In one mental health trust, a male-born patient who identified as a woman sexually assaulted patients on a female-only ward on two separate admissions, despite staff raising concerns. 

NHS policy introduced in 2010 is that providers of care are expected to have a “zero-tolerance” approach to mixed-sex accommodation. There are strict reporting requirements and financial penalties for hospital trusts that breach these standards.

Patients are told they are being placed in separate accommodation for male and female patients.


But in practice staff are told to operate on the basis of gender self-identification. For NHS England, the policy developed in 2010 and updated in 2019 includes ‘Annex B’ which tells hospitals that they must allow people to chose to be in opposite-sex wards if they identify as transgender or non-binary, even if they have had no diagnosis, treatment or surgery.

Sajid Javid, the Health Secretary, has said that this government will review the policy.

Sex Matters has produced a briefing for policy makers on how to revise Annex B.

Principles for respecting everybody’s rights

We argue that this should start with a set of high-level principles. Proposed are:

  1. Annex B should be consistent with the rest of the policy – in language, meaning and outcomes.
  2. It should be clear to staff and patients what to expect and what situations they are being put in when they are told they are in a same-sex or mixed-sex setting.
  3. The policy should prioritise the safety, privacy and dignity of all patients.
  4. The policy should not force staff to misrecord a patient’s sex on medical records, risk assessments or administrative records.
  5. The policy should consider the needs, privacy and dignity of trans patients, recognising that there are difficult situations, and decisions need to be made flexibly.
  6. The policy should generate data on where trans patients are accommodated, without fining healthcare providers for complying with same-sex accommodation.

Our document proposes revised text for Annex B with clear definitions and principles for accommodating and recording all patients safely and with dignity.