NHS England has published new guidance requiring trans women to be placed on wards and use facilities based on biological sex rather than gender identity.

The rules, released Thursday, apply to single-sex wards, toilets and changing rooms across NHS trusts. The guidance states trans people should be "accommodated in line with their biological sex" while ensuring clinical needs are met and "privacy, dignity and safety are maintained" for all patients and staff. Where clinical needs and same-sex accommodation cannot both be satisfied, clinical needs take priority.

NHS trusts have been instructed to conduct audits of their provision. Where single-sex facilities cannot be provided, NHS England says "suitable and accessible alternatives, such as single-occupancy or mixed-sex facilities with individual lockable rooms, can be provided".

The update follows a 2024 Supreme Court ruling that established "woman" and "sex" in the Equality Act refer only to biological sex and do not include transgender women with gender recognition certificates. The Equality and Human Rights Commission has already revised its code to confirm services must operate on the basis of biological sex to qualify as single-sex under the Equality Act.

This reverses previous NHS England guidance, which allowed patients and staff to be accommodated based on gender identity.

TransActual and Trans+ Solidarity Alliance said the guidance would "not survive contact with reality in resource-strapped hospitals and will create unworkable operational challenges". They stated it leaves healthcare professionals unclear on implementation and argued that "forcing trans people into spaces for our sex assigned at birth will never be the most clinically appropriate decision, and would push trans people away from accessing care".

Maya Forstater, chief executive of the charity Sex Matters, called the policies "a momentous shift back to reality" but expressed concern NHS England had not clarified implementation. She criticised the 18-month delay since the Supreme Court judgment, noting guidance was initially promised "within weeks".

Bethany Hutchison, lawyer for female nurses at Darlington Memorial Hospital who won an employment tribunal case in January over forced use of shared changing rooms with a trans colleague, welcomed the new guidance but said "the test now is whether NHS trusts will actually follow it". The tribunal found the nurses faced "a hostile, intimidating, humiliating and degrading environment".