NHS England’s new guidance on ‘Privacy, dignity and safety in hospital accommodation’ including single-sex hospital accommodation, introduces significant changes for trans+ patients, including how they are accommodated on hospital wards and how individual clinical needs should be considered.

GIRES examines what has changed, what the guidance means for trans and non-binary patients, and the responsibilities NHS organisations still have to provide safe, dignified and non-discriminatory healthcare.

We explore the evidence behind the changes, the potential risks to patient safety, privacy and access to treatment, and the important questions that remain unanswered about how the guidance will work in practice.

What is it? 

NHS England has published updated guidance explaining how hospitals should provide accommodation that protects patients’ privacy, dignity and safety. 

The guidance covers arrangements for patients sharing sleeping accommodation, including hospital wards and bays, and the provision of associated facilities. 

It replaces previous guidance under which trans+ patients could generally be accommodated in accordance with their gender identity. 

Under the updated approach, NHS England says that trans+ patients should ordinarily be accommodated according to what the guidance describes as their “biological sex”*, rather than their gender identity.  

The guidance also recognises that individual clinical needs must be met and that alternative arrangements may be necessary.  

*Note: “Biological sex” in the context of the guidance refers to sex assigned at birth. Where “biological sex” is used in this document, it is used in this context. 

The term trans+ is used throughout this document as an inclusive umbrella term encompassing people who identify as trans, transgender, non-binary, gender fluid, gender queer, and other gender-diverse identities. 

Why does this matter? 

Hospital accommodation affects more than where someone sleeps. It can influence patients’ privacy, dignity, wellbeing, confidence in healthcare services and access to appropriate treatment. 

The changes are particularly significant for trans+ patients, who may face difficult or distressing accommodation arrangements if required to be accommodated in spaces in line with their biological sex, rather than gender identity.  

Healthcare professionals must also understand how to apply the guidance while meeting their wider responsibilities to provide safe, appropriate and non-discriminatory care. 

What does the guidance say? 

Accommodation according to sex 

The guidance states that patients should ordinarily be accommodated in single-sex sleeping accommodation and that trans+ patients should generally be placed according to biological sex rather than gender identity. 

This represents a significant change from previous NHS guidance. 

Clinical needs remain a priority 

The guidance recognises that there may be circumstances in which accommodating a trans+ patient according to biological sex would not be clinically appropriate. 

Where clinical needs and the usual single-sex accommodation arrangements cannot both be met, clinical needs should take priority and alternative arrangements should be considered. 

Single rooms and alternative accommodation 

The guidance says that trans+ patients should be offered a single room, subject to an assessment of individual circumstances and wider clinical requirements. 

However, access to a single room is not guaranteed. Hospitals must also consider the needs of other patients and the availability of appropriate accommodation. 

Privacy, dignity and safety 

Healthcare providers remain responsible for protecting the privacy, dignity and safety of all patients, including trans+ people. 

Decisions should also consider individual circumstances and involve patients wherever possible. 

Recording and reporting decisions 

Where accommodation decisions depart from the guidance’s usual single-sex arrangements on clinical grounds, the reasons should be recorded and the placement reported in accordance with its requirements. However, patient information should remain private to ensure patient privacy is maintained.  

Where the guidance applies 

The guidance concerns specified inpatient accommodation in NHS-funded hospital services, including acute, mental health and community settings. 

It does not apply in the same way to every clinical environment. For example, emergency departments and adult critical care have different accommodation arrangements and clinical priorities. 

The separate NHS England guidance on staff facilities is not covered by this overview. 

What is confirmed, proposed, and unclear? 

What is confirmed 

• NHS England has published revised hospital accommodation guidance replacing the previous approach to accommodating trans patients according to gender identity. 

• Accommodation according to biological sex is now the stated default for trans+ patients in settings covered by the guidance. 

• Individual clinical needs remain relevant and should be considered when evaluating whether patients may require alternative arrangements. 

• Single rooms should be considered and offered in accordance with the guidance, but availability is not guaranteed. 

• Healthcare providers retain responsibilities relating to patient safety, privacy, dignity and equality. 

What is proposed or subject to implementation 

• The guidance has been published and is now live. 

• However, individual NHS organisations must review and implement the requirements through their own policies, accommodation arrangements and clinical procedures. 

• This may involve updating local guidance, staff training, decision-making processes and patient information. 

What remains unclear 

Several important practical questions remain, including: 

• How will healthcare professionals determine when accommodation according to biological sex is not clinically appropriate? 

• What alternative accommodation will be available where single rooms are unavailable? 

• How will patients be involved in decisions affecting their care? 

• How will hospitals ensure consistent decision-making across different wards and services? 

• What safeguards will prevent patients experiencing unnecessary distress, delays or inappropriate accommodation? 

• How will the effects of the guidance on trans+ patients be monitored? 

• Who is recording the information, what are they recording, and who sees what they are recording in relation to where a trans+ person is accommodated in hospital (information outside of the scope of treatment is a breach of privacy and dignity) 

These questions concern the practical implementation of the guidance, rather than suggesting that healthcare providers have no existing clinical or legal responsibilities. 

Key questions raised 

The new guidance raises questions for patients, healthcare professionals and NHS organisations. 

For patients 

What accommodation can a trans+ patient expect when admitted to hospital? Can they discuss concerns about their safety or dignity? What happens if the proposed accommodation is clinically inappropriate or causes significant distress? Where and how will accommodation decisions be recorded, who will have access to this information, and what safeguards will ensure that patients’ privacy and confidentiality are protected? 

For healthcare professionals 

How should clinical judgement be exercised? What factors should inform individual decisions? Who is responsible for resolving disagreements, and what guidance or support is available? How will patients who have a Gender Recognition Certificate (GRC) be assessed? 

For NHS organisations 

How will hospitals balance the needs of different patients, particularly where suitable accommodation is limited? What processes will ensure that decisions are consistent, proportionate, properly documented and clinically appropriate? 

For policymakers 

What evidence informed the change in approach? How were potential impacts assessed, particularly for patients who already experience barriers to healthcare? How will adverse consequences be identified and addressed? 

GIRES considers these questions important in ensuring that implementation of this guidance does not compromise patients’ access to necessary healthcare 

Wider context 

Legal and policy background 

The updated guidance follows the UK Supreme Court’s April 2025 judgment in For Women Scotland Ltd v The Scottish Ministers, which addressed the meaning of sex under the Equality Act 2010. 

It also follows the revised Equality and Human Rights Commission Code of Practice for services, public functions and associations, which came into force in August 2026. 

Trans+ people continue to have protection under the Equality Act, including through the protected characteristic of gender reassignment. Healthcare providers must also comply with their wider legal and professional obligations. 

The NHS Constitution for England includes commitments concerning patients’ dignity, respect, access to services and non-discrimination. 

Existing health inequalities 

Research has identified inequalities in the health and healthcare experiences of trans and non-binary people. 

A 2023 study published in BMJ Open found higher reported prevalence of several long-term health conditions among trans and non-binary adults compared with cisgender adults. 

Research and community surveys also indicate that some trans people avoid healthcare because of previous experiences or concerns about discrimination. 

For example, TransActual’s Trans Lives 2025 survey reported that 44% of disabled trans respondents had avoided attending A&E despite needing urgent medical care. 

These findings do not establish what impact the new accommodation guidance will have. They do, however, highlight why potential consequences for healthcare access, patient confidence and safety deserve careful consideration. 

Previous hospital accommodation arrangements 

Previous NHS guidance generally supported accommodating trans patients according to their gender identity. 

TransLucent published findings from Freedom of Information requests concerning complaints about trans women sharing women’s hospital wards under the previous guidance. It found that there was only one complaint made across 102 NHS UK trusts in a two-year period, which raises questions about the evidence of problems under previous arrangements. 

Professional perspectives 

The British Medical Association (BMA) has published policy supporting trans and non-binary patients being accommodated according to their gender identity, alongside wider commitments to patient-centred and inclusive healthcare. The BMA have also made a statement in response to the NHS guidance on ‘privacy, dignity, and safety in hospital accommodation.‘

This illustrates an important difference between the updated NHS accommodation approach and the BMA’s stated policy position. 

Potential impacts 

An NHS England impact assessment, reported publicly on 18 October 2026, identifies possible adverse consequences for trans patients, including delays to care, distressing or unsuitable accommodation, risks to privacy and of trans+ people not accessing necessary healthcare. 

Placing trans patients in single rooms may also affect their access to specialist care if they are accommodated away from the wards or clinical teams they need. The Justice for Joelle case, in which her family alleges that inappropriate accommodation contributed to delays in cancer treatment, highlights these concerns. Although the allegations have not been legally established, the case raises important questions about ensuring that accommodation decisions do not compromise the quality or timeliness of care. 

These are potential impacts rather than established outcomes of implementation. 

GIRES believes it is important that NHS organisations assess and monitor these risks for all patients, with particular consideration given to those with disabilities, complex health needs or existing barriers to accessing healthcare. 

Further information 

Official guidance and policy 

• NHS England: Privacy, dignity and safety in hospital accommodation 

• NHS England: Mixed-sex accommodation information and statistics 

• NHS Constitution for England 

• EHRC: Code of Practice for services, public functions and associations 

Research and professional perspectives 

• BMJ Open: Long-term health conditions among trans and non-binary adults 

• TransActual: Trans Lives 2025 

• TransLucent: Women’s Single-Sex Spaces in Hospitals 

• BMA: Policy position on the rights of transgender and non-binary people in healthcare settings 

• BMA STATEMENT: EHRC code of practice for services, public functions and associations  

• BMA STATEMENT: NHS guidance on the provision of single-sex services and facilities 

Further information 

• The Guardian: NHS England policy for trans people could have ‘a number of adverse impacts’, report finds 

This overview forms part of GIRES’ response to the updated guidance. More detailed information will be provided in accompanying resources covering (upcoming): 

• NHSE guidance on single sex spaces: Impact on trans and non-binary patients 

• NHSE guidance on single sex spaces: Implications for healthcare professionals 

• NHSE guidance on single sex spaces: Key issues and GIRES’ perspective 

• NHSE guidance on single sex spaces: Supporting research and resources 

Summary information  

• Document Name:  NHS England: Privacy, dignity and safety in hospital accommodation (single sex spaces) 

• Type: NHS England guidance for healthcare providers 

• Published by: NHS England 

• Date published: 15 October 2026 

• Primary source link: https://www.england.nhs.uk/long-read/privacy-dignity-and-safety-in-hospital-accommodation/  

• Status: Published guidance (replacing the previous ‘Delivering same-sex accommodation’ guidance) 

 

GIRES will continue reviewing the guidance and its implementation as and when further information becomes available.