Trans patients in England should be cared for on single-sex hospital wards or bays that match their biological sex rather than their gender identity, according to new NHS England guidance, the BBC and The Guardian reported.

The guidance, issued Thursday, also says staff toilets and changing rooms should be used based on biological sex, the outlets reported. The guidance says trans patients' clinical needs must be met and the "privacy, dignity and safety" of everyone sharing the space maintained, The Guardian reported. Where clinical needs and same-sex accommodation cannot both be met, clinical needs are the priority, The Guardian reported. The BBC said the guidance names emergency and urgent care settings as places where clinical need is the overriding priority.

Trusts should offer enough alternatives to single-sex facilities, such as single-occupancy toilets, and are encouraged to audit what they provide, the BBC reported. It said the guidance emphasizes that trans people should be offered gender-neutral spaces to avoid discriminating against them.

Earlier NHS England guidance said patients and staff could use wards and facilities based on their gender identity, the outlets reported. That guidance was withdrawn after the U.K. Supreme Court ruled in April 2025 that "sex" in equality law means biological sex, the BBC said.

Many hospitals already struggle to keep wards single-sex. NHS England data shows 5,520 breaches of the mixed-sex accommodation guidance in August 2026, compared with 3,853 in June 2025, the BBC reported.

In a joint statement, TransActual and Trans+ Solidarity Alliance said the guidance would "not survive contact with reality in resource-strapped hospitals," the outlets reported. The groups said it leaves staff unclear on how to safely care for trans patients, the outlets reported. "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," they said, according to The Guardian. They also blamed the government for failing to "get a grip of this legal mess," The Guardian reported. Neither outlet carried a response from the government.

Maya Forstater, chief executive of the charity Sex Matters, called the change a "momentous shift back to reality," the outlets reported. She was concerned that NHS England had not said how the rules will be put in place, and criticized the 18 months it took to publish them after the Supreme Court ruling, The Guardian reported.

Bethany Hutchison, a nurse who led a tribunal claim by Darlington nurses over sharing a changing room with a trans colleague, welcomed the "clear and necessary guidance," the outlets reported. The nurses won that case in January, the outlets said.

What we know: NHS England now says wards, bays and staff facilities should be used by biological sex, with clinical needs taking priority.
What we don't: How hospital trusts will apply the rules; Sex Matters said NHS England has not explained that.