Anyone self-identifying in the UK as a woman, including male-born sex offenders, may be placed in female-only hospital wards, according to new National Health Service (NHS) hospital official guidelines.
Countrywide NHS Trusts, reports The Telegraph, have issued guidance saying patients should be admitted based on the gender with which they identify and therefore can choose which ward, lavatory and shower facilities they use.
The policies have been put in place despite an order from the Department of Health that hospitals have to provide single-sex wards. Medical staff have warned that the guidance documents put them in breach of their code of conduct and leave the most vulnerable at risk.
Baroness Nicholson of Winterbourne, chair of Parliamentary campaign group Children and Women First, said that by “manipulating and distorting” equality laws, the NHS is denying women the right to “dignity and privacy” in their treatment.
Devon, Oxford and Nottinghamshire hospitals all tell staff a criminal history should be part of a risk assessment when placing male-born people on female-only wards, but are not a bar to admission.
Patients uncomfortable with the policies have been called transphobic by some trusts, who have compared them to racists in official guidelines: The Telegraph notes that some of them order medics to call the police and report a hate crime if patients do not accept another personʼs gender identity.
Doctors say self-identification is particularly an issue on mental health wards, where patients may be suffering delusions, and which are locked so patients cannot leave. Rape allegations have been made on one such unit.
One nurse said risk assessments of patients, including those with a history of sexual offences, did not happen as staff were too busy. “In-patients are often frail, elderly and confused and nurses have a duty to protect them,” she said.
However, Dr Jane Hamlin, president of the Beaumont Society, a trans support group, said: “If anyone starts off with an assumption that a trans person is a sex offender – or even a potential sex offender – that is discrimination and transphobia. All patients, including trans people, should feel safe when in hospital.”
Staff are now too scared to raise safeguarding issues, with reports of nurses who have spoken up having lost their jobs.
Devon Partnership NHS Trust says that patients “will be admitted based on the gender which they identify as at the point of admission”, not on physical characteristics or the person proving they have legally changed their gender or name, as they claim this is illegal.
“Where a transgender woman is admitted and has a history of sex offending, decisions regarding risk should include consideration of whether they are being prescribed anti-libidinal medication expected to reduce sexual risk,” the document states. It says transgender people must be able to use the facilities of their preferred gender while admitted. This includes shower rooms, toilets and single sex lounges.
The Oxford trust states: “If the service user has a sex-offending history, risk should be managed in the same way as with any other client, irrespective of gender”.
The basis for the documents comes from an instruction by NHS England, saying hospitals should allow patients to be “accommodated according to their presentation: the way they dress, and the name and pronouns they currently use”.
This means a physically intact male can choose to be accommodated on a female ward and to use womenʼs toilets and facilities. There is no requirement for the person to have begun to legally change their gender, as is specified under equality laws, or to provide proof of living as the opposite sex.
According to The Telegraph, since then, NHS Trusts have written their own policy and guidance documents on treating transgender patients, which medics and campaigners warn have created an “unsafe and dangerous” environment.
When hospitals were ordered to eliminate mixed-sex wards more than a decade ago, patients hoped it would mean privacy and dignity during a difficult time. But since then female patients have been accused of hate crimes, placed in seclusion and even threatened with their treatment being withdrawn for questioning why men who self-identify as women are placed in single-sex accommodation.
Baroness Nicholson of Winterbourne said they’d heard evidence of rape on a psychiatric unit, of physically intact males having to be removed from wards for masturbating, of people being reported for hate crimes, and of nurses losing their jobs for questioning new teaching that did not fit with their training. She said the law was being “purposefully misused”.
An NHS spokesman said: “Hospitals must safeguard the safety, privacy and dignity of all patients, including following the legal requirements established by Parliament.”
See more from MedicalBrief archives: