The NHS No Longer Recognises the Reality of Biological Sex

The For Women Scotland Judgment in the Supreme Court clarified that for the purposes of the Equality Act, a woman is an adult human female. It also confirmed that women’s single sex spaces and services must be single sex. This has increased pressure on the NHS to re-establish science and sanity on all matters related to biological sex, whether that be the provision of single sex spaces and services, including hospital wards, the dignified treatment of staff who need single sex spaces, accurate language to describe men and women and their medical conditions and treatments, accurate recording of whether users of the NHS are in fact male or female, accurate recording of the sex of medical staff, and safeguarding and evidence-led treatment of vulnerable individuals impacted by gender ideology – the list is long.

Campaigners who expected to see progress on this issue in the NHS in the wake of the judgment are becoming frustrated. The NHS seems unwilling to budge. A typical response in the wake of the judgment is from NHS Fife, which said it “notes the clarity provided by today’s Supreme Court ruling regarding the legal definition of a woman. We will now take time to carefully consider the judgment and its implications”. The Daily Mail has gathered examples of NHS intransigence, including from NHS England. More are reported here in the Telegraph.

However, if we continue to expect rapid movement from the NHS on this issue we are likely to be disappointed. The working model of campaigners to date has broadly been to assume that gender quackery exists in ideologically-driven pockets of an otherwise sane NHS, which remains firmly anchored in science and common sense. We have imagined an ideological tail and a sane dog.

This has been a mistake – we have been using the wrong model. We are a sexed species, sexed in every cell of our bodies. There is probably no institution where sex matters more, for the safety of all of us and the sanity of our society, than in the day-to-day operations of our national health service, the NHS. However, at some point over the last decade or so, gender ideologues fully expelled the notion of biological sex from the ‘operation manuals’ of the NHS. It doesn’t exist anymore. Only gender self-identification exists. What is more, it is not gender self-ID anchored by the underlying reality of biological sex. It is gender self-ID in and of itself – full stop.

There is a group of women on Mumsnet who have been auditing NHS sex and gender policies and who have more or less come to this same conclusion working from the top down. The NHS Policy Audit working party says:

Our working theory is that there were no single sex spaces for NHS Staff or Patients in the entire country before [the FWS Judgment, April 16th 2025], having all been removed by stealth. We are aiming to prove this by auditing websites and policies for all the UK trusts and using the results to raise public awareness. As well as recording what has happened historically, the information will form a baseline so we can check which trusts comply or defy the judgment in due course.

One of the Mumsnet researchers conclude:

I have been reading NHS policy after NHS policy as part of our audit, and I hate to tell you all this, but in every single trust, everything that happened to the Darlington nurses would not only be possible, but obligatory. And it wasn’t the fault of one rogue person in Darlington (or Fife, or whatever trust Jennifer Melle is at) HR, nor one person in management, nor even one small team of people that decided these policies. It is BUILT IN to every single NHS trust policy.

The Mumsnetters have reached this conclusion from the top down. I believe I can prove it from the bottom up. I have been down to the underlying anchors of NHS operations, clicking through policies and past definitions into databases and finally to dictionaries. Sex has disappeared. Science has been kicked out; pseudoscience and ideology have replaced it.

As the Mumsnetter above has inferred, this potentially means that NHS trusts can’t easily fix the problem – data fields and definitions for referring to sex accurately and then acting accordingly don’t exist in the NHS. On the other hand, if we have found a root cause we can address the root cause. Secretary of State for Health, Wes Streeting, has brought NHS England back in-house and under his direct remit. He can instruct it to address this problem at its root. We can see if the NHS responds. We can hold him to account accordingly.

Now turning to the evidence.

I started with a document entitled ‘Data quality of protected characteristics and other vulnerable groups‘ produced by NHS England Digital in April 2022. This is a good starting point because the document is about accurate data collection and management. The specific document relates to Mental Health and Psychological Therapy Services – I do not know if parallel documents exist for other services, the impenetrability of the NHS is part of our problem.

I note straight up that sex has disappeared from the list of protected characteristics, to be replaced by gender identity:

I clicked through to gender identity.

I note that ‘non-binary’ is given the same footing as male and female. I also noted that sex is merely “registered at birth”.

The whole document is mind-boggling, but the next bit is particularly so. With flagrant audacity the authors have normalised the idea that all of us are sensitive about making a sex or gender disclosure. NHS staff must find “the right time” to ask. The NHS must also “avoid cisnormativity”. Patients “can also leave the field blank”. Sex is not relevant to being human or receiving medical treatment.

Next comes “How to collect and record gender identity data”. Notice there is a mention of sex but it’s merely “registered at birth”. Note also that it’s important not to use old data because “it’s possible that a patient’s gender identity may have been recorded differently by services at an earlier time in their journey in understanding their identity”. This reinforces the ideological positioning of sex and gender as a mere effervescence, how it “feels”.

Now we come to the actual data codes used by the NHS. Gender identity is the priority code and it is simply a record of how a patient feels. The old “Person Stated Gender Code” is “no longer a priority item” – in fact it can be left blank.

Now we come to the justification. Notice that it has literally zero to say about medicine, science or reality. Ideology and pseudoscience have fully replaced facts and reason.

Next, there is a final comment on the rationale for getting rid of the last potential shred of sense, “the Person Stated Gender code”. First, note that it had already been successfully corrupted so it can go. Second, with the rigour of ideology, there is no accidental mention of ‘sex’ – it is of course “sex assigned at birth”.

I have included the next bit to illustrate the complete drift into ideology and pseudoscience. Does a non-binary individual not have a ‘gender at birth’? Was he or she born non-binary? The straight-faced “it is not possible to identify gender at birth for patients whose gender identity is non-binary” is gob-smacking. At least the authors have been identified and can perhaps be hauled in front of a Select Committee to explain themselves and to identify who, how and when this was all signed off.

Still, the honest person wonders, is all of the above ‘EDI’ crankery which does not really make its way into real NHS practices?

No. We now move on to the ‘Implementation tools and guidance: Mental Health Services Data Set‘ – see the ‘MHSDS v6.0 User Guidance’. This document “outlines how the national data set should be used and interpreted by users, system suppliers and other stakeholders”.

This is actual guidance about how to encode specific data fields. It was last updated in May 2024, long after NHS management were aware of politicians and the public’s concerns about gender ideology.

Here are the fields tangentially related to the sex of a patient.

But surely, you suggest, there is still also an actual ‘sex’ code? Search for yourself. It doesn’t exist.

But it must exist… somewhere else? If you click on the defined terms in the left hand fields above you are taken to the ‘NHS Data Model and Dictionary‘. This is the NHS’s data and information management bible.

The NHS Data Model and Dictionary gives a reference point for assured information standards, to support health care activities in the NHS in England. The NHS Data Model and Dictionary has been developed for everyone who is actively involved in the collection of data and the management of information in the NHS.

Go and search for gender and have a good look around.

Here is the ‘gender identity code’. You can see that it is fully, finally, completely, unanchored from biological sex. It is whatever the individual says it is.

So now, the stubborn optimist asks, show me the ‘sex’ code.

I am sorry to have to report that it simply exists as a tag to note a legacy item. It does not even note the legacy item of biological reality. Once there was an aspiration for the NHS to provide single sex wards. The word sex lingers in an old ward policy. It is this that is referred to. The “ward intended sex of patients” just states the type of ward they will go to.

In case you think I am joking, the possible entries against the code are Male, Female, not specified and Home Leave. These are locations – whether a patient will go to a male ward, female ward or be at home.

The situation is astonishing. The ideologues took complete control. The most senior NHS managers must now be hauled in front of Select Committee. A book needs to be written. How did this happen?

But it makes it easier to fix. We can tackle it from bottom up. We can click through to dictionaries and datasets and see if it has been fixed. Wes Streeting has brought NHS England back in house and is now positioned to issue instructions. We even have a Data Bill before Parliament. A late amendment could reinstate sex in NHS dictionaries and data codes. Gender identity could be removed in its entirety. No more excuses – we can get to work.

Caroline Ffiske is a Director of Conservatives for Women. Find her on X.