Hospital staff deciding where to admit a trans patient have new instructions from NHS England. Published on 15 October, the guidance says single-sex wards and bays should be organised according to what it calls “biological sex”. It replaces advice issued in 2019.

If that placement would be clinically inappropriate for a trans patient, the hospital should find another arrangement. Staff should involve the patient in the decision wherever possible and protect everyone’s privacy, dignity and safety.

A single room is one possibility, subject to other demands on the hospital. Rooms may also be needed to control infections or care for people at the end of their lives. The guidance says patients have no legal right to a single room.

A patient who needs admission should still be admitted if no single-sex bed is available. When clinical needs and the accommodation rules cannot both be met, care takes priority. Staff should record the reasons for the placement and report the breach.

The policy covers NHS-funded inpatient care in England, including care in independent hospitals. It lists exceptions for A&E, adult critical care and children’s areas.

Health leaders are now asking how to put the guidance into practice. In a 16 October response covering both hospital accommodation and separate staff-facilities guidance, NHS Alliance chief executive Sir Ciarán Devane sought clearer instructions to avoid inconsistent implementation. He said the costs of adapting facilities and the extra reporting work would need proper resources.

Gendered Intelligence raised a concern about geographical differences in its initial response on 15 October. The charity said it was unclear whether trans patients could receive different levels of care or inclusion depending on where they live. It plans to examine the guidance further.