Health Secretary intervenes over NHS guidance on transgender patients in hospitals

·4-min read
Hospital ward - Getty
Hospital ward - Getty

The Health Secretary is to review guidance on transgender patients being admitted to single-sex wards in the wake of an investigation by The Telegraph.

Sajid Javid is to take “fresh advice” on policies issued by NHS trusts after The Telegraph revealed that they included instructions that male sex offenders who self-identify as women can be placed on female-only wards.

Despite instructions from the Department of Health to eliminate mixed-sex wards, guidance from hospitals across England states that patients should be admitted based on the gender they identify with and can choose which ward, lavatories and facilities they use.

On Tuesday night, Mr Javid said: “All patients, including women and transgender people, should feel comfortable and safe in hospital.

“It's not wrong to look at whether guidance is right, or how it's being applied, to reassure everyone. I’ve asked the Department of Health for fresh advice.”

It comes as The Telegraph can reveal that NHS England has told hospitals to allow children to self-identify their gender, even if they are not deemed competent and their parents disagree.

Gillick competence - the test in medical law

Central guidance on single-sex accommodation states that children and young people should be accommodated “in accordance with the dress, preferred name and/or stated gender identity”.

They have told medics that some parents “have a view that is not consistent with the child’s view. If possible, the child’s preference should prevail even if the child is not Gillick competent.”

Gillick competence is a test in medical law to decide whether a child under the age of 16 is able to consent to their treatment without parental consent.

Last night parents’ groups and medics questioned why the health service was overriding legal protections put in place to protect both patients and professionals.

The guidance, issued in 2019, states patients should be “accommodated according to their presentation: the way they dress, and the name and pronouns they currently use”.

It can now be revealed that the NHS says that children and young people should also have the “same respect for their self-defined gender as are trans adults, regardless of their genital sex”.

It states that this should apply “if possible” even when someone with parental responsibility objects and the child does not have the capacity to consent.

The guidelines point out that children’s wards are often not segregated.

‘Why would anyone ignore child’s wishes about their accommodation?’

Dr Jane Hamlin, president of the Beaumont Society, a trans support group, said: “If children are in hospital for treatment it is important that they feel as comfortable and relaxed as possible in the circumstances. Why would anyone want to ignore the child’s wishes about their accommodation?

“It is important that the gender on the NHS record reflects how the person identifies to avoid embarrassing misunderstandings should a person have to see a GP who does not know them, or go into hospital.”

Concerns for vulnerable patients

However, Dr Julie Maxwell, a paediatrician, warned that patients on mental health wards, which were often split between sexes, were most likely to be left vulnerable by this situation.

“I wouldn’t agree with any situation where the wishes of the parents were ignored unless there were safeguarding concerns,” Dr Maxwell told The Telegraph.

Her comments were echoed by Stella O’Malley, a psychotherapist who founded Genspect, a parental support group for those concerned about the treatment that their children are receiving for gender issues.

Ms O’Malley, who says that she has been contacted by thousands of parents from around the world on this issue, said: “On what basis should Gillick competence be overridden?

“We have these well-thought-out legal principles which are put down to save us from ourselves in exactly this kind of clinical situation.

“There is a tendency to make an exception around gender dysphoria which is entirely inappropriate.

“We have to stick to the principles of medicine and therapy and treatment because to disregard them would be reckless and irresponsible, the rules have been made for a reason. This principle of capacity to consent keeps everybody safe.”

Potential problems with misdiagnosis and incorrect treatment

Dr Maxwell said that the guidance was not the only concern among medics about the way that the NHS has made changes “without thinking them through” to the way that children and young people can register their gender.

She said that there had been a number of occasions when she had seen patients, all under 16, who had their name, gender and in some cases even NHS number changed on their medical records, meaning that there was no mention of their biological sex.

This could create problems with misdiagnosis and incorrect treatment, she warned.

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