NHS bosses have finally told hospitals they must stop letting trans women onto female wards 18 months after a landmark court ruling.

Under new guidance published this afternoon, staff are required to accommodate patients according to their ‘biological sex’.

It marks a complete U–turn from previous policy, published in 2019, which said healthcare workers should respect an individual's gender identity.

Women’s rights groups tonight welcomed the new guidance but expressed fears that some woke trusts could continue to flout the law or seek to slow its implementation, spurred on by activist staff in rainbow lanyards.

The changes follow the Supreme Court's ruling in April 2025 that the terms 'woman' and 'sex' in the Equality Act 2010 refer to biological sex, and subsequent guidance from the Equality and Human Rights Commission.

The old NHS guidelines on patient accommodation said: 'Trans people should be accommodated according to their presentation: the way they dress, and the name and pronouns they currently use.'

Critics warned that this was unsafe and placed women at risk of sexual assault as the document made clear that having male genitalia was 'not a bar' to being allowed in female wards, toilets and showers.

Where other patients objected, hospitals were required to balance the competing needs and rights of those involved, with transgender patients permitted when staff considered it necessary and appropriate.

But the new guidance on single-sex spaces reverses this position, with patients required to be accommodated according to their sex registered at birth.

Trust should identify ‘alternative arrangements’, such as singe bed bays, for trans patients in cases ‘where it would not be clinically appropriate’ to care for them on a ward of their biological sex, it adds, in order to protect their ‘privacy, dignity and safety’.

The new guidance applies to acute, mental health and community NHS trusts as well as NHS-funded patients in private settings but not A&E departments, urgent treatment centres or paediatrics.

A number of NHS trusts have continued to allow trans women onto female wards in defiance of the court ruling while they waited for national NHS guidance.

Former health secretary Wes Streeting had promised to publish revised NHS guidelines by summer 2025 but it has now been a year and a half since the Supreme Court ruling.

Separate new guidelines, also published yesterday, make clear that staff must use single sex changing rooms and toilets that align with their biological sex.

Female nurses have previously told of their unease at being forced to undress in front of transgender colleagues.

NHS England has written to NHS trusts and integrated care boards to inform them of the new guidelines and require chief executives and boards to take action, starting with audits of facilities.

Cathy Larkman, a director at Women's Rights Network, said: 'NHS Trusts have prioritised inner feelings of “gender identity” over the reality of biological sex for too long.

‘It is shocking that they have not been following the law, even after the Supreme Court ruling.

‘WRN members who work in the NHS tell us that militant activist staff have been doing their best to ignore the law for the last 18 months, so we suspect they will continue to try to override this guidance.

‘It’s vital that the NHS shows strong leadership and robust management to stop this – we will be watching their actions closely.’

Maya Forstater, chief executive of sex-based rights charity Sex Matters, welcomed the policies as representing ‘a momentous shift back to reality’ but voiced concerns as to how they will be implemented.

She said: ‘NHS patient data is a mess, with potentially thousands of trans-identifying people recorded as the opposite sex.’

In a joint statement, campaign groups TransActual and Trans+ Solidarity Alliance said: ‘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.

‘This guidance will not survive contact with reality in resource-strapped hospitals and will create unworkable operational challenges.

‘The Government failing to get a grip of this legal mess is sadly putting politics over patient care.’

In one incident a ‘bearded’ biologically male patient allegedly exposed themselves to ‘vulnerable’ patients on a female psychiatric ward in Manchester.

And in another case, a 5ft 3in transgender man - who was biologically female - was raped within an hour of being placed on a male psychiatric ward in south London.

An NHS trust paid out £187,000 in damages in June this year after an employment tribunal found it harassed seven nurses by requiring them to share a changing room with a transgender woman.

Judges ruled County Durham and Darlington NHS Foundation Trust created a 'hostile environment' for nurses who objected to Rose Henderson, who was born male and identifies as a woman, using the single–sex changing rooms.

One of the claimants, Bethany Hutchison, said the nurses raised their concerns to protect women but were instead subjected to 'pressure and intimidation’.

Responding to the 2025 Supreme Court ruling, Chelsea and Westminster Hospital NHS Foundation Trust said: 'We will continue to respect and uphold our service users’ right to self-identify and remain committed to delivering safe, compassionate care to every patient.'