NHS update on recording patient sex and gender identity

It doesn’t matter what your definition of sex is, scientifically or ideologically or what terminology you use - the relevant questions are what information is being recorded, and whether and why that information needs to be mandatory. For a trans person, their sex at birth and the sex currently recorded or used in their care can be different pieces of information with different implications for privacy.

There is already a field where sex is recorded. For the vast majority of people, this is their sex at birth, so the new policy will have no practical consequence whatsoever. What the new system does is mandate that, for everyone, what is recorded in that field is specifically their sex at birth. The practical change affects trans people: for a trans patient, new information is now required to be recorded in their medical record that can identify them as trans, where that information may not previously have been recorded.

I’m not arguing that sex changes. I’m saying that sex at birth and gender identity are different pieces of information. The terminology you use and your semantic, scientific or ideological understandings of the words don't alter the privacy implications of mandatorily recording information that can reveal someone’s trans status.

And the fact that the implementer’s guidance specifically recognises that this information may be sensitive and advises caution about who sees it and when rather supports my point than undermines it. We agree that the information can be clinically relevant. The question is whether making it mandatory creates a legitimate privacy issue for trans patients. Clearly, the NHS itself recognises that it can.

I’d be fine with it on my record as long as it’s only available to medical practitioners

I think it’s sensible and should improve patient care. Most health information needs strong privacy safeguards, whether it’s the fact that someone is trans, or has a medical condition, or significant family history…. It’s a step forward.

It's your medical record. It's for medical practitioners.

They shouldn’t be having the wrong sex recorded. That’s the whole point. Your “gender” is not your sex. You call men who identify as women “trans women” and I do not but the objective fact is that they are members of the male biological sex.

There are plenty of admin roles that also have access that won’t need that information. If my trans status is going to be disclosed it need be to a minimal group of people as possible.

Why? I'm serious. What does it matter? What problems are you expecting?

Because some people can be shitty about it if they know. It’s just reality that some people have an issue with trans people and will use that knowledge to be unpleasant.

If they don’t need to know for a specific purpose, then why tell them?

So, paranoia? Hardly a convincing reason.

I'm not saying we should tell admin people specifically. But if telling HCPs in the records, means admin people might know as well, then tough luck, we'll just have to deal with it like the adults we are.

The NHS is already taking precautions to keep this info as confidential as possible; arguing that they shouldn't record it at all would be nonsensical and harmful.

This was answered for you above @Seethlaw . There is a reason why democratic societies have data protection laws governing the collection, recording and sharing of personal information.
Potential harms of sharing personal information can include:

• violating the privacy and dignity of the person,
• the risk of discrimination,
• potential security breaches and misuse of personal information, and
• the risk of “functional creep”—where information collected for one purpose is gradually used for others.

These aren’t concerns born of “paranoia”. They are ordinary, legitimate privacy concerns that we recognise and protect against precisely because personal information can have consequences for the people it concerns. There is no reason to trivialise those concerns when they arise in relation to trans people.

There is a reason why democratic societies have data protection laws governing the recording and sharing of personal information.

Indeed. And under those laws, it is perfectly acceptable, and in fact even necessary, to record a person's sex in several contexts, including in their medical records.

So what's your point?

It’s hardly paranoia. It’s daily reality for far too many trans people.

It doesn’t have to be one or the other. The system can be designed for privacy when implementing this new data field.

Why was there ever a need to record sex or gender in this format? It seems as if it is fine with the genderists when the sex field can be falsified. But not when that loophole may be closed?

Also, it’s not really “new”, as Alice Sullivan said, the sex field which was supposed to accurately reflect biology, was appropriated for the disputed concept of “gender identity”. For political reasons and due to ideological capture.

Eh??

Data protection law does not establish that because information can legitimately be recorded in some contexts, it therefore ceases to be sensitive information or should be made mandatory in other contexts regardless of the potential consequences.

The relevant questions are: what information is being collected, from whom and in what context? What are the privacy consequences of collecting that information for that person in that context? Is making its collection mandatory necessary and proportionate to the purpose, and who will have access to it?

I’m not arguing that sex should never be recorded in medical records. I’m questioning the specific requirement to make sex at birth a mandatory field for every patient, given that for trans patients this can disclose their trans status. The existence of legitimate clinical contexts in which birth sex might be relevant to care doesn’t answer that question.

I’ve explained this distinction several times now, but you don’t seem willing to engage with it. I’m therefore going to leave it here, as this is becoming a rather pointless exercise. Have a nice evening.

The system can be designed for privacy when implementing this new data field.

We agree then. And it's not like handlers of medical records don't have a long experience in dealing with very sensitive data, so I don't see why this one bit of information should be a problem.

It’s not “birth sex”. It’s just sex. You can’t change sex.

The existence of legitimate clinical contexts in which birth sex might be relevant to care doesn’t answer that question.

Yeah. If you think stopping HCPs from knowing someone is trans, is more important that making sure trans people get the care they actually need, then we don't have much to discuss indeed.

"False. It's true that there were fields for sex and gender but what happened in effect was that everyone's sex was listed in the gender field, except for trans-identified people whose gender identity was recorded in that field. So the only bit of information that doctors had about trans-identified patients was their gender identity and even worse that was written to appear as if it was their sex. This issue was uncovered in FOI requests by GC campaigners and has also been written about by doctors and nurses."

Yes, I know — that is exactly what I am saying.

Sex is already recorded in medical records; there is already a field for it. For the vast majority of people, the sex recorded in this field is their sex at birth. The practical effect of the new requirement is therefore only on the subset of trans patients whose existing sex marker has been changed to reflect their gender identity rather than their birth sex.

For those patients, the new rule creates a mandatory requirement for information about their sex at birth to appear in their clinical record that was not previously required. That information can reveal that they are trans and will be accessible to a wide range of people, and in contexts where it is not directly relevant or necessary for clinical care.

So I’m not arguing that clinicians should be deprived of information about sex generally and where it's relevant, or that birth sex should never be recorded. I am pointing out that the new requirement changes what information must be recorded for this particular group of patients regardless of consent, and creates a specific privacy concern for them.

Men are redefining the acknowledgment of their sex as trauma. When it would be clear to any medical professional which sex they are.

Why does it matter then? If it’s obvious to all medical professionals then it doesn’t matter if it’s on the medical record, right?