NHS Greater Glasgow and Clyde withdraws trans advice for female-only wards - Times Scotland

[Igneococcus]

Good news on this chilly morning:

www.thetimes.co.uk/article/6cf9add4-4891-11eb-9dbc-44d114c9d92d?shareToken=6281a2d28333a5b52bf5586ef503527d

The article has been amended-how interesting. Still no comments showing...

For it to be real progress the trust would need to have come out and said, no males will ever be accommodated in woman's wards, regardless of how they identify - and specify their plans for males who for whatever reason don't want to be accommodated on the ordinary men's wards. (Because of course huge importance will be placed on their feelings about this - whereas none at all is placed on women's.)

Yes, I agree. But it's encouraging that now feel they can't just say TWAW no debate. Baby steps.

Even with the rest deleted that's a bloody annoying sentence. The semantic flip is an expression of male supremacy.

The groups in question, just like everyone here, are in favour of women who transition still having full women's rights - no amount of cosmetic surgery should disqualify any female person from access to women's rights.

Once again, transmen and their rights are entirely invisible.

the rest of the original sentence does not appear.

I guess because it was pointed out that it's a slanderous lie?

Datun
Hospitals have discriminated based on sex, since forever.

Well, not always.

Single-sex wards were being phased out from the end of the 1970s at least, and Age Concern were already protesting about it then to no avail.

In 1983 I had my gall-bladder removed, and was kept in "women's surgical 2" ward at the local hospital for a week. At some point not long after that it was decided that it would be a good idea (for reasons of cost) to get rid of the single-sex wards and turn them all into mixed sex ones, so "women's surgical 1" and "women's surgical 2" were merged with "men's surgical 1" and "men's surgical 2" and became wards 1, 2, 3 and 4. I discovered this when I was visiting a friend in that hospital, and was taken aback to encounter a man in non-genital-concealing pyjamas wandering about in the ward where she was. His bed was next but one to hers, and she found him an embarrassing nuisance: she kept the curtains round her bed drawn the whole time.

When I was in a hospital ward for a week in 2004 there were two other women and five men in it.

This mixed-sex policy has not as far as I know been fully reversed, in spite of Tony Blair and every Prime Minister since he noticed it in 1996 being opposed to it. Lansley tried in 2009, Clegg did his best in 2010, and the Government pledge in 2011 to abolish all mixed sex NHS hospital accommodation in England except in intensive care units and emergency departments introduced fines for every occasion on which a patient was placed against his or her will in a ward with patients of the other sex; it was also mentioned in the new Patients' Charter that year. In 2014 Jeremy Hunt said that mixed-sex wards had "nearly" been eliminated; but that does not include mental health hospital wards, to this day. And then it went up again: www.bbc.co.uk/news/health-38796338

This is from The Guardian (!); Catherine Bennett on Sun 30 Jul 2017 00.05 BST www.theguardian.com/commentisfree/2017/jul/30/mixed-sexed-wards-endanger-and-humiliate-women

I was in a mixed sex ward in 1996. Although the bays with beds were single sex, the few toilet/washing facilities were mixed sex. And didn't we know it.

The much heralded Abolition of mixed sex wards continued to be a lie in 2010

twitter.com/HairyLeggdHarpy/status/1052296768115888128

^When the "Abolishing Mixed Sex Wards" Policy was introduced in 2010 by the Health Secretary Andrew Lansley, it was heralded with:
"It should be more than an expectation, it should be a requirement that patients who are admitted should be admitted to single-sex accommodation”^

@TheGreatSloth

So what will happen when nurses use their judgement?

I can't see a nurse moving a male patient out of a female ward, if he claims to have a female identity (whatever that is). That would put the nurse right in the firing line of publicity and personal criticism. They'd be accused of bigotry, transphobia, there would be complaints to their work, possible disciplinary procedures. No one who wants to protect their job will do that.

I suspect this means the males will stay, and that women will be made to feel bad about not wanting to have them in their wards. In other words, exactly the same but done by the back door.

For it to be real progress the trust would need to have come out and said, no males will ever be accommodated in woman's wards, regardless of how they identify - and specify their plans for males who for whatever reason don't want to be accommodated on the ordinary men's wards. (Because of course huge importance will be placed on their feelings about this - whereas none at all is placed on women's.)

I actually think this is very disingenuous of them and not an improvement.

I completely agree and it is so unfair putting that responsibility on individual staff.

Need to keep pushing on this.

I guess there are always going to be situations in our hospitals where supply and demand (for beds in a particular ward) is going to be incompatible.

I doubt that any patient would be turned away from a hospital because the only bed available is on the wrong ward and the monitoring carried out will subsequently inform the need for extra capacity for budget planning purposes.

However the problem here is that many hospital trusts (certainly the policies I have seen in the South West) seem not to even record the placement of a transgender patient on the opposite sex ward as a breach of single sex wards. This means that there is absolutely no record of how often this happens, therefore no record of the impact on women and absolutely no chance of the data informing policy.

We could theoretically end up with thousands of women being affected by this (similar to sports teams, it only takes one male-bodied transgender person inappropriately place to affect all of the women on that ward and wanting to use the toilets/showers nearby so the numbers of women affected could be disproportionate to the number of transgender patients).

I can't see a nurse moving a male patient out of a female ward, if he claims to have a female identity (whatever that is). That would put the nurse right in the firing line of publicity and personal criticism. They'd be accused of bigotry, transphobia, there would be complaints to their work, possible disciplinary procedures. No one who wants to protect their job will do that.

The policy in a number of trusts would make this conversation impossible. The policy is very clear that staff are not to breach the privacy of a trans patient under threat of prosecution and large fines (and presumably a threat to their job) unless essential on medical grounds.

How is any staff member going to be able to discuss whether the presence of one particular patient is causing a problem and actually do anything about it in those circumstances? Their hands are tied.

So ‘it doesn’t happen’ and ‘we can’t discuss that with you’.

Yep. It’s impossible

I can't see a nurse moving a male patient out of a female ward, if he claims to have a female identity (whatever that is). That would put the nurse right in the firing line of publicity and personal criticism. They'd be accused of bigotry, transphobia, there would be complaints to their work, possible disciplinary procedures. No one who wants to protect their job will do that.

I'm fairly sure that the allocation of beds is not within the nurses' remit anyway: isn't there a manager who does that? So the nurse would have to get hold of that person and get them to reshuffle the patients, which would be extremely unpopular with the management team.

There has not been a national policy of Single Sex Wards in the NHS since at least 2009. The Directive from the Dept of Health under the Labour Government in May 2009 titled "Eliminating Mixed Sex Accommodation" was actually a directive to create Single Gender Accommodation, with Gender being determined by Self-ID.

This was confirmed by Andrew Lansley a year later under the Tories.

Despite warnings from NHS IT and Medical Records, Lansley also gave instructions that the public should be misled by using the field labelled "Sex" in medical records to record self-declared "gender".

I wittered on about this a few hours ago - there are links in this post to an older, very relevant Mumsnet Thread plus the 2009 Directive mentioned above:

www.mumsnet.com/Talk/womens_rights/4116944-Liz-Truss-writes-in-the-Mail-on-Sunday?msgid=103016092

AskingQuestionsAllTheTime - "The policy in a number of trusts would make this conversation impossible. The policy is very clear that staff are not to breach the privacy of a trans patient under threat of prosecution and large fines (and presumably a threat to their job) unless essential on medical grounds."

Have you got any examples of this policy? It sounds like a misunderstanding of the very specific prohibitions in Section 22 of the Gender Recognition Act 2004. This protects against disclosing that a person has a Gender Recognition Certificate or has applied for a GRC, although there are exceptions.

www.legislation.gov.uk/ukpga/2004/7/section/22

22 Prohibition on disclosure of information

(1)It is an offence for a person who has acquired protected information in an official capacity to disclose the information to any other person.

(2)“Protected information” means information which relates to a person who has made an application under section 1(1) and which—

(a)concerns that application or any application by the person under section [F14A,] [F24C, 4F,] 5(2) [F3, 5A(2)] or 6(1), or

(b)if the application under section 1(1) is granted, otherwise concerns the person’s gender before it becomes the acquired gender.

(3)A person acquires protected information in an official capacity if the person acquires it—

(a)in connection with the person’s functions as a member of the civil service, a constable or the holder of any other public office or in connection with the functions of a local or public authority or of a voluntary organisation,

(b)as an employer, or prospective employer, of the person to whom the information relates or as a person employed by such an employer or prospective employer, or

(c)in the course of, or otherwise in connection with, the conduct of business or the supply of professional services.

(4)But it is not an offence under this section to disclose protected information relating to a person if—

(a)the information does not enable that person to be identified,

(b)that person has agreed to the disclosure of the information,

(c)the information is protected information by virtue of subsection (2)(b) and the person by whom the disclosure is made does not know or believe that a full gender recognition certificate has been issued,

(d)the disclosure is in accordance with an order of a court or tribunal,

(e)the disclosure is for the purpose of instituting, or otherwise for the purposes of, proceedings before a court or tribunal,

(f)the disclosure is for the purpose of preventing or investigating crime,

(g)the disclosure is made to the Registrar General for England and Wales, the Registrar General for Scotland or the Registrar General for Northern Ireland,

(h)the disclosure is made for the purposes of the social security system or a pension scheme,

(i)the disclosure is in accordance with provision made by an order under subsection (5), or

(j)the disclosure is in accordance with any provision of, or made by virtue of, an enactment other than this section.

(5)The Secretary of State may by order make provision prescribing circumstances in which the disclosure of protected information is not to constitute an offence under this section.

(6)The power conferred by subsection (5) is exercisable by the Scottish Ministers (rather than the Secretary of State) where the provision to be made is within the legislative competence of the Scottish Parliament.

[F4(6A)The power conferred by subsection (5) is exercisable by the Department of Justice in Northern Ireland (rather than the Secretary of State) where the provision to be made could be made by an Act of the Northern Ireland Assembly without the consent of the Secretary of State (see sections 6 to 8 of the Northern Ireland Act 1998).]

(7)An order under subsection (5) may make provision permitting—

(a)disclosure to specified persons or persons of a specified description,

(b)disclosure for specified purposes,

(c)disclosure of specified descriptions of information, or

(d)disclosure by specified persons or persons of a specified description.

(8)A person guilty of an offence under this section is liable on summary conviction to a fine not exceeding level 5 on the standard scale.

(My bolding above).

Section 1(1), referred to in Section 22 says:

1Applications

(1)A person of either gender who is aged at least 18 may make an application for a gender recognition certificate on the basis of—

(a)living in the other gender, or

(b)having changed gender under the law of a country or territory outside the United Kingdom.

www.legislation.gov.uk/ukpga/2004/7/section/1

This is relevant because the NHS operates a "Self-ID" policy at the point of hospital admission rather than requiring evidence of legal sex by sight of a birth certificate or GRC. I suspect the same will be true in Scotland.

"Self-ID" is not covered by Section 22.

I am not suggesting that the wording in the GRA 2004 makes it easy to ensure that random males who choose to Self-declare as female are not placed in NHS Wards for Women. However, any local policy needs to attend to the provisions in both the GRA 2004 and the Equality Act 2010, which includes exemptions under which a male with or without a GRC can be excluded from single sex accommodation for women.

NHS policies and guidance from Health Profession organisations do emphasise confidentiality around self-declared "gender reassignment" but this is different to the legal prohibitions in Section 22 of the GRA 2004.

It is easy for a patient to formally request a change to the gender stated in their NHS records. This would normally be via the GP and would result in issue of a new NHS Number.

Primary Care Support England: Adoption and gender re-assignment processes

Gender re-assignment process

It is important that practices are aware of the steps that need to be taken when a patient changes gender. Following the process will ensure continued patient care and ensure there isn’t an impact on your practice payments.

Please note: Patients may request to change gender on their patient record at any time and do not need to have undergone any form of gender reassignment treatment in order to do so.

When a patient changes gender, they are given a new NHS number and must be registered as a new patient at your practice. All previous medical information relating to the patient needs to be transferred into a newly created medical record. When the patient informs the practice that they wish to change gender, the practice must inform the patient that this will involve a new NHS number being issued for the them, which is not reversible. To revert back to their original gender, they would receive a third NHS number. The practice should confirm this has been discussed with the patient when notifying PCSE.

The process is as follows:

- GP practice notifies PCSE that a patient wishes to change gender via the enquiries form. The practice should include the patient’s name and NHS number in the notification to PCSE, plus confirmation that they have discussed with the patient that this will involve the creation of a new NHS number

- PCSE sends the GP practice a deduction notification for the patient and emails the main contact we hold for the practice (if available) the new details for the patient

- GP practice accepts the deduction and registers the patient using the new details provided by PCSE. Important: Do not update the patient’s original record with their new NHS number. If this happens they will not be registered and will miss out on continuity of care

- PCSE sends a new patient medical record envelope with the patient’s updated details to the GP practice

- GP practice creates new patient record using new details, and transfers all previous medical information from the original medical record. Any information relating to the patient’s previous identity should not be included in the new record.

- If the gender is being re-assigned from male to female, the screening team will contact the practice for no cervix confirmation

- If the gender is being re-assigned from female to male, screening will become the responsibility of the practice.

Continued at:
pcse.england.nhs.uk/help/registrations/adoption-and-gender-re-assignment-processes/

If hospitals did not operate on the basis of a self-declared gender on admission (or mode of dress if unable to advise) then it would at least be possible to refer the gender stated in the patient's NHS record when determining where a person should be accommodated. However, this is not what is required of hospitals under the NHS Policy "Delivering same-sex accommodation" - where "same-sex" actually means "same-gender".

All of this confusion is down to:

• The GRA 2004 creating the legal fiction that it possible to change sex.

• The GRA 2004 being worded in such a way that the primacy and material reality of biological sex has been supplanted by recognition in law of an unverifiable, theoretical, subjective feeling called "gender"

• Policy capture within the NHS (and other statutory bodies) resulting in a stealthy, covert redefinition of "sex" to mean "gender".

It might sound insane, because it is, but wherever NHS policies and patient records refer to sex (Male vs Female) it is generally safe to assume that they actually mean gender.

For example:

"Delivering same-sex accommodation"
September 2019

improvement.nhs.uk/documents/6005/Delivering_same_sex_accommodation_sep2019.pdf

See:

• Annex B Delivering same-sex accommodation for trans people and gender variant children

(a bit too lengthy to copy and paste so I have attached screen-shots and hope they are legible - this is an important section!)

and

• Annex C: Frequently asked questions

18. How can I ensure that the wishes of all patients in an area or on a ward/bay are considered when accommodating the wishes of a small number of those patients?

A) Staff should remember that, under the Equalities Act and the Public Sector Equality Duty, it is a legal requirement to ensure that trans people are not discriminated against. This guidance clearly states that trans and non-binary people should be accommodated in line with their stated gender identity. In all cases staff should communicate to all patients and or their carers the situation that arises, ensuring sensitivity to all views and acting accordingly to protect the privacy and dignity of all patients. Where the situation, for example, relates to trans patients, staff should do everything they can to respond to the wishes of all patients, while still protecting the dignity and legal rights of the trans person. There may be some circumstances where it is lawful to provide a different service or exclude a trans person from a single sex ward of their preferred gender but only if this is a proportionate means of achieving a legitimate aim. Any decision to do this must therefore be made on a case-by-case basis, and based on:

• an objective and evidence-based assessment of the circumstances and relevant information

• respecting the rights and needs of the trans person and the detriment to them if they are denied access and balancing that against the needs of other service users and any detriment to them if the trans person is admitted.

Unless the Scottish NHS policy is very different, it will be hard to ensure same sex accommodation. Also, a same-sex but mixed-gender situation would be in breach of same-sex accommodation policies. Which goes to prove that when the NHS says "sex" - it means "gender". And it has done at the highest level since at least 2009 and possibly earlier,

The person you need to ask for an answer to your question is
gardenbird48, not me, MoleSmokes.

This is also good news for women in Bristol, N Somerset and S Gloucestershire as we have been challenging simlar trans guidance. The CCG carried out an Equality Impact Assessment in which they mention the challenge to the Glasgow and Clyde guidance and state that they will update it when there is an outcome. So thank you very much Scottish women! Brilliant work!

Agree with PPs tho that until there are clear replacement policies that specify that sex means sex, it's just dumping it onto overworked, low-paid, mainly female staff.

The second page of that policy indicates that if a patient is incapacitated they should be placed into a ward based on “presentation and mode of dress”. Gender Presentation was earlier defined to be “mode of dress and name and pronouns used... may not align with visible sex characteristics.”

So if I have short hair and wear clothing by purchased from the men’s section and am unconscious, I can be expected to be placed in a men’s ward? We are elevating stereotypical gender roles above sex in terms of importance to medicine.

Actual erasure of GNC men and women in favor of making sure not to make unconscious trans people have sad feelings.

So I actually think that last scenario, FWR lurker, is the key to challenging this. That is a breach of a GNC female‘s right to bodily integrity by exposing her to a risk of sexual assault and possible rape leading to pregnancy which male patients do not face - it is therefore also illegal as direct sex discrimination.

Could any of you wonderful women help the women of Devon please- Devon NHS want them to share women's wards with male rapists...

www.mumsnet.com/Talk/womens_rights/4114228-Attention-Women-in-Devon

"The use of mixed-sex wards and bays has previously been widely criticised and they were ultimately abolished in Scotland in 2005."
www.eveningtelegraph.co.uk/2015/07/16/use-of-mixed-sex-ninewells-wards-has-got-to-stop/

That's the theory anyway..

AskingQuestionsAllTheTime - thank you!

Watermonster - thank you for the heads up!

BetsyM00 - I'll eat my hat if Ninewells has implemented a "same sex" rather than "same gender" policy

MoleSmokes Agreed. But NHS Scotland and NHS England are completely separate orgs, and while England has been working towards eliminating mixed-sex wards, it has supposed to have been achieved in Scotland (with exception of HDU).

I'm working on the premise that this should give us something more concrete to point NHS Boards at when tackling the infiltration of gender policies.

At the risk of sounding hyperbolic, I wonder how many women need to be assaulted in hospitals before this is recognised more widely as incredibly dangerous. (It's always 'n+1', isn't it?)

Have you got any examples of this policy? It sounds like a misunderstanding of the very specific prohibitions in Section 22 of the Gender Recognition Act 2004. This protects against disclosing that a person has a Gender Recognition Certificate or has applied for a GRC, although there are exceptions.

Hi Molesmokes - I’ve got it on my laptop and will dig out the exact document in a bit - it is either the Devon one or the Bristol policy (or both) - I’ve got a feeling that it was Devon as that seemed so draconian and badly written (prescribing anti libidinous drugs to known sex offenders placed on women’s wards) - it struck me because it specifically mentioned prosecution and potentially large fines for staff disclosing trans status.

This is Ireland, not the UK, but it's an example of the worst-case scenario coming true as a consequence of mixed sex wards.

www.irishtimes.com/news/ireland/irish-news/judge-criticises-hospital-after-girl-sexually-assaulted-by-man-63-on-ward-1.4170837

Kathleen Stock made a good point to the WESC recently about the whole privacy aspect that the GRA/a GRC was supposed to address, and her point illustrates the absurdity of the whole privacy aspect with self ID. There is no privacy for a male who self declares he identifies as a woman, if he doesn't undergo extended cosmetic surgery and I'd argue even with the 'extensive' medical interventions claimed would give transsexuals the ability to be stealthily accessing women's spaces, there are a vanishingly tiny % of males who would pass to the point women would be completely oblivious to the fact the person is male. So many appear convinced that their use of female only space is event free because they've 'passed' when it's more likely to be women's discomfort being suppressed or they're aware that to say anything puts them at risk. Especially in the current climate.

Placing any male on a female ward is effectively 'outing' them because so few women would be unaware of their male status. This aspect of the GRA & the right to privacy it claims to afford TSs is dependent on women just not speaking up. It's dependent on female socialisation & the expectation that women should put up & shut up. That's crystal clear in the various policies that the NHS trusts have implemented by their instructions to 'educate' any women & to deny the fact that there's a male person in the female ward.

The common sense policy would be to place the TW or TM in a private room, if there was a genuine attempt to maintain their right to privacy. Because anything else does the opposite & ensures there's no privacy for either the TW/TM nor the other patients who expect single sex wards. Any TW claiming it's their right to access single sex spaces such as hospital wards isn't trying to maintain their own privacy either.

There is definitely a balance to be achieved on a trans person's right to privacy in specific circumstances where they'd be subjected to possible discrimination but it's absurd we're in the situation where it's claimed to be ensuring a TW's right to privacy on their trans status by placing them in a female ward.

All very true.

And yes: several issues are often helpfully conflated.

Where there is an absolutely reasonable desire due to identity and/or transition (not wanting to make assumptions) for privacy from other patients of that sex, for safety from harassment or worse, for personal identity to be supported and recognised, and all this involving someone who may be unwell, incapacitated, vulnerable - yes, absolutely that person should have an unquestioned right to be placed in a situation where their feelings of safety, dignity, privacy and emotional needs can be met.

When however you conflate the aspect of required action that demonstrates treating that person as if they were someone of the opposite sex, this presents that it is not possible to provide this patient with any of the above without removing the right of all female patients to have their feelings of safety, dignity, privacy and emotional needs met.

That puts forward a very basic, sex based inequality: the needs of a male for x must take priority of the needs of all female patients for x. Male trumps female. Hello good old fashioned male supremacism.

When you add to this the idea of 'educate' the female, also likely to be incapacitated, unwell, vulnerable and in no state to advocate for themselves, who shows distress or protests their own right to the privacy, dignity, recognition of individual need and identity that is regarded so important to the male patient - which means essentially to warn them that they must behave as if they do not expect that right and that the male patient's needs must be their priority over their own needs - and that this may quite possibly lead to female patients discharging themselves and not being able to access any medical care in that place so that a male patient may have their exact choice of where and how they receive care...

It's unjustifiable.

It is absolutely right and possible to provide additional and inclusive provision to meet needs. It is absolutely wrong and unjustifiable discrimination to remove the exact same rights from female patients as are seen as so important for male patients, and female people should not be put in the position of being used in a wholly sex class based way, without equal recognition of their own needs, differences and diversity, to meet the needs of male people.