NHS Policy Audit - working party

[KnottyAuty]

Following on from Thread #23 of the Peggie v NHS Employment Tribunal. Anyone who wants to help with survey/audit of paperwork against the Equality Act protected characteristics please join here 😊

Cantunseeit

Thanks for the link. I took one look and could see that despite an extensive list of references it's become the usual muddled garbage. But I won't derail the thread further.

Keep up with the good work. It's important that people have it brought to their attention that single sex no longer is in many cases.

This dates back not just to 2015, but all the way to 2009!

I just found this document, from the Chief Nursing Officer and Director General NHS Finance, Performance and Operations dated May 2009, requiring Trusts to implement by 30th June 2009 stating,

" • Trans people should be accommodated according to their presentation: the way they dress, and the name and pronouns that they currently use.
• This may not always accord with the physical sex appearance of the chest or genitalia;
• It does not depend upon their having a gender recognition certificate (GRC) or legal name change;
• It applies to toilet and bathing facilities (except, for instance, that pre-operative trans people should not share open shower facilities);
• Views of family members may not accord with the trans person’s wishes, in which case, the trans person’s view takes priority.

Different genital or breast sex appearance is not a bar to this, since sufficient privacy can usually be ensured through the use of curtains or by accommodation in a single side room adjacent to a gender appropriate ward.

Particular considerations for children and young people Gender variant children and young people should be accorded the same respect for their self defined gender as are trans adults, regardless of their genital sex."

Familiar wording for anyone who has been looking at these!

Full document can be found here: https://assets.publishing.service.gov.uk/media/5a7cd02ced915d6b29fa8d19/CNOnotedh098893.pdf

This document was withdrawn 27th Sept 2019 (though I've yet to locate what is was replaced with) yet was cited as a guiding document for West London's Delivering Same-Sex Accommodation policy.

That’s it! You’ve found the source document! Brilliant sleuthing.

@KnottyAuty, at the risk of giving you more work, I wonder if it’s worth having a place to upload links and docs for these supra-documents - the ones that the trusts seem to have been cutting and pasting from?

I'm in awe of the work you have been doing!

That last message "That’s it! You’ve found the source document!" actually made a shiver run down my spine.

I'm sorry I can't be of any practical help, I'm drowning at work, but I'm cheering you along from the sidelines.

@KnottyAuty I've submitted Whittington now. I included the 2013 Single Sex declaration as well as the new "improved" single gender declaration for comparison. There are a lot of v old policy style docs on the website - Equal opportunities policy hails from 2003 long pre-dating the Equality Act - so I can't say for sure that it is conspiracy not cock-up to leave the old single sex accommodation declaration up for incompetent searchers like me to find. But the fact that it is there is certainly egregious as anyone searching for single sex reassurance will find it 😢

I'll be happy to do some more in the next phase when we start it - learnt from getting burnt this time so hopefully will be more canny in future. But again why do we need to be canny to find out if we can access single sex accommodation in an NHS hospital in 2025 - when (apart from Annex B) it is legally required to be provided?

Feeling much angrier now. Off to channel that rage into something productive

Did you happen to download the pdf doc? B/c when I click the link it appears to be broken…

Yes, I used nuts as an analogy because of NC's prior use of it. It's such an apposite analogy!

So I have finished North East London from last week and also completed Kings College. I am left with the distinct feeling that they are trying not to share info with the public. Kings has no policies at all on its website the only ones I could find were from Ermines FOI trawl last year. Their website actually invites you to send in an FOI if you want to see anything!! I suspect this would put a lot of people off. NE London isn't much better.

Lovely thanks - and please don't worry about "getting burnt" because that indeed is the whole point of this exercise. Normal people are indeed getting burnt and they won't like it. It's actually been terribly useful to have pairs of fresh eyes saying - ooh this one is fine - only then to discover it is not. Because that IS the problem. It's awful that someone would go into hospital and be faced with "the sexually disinhibited pre-operative transexual patient" to make a comment and then be at risk of either being gaslit or of having treatment refused. It's horrible

@TwoLoonsAndASprout try here: https://www.gov.uk/government/publications/eliminating-mixed-sex-accommodation-in-hospitals

Weirdly, when i open it, the pdf title at the top of my screen says
THE PNEUMOCCOCAL IMMUNISATION PROGRAMME, which perhaps is just another way of burying it!

@KnottyAuty please can you send me the London Jotform link? Thanks!

Isn’t it marvellous that it’s titled “Eliminating mixed sex accommodation in hospitals”?

🤦‍♀️

I think the basic summary is hospitals insisting they offer only single sex wards etc. (unless where medically not possible such as intensive care) - but then hiding a sentence at the end saying people will be accommodated according to how they present. So, a man wearing his female fetish outfit gets to be in with women regardless of their feelings about it all.

Also, they boast about how they have successfully accommodated all patients on single sex wards when actually they've done nothing of the sort

It's the same bottom line, always. Starmer repeats this frequently.

Yes, absolutely, there must be single sex spaces for women. And men can be any sex they like.

Another one cheering this on from the sidelines.

Eliminating Single Sex Accommodation more like

@KnottyAuty I think a region by region approach makes sense. As a midlander i am not surprised by london NHS. As my first encounter with gender neutral facilities were there.

There is a creep in the midlands but not so obvious to the general populous.

I’m a midlands lass although looking at my own trust I’m not sure it’s better just less awareness of the issues. I wonder if it is worth thinking about the timing of the next stage. The Easter hols are coming up. I am away the first week and then have a house full over the Easter weekend so will be very limited in time.
K

On the important documents I have tried to collate the ones which seem to be most important - see image below - have I missed anything?

It seems like in 2009 the DfH started with the Eliminating Mixed Sex Accommodation (EMSA). It was all about privacy and dignity; monthly national reporting was required. I think it is fair to say that any casual observer would expect this to mean single sex accommodation - but the 2009 and 2010 guidance refers to self ID transgender patients right from the start 16 years ago in the main text and with a detailed Annex E. Quite a bit of the wording from these documents has been carried forward to policies today? I assume that at this time the numbers of transgender and non binary people were far far less than at present.

Data gathering on mixed sex breaches began in 2010 and is recorded here - again there is very little indication for the average person about what this means for them: https://www.england.nhs.uk/statistics/statistical-work-areas/mixed-sex-accommodation/msa-data/. If a trust reports zero breaches - what does that actually mean if males can self ID into female spaces?

By the time of the 2015 Transgender Services document policy definitely was fully self ID:
pp 8 A trans person should be free to select the facilities (such as toilets or changing rooms) appropriate to the gender in which they present. For example, when a trans person starts to live in their acquired gender on a full-time basis they should be afforded the right to use the facilities appropriate to their acquired gender. Service providers must avoid discriminating against anyone with the protected characteristic of ‘gender reassignment'

Sept 2019 the EMSA documents from 2009 and 2010 were withdrawn and replaced by "Delivering Same-Sex Accommodation" and at this point the mentioning of transgender people was omitted from the main text and not listed with reasons for an acceptable breach. A transgender section in Annex B lists out the self ID policy but it is completely disconnected/unreferenced from the rest of the document - so makes it even harder to spot that this potentially makes all single sex spaces into mixed spaces. Presumably the numbers and variability of transgender people was rapidly increasing based on self ID principles but the effect was not entirely evident then?

[2019-2023 was the Bryson / Scotland's Gender Recognition Reform Bill problems. April 2024 Cass Review]

April 2024 "The Providing services for transgender customers: a guide" was withdrawn and users directed to the EHRC's 2022 document which describes how single sex spaces are legal under the Equality Act.

Am I right in saying that the majority of policies are still referring to the 2009 and 2010 documents which were withdrawn 6 years ago?

And that noone refers to the EHRC 2022 guidance?

This may be worth a look for the Midlands:
https://x.com/ripx4nutmeg/status/1904094734680817776?s=46

Me too - I think we all deserve an Easter break!

But it would be good to agree what to tackle next and how I might fix up the form for the next round of audit before we pause

Definitely. Policies used to be shared on their websites. Now they suppress them.

@KnottyAuty, that is an excellent timeline - I think you’ve captured everything. Yes, as far as I can tell the majority of policies for London refer to the withdrawn documents, and not to the EHRC 2022 one.

@KnottyAuty I think we should shine a light on Brighton and surrounding areas. Will be a lark!!!

I just idly checked my local trust. Not a single mention of transgender on the website (three 'trans' but relating to sexual health etc).

No EDI policies. So far, so standard.

The bit I found interesting was the total lack of any reference at all to single sex accommodation. Not one single mention. They've got more information on patient parking and WiFi access.

There's prolly an alert to the local rozzers if you search for 'single sex' or 'women' on the Brighton site.