NHS Policy Audit - working party - thread #2

[KnottyAuty]

This is a thread about “keeping the receipts” on NHS Policies prior to the Supreme Court ruling on 16th April 2025.

Our working theory is that there were no single sex spaces for NHS Staff or Patients in the entire country before that date, having all been removed by stealth. We are aiming to prove this by auditing websites and policies for all the UK trusts and using the results to raise public awareness. As well as recording what has happened historically, the information will form a baseline so we can check which Trusts comply or defy the judgement in due course.

We are working around the country region by region. If you fancy getting involved in a bit of grassroots feminism then please do join in to help!? Each trust takes about an hour to research and you can upload online without giving any personal details away. Comment below and we can give you the link to an online survey - it changes for each region.

Thanks soooo much to all the vipers who have helped so far and @ Twoloons for doing a great job with the thread wrangling!

Here are the press articles we’ve managed to generate so far:

Scotland:
25th March: The Telegraph
https://archive.is/dTUhY
26th March: Scottish Daily Express
https://archive.is/kaLCB
26th March: The Telegraph
https://archive.is/iSD9m

London:
21st April: The Telegraph
https://archive.is/awGuz
23rd April: The Telegraph (in conjunction with another thread by NHS mumsnetters)
https://archive.is/1DO8d

Original thread #1 here:
https://www.mumsnet.com/talk/womens_rights/5291237-nhs-policy-audit-working-party?page=1

I naively assumed there was a sign off step from the legal department. It makes sense that no one with drafting training reviews policies before they are approved. Any old policy clause someone once saw can be included. I know the lawyers too have been trained to treat Stonewall law as law so would not have stopped the nonsense.

It will be interesting when the EDI officer from NHS Fife Board is cross examined by Naomi Cunningham in their employment tribunal.

I am just re-reading a bunch of policies for specific dementia refs, and have come across this from Northampton General Hospital:

”This policy sets out Northampton General Hospital NHS (NGH) commitment to meeting and going beyond the requirements of the Equality Act 2010 in respect of Transgender equality.” [emphasis mine]

eta - I can’t imagine a decent lawyer approving that.

@TwoLoonsAndASprout I think I’ve found the Dept of Health guidance that the ‘going beyond’ wording came from. Of course, that guidance itself should have gone through a proper sign off process, including legal review.

I can't speak for the whole NHS, and I hope some do get legal sign-off. I think there's a general perception that EDI policies don't really matter, so not too much thought goes into them. I don't think anyone writing them foresaw any legal implications.
In my experience in several NHS Trusts, there's a general ignorance of the fact that The Law supersedes internal policy. So I can see why NHS Fife thought they would win, because in their view, Sandie Peggie breached the bullying policy, therefore she is guilty. I suspect they had no notion that their policies were actually unlawful.

Should have.

Hmm.

This is my suspicion as well. I think the policies are so well embedded - and un-thought-about - that NHS Fife were genuinely shocked that anyone would contradict them. It's a policy. They are good things, meant to protect people. Right? Right?

And to be honest, why would your average person working on a hospital ward think about whether their hospital policies were breaking the law? You just wouldn't, would you?

@TwoLoonsAndASprout
Exactly. Everyone thinks, as long as they follow the policy, they're covered. Few people question the policy, or if they try to it's likely they'll get fobbed off. Following the policy is the path of least resistance. I have some sympathy for clinical staff, because generally they just want to get on with treating the never-ending list of waiting patients, so they can't devote too much thinking power to policies. I have no sympathy for an EDI manager who has one job to do and plenty of time to do it.

That explains a lot!
I’ve just not been able to get my head around this at all. The policies I have seen have boxes for signatories and lots have a name there. For the attached EqIA there’s space for 2 signatories usually. But 50% roughly are missing. The other 49% are totally inadequate as impact assessments. Embarrassingly bad. Myopic. In most cases the consultation if listed at all are all LGBTQ+ groups or consultants. So not the broad balanced view & balancing of needs required by the EA2010. I saw one which included advice from a legal counsel. It was dubious advice but that policy was a lot less wild than many others I’ve seen.. Finding someone who can write a good EqIA for this is going to be essential to clean up the unholy mess that Stonewall has left…

Actually our audit will help this won’t it?
it gives support to those inside Trusts who need to follow the law rather than their feelings

In principle yes! In practice, not unless we get the policies changed.

Legal Feminist posted that your employer can fire you for whatever reason they want, including that you won’t go along with their illegal policy. You will then have all sorts of evidence that will stand you in excellent stead at an ET. But! for most people, most of the time, a job that brings in a salary is going to be far better and safer then an ET, even with the law on your side.

Publicising what is happening will make people aware and bring them onside. But really, I don’t think people who work in the hospitals will be protected from this unless - until! - we manage to get the policies changed.

I used to write policies for a couple of different organisations and the law and evidence were key elements of researching the basis for, consulting on and developing the policies. I had quite a bit of training on it. Having a decent policy development process is not rocket science, or even brain surgery (given the NHS context). We used to get legal opinions to help with policy development where the law wasn't clear.

In fact maybe this is another angle of attack? Our audit has uncovered policies that are breaking the law, so asking 'What is your policy development procedure?' may be a good FOI question. 'We don't have one' or 'we just get them from Stonewall/ other activist groups' or 'we just let our EDI colleagues with no qualifications or experience write them with no legal oversight' doesn't seem like it's an answer in the public best interest or compatible with their job to provide good healthcare services.

Given how much the EDI staff get paid, what the hell do they actually do? Is it literally all just hanging out with Stonewall and rainbow lanyards and making stuff up to suit themselves?

@KnottyAuty
For the policies that are signed off, what are the job titles/ level of seniority?

I've been thinking alot about how to rectify this mess. It's endemic in the NHS (not to mention other public institutions) and it affects all sorts of policies outwith EDI and hospital accommodation. The language itself has been corrupted. NHS managers coming from a clinical background don't receive the appropriate training to write policies. I think it needs external input, to rewrite everything, and to train managers how to do it in future. Before that can happen, I think there needs to be an independent review to identify how severe and widespread the problem is. I can't see any NHS organisations volunteering for this; it needs to be forced upon them.

Edited to add: Health is devolved in Scotland, and ScotGov are resistant to any outside meddling. I think there's a better chance of making changes in the NHS in England.

I think there is a role for Boards here - Non Executive Directors are meant to take a strategic overview and act as a critical friend to the Executive. Interrogating whether they have a robust policy making process for internal policies which includes lawyers checking that these policies are lawful, feels like something Boards might well take an interest in.

This is partly because I’ve just been reading the advice to NHS Boards that the Dept of Health produced in 2006, on the Equality Act. It definitely needs an update (though possibly I just haven’t yet found the more recent version).

https://www.england.nhs.uk/non-executive-opportunities/category/public-appointments/

Just to say still Pom Poming for you, plus
i know you’re talking management atm,but wanted to say in case it cheers any one up, i know the message is getting spread at staff level. never would post about my family or friends specifically as im so “outable” but as regular nhs user i know there are nurses who are pushing back and I mean literal as - not pushing forcefully ofc! - but physically guiding men away from women’s bays or cubicles and not afraid to do it and speak out loudly. i also hear it a lot in an and e, much more than i used to I believe.

i think some staff would like a bat signal to suss out whether they can talk freely to certain colleagues esp higher up, I have suggested taking tunnocks in and offering them around or asking other person if they like tunnocks…

it kind of sums up how fucked up the whole thing is. your research is jaw dropping esp the children policies. I believe it is literally criminal as its caused a lot of physical and mental harm to a lot of children.
I may start a separate thread or look for old one for bat signals for nurses…the culture of fear caused by everything you vipers have uncovered is ridiculous that this is needed. If that makes sense!

@GCEpileptic, it makes total sense! And oh thank you for telling us all that, because it can get a little weird when you are staring at your hundredth policy that says “yay, we have single-sex spaces (but actually they’re single-gender, but we won’t tell you that and we are instructed to deny that if you ask”.

A bat signal would be excellent - I think there was a thread about suffragette colours a little while back too. And the whole thing about employers having illegal policies is also so tricky - as I said above, your employer can totally fire you for not following illegal policies. You will then be in a great position at an ET, but you would then have to go through an ET, which is costly and emotionally draining. Many, many people would be better off keeping their heads down and keeping their jobs.

Bravo to the brave nurses who are speaking out!

NHS managers coming from a clinical background don't receive the appropriate training to write policies. I think it needs external input, to rewrite everything, and to train managers how to do it in future.

This is relevant. In the context of an acute hospital Trust, there will be literally thousands of policies, and the majority of them will be about clinical practice. And everyone assumes (and kind of has to assume in order for things not to grind to a halt) that a policy written by a given department is sound and sets out best practice - if I work in cardiac and have a patient who is also a kidney cancer patient and needs antibiotics, I'll look at the policy for giving antibiotics to kidney cancer patients. And I'll assume that that policy was written by an expert in kidney cancer and that what is in the policy represents best practice. I know my niche and assume they know theirs.

So when policies are written by the EDI expert, or by an external agent who positions themselves as an expert in this niche, it is very likely who ever signs them off will assume that the policy was written by an expert and represents best practice. They will not interrogate the detail of the policy any more than they would the antibiotics policy, they'll assume it's good because the experts wrote it and the experts know their field and how things should be done. And I think that's the case whether the director etc who signs it off has a clinical background or not.

There is an assumption that the person who wrote a thing knows what they're talking about. So you get quite high up people confidently stating e.g. 'it would be illegal not to treat a trans person as their chosen gender identity'. And when you push back and say 'that's not what the law says, who told you that?' the answer is invariably that they asked the LGBTQ+ staff group, and that's what they said, so it must be right because they're the experts.

It's actually quite easy to misdirect multiple policies in this way. For example, my Trust had a policy on how to write an EqIA. And it misrepresented the PCs and replaced sex with gender. So everyone who wrote a policy which needed an EqIA, looked up the EqIA policy and followed it, and every EqIA had gender assessed in it instead of sex. And so it spreads.

@GCEpileptic I'm not surprised people are scared to speak out. This, from RDaSH, is one of the most chilling policies I've read, but they all contain this kind of thing:

"This policy applies to all employees working in the trust, in any capacity. Failure to follow the requirements of the policy may result in investigation and management action being taken as considered appropriate. If reported as a hate crime this could be investigated as a criminal offence a trans person should be treated in a dignified, non-discriminatory way.

"Personal beliefs which do not align with the principles of this policy will not be shared with colleagues or people who use our services and decisions taken in a professional role will be aligned entirely with the trust policy. All employees regardless of grade or profession must:

• adhere to and abide by this policy
• ensure its implementation and uphold the procedures referred to within
• ensure that new staff are appropriately briefed at induction on compliance with this policy challenge or report discriminatory practice or language"

@nothingcomestonothing, this comes up again and again - in fact we’re seeing it in all the TRA noise about how there were no trans people represented at the SC. There is this idea that in order for someone to be the expert on something, they must have “lived experience” of that something. But there is never any acknowledgment that someone with “lived experience A” may, perhaps even by virtue of their “lived experience,” be biased against - or even just oblivious about - people with “lived experience B.”

I don’t know where this comes from. I presume it has something to do with the exaltation of the cult of the individual.

RDaSH again, with this choice little nugget, confirming that literally no effort needs to be made to get the special treatment under this policy, other than uttering the magic words "I'm trans":

"Trans, gender fluid or non-binary persons should be accommodated according to the gender they identify with. This may or may not be related to their current presentation, for example, dress or name and it is important to discuss and clarify with the person when it is appropriate to do so."

@umbel
Presumably the "gender fluid" can change their gender at will, forcing staff to move them to a different ward, and rewriting their medical notes whenever they feel like it. What a nonsense.

@nothingcomestonothing
There is an assumption that the person who wrote a thing knows what they're talking about. So you get quite high up people confidently stating e.g. 'it would be illegal not to treat a trans person as their chosen gender identity'. And when you push back and say 'that's not what the law says, who told you that?' the answer is invariably that they asked the LGBTQ+ staff group, and that's what they said, so it must be right because they're the experts

Even more authority than that. The Dept of Health guidance says that’s the law. Or at least strongly implies it, and has annexes and worksheets and FAQs that make it clear what they regard as best practice.
That phrasing about treating someone how they present goes back to Dept of Health gender equality guidance in 2007.

Illegal Policies over-riding the law, as with Fife and Darlington Nurses. One would have expected the Legal Team at a Trade Union to pick this up.
If that is they were interested. . . .

Yes it was completely embedded from the top down by GIRES since before Delivering Single Sex Accommodation even existed. But the directors or chief nurses office or whoever signs off these policies won't be aware of NHS England guidance on gender or anything like that , I think they fully assume that the person who wrote the policy must be writing the right things as they are an expert. Even though the expert is a DEI practitioner whose 'expertise' in DEI as it relates to healthcare is that they have a gender identity, they used to work in Lush, and they were a COVID tracer. I may or may not be thinking of an actual NHS DEI person there.

Hi, I can't find anything other than what is available on Harrogate's website - do I just leave blank?