NHS update on recording patient sex and gender identity

[Whatchamacallitt]

For a long time sex has been erased and replaced with gender identity. Trans-identified people actually lose out the most with this. There have been cases of trans-identified women having heart attacks, pregnancy emergencies, and kidney failure missed due to clinicians relying on normal male test ranges or presumed male sex. There have been issues for trans-identified men too but unsurprisingly it is the women who have suffered the most due to these policies.

Fortunately the NHS Core Information Standard has been updated to make 'sex at birth' a mandatory data item, with the option to record gender identity separately for patients who feel they have one.

(I don't personally believe in gender identity but recognise it is a genuinely held belief for many trans-identified people and also that it could be helpful information in the context of an altered body due to medicalisation.)

My GP surgery uses an online provider for appointments and thankfully they use sex registered at birth with no mention of gender.

Now wondering if that is ever coded on records though?

finally !!!!

Seems like a step forward.

This is great.

If I'm understanding it properly, sex is mandatory and gender identity can't be recorded going forward (it will be left as a legacy field if already completed) as it would be considered inappropriate to do so alongside a patient's sex.

Sounds good. It's biological sex that is relevant for treating patients. If a female takes testosterone (or a male takes oestrogen) this should/would be available on their notes just like any other medication. The patient can choose to share any gender identity belief with the medical team treating them... or not. Just like patients can choose to share (or not) other beliefs, like religions.

Edited for clarity.

It just baffles me that the NHS could ignore that a person's sex in a medical setting is actually of importance.

A return to sanity would be so welcome for the sake of everyone! I've been saying for so long that this practice of ignoring sex in a medical setting is really dangerous for trans identified people. I hope this makes it far less likely for a trans identified person to end up receiving damaging wrong sex medical treatments.

Does anyone have the history into why and when it changed? Are we likely to see this welcome news going through a legal challenge?

Yes I think I misunderstood that. Looking back over it, it appears that the gender identity field has been removed. They still have a administrative gender field. I imagine they may record trans-identified people as their 'identified gender' in that, particularly if they have a GRC.

I'm not personally bothered if they wish to record 'gender identity' for trans-identified people in some form, as it could improve patient engagement and as long as there isn't any harm done by obfuscation of sex. Of course the 'sex at birth' field should be utilised for patient care and also ward placement.

Great step forward.

At some point they began permitting trans-identified people to change their registered sex and NHS number. I'm not sure when that came about, but in the mean time there has been a insidious creep towards prioritising 'gender identity' in all matters.

Alice Sullivan wrote a report about the harms this has done, both on a wide societal scale, but also the danger for trans-identified people themselves. This appears to be the NHS acting on her recommendations.

The first step was them banning the changing of NHS numbers for under 18s. This step will now protect trans-identified adults, many of whom are vulnerable in some form, particularly the women.

Finally, sanity prevails! It's a good first step, and should hopefully mean that every patient's body receives the evidence-based medical care appropriate to its needs, which is, after all, what medicine is about. Treating a biological male as though he were a biological female, and vice versa, is not good medicine.

Mental health approaches need to be improved and beefed up now, but this is a good sign.

Now to fix all those patients policies...

I imagine they may record trans-identified people as their 'identified gender' in that, particularly if they have a GRC.

This just seems to be a legacy field. It says read only. So presumably it's there in case someone specifically wanted their self-described gender identity (belief) to be known.

I can't imagine GRCs would make a difference but I could be wrong on that bit.

I know that my GPs only recorded gender until I threatened them with the information commissioner if they didn't correct both mine and my sons records as we do not have a gender and I've always crossed out gender and replaced it with sex on all forms. They had initially claimed that I had filled out forms with my gender until I asked them to provide any paperwork where I had and they couldn't as it all had sex handwritten in.
The practice now asks for both sex and gender with gender being a free text box which allows you to write none and records both.
Whilst the practice manager may not like me very much I know from my lovely GP that she and a couple of nurses used my complaint to peak most of the staff by explaining the dangers and risk of harm/malpractice if they were viewing male or female blood test results against the standards for the opposite sex because they only recorded gender and the NHS let's people change their NHS number to the opposite sex

Yes it’s the NHS numbers that do real harm. We use SystmOne at work and they only have a ‘gender’ field. Which is affected by the NHS number. What’s crazy is that once you have a new NHS number in your acquired gender your old notes are COMPLETELY ERASED so you lose your entire medical history. How anyone thinks or ever thought this was okay is beyond me. This doesn’t happen to adopted people or those with controversial mental health histories or anyone else. It’s a huge barrier to providing decent and safe care to transgender individuals.

When we started doing remote triage at work during Covid I had to fight hard to persuade my colleagues and bosses that we needed some way of knowing whether someone was the sex they were labelled on their notes.

When the Sullivan report was released I emailed TPP, who produced SystmOne, and asked when they would be introducing a ‘sex’ identifier instead of/as well as gender and I was completely ignored.

This latest pronouncement is good to hear but my breath is not held…

Ah sorry, I've got it wrong again. Looking back you are correct that it says legacy. Thank you for correcting me.

Gosh that's so dangerous and truly unbelievable. Thanks for your additional information. It sounds like there is a lot of work to be done to get the NHS data system put to rights. I remain hopeful that this is a step in the right direction.

Despite allegations I've received from TRAs that I hate trans-identified people, I absolutely do not hate them as a whole (of course there are individuals) and I don't want to see vulnerable people undergo medical harm because of the nonsense that is prioritising identity over actual sex.

Seeing is believing.

But yay!

Trans-identified redditers are posting about it predictably. Cries of bigotry and the invoking of they who shall not be named (Sex Matters). There's a single sensible comment from a trans-identified woman explaining why it was important for staff to know her sex in a medical emergency (peritonitis that was ultimately being caused by underlying pelvic inflammatory disease, which only women get).

Screenshots from the NHS standards directory.

Hazards:
For England
Replaced Hazard 16 “Sex data item may cause accidental disclosure of gender reassignment without consent”
with a new hazard: >
“Recording an individual's 'Gender identity' alongside their 'Sex at birth (observed)' in their clinical record and displaying together along with 'Administrative gender' (derived from the Personal Demographics Service) may cause accidental disclosure of transgender, non-binary or gender diverse status causing psychological harm”.

The hazard is that recording both sex and gender identity might accidentally out a trans person.

Presumably the hazard is there only if the trans person ‘passes’ completely.

Why are they using the word observed for sex at birth? Sex at birth is your sex and determined by chromosomes and genitalia?

Maybe I'm being thick here but surely it's obvious what a babies sex is?

Also don't understand the harm as if someone is identifying as a gender not aligned to their sex on their medical records they have chosen to do so and have outed themselves.

Yes, a babies sex is almost always obvious. That's what "observed" means.

It’s frustrating that it’s ‘sex at birth’. The implication being that sex can change after your birth..

It may cause psychological harm, as would any information about medical treatment that someone undertook and didn’t want the world to know about. However, in situations where your sex is important it could be a matter of life or death.

In most Intensive Care Units there will be an ICNARC (Intensive Care National Audit and Research Centre) audit nurse, who tracks a patient's journey through their first 24 hours on the unit and then to discharge, collecting physiological data and medical conditions, etc. The coding manual is very clear that it is 'sex assigned at birth' that is recorded.

Yeah, that's why I put it in quotes... it's just sex. But I'll take it if it means patient sex is accurately recorded, at least.