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.)

At least there's one area in the NHS where common sense has prevailed!

This is why I had to fight so hard to get a marker on our patients’ records at work. It’s all about preventing the psychological harm of being ‘outed’ without any recognition that it’s incredibly dangerous to not know what sex of body you’re dealing with in a medical context.

And not just (immediately) life and death situations either - blood results are affected by sex, so are clinical risk assessment tools, so are some medications, invitation to screening programmes etc etc. it’s incredibly stupid that the NHS just rolled over and let this happen.

In any other situation where there is information in a patient’s record that they disagree with (diagnosis of personality disorder used to be one we were frequently asked about) the line was that that reflected the medical assessment at the time and that we could and would record their disagreements but couldn’t delete a diagnosis permanently.

And yet this - bodily sex - can be erased completely by just applying for a new NHS number. (Which, btw, I don’t believe you need a GRC to get.) Thus making your own healthcare less safe and the work of the clinicians treating you infinitely more stressful and complicated.

I wouldn't even opposed to reasonable measures to protect privacy like making trans identity visible only to the medical staff. But there is no way that the actual doctors, nurses etc. shouldn't be accurately informed of a patient's sex. It's absurd.

Yes absolutely. No one is trying to cause distress or to humiliate anyone here. But the absolute denialism of biological reality in healthcare is astonishing.

Do you recognise that this change is causing profound distress for many trans people? Framing the discussion in terms of trans health and wellbeing is particularly troubling and distasteful given the impact it is having on the very people whose wellbeing is (apparently) being discussed.

Its an accurate way of asking people who often lie about their sex without using the activist assigned at birth.
Its a compromise but 1 I'll take

We are talking about the well-being of everyone, not just trans people.

People who don't like gender being recorded instead of sex need to have their wellbeing looked out for too.

Why are they distressed by it? Sex and gender identity are completely separate things. Sex cannot be changed and is important for correct medical care.

There are many people whose beliefs are not aligned with biology or science.

For example some (but not all) catholics believe that wine literally becomes blood during transubstantiation.

We live in a country where thankfully we have freedom of belief.

Equally thankfully, medical treatments are related to biology not belief. For the safety of patients, we don't get transubstantiated wine in blood banks.

I can imagine it is upsetting for anyone with a belief in gender identity to acknowledge that their belief is irrelevant to their medical treatment.

But for their safety, it is imperative that doctors and nurses know their sex. They are still free to believe that they have a gender identity which differs from it.

Yes I'm aware that many trans-identified people are unhappy. But I think that unhappiness is at its core related to their delusion that they are the opposite sex and their unreasonable demand that the world agrees to that, even when it would cost them their life. Ultimately, receiving appropriate medical care for their body is more significant for wellbeing than propping up their mental illness.

As stated by another user here, the desire is not to distress and humiliate and I would be fine with measures that kept the information private from staff who don't need to know, such as the receptionist at a GP surgery. But it's absolutely essential that doctors and nurses diagnosing and treating patients are aware of their sex. Trans-identified people have lost out the most by a failure to do this.

What do you think to the wellbeing of the trans-identified women who almost died because her kidney failure wasn't recognised as they were using male reference ranges? How about the wellbeing of the trans-identified woman who was placed on a male psychiatric ward and raped within an hour by men who chanted 'no adam's apple' at her. Do you not think that vulnerable people with a mental illness deserve to be safeguarded and protected, even against their own desires if necessary?

Profound distress is also not universal @Sunnibee . Take this trans-identified woman who is fully aware that clinicians knowing her sex saved her life.

Would you want to be the patient who experiences traumatic lung injury because you've been given ventilation pressures that are excessive for your lungs (transman), or the patient that experiences brain damage because you've been hypoventilated (transwoman)?

Do you want to be over sedated because you've been given an excessive dose of propofol (transwoman) or do you want to wake up prematurely (transman)?

Doctors aren't just being nosey or unkind. Sex matters.

Why would having accurate medically nesscary data being held about a trans identifying persons biological sex be in anyway distressing to them?

Some of those on transgender reddit are in favour of the change, for clinical reasons. They make the fair point that it is also important that medical staff are aware of any hormones or surgery, because this can take test results out of the normal ranges for their sex. They would also prefer it if the information is only available to clinical staff.

Yes, nice to see a couple of reasonable and common sense attitudes towards this change, which is for patient safety not to 'kill' trans people as one drama queen bemoaned.

We keep being told that not one person with a transgender identity denies their sex category. Why are you telling us something that contradicts that statement.

If they are not denying their sex category, why would they not be upfront on medical forms where it is imperative for HCPs to know?

Yes I remember that from Covid data.

There is also a recognition that changing your NHS number can lead to your entire medical history being erased and that this is not necessarily a good thing.

In what sense is recognising the reality and importance of biological sex “troubling and distasteful”?

Whilst I get blind with range at the violation of women's rights by some trans-identified men I do ultimately feel sorry for trans-identified people as a whole. They have been so let down by the medical profession for not properly treating their mental illness but actually propping up and facilitating it to the detriment of both their mental and physical health.

It is pure madness that someone's medical history could be erased, that women are not being called to cervical cancer screening and that people have been seriously harmed by medical staff not being aware of their sex.

IMO they should do away entirely with the changing of NHS numbers, not just for children but for adults too, and instead record people's sex, the medical interventions they have had and, if they truly feel it is necessary, then their gender identity or 'legal sex'.

You do know that most medical professionals will know whether someone is male or female within seconds of meeting them? Most patients notice too. Being in a hospital gown doesn't hide much.

Transgender individuals are accorded as much dignity, sensitivity and respect as possible. Killing them or causing them harm because they are being treated as the opposite sex is not 'kind'.

I’ve had some forms to fill in and take along with me to my scan appointment…it’s asking for my gender identity! I’ve left it blank (it also asks sex at birth)

Unsurprisingly the one sensible commenter on that Reddit post has been downvoted. She said absolutely nothing that could be interpreted as offensive against trans people but simply by stating that there are some areas of health where sex is relevant (and not just when it comes to genitalia) she has been condemned by the hive mind.

Good! We shouldn't go along with this nonsense. You're having a bloody baby, it should be obvious to everybody what your sex is. I have nothing against pregnant trans-identified women being treated compassionately and sensitively by staff, but there's no need to inflict the concept of gender identity on all of us. Many of us find it regressive and deeply offensive.

I've found more documents and it turns out the original link contained a very poorly formatted table that obscured accuracy. @BonfireLady this is relevant to our discussion earlier.

The actual change is as follows:

• 'Sex' and 'Gender' have been removed as data items.
• 'Sex at birth (observed)', 'Administrative gender', 'Gender identity'. 'Additional information about gender identity' and 'Pronouns' have been added as new data items.

This is summarised on the second page here.

Additional guidance on implementation is also offered (link to follow in next comment as it doesn't seem to want to let me put two links in), of particular relevance is page 14 section 3.1.1 Sex and Gender. Some relevant passages -

• Sex at birth (observed): The phenotypic sex of the person. This is as observed by clinical examination and assessment at birth. Where there is no health and care record from birth, and clinical examination and assessment is not possible, this can be stated by the person or proxy

• Gender identity should ONLY be recorded if a person has a gender identity and wants it recorded in their healthcare record and a clinician decides it is appropriate to record it.

• Pronouns should ONLY be recorded if a person wants their pronouns recorded in their healthcare record and a clinician decides it is appropriate to record them.

• Implementers should seek information governance advice on when and to whom access can be given to a person’s record (or specific data within a person’s record) where information in the record indicates transgender, non-binary or gender diverse status.

Some good and bad here. The part about sex possibly being stated by a person or proxy would obviously only apply in rare circumstances, but is a worrying loophole all the same.

It's good that they have recognised that gender identity and pronouns are a contentious topic and shouldn't be routinely recorded. I have no issue with it being recorded for trans-identified people if it improves their engagement with health services since their true sex is now made clear.

Care does appear to be being taken to ensure privacy for trans-identified patients by telling implementers to be considerate as to what fields are visible under different contexts. That would seem to address the concern that some trans-identified people have had regarding non-medical staff accessing this information.