The health secretary has ordered a review of NHS guidance after it was revealed that three hospital trusts in England advised that biologically male sex offenders who “self-identify” as women could be admitted onto female-only wards after a risk assessment.
The guidance is reportedly a result of instructions by NHS England seen by The Telegraph, which advises that patients, such as biological and “physically intact” males, should be “accommodated according to their presentation: the way they dress, and the name and pronouns they currently use” and be permitted onto the wards of their choice. The newspaper says hospitals across the country have adopted the guidance.
Such accommodation is reliant on so-called self-identification, rather than beginning the legal process to changing gender, which includes medical reports demonstrating a diagnosis for gender dysphoria or surgery to change the appearance of sexual characteristics, having lived as the opposite sex for at least two years, and expressing the intention to live as the other sex for the rest of their life.
According to documents seen by the newspaper, trusts have told hospitals in Devon, Nottinghamshire, and Oxford that examining criminal history should be included in the risk assessment of placing biological males in women’s wards, but they do not state that a record for sex offences could be a bar to entry.
Oxford Health NHS Foundation Trust claimed in their guidance that the “risk of sexual offending in a trans context is very rare”. The document continued that “if the service user has a sex-offending history, risk should be managed in the same way as it would be with any other client, irrespective of gender”.
Devon Partnership NHS Trust says people “will be admitted based on the gender which they identify as at the point of admission” rather than the legal definition of gender, and that they “must be able to use the facilities of their preferred gender while admitted. This includes shower rooms, toilets and single sex lounges.”
Indicating a possible admission for those patients with a history of sexual offences, Devon stated: “Where a transgender woman is admitted and has a history of sex offending, decisions regarding risk should include consideration of whether they are being prescribed anti-libidinal medication that would be expected to reduce sexual risk.”
However, one nurse who spoke anonymously to The Telegraph said that risk assessments of patients, including those who are known to have a history of sexual violence, were not always completed because staff were too busy.
The nurse pointed out that “in-patients are often frail, elderly and confused”, but that despite medics’ duty to protect them, “they are not being safeguarded and they are not getting the dignity and the privacy they deserve.
“The public believe that we have single-sex spaces for our most vulnerable, our mothers, our grandmothers, but it is simply not true. NHS wards are replicating what is happening in jails.”
The nurse was referencing the phenomena in recent years of male criminals identifying as women, reportedly in order to have their own cells and be allowed to shower alone, or even requesting to be placed in female prisons.
In 2019, the HM Chief Inspector of Prisons for England and Wales revealed that one in 50 adult male prisoners identified as transgender. A 2017 report from feminist charity Fair Play for Women claimed that at least 41 per cent of transgender inmates are convicted sex offenders, compared to 17 per cent of the prison population as a whole.
In one widely-publicised case, transgender Karen White, born Stephen Wood, had previous convictions for indecent assault and gross indecency involving children but was placed in a women’s prison despite being an intact male due to identifying as a woman.
Within days, White went on to sexually assault two female inmates. White also admitted to two counts of historic rape outside of prison, once in 2003 and up to six times against another woman in 2016. The sex offender was sentenced in 2018 to at least nine-and-a-half years’ incarceration, this time serving in a men’s prison.
The Telegraph report also claimed to have revealed the culture of fear that NHS staff in such hospitals work under, with some claiming they will not raise safeguarding issues concerning transgender patients in single-sex wards, not only because they are “fearful of discipline of censure” and job losses, but also because they “in some cases risk being charged with a criminal offences”, according to one nurse.
Disturbing phenomena also uncovered by the newspaper was that some trusts labelled patients who felt uncomfortable sharing wards with people of the same biological sex as transphobic, comparing them to racists, and ordering staff to report them to the police for hate crimes. One hospital had until recently even advised withdrawing treatment if a woman in their care objected to intact men being in their wards.
“One organisation is suggesting that any woman who objects to a male on a single-sex ward is put in seclusion, as in a psychiatric setting,” Dr Lucy Griffin had told MPs and peers.
In apparent response to the reports on Tuesday, Health Secretary Sajid Javid ordered a review into NHS guidance on transgender sex offenders in women’s wards.
“All patients, including women and transgender people, should feel comfortable and safe in hospital. It’s not wrong to look at whether guidance is right, or how it’s being applied, to reassure everyone. I’ve asked the Department for Health and Social Care for fresh advice,” Mr Javid said.
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