Sex, Gender & the NHS

Anne Harper-Wright
Oct 16, 2018 · 16 min read

Part 1: The “Single-Sex Hospital Wards” that have always been a lie

“Sex” refers to the biological and physiological characteristics that define men and women.

“Gender” refers to the socially constructed roles, behaviours, activities, and attributes that a given society considers appropriate for men and women.

To put it another way:
“Male” and “female” are sex categories, while “masculine” and “feminine” are gender categories. ~World Health Organisation

Definition of female

1 a (1) : of, relating to, or being the sex that typically has the capacity to bear young or produce eggs ~Merriam Webster dictionary

Gender and sex are not the same.

Not medically, and not legally.

The government knows this.

The judiciary knows this.

The NHS knows this

The Organisations lobbying to change laws from sex to gender know this

So, if every major institution understands the importance of differentiating between the two concepts, why do they perpetuate such huge conflation and confusion in the general public? What is there to gain when maximum public confusion is not just a mistake, but seemingly, a goal?

Is there is a vested interest in keeping the general public as confused as possible about the two concepts? Where once the words sex and gender were used interchangeably, a little over a decade ago they began to sharply diverge in law, in meaning, and in societal understanding. One concept, sex, retaining its material and physical reality, the other, gender, becoming somewhat…mythical. The resultant divergence can be characterised thus:

If sex is binary biology, then gender is best described as ‘binary psychology’.

Where ‘of the female sex’ means the half of humanity born with a certain genetic makeup and reproductive type, ‘of the female gender’ means nothing of the sort. What does gender mean, exactly? There are those who are fierce advocates of the supremacy of gender over sex, and who group people accordingly, yet they are also the most coy when asked to define any mutual characteristics of those people forming the group ‘of the female gender’. Occasionally, in an unguarded moment, a gender advocate may let slip a revealing clue as to what they truly believe are the shared psychological characteristics of ‘the male gender’ and ‘the female gender’. Those clues often sound rather too much like reconstituted sexist stereotypes. But for the most part, the canniest gender advocates are usually careful to hold the position that gender means something entirely individual to each person. They argue, confusingly, that there is no commonality at all of female gender characteristics, yet will simultaneously insist that gender must be the mechanism of grouping large numbers of dissimilar people into a common class. Those who are of one gender are thus all utterly different from one another, yet at the same time exactly the same. Having nothing in common, least of all their sexes; yet grouped together and divided from the other indescribable gender. All of which sounds like the basis for a bad philosophy essay, except that gradually people are waking up to the fact that gender is now enshrined in law, sex has been downgraded, and our legal rights are changing. And we missed the memo.

How do you want to be grouped, when grouping is required? By sex or by gender? Who do you want to be grouped with? What is it you have in common with other people, your body-type, or your mind-type? It’s a serious question, although almost a moot point, because in almost every walk of life over the last decade you’ve already been re-categorised. You already belong to a ‘gender identity group’ that you didn’t knowingly opt into, which contains people of both biological sexes, and that you can’t easily get out of. Where did your sex-based rights go?

When the law added the legal concept of ‘gender’ to the measure of who is male and who is female, it created an almighty conflict with sex. Sex or gender can be paramount, but both cannot be balanced equally. Because there an irresolvable clash between the two concepts, and one must win. Are you ‘of the female sex’? Or ‘of the female gender’? It’s essentially a question of ‘who do you share common characteristics with, what are those characteristics, and how important is that commonality to you?’

You need to decide how you want to be grouped. We all do. And you may need to make a bit of a fuss when you find you’re being grouped in a way that doesn’t seem right or fair, or even grounded in reality at all.

For example, when you are at your most vulnerable and want privacy amongst your sex. In a Hospital ward, say.

The birth of Legal Gender; the death of Legal Sex. The Gender Recognition Act.

In 2004, a piece of legislation called the Gender Recognition Act quietly became law. The primary purpose of the act was ostensibly to allow approximately 5000 mostly biologically male transsexuals, via a tightly controlled and medically certificated approval process, to be treated as if they were female so that they could marry another man. In the era when same sex marriage was prohibited, there was a greater appetite for creating an apparent ‘heterosexual’ marriage from a same sex relationship, than there was to legalise same sex marriage. A ‘legal fiction’ was approved. Birth certificates were altered. Biologically male became legally female. ‘Gender’ became legally recognised, and, it was agreed, gender trumps sex.

The Act in essence changed the definition of male and female from a biological definition to a psychological one.

This set in motion the re-categorisation of an entire society into two psychological gender groups instead of by the sexes.

Gender gradually REPLACED sex. For all of us. People started to be sorted by purported ‘psychology’, not biology.

The votes for the Gender Recognition bill were split down party lines. A Labour Government whip resulted in 289 labour votes for the bill. Most conservative MPs however, voted against the passing of this bill that enabled the concept of ‘gender’ to supersede sex. A conservative MP, Andrew Lansley, however, rebelled and voted aye.

Andrew Lansley was in no doubt of the distinction between sex and gender. He voted for gender to legally outrank and overwrite sex.

Six years later in 2010 Andrew Lansley rose to the role of Health Secretary within the coalition government.

The NHS understands the clear distinction between sex and gender.

The NHS, in addition to treating patients by biological sex, are legally bound to respect a person’s ‘gender identity’ too, should they declare one. Biological sex remains immutable, and important. Medical treatment of the sexes differs between males and females. Male and female anatomy, genetics, reproductive organs, diseases, response to drugs are critically different. To overwrite a patient’s biological sex in a medical record with their gender identity would be dangerous. The NHS was so concerned about inadvertent confusion between the two concepts that it took careful action to ensure it could keep a record of both.

The NHS Sex and Gender Standards

In 2005, shortly after the Gender Recognition Act was made law, an NHS exercise was commenced to standardise patient information and data within the various IT systems across the NHS. Within this exercise a suite of documentation was created, dedicated to designing a system architecture that could attempt to cope with the challenges specific to using BOTH sex AND gender as data.

Because the consequences of an NHS mix up between sex and gender was recognised as dire. And this risk was noted in several NHS documents, produced by the Microsoft Health Common User Interface team. The following quotes link to the NHS documents for public viewing.

“The term ‘Gender’ is now considered too ambiguous to be desirable or safe”

“Users may confuse the terms current gender and sex, or assume that they are synonymous”

“It is therefore desirable to use the two distinct terms ‘Sex’ and ‘Current Gender’ “

“The Current Gender input controls are used to record the gender, according to how a patient currently describes themselves, whereas the Sex input controls records their phenotypic sex”

~NHS Sex and Current Gender Input and Display User Interface Design Guidance

The NHS went to a lot of trouble and expense designing a database to hold our medical records that wouldn’t mix up our sex with our ‘gender identity’ if we professed to have one. The NHS CANNOT ignore sex, even if the law says gender identity trumps it. And the design guidance is very clear: capture ‘gender feelings’ if you must, but the NHS categorically must record SEX separately, or people will get hurt. Do not overwrite physical reality with feelings on medical records.

The NHS is very clear when sex means sex, and when gender means something entirely different. They have an entire suite of published “Sex and Gender” Information Standards which makes the distinction between the two concepts crystal clear.

Which makes the next part of this story bewildering.

The claim: Elimination of Mixed Sex wards.

In 2010, to great fanfare, Health Secretary Andrew Lansley of the Conservative party announced the Coalition Government’s laudable commitment to place all NHS hospital patients in single-sex wards — with any mixed sex breaches made public and financial penalties imposed.

“It should be more than an expectation, it should be a requirement that patients who are admitted should be admitted to single-sex accommodation,” the Health Secretary told BBC Radio 4’s PM programme.

“Patients should be in single-sex accommodation, meaning that all of their period that they are admitted they should be in a bed or a bay which only consists of people of the same sex.

“And they should be able to come and go, for example to all their washing and toilet facilities, without having to pass through a part of the ward or another ward where there might be people of a different sex… so to that extent they would have the kind of privacy and dignity people have a right to expect.”

And he added:

“Patients should not suffer the indignity of being cared for in mixed-sex accommodation. I am determined to put an end to this practice, where it is not clinically justified.”

Categorical statements such as these from Lansley were uttered in the same year that a new Act; the Equality Act 2010, committed to continuing to protect biological SEX based rights, with sex being one of 9 protected characteristics that would be monitored to stop discrimination. ‘Gender reassignment’ was one of the nine protected characteristics, and biological sex was another, protected in its own right. The two characteristics are differentiated and distinct in law.

So when the Government announced the characteristic for NHS ward segregation would be ‘sex’ that was an unambiguous statement relating to a specific protected characteristic. Biological sex is a tangible, physical reality. NHS Wards were promised to be explicitly single sex, not single gender. Bodily dignity and privacy for the biological sexes, not segregation by invisible personality type. The government’s commitment to respecting the privacy and dignity of the sexes, they reassured us, still remained unassailable.

Mr Lansley’s choice of the word SEX rather than gender was very deliberate.

Sex and gender are not the same thing, after all.

The truth: “The policy commitment relates to gender, not sex”.

Despite what the public were told, the policy was always explicitly based upon segregating by ‘gender’ and not sex, right from its inception.

NHS documents and records dated from 2010 show that before the policy was implemented, whilst still in its design stages, the specifications always related to gender, not sex. And yet the name of the policy, and all references to it to the general public were explicitly instructed to be sex, not gender. The opposite of the truth.

The deliberate use of the word SEX to name the policy, whilst using GENDER to facilitate it, was a Department of Health mandate from Andrew Lansley.

The NHS Information Standards Team who were tasked with creating the infrastructure to execute monitoring and reporting on breaches of this policy understood their task. To utilise patient data relating to gender, not sex. To segregate wards by assumed or self-declared ‘gender’, not sex. Discussions at that time between the NHS team and the DOH left no doubt; what was being created was a standard that measured breaches in mixed-gender, not mixed sex wards. Mixing people of differently sexed bodies was acceptable, whilst ‘psyches’ were separated.

The NHS team told the Department of Health that the name of this policy was misleading. They insisted it should truthfully be called “Eliminating Mixed Gender Accommodation’. A source within the NHS confirmed that they fully understood that this policy related to gender, but that the DOH was explicit in its directive:

Segregate wards by gender. But definitely tell people it is by sex. “To ensure a better public understanding”.

The ‘Eliminating Mixed Sex Accommodation Standard’ was managed, appraised and published within six weeks.

A year after the implementation of the policy, The NHS board meeting minutes of the Post Implementation Review once again specifically broach the subject of the misnomer between the fact of the policy, and its name and public references. And once more, they noted that “The Department of Health had purposefully used the word ‘sex’ in the standard”.


This is quite the bait and switch trick enacted upon an entire population. Why the deliberate misdirection of the government to the public? One can only speculate. Perhaps it was intended to be a kindness to not let the frogs know that the pot was being heated, when boiling point was still some way off.

Nevertheless you, we, I are all grouped into a class with other people for the purposes of ward segregation, by so-called gender, and definitely not by sex, despite what we have been told. And by this sleight of hand, so called ‘single-sex’ wards are in fact truthfully ‘single self-declared gender’ wards. Otherwise known as ‘mixed sex’ wards. So, having acknowledged mixed-sex wards be a scandal, an indignity, and a breach of the rules, by virtue of using ‘gender’ under the radar to record and measure wards, the breach is rendered instantly non-existent. The fiction of gender masks the reality of sex.

A person of male sex is recorded as of the female gender. No breach here, nothing to see.

Not only that, but this situation has created the counter intuitive situation, that if a male person is accommodated on a ward with other male people, this could be counted as a ‘mixed-sex’ breach incurring a fine if at any point he declared his gender identity to be female.

By elevating gender above sex, we have financially incentivised the placing of male patients with a claimed ’female gender identity’ on female wards, and dis-incentivised placing them on wards of their own sex.

The advent of gender self-declaration; the overruling of all sex based rights.

Is this a big problem, if there are only 5000 or so people granted legal recognition as the opposite sex? In 2004 when the law enshrined gender the numbers were specifically limited by the gate-keeping GRC process. But things quickly evolved. By 2007 the Department of Health (DH) Equality and Human Rights Group were already instructing the NHS that “staff should treat individuals whose self assigned gender is different from that assigned at birth as if they had Full Gender Recognition under the Act.”

So, as it turns out, quite soon after the GRA was created there was already a population of many more people than the original 5000 legal transsexuals that wished to be treated as the opposite gender. And these people wished to bypass the GRA gatekeeping process. We galloped into the era of ‘self-ID’.

The number of people declaring, or ‘self-identifying’ themselves to be the opposite gender has exploded.

From an estimated 5000 officially recognised transsexuals in 2003, to an estimated 650,000 self-identified transgender (1% of the population) in 2009. And then in 2016 GIRES indicated substantially greater prevalence, around 5%. That’s more than 3 million people.

The gatekeeping measures and safeguarding process of the Gender Recognition Process were designed to accommodate 5000 very specific, legally noted and medically agreed exceptions to the rule. It was assumed that the carefully curated, medically monitored numbers were so small that the legal lie would be tolerable.

But this ‘give an inch’ gatekeeping approach is being swept away by the tsunami of gender self-declarers. The principle that one can legally change gender, and that gender should supersede sex, now codified into law, has been grasped enthusiastically by an enormous and growing population who vehemently reject the notion that any gatekeeping, least of all medical or legal, should apply to them. In theory, the law still allows that only those who meet specific requirements are granted the right to legally change their sex. And they still number around 5000, surprisingly. But in practice, UK institutions have one by one responded submissively, ‘ahead of the law’ by capitulating to all gender self-declarations, without exception. All affirming such declarations to be as unassailable as they are unverifiable.

The NHS must “be prepared” for nearly two million Britons to question their gender in coming years, a health boss has said.

James Palmer, the medical director for specialised services at NHS England, said in the future he expected up to three per cent of the population would make contact with transgender health services at some point in their lives.

The government have acknowledged the vulnerability, distress and indignity experienced by people when they are forced to share hospital accommodation with a member of the opposite sex. This distress is not ameliorated by the purported presence of an invisible ‘psyche’ in the opposite sex patient you find yourself sharing a ward with. They may genuinely believe that they and you share a matching psychological gender. You may disagree. You may not even recall declaring your own NHS-recorded gender. You may wish to invoke instead your protected characteristic, sex, and quote something of the indignity of being forced to share with the opposite sex. It’s quite likely you’ll be called a bigot if you do.

Gender outranks sex.

Wards are single gender, not single sex.

Official Guidance issued to the NHS in 2009 confirmed that regardless of anatomy, legal status, or documentation, the self-declared gender identity of one patient would take precedence over the actual sex of all others in their shared ward. NHS rules state you do not need a gender recognition certificate. There is only one requirement. You must incant the words “I identify as …”

“Transsexual people, that is, individuals who have proposed, commenced or completed reassignment of gender, enjoy legal protection against discrimination. In addition, good practice requires that clinical responses be patient-centred, respectful and flexible towards all transgender people who do not meet these criteria but who live continuously or temporarily in the gender role that is opposite to their natal sex. General key points are that:

• 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;

Gender variant children and young people should be accorded the same respect for their selfdefined gender as are trans adults, regardless of their genital sex. Where there is no segregation, as is often the case with children, there may be no requirement to treat a young gender variant person any differently from other children and young people. Where segregation is deemed necessary, then it should be in accordance with the dress, preferred name and/or stated gender identity of the child or young person.

The same rule applying to children who self-define their gender, including, astonishingly, against their parents’ wishes and despite not necessarily being Gillick competent.

In some instances, parents or those with parental responsibility may have a view that is not consistent with the child’s view. If possible, the child’s preference should prevail even if the child is not Gillick competent.

Any person, adult or child, who merely declares a gender different to their sex, will be accommodated without question in a ward with members of the opposite sex (whose compulsory gendered psyche will be assumed on their behalf, and whose objections will be considered groundless and probably bigoted).

There is no such thing as a single sex ward, because we don’t even consider sex when segregating wards.

The Care Quality Commission published a report in September that demonstrated that sexual incidents, including harassment, assaults and rapes are “commonplace” in NHS mental health units. A total of 1,120 sexual incidents — 65 a week — occurred on mental health wards in England during April, May and June of 2017. The figures included 29 alleged rapes. And this figure only relates to mental health units, not other wards.

Creating a situation that on the one hand acknowledges the risks and indignities of mixing the sexes in wards, yet on the other hand facilitates an ever growing population of gender self-declarers into opposite sex wards of their choice is creating the perfect storm for increased sexual assaults.

Telling the general public that we have all but eliminated mixed sex wards, whilst the opposite is actually true, is a direct consequence of re-categorising an unwitting population by gender, and then allowing gender to trump sex.

And the key to this is keeping the public in the dark about the stark difference between sex and gender.

This is happening in the NHS, one of the few national institutions that has explicitly documented the categorical importance of not confusing the two concepts, and the risks of muddling them up.

“The term ‘Gender’ is now considered too ambiguous to be desirable or safe”

What is happening to sex-based rights in the UK? Have we already made them impossible to invoke? Are there any circumstances left where we can be reassured that our biological sex matters, is recorded, is important? When, if ever, can we say, “I’d rather be grouped by my protected characteristic of sex please, and treated accordingly”? For that matter, are the NHS even following their own safety guidance in the Sex and Gender Standards; are they heeding their own warnings about the importance of recording sex and gender separately and using the two concepts differently?

No. They are not. This wholesale replacement of sex with gender isn’t just about hospital wards. The NHS may be exposing us to even greater risk with a failure to keep sex and gender in their proper places.

Part two explains what else the general public might be surprised to discover about their medical records.

Sex, Gender and the NHS Part 2: Your medical record, and your Ladybrain