Have your say!
The government has launched its consultation on changes to the NHS Constitution and we need you to use your voice to support the LGBTIQ+ community!
The NHS Constitution sets out the principles, values, rights, and pledges underpinning the NHS as a comprehensive health service. However, several proposed changes pose a significant threat to the rights and dignity of transgender patients accessing the NHS.
We want to ensure that trans people are not #SingledOut when accessing health care, but we can’t do it without your support.
Whether you are a community member, ally, healthcare professional, or professional body, we need you to say “no” to these changes and add your voice in support of transgender patients.
The consultation will close at 11:59pm on 25 June 2024. Please submit your response and spread the word!
Together we can create an NHS where no one is #SingledOut because of who they are.
Guidance on how to respond has been drafted by Transactual and is available online.
As with all consultations, we encourage you to speak from your personal and professional experience as you provide your opinion. A greater variety of experiences in responses helps to demonstrate the breadth of community in support of trans rights in health.
To support you in drafting your response, we have outlined some of OUTpatients’ thoughts about the consultation that may be helpful. You may also want to read our CEO’s statement.
OUTpatients' thoughts on the proposed changes to the NHS Constitution
- Healthcare is a human right
Healthcare is a human right for all patients, including those who are transgender. The NHS Constitution clearly and proudly states “You have the right not to be unlawfully discriminated against in the provision of NHS services including on grounds of gender, race, disability, age, sexual orientation, religion, belief, gender reassignment, pregnancy and maternity or marital or civil partnership status.” Yet proposed changes to the NHS Constitution have the potential to limit transgender people’s access to this protection.
- These changes are incompatible with NHS commitments to equitable, person-centred care
We are unclear how the NHS can appear to advocate for ‘person-centred care’ whilst excluding people based on their trans status. We believe that these frequent attacks on trans people’s health has the potential to escalate the medical mistrust already prevalent among our community, and how these will impact NHS targets – in particular to cancer, the early diagnostic goal that sits within Core20PLUS5. How do we expect patients to engage with healthcare in a timely manner and adhere to their care if we remove existing policies and guarantees of appropriate care?
- Single-sex accommodation
Transgender people are not new. The discussion about how to place trans people who are inpatients is also not new. The current Single Sex Accommodation Policy includes recommendations for the placement of trans persons on wards aligned to their gender or the provision of a separate side room where deemed appropriate, to be assessed on a case by case basis. This approach is in line with the 2019 position of the Equality and Human Rights Commission’s interpretation of the Equality Act.
As anyone in healthcare knows, spare side rooms are a rare commodity, so if their use was mandated for all trans patients, it would largely be unenforceable. It is necessary to consider the broad variety of people who can and do use side rooms and their availability across the NHS. As per NHS Estates documents, increased floor area, capital cost, and management and staffing issues also need to be considered.
We are also concerned about how this increased scrutiny by NHS staff coupled with no training or support may impact butch and gender non-conforming women.
“Public toilets are very stressful because people will always challenge me whenever I go in. They will ask me if I’m in the right toilet, or get members of staff to question why I’m there – to which I have to constantly explain that I had cancer.” – Tiffany, breast cancer patient via ITVX
- Access to health services
This proposed change seeks to “make clear [that] patients have a right to expect that NHS services will reflect their preferences and meet their needs, including the differing biological needs of the sexes.” It is unclear what needs are not being presently met in this domain within the NHS. We also question the language of “biological needs of the sexes” as this statement is unclear in its specificity and appears to use language common in anti-trans activity.
- Inclusive language
We are concerned by the discussion of limiting the use of inclusive language across the NHS, as highlighted by news coverage.
Inclusive language attempts to describe anatomy and eligibility as a means of clinical accuracy and inclusion. For example, to say cervical screening is for all women is inaccurate, it is for those with a cervix. If someone has had a procedure that has completely removed the cervix, they no longer need to attend for cervical screening, for example a total hysterectomy.
Recent opposition to community specific language has focused on the term chestfeeding, which may be used by transmasculine and non-binary patients. It is our view that inclusive language is another tool in the clinician’s toolbox to provide person-centred care, and does not in any way impede on others with whom this language is not used. In short, choice is a core principle in the use of inclusive language that allows clinicians to reflect the needs and preferences of each individual rather than taking a “one size fits all” approach. In essence, person-centred care.
Sex specific language is alive and well throughout healthcare. The LGBTIQ+ community does not refute its importance and recognises that both sex AND gender identity are impactful in patient and public health.
“In terms of [people who have chronic health conditions] who have to engage with the system in different ways, it comes back to it being doubly traumatic because people don’t understand trans people, or know how to talk about us or to us, or how to engage with our bodies or talk about our bodies.” – Nim Ralph, Activist and Community Expert, Transforming Futures Health Report, 2022
- Potential effect on the Equality Act
We question the government’s repeated attempts to change references of “gender” to “biological sex” in various legislation and statutory documents. As the consultation notes, making this change in the NHS Constitution would “require the government to introduce secondary legislation” as it may conflict with the Equality Act.
- The UK’s ranking on LGBTIQ+ rights
The UK has been steadily plummeting on ILGA Europe’s Rainbow Index of 49 countries across Europe, from being ranked 1st for LGBTIQ+ equality laws and policies in 2015 to 17th in 2023. In 2023, the UN independent expert on sexual orientation and gender identity Victor Madrigal-Borloz expressed that “State actions are cause for concern” in fuelling increasing incidents of harassment, threats, and violence directed towards trans people in the UK. Similarly, the IPSOS 2023 LGBT+ Report found the UK to be ranked at the bottom of the list for its views on transgender people being allowed to use single-sex facilities, ranking at 29 out of 30 countries globally. We feel that the proposed changes within this consultation add further evidence of decline in transgender rights in the UK.
“When trans people can’t access public bathrooms we can’t go to school effectively, go to work effectively, access health-care facilities — it’s about us existing in public space.” – Laverne Cox
- A loss of community trust
The NHS professes to celebrate and centre “expert by experience” voices, yet in the application of this value to trans rights and access to health, the silence is deafening. We know that 56% of trans people avoid healthcare, even when they are unwell, and that 38% report poor experiences of healthcare due to their gender identity. Furthermore, both the GP Patient Survey and Cancer Patient Experience Survey have consistently shown poorer experiences in our community across a range of areas. Instead of seeking to create a hostile environment for trans people, the government should instead be seeking to address the epidemic of medical mistrust and avoidance that it is now contributing to.
From my experience, and the experience of friends who have routinely skipped screenings, whether that’s for breast cancer, or cervical cancer, it’s always been because of a really deep-seated fear of how they’re going to be treated at the GP’s office.” – Focus Group Attendee
- Limiting professionals
We work with thousands of healthcare professionals each year who are committed to delivering equitable care to all patients, including our community. We have seen profound progress across the NHS in addressing health inequalities and embedding LGBTIQ+ issues in person-centred care. It is our view that the proposed changes undermine these values and the hard work of the fantastic NHS staff working to improve patient care.
Research by the BMA in 2022 identified significant issues around homophobia and transphobia within the NHS as a workplace. More than two in five (43%) LGB+ respondents and almost half (49%) of trans respondents had directly experienced homophobia, biphobia, or transphobia at work at least once in the past two years. We are concerned that the proposed changes have the potential to increase the prevalence of LGBTIQ+phobia within the NHS for both patients and professionals.
“It is with sadness that I have read the proposed changes to the NHS Constitution in regard to ‘sex and gender reassignment’, particularly around access to single-sex wards. These proposals represent a step backwards and risks widening health inequalities by further discouraging trans people from accessing medical care.
The priority when any person is admitted to hospital should be attending to their immediate medical need. Searching for a single room could delay care, as these are already in high demand. This is particularly true for cancer patients where there is a need to isolate people who are either infectious or have weakened immune systems. There are also scenarios when it is safer for patients to be in an open bay, in regular view of medical staff.
If the Government feels that there is not suitable privacy or safety on wards in their current form, this is not going to be changed by excluding trans patients. Instead, they should focus on an investment in NHS buildings and staff.
In my personal view, the intentions behind the proposed changes appear to be discriminatory, implying that all trans patients are by default somehow a threat to other patients. A government wishing to uphold dignity, should be fighting for every patient, regardless of gender identity.” – Dr Alison Berner