January 2, 2023 - 4:00pm

The NHS exists to look after patients. Some of them will be scared or embarrassed about having intimate procedures performed by a stranger, which is why women often ask for a female doctor or nurse. So how did any section of the NHS ever come to the conclusion that it is acceptable in some instances to override such requests? Even more astonishingly, evidence has emerged that an NHS trust in the west of England believes that patients are not always entitled to know the ‘gender identity’ of the person proposing to treat them.

‘Gender identity’ didn’t exist until about a decade ago. What matters is biological sex, which is one of the first things we notice about another human being. If a woman asks to have a cervical smear carried out by a female nurse, she doesn’t want to be treated by a man who ‘identifies’ as a woman and uses female pronouns. And she doesn’t want to be denied treatment for insisting that the person in front of her, speculum in hand, is male.

Many people will be astonished to discover that this is happening in a service where so much is based on trust. But the practice is confirmed in a report from the think tank Policy Exchange, which suggests that trans NHS staff are being permitted to treat patients who have asked for same-sex care for intimate procedures. It has obtained a letter, written in 2021 on behalf of the North Bristol NHS Trust, which even argues that there is ‘no requirement for clinicians to disclose their gender identity’.

At first sight, it is hard to know what this means, although it appears to suggest an element of deception. If a woman who has asked for same-sex care suspects that the person proposing to treat her is male, surely she is entitled to be told. Only in exceptional cases, according to the letter, which cites the example of a transgender person who is providing intimate care to vulnerable people. If the staff member has a gender recognition certificate and is ‘fully transitioned’, however, the exception will not apply.

Let’s be blunt about what this means: sick and worried people are being expected to put aside their right to informed consent to spare the feelings of a clinician or carer who believes human beings can change sex. In a development few, if any, patients have ever been consulted about, screening programmes for life-threatening conditions, such as cancer, are at risk of being turned into a process for affirming someone’s ‘gender identity’. 

So is hospital care, according to guidance from NHS England, published in 2019, which says trans patients should be accommodated according to the way they dress and the pronouns they use. It is currently carrying out a review into same-sex guidance, although some of us would say that the answer — putting the privacy and wishes of female patients first — is blindingly obvious.

In a blistering foreword to the Policy Exchange report, the government’s former advisor on violence against women, Nimco Ali, writes that the North Bristol NHS trust letter ‘reveals the NHS to be seriously compromised by an ideology that is diminishing the rights of women and girls’. 

It is hard to know how far this ideology has spread within the NHS, but it raises an urgent question for managers. If a woman who asked for same-sex treatment discovers later that it was carried out by a man, it undermines the entire concept of informed consent. And without consent, some intimate procedures might begin to look and feel like a serious breach of trust.

Joan Smith is a novelist and columnist. She has been Chair of the Mayor of London’s Violence Against Women and Girls Board since 2013. Her book Homegrown: How Domestic Violence Turns Men Into Terrorists was published in 2019.