Patients trans equality policy

1 Introduction

Rotherham, Doncaster and South Humber NHS Foundation Trust (RDaSH) is committed to promoting equality, diversity, and good relations in everything it does, as a community leader, as a provider, and as an employer.

For trans, non-binary or gender non-conforming people, there are concerns around historical discrimination, structural inequalities, health inequalities, data protection and interpersonal communication that need to be thoughtfully and respectfully considered.

The purpose of this policy is to support the trust to ensure that any person who identifies as trans, gender fluid or non-binary are always treated as the gender in which they currently present.

This policy supports the trust in its delivery of inclusive services and ensures it does not breach the Equality Act 2010. Under this legislation, it states that a trans person no longer must be under medical supervision or have a gender recognition certificate to prove that they are Trans. They must be treated as the gender that they currently present with.

Trans is an umbrella term to describe people whose gender is not the same as, or does not sit comfortably with, the sex they were assigned at birth.

Trans people may describe themselves using one or more of a wide variety of terms, including (but not limited to) transgender, cross dresser, non-binary, gender queer.

It is important to remember, trans identities are diverse. Trans young people may identify in lots of different ways.

Not everyone identifies as ‘male’ or ‘female’. Sometimes, people assume that being trans is about feeling you are the ‘opposite’ gender. This is true for some trans people, but not for others. This assumption makes things difficult for those who identify outside of ‘male’ or ‘female’, for example non-binary young people. A non-binary young person may need some different things to feel comfortable to, for example, a trans young person who identifies as ‘male’.

Not every trans young person will want to transition but may still like, or benefit from, ongoing support of some kind.

Language is important. Clinical staff sometimes worry about using the correct language when talking about gender identity and are often concerned about ‘getting it wrong’.

2 Purpose

This policy provides guidance for the trust’s employees, line managers and trans people on the expectations and other considerations that may be necessary to improve the experiences and opportunities of trans people.

Trans people are protected by the following legislative acts and where possible the trust is committed to afford full protection of trans patients on the grounds of:

gender
identity
gender expression

2.1 Equality Act 2010

The Equality Act 2010 (England, Scotland, and Wales) protects against discrimination because of gender reassignment in employment and service delivery.

It bans direct and indirect discrimination and victimisation. The act makes clear that it is not necessary for people to have any medical diagnosis or treatment to gain this protection; it is a personal process of moving away from the gender assigned at birth to the gender they would prefer.

People discriminated against because they are wrongly perceived to be trans, or who are discriminated against because of their association with Trans people or issues are also protected.

2.2 Gender Recognition Act 2004

The UK Gender Recognition Act (GRA) enables people aged over eighteen to gain full legal recognition for the gender in which they live. Applications are considered by the gender recognition panel. Once a person receives a gender recognition certificate (GRC), they are legally of that gender for every purpose and have all the rights and responsibilities associated with that gender. Not all trans people will obtain or seek to obtain a GRC.

The Gender Recognition Act gives anyone applying for or holding a gender recognition certificate particular privacy rights. It is a criminal offence to pass on information acquired ‘in the course of official duties’ about someone’s gender recognition, without the consent of the individual affected. ‘official duties’ include:

employment
trade union representation
supply of business or professional services

It is also an offence to pass on information relating to an individual’s trans history or identity as a trans person without their consent, regardless of whether the individual has a GRC or not. Article 8 of the European Convention on Human Rights provides a right to respect for one’s “private and family life, his home and his correspondence”, subject to certain restrictions that are “in accordance with law” and “necessary in a democratic society”.

Everyone has the right to respect for his private and family life, his home and his correspondence.
There shall be no interference by a public authority with the exercise of this right except such as is in accordance with the law and is necessary in a democratic society in the interests of national security, public safety or the economic wellbeing of the country, for the prevention of disorder or crime, for the protection of health or morals, or for the protection of the rights and freedoms of others.

3 Scope

This policy applies to all staff working in the trust, in any capacity. A failure to follow the requirements of the policy may result in investigation and management action being taken as considered appropriate. If reported as a hate crime could be investigated as a criminal offence a trans person should be treated in a dignified, non- discriminatory way.

‘Trans’ or ‘transgender’ describes people whose gender identity differs from their sex (gender) assigned at birth. They are umbrella terms covering people who:

identify as having a gender different from that which they were assigned at birth and are planning or have had medical interventions such as hormones or surgery
identify as having a gender different from that which they were assigned at birth, but who are not planning any medical intervention
are intending to transition, are currently transitioning, or have transitioned at any stage
are non-binary, that is, they are not solely (identify as) male or female. They may define themselves as both, neither or something entirely different. They may or not have medical interventions to align their body with their non-binary gender identity

These are not mutually exclusive alternatives.

The steps a trans person may take to live in the gender with which they identify.

Each person’s transition will involve different things. For some this involves medical intervention, such as hormone therapy and surgeries, but not all trans people want or are able to have this. Transitioning also might involve things such as telling friends and family, dressing differently and changing official documents.

Rotherham, Doncaster and South Humber NHS Foundation Trust acknowledges that transitioning is an individual process and is committed to supporting each person in their decisions.

4 Responsibilities, accountabilities and duties

4.1 Chief executive and board

The trust board and the trust Management team have a responsibility to develop a culture and climate which is free from any form of discrimination. To ensure that this policy is acted upon through delegation to appropriate care groups and committees.

4.2 The role of individual staff

Every employee has a personal responsibility for their own behaviour and must treat colleagues, patients and visitors with respect and fairness regardless of their:

gender
gender identity
gender expression
sex
race
nationality
age
disability
religion or beliefs

Personal beliefs which do not align with the principles of this policy will not be shared with colleagues or people who use our services and decisions taken in a professional role will be aligned entirely with the trust policy. All staff members regardless of grade or profession must:

adhere to and abide by this policy
ensure its implementation and uphold the procedures referred to within
ensure that new staff are appropriately briefed at induction on compliance with this policy
challenge or report discriminatory practice or language

4.3 Role of the managers

Care groups and clinical care group directors are responsible for the operational implementation of this policy across the care groups triumvirates. Will identify any additional training and support needs required to enable their teams to provide person-centred, compassionate, safe and effective care to trans people.

4.4 Role of the equality, diversity, inclusion and participation (EDI and P) workstream

The EDI and P standards workstream is responsible for:

overseeing the development and monitoring of the trans equality patient policy
consulting with members of the LGBTQ+ staff network and trans community
reporting to the board through the people and organisational development committee, on any issues of discrimination or non-compliance of the trans guidance

4.6 LGBTQ+ staff network

Act as a support network for trans staff in the workplace.
Take on a wider consultation and advice role to ensure the mental health and physical wellbeing of the wider trans community in RDaSH, is being met by the trust by monitoring policy effectiveness and advising on implementation.

4.7 Promotion of trans equality

As well as ensuring that trans patients are fully supported, the trust will demonstrate our commitment to trans equality in the following ways:

ensuring that all training courses that are delivered are fully inclusive of trans people, this includes both face to face training and e-learning
marking important dates for the trans community, such as trans day of visibility (31 March) and transgender day of remembrance (20th November)
including trans people in publicity and marketing materials
ensuring that all forms and surveys are inclusive of trans people, including non-binary people for both staff and service users
including trans equality as a core part of the organisation’s equality agenda and objectives
investigating fully all complaints of harassment, victimisation or discrimination on the grounds of gender identity, gender history, trans status or gender expression
monitoring the implementation of this policy

5 Procedure and implementation

RDaSH will ensure that trans, gender fluid or non-binary persons are always treated as the gender they present. The person does not have to be under medical supervision or hold a gender recognition certificate.

In instances where a trans, gender fluid or non-binary, person is admitted to inpatient services, protecting their dignity, safety and privacy must be paramount. In such circumstance’s decisions such as ward or room allocation, should be made in conjunction with the service user themselves and in accordance with their presenting gender identity, for example wishes to be known as a woman must be treated as a woman.

Trans, gender fluid or non-binary persons (that is individuals who wish to start treatment or have commenced or completed reassignment of gender) have legal protection against discrimination. In addition, good practice requires that clinical responses be patient centred, respectful and flexible towards all individuals who live continuously or temporarily in the gender role. Further information of procedures is available in appendix A.

5.1 Gender Recognition Act 2004

The UK Gender Recognition Act 2004 (GRA) enables people aged over eighteen to gain full legal recognition for the gender in which they live. Applications are considered by the gender recognition panel. Once a person receives a gender recognition certificate (GRC), they are legally of that gender for every purpose and have all the rights and responsibilities associated with that gender.

Patients’ rights do not depend on whether a person has a gender recognition certificate. Staff should not ask for a person’s GRC and it should never be a pre-condition for transitioning whilst in the care of the trust. To make an application for a GRC, a person needs to show they have been living in that gender for at least two years.

The GRA 2004 gives anyone applying for or holding a gender recognition certificate particular privacy rights. It is a criminal offence to pass on information acquired ‘in the course of official duties’ about someone’s gender recognition, without the consent of the individual affected.

It should be noted that the majority of documents can be changed without a GRC (for example bank accounts, driving licence and passport) and that not all trans people are able to apply for a GRC (for example non-binary people, trans people who haven’t had any transition related medical treatment or trans people without the necessary documentation).

5.2 Equality Act 2010

The Equality Act 2010 (England, Scotland and Wales) protects against discrimination because of gender reassignment in employment and service delivery. It bans direct and indirect discrimination and victimisation.

The act makes clear that it is not necessary for people to have any medical diagnosis or treatment to gain this protection, it is a personal process of moving away from the gender assigned at birth to their identified gender.

People discriminated against because they are wrongly perceived to be a trans person, or who are discriminated against because of their association with trans people or issues, are also protected.

6 Training implications

The trust is committed to high quality targeted training and effective communication to support this policy document. The objective is to implement this policy document and meet the training needs of staff over time. The focus of trust monitoring will be on this group over the agreed period or lifetime of the policy document. All staff need to be aware of the key points that the policy covers. Staff can be made aware through a variety of means such as:

continuous professional development sessions
one to one meetings and supervision
local induction
posters
team meetings
practice development days

7 Monitoring arrangements

7.1 Compliance with policy by all trust staff and volunteers

How: Review of a grievances or concerns raised via IR1’s or FTSU.
Who by: Head of EDI and P.
Reported to: EDI and P workstream.
Frequency: Quarterly.

8 Equality impact assessment screening

To access the equality impact assessment for this policy, please email rdash.equalityanddiversity@nhs.net to request the document.

8.1 Privacy, dignity and respect

The NHS Constitution states that all patients should feel that their privacy and dignity are respected while they are in hospital. High Quality Care for All (2008), Lord Darzi’s review of the NHS, identifies the need to organise care around the individual, ‘not just clinically but in terms of dignity and respect’.

As a consequence the trust is required to articulate its intent to deliver care with privacy and dignity that treats all service users with respect. Therefore, all procedural documents will be considered, if relevant, to reflect the requirement to treat everyone with privacy, dignity and respect, (when appropriate this should also include how same sex accommodation is provided).

8.1.1 How this will be met

No issues have been identified in relation to this policy.

8.2 Mental Capacity Act

Central to any aspect of care delivered to adults and young people aged 16 years or over will be the consideration of the individuals capacity to participate in the decision making process. Consequently, no intervention should be carried out without either the individuals informed consent, or the powers included in a legal framework, or by order of the court.

Therefore, the trust is required to make sure that all employees working with individuals who use our service are familiar with the provisions within the Mental Capacity Act (2005). For this reason all procedural documents will be considered, if relevant to reflect the provisions of the Mental Capacity Act (2005) to ensure that the interests of an individual whose capacity is in question can continue to make as many decisions for themselves as possible.

9 Associated documents

10 References

Equality Act 2010 (and Subsequent Amendments).
Gender Recognition Act 2004.
Data Protection Act (1998) and Human Rights Act (1998).
Stonewall Scotland and Scottish Transgender Alliance “Changing for the better, How to include transgender people in your workplace, a guide for forward thinking employers”.
Department of Health (DH) Trans guidance for the NHS (2008).
Primary Care Support England (PCSE).

11 Appendices

11.1 Appendix A Procedures

11.1.1 Provision of inpatient accommodation

A trans, gender fluid or non-binary person has equal rights to access single gendered accommodation as any other person and therefore should be admitted in accordance with their presenting gender identify. It is good practice to involve the patient, as much as possible, in the admission process. This can help reassure the patient and help staff understand what they can do to support the trans person.

Trans, gender fluid or non-binary persons should be accommodated according to the gender they identify with. This may or may not be related to their current presentation, for example, dress or name and it is important to discuss and clarify with the person when it is appropriate to do so.

It does not depend on their having a gender recognition certificate (GRC) or legal name change. It applies to toilet and bathing facilities.

Sensitivity and discretion should always be considered regarding the individual presentation whilst using single gendered facilities, for example, if a male presenting as a trans female with overtly male characteristics should be encouraged to use their own facilities. Views of family members may not accord with the individuals wishes in which case the trans, gender fluid or non-binary person’s view takes priority.

Always use the name title (for example, Mr, Mrs, Miss, Ms, Mx (does not indicate gender), or none of these) and pronouns that the Trans person deems correct and make sure that any records are clearly marked with this name and preferred title.

The trust has a legal duty to ensure that the person is protected from discrimination or harassment. This includes not tolerating negative views, comments or opinions of other patients or members of staff.

Confidentiality is essential. Discussions related to accommodating a person sensitively and meeting their needs should be undertaken only with relevant persons and with consent. If staff are unsure about a person’s gender, they should use gender neutral terms until it is appropriate to ask how they wish to be known.

If on admission the person is unconscious or incapacitated then, in the first instance, inferences should be drawn from presentation and mode of dress.

Display information about trans, gender fluid or non-binary person support groups, this gives a clear visual statement of support, inclusivity and practical information.

11.1.2 Concerns for children and young people

Children and young people should be accorded the same respect for the gender they present as.

Where there is no segregation, as it is often the case with children, there may be no requirement to treat a young person any differently from other children and young people. Where segregation is deemed necessary, then it should be in accordance with the preferred name and stated gender identity of the child or young person.

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. Gillick competence is a term used in medical law to decide whether a child (16 years or younger) can consent to his or her own medical treatment, without the need for parental permission or knowledge. Mental Capacity Act 2005 to be used after the age of 16 or over.

More in-depth and greater sensitivity may need to be extended to adolescents whose secondary sex characteristics have developed and whose view of their gender identity may have consolidated in contradiction to their sex appearance. It should be borne in mind that they are extremely likely to continue to experience gender identity that is inconsistent with their natal sex appearance, so their current gender identity should be fully supported in terms of their accommodation and use of toilet and bathing facilities.

11.1.3 Risk assessment

Staff may be concerned about possible risks and vulnerabilities that could arise because of a transgender, gender fluid or non-binary person being admitted to a ward or unit in accordance with their preferred gender. These should be assessed objectively considering the cause of that concern.

After consideration it may be appropriate to take additional action to manage risks such as enhanced observation or even moving the service user. But a trans, gender fluid or non-binary service user should not be moved to an inappropriate setting and the decision should not solely be made on the basis their trans identity.

11.1.4 Changes in gender presentation

Staff should be mindful that patients presentation may change due to circumstances and how someone identifies themselves. For example, an individual may identify as a trans man, but in times of crisis derive comfort from wearing female clothing.

There may be times when staff will need to determine if their presentation is due to current mental health needs, or otherwise. Each case will need to be determined on its merits. Some people prefer to occasionally wear clothing not usually worn by their assigned gender for reasons of comfort. This should be respected so long as (with other service users) it is not overly revealing or sexualised. Some people may choose to change their gender presentation in direct response to family dynamics or family anxieties about their gender presentation.

11.1.5 Physical healthcare

All patients are offered a full physical health assessment on admission to mental health services. For a trans, gender fluid or non-binary person people there are some additional physical health considerations for the health care team, such as any pre- or post- operative care or follow up that may be required, hair treatment including transplantation or removal, and speech and language therapy. Wherever possible, appointments for specialist care and treatment should be enabled.

11.1.6 Safeguarding

Patients may have difficulties accepting the service users gender identity. This may put the service users at risk, so enhanced observation may be necessary, until the risk is no longer present. Consideration should always be given to any safeguarding issues and these be reported through the normal channels. Advice can be sought from the Safeguarding team. The safeguarding team will always support the patient in these circumstances as well as the staff with any complex issues to ensure the patients’ rights are upheld and that there is a safe environment. This may involve reporting unacceptable behaviours as a hate crime to the police on local authority safeguarding teams.

11.1.7 Breaches of policy

It is unlawful to discriminate against or harass such people in employment or vocational training or in the provision of goods, facilities and services. A criminal offence can be committed by staff who disclose the gender history of a legally recognised trans person without explicit consent.

Staff who become aware of a breach of this policy are asked to raise the issue with their line manager in the first instance.

Line managers should seek to resolve the issue informally before escalating to Workforce and Organisational Development team for further support if required.

If the breach in policy could affect the reputation of the trust, then the chief executive’s office must be notified along with the head of communications in case of press enquiries.

11.2 Glossary of terms

Definitions
Definition	Explanation
Ally	A (typically) straight or cis person who supports members of the LGBT community
Cisgender or Cis	Someone whose gender identity is the same as the sex they were assigned at birth. Non-Trans is also used by some people
Trans	An umbrella term for people whose identity differs from what is typically associated with the sex they were assigned at birth. People under the trans umbrella may describe themselves using one or more of a wide variety of terms
Transgender	Refers to a broad range of people who experience and or express their gender differently from what most people expect, either in terms of expressing a gender that does not match the sex listed on their original birth certificate (for example, designated sex at birth), or physically changing their sex. It includes people who are transsexual, cross-dressers or otherwise gender non-conforming. Not all people who consider themselves (or who may be considered by others as) Transgender will undergo a gender transition. use unison definition
Gender	Is the social meaning given to sex. A person’s gender role reflects the duties, qualities, and expectations of society based on gender, which includes how we have learned to walk, look, act, dress, what job we choose, what first name we have and so on
Gender expression	Refers to all external characteristics and behaviours that are socially defined as either masculine or feminine, such as dress, mannerisms, and speech patterns
Gender identity	This is an individual’s internal self-perception of their own gender. A person may identify as a man, as a woman or as having a non-binary gender
Bi-gendered,	A person who considers themselves to be both male and female at different times
Non-gendered	A person who does not identify with any gender
Gender dysphoria or gender identity disorder (clinical terms)	A person with gender dysphoria can experience anxiety, uncertainty, or uncomfortable feelings about the gender they were born with. They may feel that they have a gender identity that is different from their biological sex
Gender reassignment	Is the term used to describe Transitioning from one gender to the other. The process may involve different stages, such as change of name and title, through to surgical intervention
Mis-gender	Is when someone refers to an individual (especially a transgender person) using a word, especially a pronoun or form of address that does not correctly reflect the gender with which they identify. If this is done deliberately with malicious intent, then it is discrimination
Gender recognition certificate (GRC)	By law, a person will be classed as their birth gender unless they apply for a GRC to change it legally. A name can be changed using a statutory declaration or deed poll
Transsexual	This was used in the past as a more medical term (similarly to homosexual) to refer to someone who transitioned to live in the ‘opposite’ gender to the one assigned at birth. This term is still used by some although many people prefer the term Trans or Transgender
Intersex	A term used to describe a person who may have the biological attributes of both sexes or whose biological attributes do not fit with societal assumptions about what constitutes male or female. Intersex people may identify as male, female, or non-binary
Sexual orientation	A person’s emotional, romantic, or sexual attraction to another person ‘heterosexual’, ‘bisexual’, and ‘homosexual’ (for example, gay or lesbian) are all sexual orientations. A person’s sexual orientation is distinct from a person’s gender identity and expression
Non-binary	An umbrella term for a person who does not identify as only male or only female, or who may identify as both
Pronoun	Words we use to refer to people’s gender in conversation, for example, ‘he’ or ‘she’. Some people may prefer others to refer to them in gender neutral language and use pronouns such as they or their and ze or zir

11.3 Updating your NHS records

11.3.1 What does updating NHS patient details do?

Changes name, title, or gender marker

11.3.2 How long does updating NHS patient details last?

This is a permanent change but can be done more than once.

11.3.4 How do I update my NHS patient details?

You can change your name, title, or gender with the NHS at any time you like by telling your GP surgery.

Most GP surgeries will be able to update your details if you ask at reception. However, some GP surgeries may be unsure of the procedure for how to do it. You may find it helpful to give them these links which explain how they can update your details:

in England, on the PCSE website (search for “how should I advise PCSE of a patient gender re-assignment?” and “a transgender patient registered at our practice would like to change their registered name”)
in Wales, on the GPOne website
in Scotland, on the NHS National Services Scotland website (opens in new window)

If your GP surgery is still unhappy to do this, or request a gender recognition certificate before making a change, you may wish to show your GP the General Medical Council guidance on this issue.

11.3.5 What happens next?

The NHS has multiple different systems that store details about patients. Most of these will be automatically updated when you tell your GP surgery, but you may find some hospitals or other NHS services are not automatically updated, and you may have to tell them as well.

Each NHS system is different and able to hold different information about titles (opens in new window)  (or lack of title) and about the gender of the patient.

In most NHS systems there are gender options for not only male and female, but often also a “not specified” marker which may be useful if you do not wish to have male or female recorded.

Usually, when you change your gender marker, you are also assigned a new NHS number (opens in new window). This means that records from before your change in gender marker are kept separately, to protect your privacy.

11.4 What should I be aware of?

11.4.1 Warning

Changing your gender marker may affect whether you are invited to important medical screening tests that you still need.

During your life the NHS will invite you to several screening tests for common conditions. As the prevalence of these conditions is different for men and women, some tests only invite people who have “female” on their NHS record, and some tests only invite people who have “male” on their NHS record. This can mean people who have changed their gender marker can be invited to the wrong tests for the body parts they have.

When you change your NHS gender marker, you should remember that you may not receive reminders for the tests you need and may have to ask for them yourself. You can read more about screening tests and which tests you might need:

Document control

Version: 1.1.
Unique reference number: 592.
Date approved: 8 January 2024.
Approved by: Corporate policy approval group.
Name of originator or author: Equality diversity, inclusion and participation administrator.
Name of responsible individual: Head of equality, diversity, inclusion and participation.
Date issued: 10 January 2024.
Review date: May 2024.
Target audience: All Staff.

Page last reviewed: April 30, 2024
Next review due: April 30, 2025

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