How NHS England’s revised hospital accommodation guidance uses its sources

Evidence Note · EN-026

Scope

This note compares documents. It examines one document, NHS England’s Privacy, dignity and safety in hospital accommodation (PRN02528i). It reads alongside it:

• NHS England’s covering letter to trust and integrated care board chief executives, issued the same day;
• the guidance it replaces, Delivering same-sex accommodation (2019, last updated April 2025);
• the Equality Act 2010, in particular Schedule 3 paragraphs 26–28 and Schedule 23 paragraph 3, and section 7;
• the Supreme Court’s judgment in For Women Scotland Ltd v The Scottish Ministers;
• the EHRC’s 2026 statutory code of practice for services;
• the NHS Constitution, whose pledge the guidance delivers;
• HSSIB recommendation R/2024/041, with its parent investigation report;
• NHS England’s mixed-sex accommodation statistics page, to which the guidance links.

It asks four questions:

1. How does the guidance represent its legal sources?
2. What changed from 2019, and what was carried over?
3. What does it cite for its factual propositions?
4. What does it leave unspecified?

What this note does not do. It does not judge whether placing trans patients by biological sex is right, lawful in any particular case, or safe. It does not appraise the research evidence on hospital accommodation. It does not examine local trust policies or contracts. It examines the collection guidance publicly linked from NHS England’s statistics page. It has not inspected the current SDCS submission form, system instructions or any reporting specification distributed through another route, and has not established which technical instructions providers are currently using. It does not assess how the guidance is implemented.

It distinguishes three levels throughout: national policy design, provider implementation, and the individual decision at the bedside. Each raises different legal and evidential questions, and a national document may properly leave some detail to local implementation.

This note is not legal advice. No lawyer has reviewed it. Where a point turns on how the Equality Act applies to hospital accommodation, it is stated as an open question, not a conclusion. The note does not alter NHS England’s published expectations, or determine any provider’s legal duties.

The aim is to treat “the evidence is too weak to show benefit” and “the evidence is too weak to show harm” as the same kind of claim, judged by the same rules. Here that means reporting where the guidance is careful and accurate as fully as where it is not.

The status of the sources

The sources carry different legal weight, and the guidance does not always say which is which.

What the guidance requires

These points summarise the guidance as retained (source 1).

• Trans patients. Trans people, and others with the protected characteristic of gender reassignment, “should be accommodated in line with their biological sex”. This is subject to clinical needs being met, and to privacy, dignity and safety being maintained “for all, including other patients sharing that accommodation” (section 4).
• Alternative arrangements. Where a birth-sex placement “would not be clinically appropriate”, providers “should identify alternative arrangements”. This is “based on an assessment of the specific circumstances in each instance” (section 4).
• Clinical priority. Where clinical needs and same-sex accommodation cannot both be met, “clinical needs are the priority” (sections 3 and 4).
• Recording and reporting. Section 4 states that, for the placements it describes (where a birth-sex placement would not be clinically appropriate and the patient is placed otherwise), “The reasons for the placement decision should be clearly recorded and reported nationally as breaches of this guidance”. It does not state that every alternative arrangement, or every single-room placement, is itself a breach. A breach occurs when one or more of four principles is not met: sleeping accommodation, toilet and bathroom facilities, walking through an area occupied by the other sex, and women-only day rooms in mental health units (section 3). Section 5 says “All breaches of same-sex hospital accommodation must be reported through the Strategic Data Collection System (SDCS)”, each occurrence “counted once for national reporting purposes, regardless of duration”. Under a separate “Local reporting” heading it lists scenarios to be “monitored and reported locally”, including “all toilet and bathroom breaches”, women-only day spaces in mental health units, and “instances of mixing of sexes in psychiatric intensive care units” (where mixing is permitted but “should be avoided whenever possible and reported locally”, section 3). The broad national-reporting sentence must be read alongside that distinction; this note has not established that every locally monitored category belongs in the national return. Section 5 of this note compares this with the collection guidance publicly linked from the statistics page; the current SDCS instructions were not inspected. A reported breach under this guidance is a reporting category. It is not a finding that care was unlawful or unsafe.
• Single rooms. “Trans patients should be offered single-bed rooms on the basis of maintaining privacy, dignity and safety for all patients”, after an assessment (FAQ 7). The FAQ adds: “No patients have a legal right to be accommodated in single rooms”. That appears to deny a general entitlement. This note has not assessed whether particular clinical circumstances or duties, including reasonable adjustments, could require a single room in an individual case.
• Settings. The guidance “does not apply” in A&E and urgent treatment centres, adult critical care (levels 2 and 3), active treatment areas, children’s units, or defined outbreak and end-of-life situations. There, “all reasonable steps should continue to be taken to maintain the privacy, dignity and safety of all patients” (section 3). These are exceptions within this accommodation and reporting framework. They do not disapply other duties governing safe and lawful care.

1. The rule combines law and policy

The guidance follows its rule on trans patients from a legal premise. It introduces the rule with “Therefore”, after stating that the code says single-sex services “should be provided on the basis of ‘biological sex'”. The guidance introduces the placement default through its account of the legal framework. It does not explicitly claim a demonstrated comparative safety benefit for that default, and it does not say that the default puts trans patients at risk. This note does not assess whether such benefit or harm could be demonstrated. The guidance should be credited for not presenting the default as a demonstrated outcome.

The rule rests on three different kinds of source:

1. A judicial interpretation of legislation. “Sex” in the Equality Act means biological sex (For Women Scotland, para 264).
2. Statutory exceptions, and the code’s account of them. The Act permits separate services for each sex (Sch 3 para 26) and services for one sex only (Sch 3 para 27), each where its conditions are met and the provision is “a proportionate means of achieving a legitimate aim”. One of the para 27 conditions is that “the service is provided at a place which is, or is part of— (a) a hospital” (para 27(5)). Gender-reassignment discrimination in those services is permitted where “the conduct in question is a proportionate means of achieving a legitimate aim” (para 28). The code explains that a single-sex service which admits people of the opposite biological sex “will no longer be a separate or single-sex service” (para 13.144).
3. NHS England’s operational policy. NHS England chose to deliver the Constitution’s pledge through a national default, with individual clinical exceptions.

The meaning of sex under the Act, and the justification for restricting a service by sex, are distinct questions. Where a provider relies on an exception permitting separate- or single-sex provision, the relevant statutory conditions and proportionality requirements must be satisfied.

The guidance states a national default and provides for individual clinical exceptions. It does not explain how proportionality is to be assessed at each level: national policy, service design, and the individual decision. Nor does it say how those assessments relate to its clinical exception. Clinical appropriateness is not the same as the legal test of proportionality. The covering letter asks boards to ensure local decisions are “lawful, proportionate, evidence-based and clearly documented”. It also asks that their plans include “reviewing or revising decisions where evidence or circumstances change”. This note has not established whether separate proportionality assessments exist, at national or provider level.

Under the code, deciding whether a single-sex service is proportionate means weighing “the benefits of offering the service as a separate or single-sex service”, “the needs of those who are accessing it” and “the impact on those who are excluded from accessing it” (para 13.115). Those are partly factual questions. The guidance cites no evidence on them.

For Women Scotland did not decide anything about NHS England’s hospital accommodation policy. It did name “female-only hospital wards and changing rooms” among its examples of single-sex services, when explaining Schedule 3 paragraph 27 (para 215).

2. How the guidance represents its legal sources

The guidance paraphrases the code. The guidance says the code “says that single-sex services, such as hospital accommodation, should be provided on the basis of ‘biological sex'”. That is a paraphrase: no sentence in the code reads that way. The biological-sex element is in the code (paras 2.49, 13.130, 13.144). The code also gives a single-sex women’s hospital ward as an example of lawful provision (para 13.106).

The paraphrase does not itself state the statutory conditions or proportionality requirements, and so leaves out the structure of the exceptions. The code does not say that services should generally be single-sex. It explains the conditions under which separate- or single-sex provision is lawful, and what follows if a service relies on them. Its own example begins “A hospital chooses to provide a single-sex hospital ward” (para 13.106). The paraphrase also does not distinguish separate services for each sex (Sch 3 para 26) from services for one sex only (Sch 3 para 27). A system of paired male and female wards may raise different questions from a single women-only ward. This note does not decide how NHS inpatient accommodation is characterised under those paragraphs.

The “necessary for everybody” passage. NHS England invokes the code’s principle concerning services “necessary for everybody”. The code itself states:

“In the case of services which are necessary for everybody… it is very unlikely to be proportionate to put a trans person in a position where there is no service that they are allowed to use.”

This extract is from para 13.148, with “such as toilets” omitted at the ellipsis. NHS England uses the same substantive principle, introduced with its own words (“services that are”), so its sentence is not an exact transcription of the code’s. The code illustrates the principle with toilets. NHS England invokes it for hospital accommodation, where a trans patient’s clinical needs cannot be met on a birth-sex ward. That may be a direct application of the general principle, or an extension by analogy; which it is depends on the circumstances and on legal analysis. The code does not specify the resulting inpatient placement.

The guidance does not mention the communal accommodation exception. Schedule 23 paragraph 3 is a separate statutory exception. It defines communal accommodation as “residential accommodation which includes dormitories or other shared sleeping accommodation which for reasons of privacy should be used only by persons of the same sex” (para 3(5)). The exception applies only if “the accommodation is managed in a way which is as fair as possible to both men and women” (para 3(2)). Account must be taken of whether the accommodation could reasonably be “altered or extended” or further accommodation provided, and of “the frequency of the demand or need for use of the accommodation by persons of one sex as compared with those of the other” (para 3(3)). In relation to gender reassignment, account must also be taken of proportionality (para 3(4)).

The code explains that excluding a person “from use of communal accommodation provided for their own sex because of gender reassignment will only be lawful if it is a proportionate means of achieving a legitimate aim” (para 13.159). That concerns exclusion from accommodation for the person’s own sex. It is a different question from exclusion from accommodation for the opposite sex.

Schedule 23 paragraph 3 is a potentially relevant alternative or additional statutory route. This note has not established which inpatient arrangements engage it, or whether its omission changes the guidance’s legal analysis.

The link to the code is correct. The guidance links to a GOV.UK address that contains the word “draft”. The publication page records “Updated text as the code is no longer in draft” on 15 July 2026, and says “The Code came into force on 5th August 2026”.

3. What changed from 2019, and what was carried over

The 2019 guidance was read in an Internet Archive copy, captured 8 January 2026, of the page as last updated on 24 April 2025. That update added a note that the guidance was being reviewed following For Women Scotland. The table compares specific passages in the two documents. It describes what the 2026 document contains. It does not establish whether arrangements outside the document (contracts, technical reporting instructions, local policies) have changed.

Two things follow. First, several of the 2026 guidance’s operational propositions appeared in 2019, also without a cited empirical basis. Inheritance neither validates nor invalidates them. Second, the 2026 guidance does not reproduce the 2019 guidance’s specific procedures for trans and non-binary patients. It supplies general decision principles in their place, and its references to the code bring in the code’s own guidance on asking about sex (section 5 below). The practical steps for these situations are less explicit than they were.

4. What the guidance cites for its factual propositions

The guidance cites no studies, empirical datasets or evidence syntheses. This was checked in the retained text and in the list of links captured from the same page. That list contains 17 links, including three to the statistics and reporting page. No study, dataset or evidence synthesis is identified there as empirical support for the factual propositions assessed in this note. The linked pages were not themselves searched for supporting literature. Its covering letter asks boards to make sure local decisions are “lawful, proportionate, evidence-based and clearly documented”. The guidance itself does not provide or link to an empirical evidence base from which local teams could assess its propositions. That is a limitation in citation transparency. It is not a finding that the propositions are unsupported, or that the policy is unjustified.

The propositions are of different kinds, and need different tests.

None of this shows the propositions are false. Some may well be true. The finding is that the guidance gives no empirical citation for them, and that some appeared in 2019 with none either.

5. What the guidance leaves unspecified

How a patient’s biological sex is established. The 2019 guidance specified how to decide placement using presentation and preferences; it did not set out a process for establishing biological sex, because its rule did not turn on it. The replacement does not reproduce those instructions, and does not provide a comparably specific process for establishing the sex category used by its new default (section 3). The code supplies general guidance on proportionate enquiries and local procedures:

• an enquiry about sex must be objectively justified (para 13.162), made “sensitively and discreetly” (para 13.165), and designed to avoid the information “being given in the presence of other service users or staff” (para 13.173);
• providers “should consider what protocols or procedures are appropriate for their particular circumstances”, and train staff in them (para 13.174).

The code also sets out limits:

• “it is not always possible to be sure of a person’s sex from their appearance” (para 13.168);
• “There is no type of official record or document in the UK which provides reliable evidence of sex” (para 13.179);
• the code says information about sex “is likely to constitute special category data” (para 13.182). That reports the code’s wording. Under the Information Commissioner’s general framework, special category status depends on what the information involved reveals. The ICO lists gender reassignment as potentially special category data “in so far as they may reveal information about a person’s health”. The ICO page checked carried a notice that the guidance “is under review” because of changes made by the Data (Use and Access) Act. Sex or gender information is not automatically special category data in every context;
• the code notes that onward disclosure of Gender Recognition Certificate information “may be a criminal offence in some circumstances” (para 13.181). Section 22 of the Gender Recognition Act 2004 concerns defined “protected information” acquired “in an official capacity”, and contains exceptions. Whether it applies to a particular disclosure depends on those conditions and exceptions.

The unresolved question is how providers should translate these principles into admission decisions, particularly where information is uncertain or the patient cannot respond. The 2026 guidance does not address patients who are unconscious or lack capacity. The 2019 guidance did. The guidance asks teams to make sure staff know local processes “so decisions are made without unnecessary delay”. It does not address uncertainty about a patient’s sex specifically. This note makes no claim that such uncertainty has delayed care.

The trans patient’s own safety. The guidance’s general safety duties encompass trans patients. It does not specify how staff should assess and mitigate risks arising for a trans patient in a biological-sex placement, beyond its general assessment principles, single-room offer and clinical exception. The code itself recognises, in an example about toilets, that requiring trans people to use facilities for their biological sex “may cause safety risks and distress for trans users” (para 13.123). Single-room accommodation brings its own competing considerations, such as observation, isolation and therapeutic interaction. These are domains for assessment, not demonstrated effects of this policy. Trans status alone does not establish that an individual poses a risk to others; assessment should consider the relevant circumstances of all patients, as the HSSIB report also records (para 4.2.11, below). Trans patients do not share a single set of risks or preferences.

HSSIB recommendation R/2024/041. HSSIB’s investigation report Mental health inpatient settings: Creating conditions for the delivery of safe and therapeutic care to adults was published on 24 October 2024. Its recommendation R/2024/041 reads:

“HSSIB recommends that NHS England, working with relevant stakeholders, develops guiding principles for providers of mental health inpatient care to support local decision making when accommodating patients, including patients who are transgender and non-binary. This is to ensure a provider’s equality and human rights obligations are considered, and all patients are cared for in environments where they feel safe and that are therapeutic.”

HSSIB’s recommendations log records NHS England’s response: it would revise the same-sex accommodation guidance, and “It is believed that this will meet the expectations of HSSIB’s safety recommendation”. The log currently displays a recommendation date of 11 March 2026 and a response received on 30 May 2025. That appears to be a metadata discrepancy, and should not be taken as the recommendation’s original issue date.

The report gives context. It found that “Approaches to accommodating patients who were transgender and non-binary varied in mental health inpatient settings”. It records that it was told any guiding principles “should consider the risk assessment of all patients, rather than assuming that a patient who is transgender and non-binary would pose an inherently greater risk to others compared to other patients” (para 4.2.11). It also records that the investigation “did not identify specific incidents through its evidence collection where a patient who was transgender and non-binary had harmed another patient”. That is a finding about one investigation’s evidence collection. It is not an estimate of incidence, or evidence that risk is absent. The report was written under the 2019 guidance and before For Women Scotland. It does not estimate the comparative effects of the 2026 policy.

The revised guidance addresses the recommendation through general decision principles: three core questions, and four themes covering skills, environment, communication and record keeping, and measurement. It refers to human rights and the Equality Act, and applies to mental health units. It does not expressly name non-binary patients. It does not set out a distinct framework for assessing therapeutic mental health environments. Some of the populations and aims the recommendation names are therefore not expressly developed. This note has not assessed implementation, or established whether HSSIB regards R/2024/041 as fulfilled.

What “clinically appropriate” means. The guidance does not define when a birth-sex placement “would not be clinically appropriate”. Safeguarding and clinical risk are expressly part of its general decision framework: “Safeguarding patients from the risk of harm, abuse and neglect is an integral part of high-quality care”, and teams should “identify any safeguarding issues” (section 2). The guidance does not separately define how those considerations, including psychological safety, risk of assault and trauma, determine a departure from the placement default, or who makes that assessment. It requires teams to “review the patient placement regularly”, and specifies no interval or event-triggered reassessment. The covering letter asks boards to ensure that “arrangements are in place to support consistent decision-making and escalate difficult issues when needed”, and that staff “know where to seek advice on complex cases”. Neither document specifies a detailed pathway, decision authority or timescale for disputed individual placements. Consent, capacity and advocacy are not addressed beyond the general principle of partnership with the patient. National guidance may properly leave such detail to providers. The point is that the guidance does not say which detail it leaves to them.

Non-binary patients and variations of sex development. The guidance does not expressly discuss non-binary patients, some of whom may have the protected characteristic of gender reassignment (Equality Act 2010, s.7). It does not discuss circumstances in which variations of sex development create uncertainty, or particular privacy and care needs. These are distinct matters: one concerns gender, the other sex characteristics, and variations of sex development are themselves varied. General provisions may still apply, but their application is not illustrated.

A timetable. The covering letter asks boards to review the guidance “at pace”, without a deadline.

The reporting guidance. The guidance says “Related reporting guidance has also been updated”. The main-content link list captured at 02:39 UTC on 17 October 2026 shows three “reporting guidance” links, all to NHS England’s mixed-sex accommodation statistics page. At 02:44 UTC on 17 October 2026, and again at 03:48 UTC immediately before publication, that page was unchanged from its 23:44 UTC capture the previous evening (same text hash). It still referred to the September 2019 policy, saying “Reporting from January 2020 data should reflect these updates”, and offered Mixed-sex accommodation guidance v1.5.

That file was retrieved and read in full for this version of the note. Its front page says “Updated: October 2019”. Its version history describes version 1.5 as “Changed to reflect the updated policy guidance” published in September 2019. It directs readers to “Delivering Same-Sex Accommodation, September 2019”, including that policy’s decision matrix on “whether it is clinically justified or not” and its “further information regarding trans patients and gender variant children (annex B)”. The return “collects monthly data on all unjustified occurrences of patients receiving care that are in breach of the sleeping accommodation guidelines”. “Justified occurrences of MSA” are outside the scope of the national return. The file’s upload path includes May 2025; the date the document itself states is October 2019.

The 2026 guidance does not use the words “justified” or “unjustified”. It says “All breaches of same-sex hospital accommodation must be reported through the Strategic Data Collection System (SDCS)”. So the collection guidance at the linked page is built on the policy the 2026 guidance replaces, and its stated scope differs from the 2026 reporting instruction. This is a difference in the documents’ stated terms. It does not by itself establish how the national reporting population changes: some circumstances previously described as justified mixing may instead fall outside the revised guidance, for example in the settings where it “does not apply”. That mapping, and any instructions issued through SDCS, require clarification. On one point the two documents align: the collection guidance places bathroom and toilet mixing outside the national return, and the 2026 guidance lists “all toilet and bathroom breaches” under local reporting. This note has not established which other categories enter the national return under the 2026 guidance.

The statistics page’s own description is consistent with the 2019 framework: “NHS organisations submit data on the number of occurrences of unjustified mixing in relation to sleeping accommodation”. It also links to a Mixed-Sex Accommodation (MSA) DCB page on NHS England Digital, which may describe the data collection. That page presented an automated browser check and could not be read, so it was not inspected. This note does not establish that no updated specification has been issued by that or any other route, including the data collection system itself. Publication lag is one possible explanation.

What this note does and does not establish

It establishes that:

• the guidance’s rule on trans patients rests on a judicial interpretation, statutory exceptions as explained by a statutory code, and an NHS policy choice, and the guidance does not explicitly claim a demonstrated comparative safety benefit for the placement default;
• its account of the code is a paraphrase that does not itself state the conditions and proportionality requirements attached to sex-restricted services, and it does not mention the communal accommodation exception;
• it gives no empirical citation for its factual propositions, several of which appeared in 2019 with none either;
• it does not reproduce the 2019 guidance’s specific procedures on enquiries, unconscious patients and non-binary patients, and supplies general principles in their place;
• it addresses HSSIB recommendation R/2024/041 through general principles, and does not expressly develop the recommendation’s references to non-binary patients or therapeutic mental health environments;
• at 03:48 UTC on 17 October 2026, immediately before publication, the collection guidance offered at the linked statistics page was the October 2019 version, built on the 2019 policy and limited to unjustified sleeping-accommodation breaches.

It does not establish:

• the policy’s overall merits, which involve legal, clinical, empirical, ethical and political questions;
• whether the policy is lawful in any particular case, or which statutory exceptions apply to any particular ward;
• whether proportionality assessments exist at national or provider level;
• whether the guidance’s factual propositions are true, or whether supporting evidence exists elsewhere;
• how the guidance is implemented, or whether HSSIB regards its recommendation as met;
• whether an updated reporting specification has been issued by a route other than the linked page.

Sources

All sources are retained. Times are UTC. “Text SHA-256” is the hash of the page’s main-content text, extracted in a browser (the innerText of the <main> element) and encoded as UTF-8. “File SHA-256” is the hash of the downloaded file’s bytes. The manifest accompanying this note lists each retained file.

Limits of the text captures. A main-content text capture omits the page header, navigation and footer, image content and link destinations, and does not preserve formatting such as emphasis or table layout. To cover link destinations, the list of links inside the main element was also captured for sources 1 and 2, with its own hash. Source 1’s list has 17 links (captured 02:39 UTC, 17 October 2026; SHA-256 eec1d6b5f278de88435b6b87012ae0958b8f410e224d1c78e94c5016c78c19bb). They go to the statistics and reporting page (three links), the NHS Constitution, an Intensive Care Society standards document (two links), legislation.gov.uk, the EHRC code, the page’s own section anchors and NHS England publication indexes. None is cited as empirical support for the factual propositions assessed in this note.

1. NHS England. Privacy, dignity and safety in hospital accommodation. Publication reference PRN02528i. 15 October 2026. https://www.england.nhs.uk/long-read/privacy-dignity-and-safety-in-hospital-accommodation/ — First read 16 October 2026; text re-captured 23:41, 16 October 2026, unchanged. 21,339 characters; text SHA-256 06bbbd0c1ed611fa210a9f56979a86f9463f9c40b845ee548dd7bd9518555e83.
2. NHS England. Privacy, dignity and safety in hospital accommodation (publication page). https://www.england.nhs.uk/publication/privacy-dignity-and-safety-in-hospital-accommodation/ — First read 16 October 2026. Text captured 02:41, 17 October 2026. 1,023 characters; text SHA-256 a9b4083533f588ffcbcf9f96e7cfec77aadefa815d17a7995110021a335f19af. Link list (7 links) SHA-256 08dbe89c62d8d5d7544ae4479cd0bf0218485a6a604145c75cdc192598453621. Shows “Document first published: 14 September 2019” and “Page updated: 16 October 2026”. Lists the guidance and the covering letter, each “Published 15 October 2026”, and refers to a separate publication, Guidance on NHS staff facilities, which this note did not examine.
3. Mortimer D, Burton D. Guidance to support NHS organisations in the provision of single-sex services and facilities. Letter to trust and ICB chief executives. NHS England; 15 October 2026 (updated 16 October 2026). https://www.england.nhs.uk/long-read/guidance-to-support-nhs-organisations-in-the-provision-of-single-sex-services-and-facilities/ — Text captured 23:43, 16 October 2026. 5,178 characters; text SHA-256 37b778b06216f9bf521eac77992b0f1b5e72647a9ef0e98201a1db270d5a9a54.
4. NHS England. Delivering same-sex accommodation. Publishing approval reference 000233. 14 September 2019; last updated 24 April 2025. Internet Archive copy captured 8 January 2026: https://web.archive.org/web/20260108233806/https://www.england.nhs.uk/long-read/delivering-same-sex-accommodation/ — Read in full; text captured and saved by 23:48, 16 October 2026. 30,488 characters; text SHA-256 b78b9133c2a1552dd197c7051c99317541a26b3da6d59eac140e1aa881f465b6. The original address now redirects to source 1.
5. Equality Act 2010, section 7; Schedule 3, paragraphs 26–28; Schedule 23, paragraph 3. legislation.gov.uk (current revised text) — Files retrieved 23:48, 16 October 2026. File SHA-256 (XML): s.7 26b7c2f76ba7a355ca44947e4e1a884abc05a38aa698e5705a3cdbe94c881456; Sch 3 c1e05a27d4ac63a484eea90d0bda7b6cf6b7d52dcb41eb2014856c534b6c8021; Sch 23 da55aa2c4cf75ae115f58326c2d7e6638a3e9eff952f653944367148e7cf1b1f.
6. For Women Scotland Ltd v The Scottish Ministers [2025] UKSC 16 (16 April 2025). https://supremecourt.uk/cases/uksc-2024-0042 — Judgment PDF retrieved 22:59, 16 October 2026, and read in full. File SHA-256 4f28da41cc23c84ef94252ffa4fd486fa69bf75fa83ab40f0c65ecdef31e1224. Paragraphs used: 215, 264–265.
7. Equality and Human Rights Commission. Equality Act 2010: Code of Practice for services, public functions and associations, 2026. ISBN 978-1-5286-6395-3. In force 5 August 2026. https://www.gov.uk/government/publications/equality-act-2010-code-of-practice-for-services-public-functions-and-associations-2026 — PDF (342 pages) retrieved 22:58, 16 October 2026, and read in full. File SHA-256 858859ba4a3b6e600b45e04be358c81cbf8ea186f65774a24ee0cfba6f581992. Publication page retrieved 23:34, 16 October 2026. Paragraphs used: 1.6, 2.49, 13.106, 13.115, 13.123, 13.130, 13.144, 13.148, 13.159, 13.162, 13.165, 13.168, 13.173–13.174, 13.179, 13.181–13.182.
8. Gender Recognition Act 2004, section 22. legislation.gov.uk — File retrieved 23:48, 16 October 2026. File SHA-256 (XML) 9dfaf50c9cdc04f4c31b791aba1860cf1bb61667bed05bf53bac3458a32ecbe2.
9. Information Commissioner’s Office. What is special category data? https://ico.org.uk/for-organisations/uk-gdpr-guidance-and-resources/lawful-basis/special-category-data/what-is-special-category-data/ — Retrieved 23:48, 16 October 2026. File SHA-256 eeb506608b6374ead114497cde401368fd282ce2b045a526e58ccbbf4bfa494f. The version checked showed a “Latest update” of 9 April 2024 and a notice that the guidance is under review following the Data (Use and Access) Act. Read: the page itself only.
10. Department of Health and Social Care. The NHS Constitution for England. Last updated 17 August 2023. https://www.gov.uk/government/publications/the-nhs-constitution-for-england/the-nhs-constitution-for-england — Retrieved 23:27, 16 October 2026. File SHA-256 9fed9320fd34812c88c858bd38c0a82ef13e5c933a8464d9d758b25767bc6823.
11. Health Services Safety Investigations Body. Mental health inpatient settings: Creating conditions for the delivery of safe and therapeutic care to adults. Investigation report, published 24 October 2024. https://www.hssib.org.uk/patient-safety-investigations/mental-health-inpatient-settings/investigation-report/ — Retrieved 23:48, 16 October 2026. File SHA-256 b642986ac2efc6561d656af94bb33925a7f54e7b3da5150d2ba193644736b106. Read: executive summary findings; section 4.2.5–4.2.12; recommendation R/2024/041.
12. Health Services Safety Investigations Body. Safety recommendations log: Mental health inpatient settings (R/2024/041). https://www.hssib.org.uk/safety-recommendations-log/mental-health-inpatient-settings-5/ — Retrieved 23:26, 16 October 2026. File SHA-256 19e2944b9ae9032c81a387631d225f3ae485ae574a948036ff05c509043bbfc6.
13. NHS England. Mixed-sex accommodation (statistics). https://www.england.nhs.uk/statistics/statistical-work-areas/mixed-sex-accommodation/ — Text captured 23:44, 16 October 2026. 4,149 characters; text SHA-256 77e6d87a79ef194a1d13c3f409a512c609de90b52302d25c7ec4d8dd40eebd2f. Re-checked 02:44 and 03:48, 17 October 2026: text hash unchanged. Linked file NHS England, Monthly Mixed-Sex Accommodation Return: Collection Guidance, version 1.5, “Updated: October 2019” (MSA-Guidance-v1.5.pdf, https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2025/05/MSA-Guidance-v1.5.pdf): 173,979 bytes; file SHA-256 138cf261eb1ab21757fad2db8a627080dc4c1503681c9cb0eb283b14f69cac21. Retrieved 17 October 2026 and read in full (file hash re-checked unchanged at 03:48): unnumbered cover plus six numbered pages (seven PDF pages). The statistics page also links to a breach rate indicator methodology (June 2025) and an NHS England Digital collection page; neither was examined, and the latter could not be read.
14. Bertuzzi A, Martin A, Clarke N, Springate C, Ashton R, Smith W, Orlowski A, McPherson D. Clinical, humanistic and economic outcomes, including experiencing of patient safety events, associated with admitting patients to single rooms compared with shared accommodation for acute hospital admissions: a systematic review and narrative synthesis. BMJ Open. 2023;13(5):e068932. doi:10.1136/bmjopen-2022-068932 — Full text retrieved from Europe PMC (PMC10163491), 23:27, 16 October 2026. Cited only for its stated conclusions, and not appraised.

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