FOI 2025/1458

Under the Freedom of Information Act, please supply the following information, with regard to Services and Facilities provided by your authority
I have 3 questions: –
Question 1. (Personal Information and Status Protection)
What arrangements have you in place under the control of the Integrated Care Board (ICB), within the Healthcare and other Services Provided by the ICB and Built Estate (i.e. NHS Services in all the hospitals and care facilities) to maintain the dignity, confidentiality and privacy of
A) Transsexual People who have a Gender Recognition Certificate (GRC) – see notes below
with respect to;
1) Patients? and
2) Staff? and
3) Patient Carers and Visitors?

and
B) those that are Protected under section 7 (gender reassignment – termed here for ease as GR or ‘transgender’) of the Equality Act 2010 (EA) – see notes below
with respect to;
1) Patients? and
2) Staff? and
3) Patient Carers and Visitors?
Question 2. (Single Sex Spaces)
If areas or facilities are designated as ‘Single Sex’,
a) how do you establish that ‘Sex’ – for Staff (Managers, Doctors, Nurses, Auxiliaries, Porters, Cleaners, etc), Patients, Carers or Visitors?
b) Is any ban of the opposite sex a ‘blanket’ ban with exclusions applying to some people (i.e Transsexuals), all people of the opposite ‘sex’ (patients, carers, staff and or visitors) or is it only applicable to Transsexual people? To whom does it apply?
c) If so, how do you justify this on a ‘proportionate means to achieve a legitimate aim’ basis, both on an individual basis and as a whole?
Question 3
Any ‘Equality and Health Inequalities Impact Assessment’ (EHIA) associated with any policies affecting transsexual people implemented or proposed since the SC Judgement in April 2025.

Notes:
1. There is a personal liability of all staff to protect, directly and indirectly the Gender history and Status of Transsexual individuals (with a GRC), as per section 22 of the Gender Recognition Act 2004 (GRA), when they find this out as part of their role. Especially, if this information is either; intentionally or inadvertently disclosed to; other staff (who don’t have a need to know), patients, visitors and members of the public. There are also similar organisational obligations and personal protections of personal data under GDPR.
2. There is no obligation for a Transsexual person (as defined in the GRA) to disclose their gender history/information, unless it is directly connected or relevant to, the medical procedure being investigated or treated.
3. The Transsexual status of an individual cannot be shared even within the hospital, either directly or ‘indirectly’, unless permission is given by the individual, on an approved need to know basis. – ‘indirectly’, an example of indirectly identifying a transsexual person would be by making the individual use a service of the wrong gender presentation or by being referred to by pronouns that do not match their Legal Sex and/or gender presentation. And as a consequence, either being overheard or seen to be using a service (by e.g. non-medical staff, other patients, or the public) that does not align with their legal sex or gender presentation.
4. GRCs are not available for public scrutiny and are not carried by the holder. The holder has a ‘corrected/re-issued birth certificate which again is not normally carried around in everyday life.
5. Treating transsexual people differently to others could be discriminatory, either through direct discrimination or indirect discrimination on the basis of Gender Reassignment, especially if they are singled out and treated less favourably than other people.
(reference Equality Act 2010 section 7). e.g. not permitting a transsexual patient on a single sex ward, but allowing staff, other patients, patient carers and visitors of both sexes into that same area. Proportionate justification could be problematic.
Supplementary Notes:
S1. Extracts from GRA section 22 – Prohibition on disclosure of information
(1) It is an offence for a person who has acquired protected information in an official capacity to disclose the information to any other person.
(3) A person acquires protected information in an official capacity if the person acquires it—
(a) in connection with the person’s functions as a member of the civil service, a constable or the holder of any other public office or in connection with the functions of a local or public authority or of a voluntary organisation,
(b) as an employer, or prospective employer, of the person to whom the information relates or as a person employed by such an employer or prospective employer, or
(c) in the course of, or otherwise in connection with, the conduct of business or the supply of professional services.
(4) But it is not an offence under this section to disclose protected information relating to a person if—
(a)the information does not enable that person to be identified,
(b)that person has agreed to the disclosure of the information,
(8) A person guilty of an offence under this section is liable on summary conviction to a fine not exceeding level 5 on the standard scale.
S2. A summary of section 7 The EA protects against several forms of discrimination based on gender reassignment:
• Direct discrimination: Treating someone less favourably because of their transgender status.
• Indirect discrimination: Having a policy that applies to everyone but disproportionately disadvantages transgender people. This can be unlawful unless the policy is objectively justified
• Harassment: Unwanted behaviour related to gender reassignment that creates a hostile, degrading, or offensive environment.
• Victimisation: Treating someone badly because they are Transsexual or Transgender or have made or supported a complaint of gender reassignment discrimination.
• Discrimination by perception or association: The protections extend to people who are wrongly perceived to be transgender or are associated with someone who is.
Important considerations:
• No Gender Recognition Certificate required: An individual is protected as soon as they propose to transition, regardless of whether they have a Gender Recognition Certificate (GRC).
• GRC Those with a GRC (transsexuals) under the GRA 2004, are legally the sex acquired under the GRA with a GRC and have additional protections.
• Sex vs. gender reassignment: The protected characteristics of “sex” and “gender reassignment” are distinct. A Supreme Court ruling in April 2025 clarified that for the purposes of the Equality Act, “sex” refers to biological sex, separate from legal gender recognition through a GRC. Yet there is no legal definition of said sex, other than in that judgment as pertaining to be as designated at birth i.e. on a birth certificate.
• Exceptions for single-sex services: The Act allows for exceptions in certain circumstances. Providers of single-sex services (e.g., women’s shelters or sports competitions) can exclude transgender people if it is a “proportionate means of achieving a legitimate aim,” such as ensuring fairness or safety.
• Non-binary and intersex people: In some situations, the gender reassignment protections may also cover non-binary people and those with variations in sex characteristics (VSC), depending on the specific circumstances.

NHS Greater Manchester (NHS GM) is the Integrated Care Board for Greater Manchester and is responsible for making decisions about health services across Greater Manchester and in the ten boroughs and cities. NHS GM does not provide health care to patients; therefore, you may wish to contact the Greater Manchester NHS Trusts in relation to their hospital sites and care facilities. To assist you please find below links to their websites and information about how to make a Freedom of Information request.

In line with our Public Sector Equality Duties, NHS GM will continue to have due regard to:

• eliminating discrimination, harassment, victimisation and any other conduct that is prohibited by or under the Act
• advancing equality of opportunity between persons who share a relevant protected characteristic and persons who do not share it
• fostering good relations between persons who share a relevant protected characteristic and persons who do not share it

The Supreme Court judgment in For Women Scotland Ltd v The Scottish Ministers [2025] UKSC 16 requires employers and service providers to review policies to ensure they reflect the legal position, which is a process we can confirm is underway in NHS GM. This will form part of our ongoing review for addressing any inequalities.  Any training or communication to staff, if identified need is established, will be undertaken where required and proportionate to do so.

The judgement also highlights the importance of sensitive and inclusive implementation, avoiding unlawful discrimination and maintaining a culture and provision for dignity and respect for all. NHS GM will continue to create an environment where individuals in our organisation and using our services feel valued, respected, and empowered to contribute fully.

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Stockport NHS Foundation Trust – Freedom of Information – Stockport NHS Foundation Trust

Tameside and Glossop Integrated Care NHS Foundation Trust – Freedom of Information Requests :: Tameside and Glossop Integrated Care (tamesideandglossopicft.nhs.uk)

Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust – WWL Teaching Hospitals NHS Foundation Trust | FOI Disclosure Log

The Christie NHS Foundation Trust – Freedom of information disclosure logs (christie.nhs.uk)

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Greater Manchester Mental Health NHS Foundation Trust – Freedom of Information | Greater Manchester Mental Health NHS FT (gmmh.nhs.uk)