Dementia Patients Should Be Challenged on 'Transphobia': NHS Report

Dementia Patients Should Be Challenged on 'Transphobia': NHS Report
An elderly patient is moved from hospital to a care home near Portsmouth, England, on May 5, 2020. (Leon Neal - Pool/Getty Images)
Patricia Devlin

Health bosses have been told that dementia patients should be challenged if they express “discriminatory” views towards transgender medical staff.

New NHS guidance on supporting trans and non-binary staff also states their relatives can be removed from health care settings if they do the same.

The newly released NHS Confederation report (pdf) also states that patients have no right to be told a health care worker’s assigned sex at birth or that they are trans or non-binary over discrimination fears.

Transgender health workers can also choose not to treat patients if they feel uncomfortable doing so.

The guidance, published in partnership with the LGBT+ Foundation, applies to all staff employed by NHS organisations in England, including community mental health and care professionals.

It advises that patients can only request care from a same-sex staff member in limited circumstances, such as if they are having an intimate examination.

It states that when a patient requests an employee administering care to be a woman or a man, “the comfort of the staff member should be prioritised.”

If a patient or relative refuses to be treated or cared for by a health care worker owing to the employee’s “protected characteristic of gender reassignment” with “no reasonable clinical merit” this, the report states, “may be direct discrimination or harassment.”

The guidance added: “It would likely be direct discrimination for organisation to accede to the request of the patient in this circumstance.

“Patients or relatives expressing any such views should be informed of the potentially discriminatory nature of their request, that such behaviour is unacceptable, and that their request cannot be accommodated as it has no reasonable clinical benefit.”


The guidance was put together following a survey of the 118 trans and non-binary individuals employed in England, according to the report.

It measured respondents’ experiences of inclusion and exclusion at work, transphobic workplace incidents, and the category of those involved in the incidents.

The survey also asked respondents to give feedback on certain types of workplace inclusion initiatives and whether they felt these to be useful, including more visible trans and non-binary role models in their workplace and different types of incident reporting procedures.

Fourteen of the respondents also took place in focus groups.

 A photo of an NHS logo taken on Nov. 6, 2010. (Dominic Lipinski/PA)
A photo of an NHS logo taken on Nov. 6, 2010. (Dominic Lipinski/PA)

The “Trans and Non-Binary Allyship in NHS Organisations” survey found that 55 percent of those surveyed reported experiencing transphobia during employment within the NHS in England.

The most common experience was “negative or stereotypical assumptions about your gender identity," it said.

A total of 41 percent said they had been verbally abused and 14 percent said they had been bullied on the grounds of gender identity.

Over 35 percent of trans staff said they faced bullying, harassment, and abuse by patients, public, or relatives, while 4.8 percent of trans staff faced physical violence at work from managers.

According to the report, the majority of “discriminatory or potentially discriminatory incidents” are perpetrated by senior colleagues and patients or relatives.

The report suggests having “workplace allies” in each health care setting to support trans and non-binary staff, and lays out guidance for those witnessing abuse or discrimination to colleagues on how to deal with and escalate the incident through a complaints process.

Patient Warning Letters

When dealing with patients or visiting relatives who abuse or discriminate against trans or non-binary staff, the report states they “should be informed of their right to receive care elsewhere, including moving to a different residential facility if necessary.”

“Depending on the duty of care to the patient, relatives or guardians may be removed from the premises.

"In some care settings, particularly primary care, receiving care elsewhere might not be possible, in these circumstances a note should be placed on the patient’s record so that they are not seen by the same member of staff again, this will also give reception staff the knowledge to book a different member of staff to see the patient in future.”

It said that colleagues should work flexibly to “accommodate this including completing clinical duties outside their usual role.”

It’s also suggested that a “formal letter” can be sent to the patient informing them of the organisation’s “zero tolerance approach to abuse and discrimination.”

“The colleague being targeted should be treated with respect and dignity by colleagues assisting them and should be given appropriate wellbeing support following an incident,” it states.

“If they no longer wish to treat or care for the patient or interact with relatives, this should be accommodated as far as reasonably possible.”

The report added: “If the discrimination or harassment displayed by a patient is due to an underlying condition such as dementia, they should still be challenged on their views where possible, and incidents should be documented.

“Encourage flexibility among your workforce to facilitate cis staff to care for the patient including asking staff to temporarily complete clinical duties outside their usual role.”

The guidance also states that if a trans or non-binary person wishes, they may be moved instead of the patient to a different department or facility “where possible."

This should only be explored at the staff member’s request, it added.

Writing in the foreword of the report, NHS Confederation Chief Executive Matthew Taylor said the guidance "comes at a time when public discussion around trans and non-binary identities is heated and divisive."

"However, we should not forget that every single member of the healthcare workforce deserves a safe and supportive working environment," he said.

“I hope that this guide goes some way to achieving that.”

Patricia is an award winning journalist based in Ireland. She specializes in investigations and giving victims of crime, abuse, and corruption a voice.