Flawed Biological Sex Data in Public Records Puts Health Care and Justice at Risk, Review Warns

Research shows that confusion between ‘sex’ and ‘gender’ in public records is undermining the reliability of government data.

A gender neutral toilet in an office building in the City of London on 11 Jan. 2024 Yui Mok/PA

Recording public sector data based on self-declared gender identity instead of biological sex could have serious implications for health care and criminal justice, an independent review has warned.

The nationwide review, led by Professor Alice Sullivan of University College London, found that terms such as “sex” and “gender” are frequently used interchangeably, creating inconsistencies in how data in public bodies are collected and reported.

This, the report argues, has led to a “widespread loss of data on sex” across key policy areas. Researchers examined over 800 administrative and research datasets and found that in some cases, the loss of data on sex poses risks to individuals.

“This is particularly apparent within health and social care. These risks are especially high in the case of minors,” the review found.

It said that NHS records often focus on gender identity instead of biological sex, causing some patients to miss important health screenings, like cervical smear tests or prostate exams. In some cases, this approach to data collection led to delayed cancer diagnoses.

Lab results were also misinterpreted owing to missing sex-based data, leading to incorrect medical assessments. The report warned that this poses a “serious safeguarding risk,” especially for children and vulnerable patients.

To fix this, the review recommended that the NHS stop changing a person’s recorded sex after they undergo gender surgery. Instead, it suggested recording both sex and gender identity separately to protect patient safety.

Health Secretary Wes Streeting said the findings highlight the need to record biological sex “not just for research and insight, but also patient safety.”

He added that recognising sex in data collection “does not prevent us from recognising and respecting people’s gender identity” and confirmed that the government will take action.

Justice and Crime Data Concerns

Some police forces classify crimes committed by male suspects as female offences if the suspect identifies as a woman. This has led to concerns that female crime rates could appear higher than they really are, the review warned.

There are also risks in police investigations. Officers may not be aware of a suspect’s past criminal record if their sex has been changed in police systems. This could lead to offenders being released without proper checks, the review found.

One example highlighted in the report was from Police Scotland in 2021. The force confirmed that if a male suspect who identifies as a woman commits rape, the crime would be recorded as a female offence.

The review also found that some government surveys, such as the Royal Navy Sexual Harassment Survey, do not ask about biological sex, only gender identity.

A registration form and a stethoscope at the Temple Fortune Health Centre GP Practice near Golders Green, London, on Sept. 10, 2014. Anthony Devlin/PA

Similarly, the NHS Staff Survey stopped collecting sex data in 2017, instead allowing people to select “non-binary” or “prefer to self-describe.”

To address these issues, the review urged the home secretary to require all police forces to record biological sex in crime data.

Shift in Data Collection Practices

The report showed that data collection has changed over the past 30 years.

In the 1990s, “gender” started replacing “sex” in records, and in the last decade, many organisations have either combined sex and gender identity questions or replaced sex-based questions with gender identity ones.

Sullivan’s team found that some surveys still record sex as “male” or “female” but also offer extra options like “other.”

The report said this does not meet official data standards, which state that sex and gender identity should not be used interchangeably.

Scottish Conservative MSP Tess White called the report’s findings “alarming,” stating that women and experts have been raising these concerns “for years.” She urged the Scottish Government to act, insisting that “gender and sex should not be conflated.”

Maya Forstater, chief executive of the charity Sex Matters, said the review is “devastatingly clear about the harms caused by carelessness with sex data.”

“The problems are everywhere, from NHS records that do not record biological sex to police forces that record male sex offenders as women. Conflating sex and gender identity is not a harmless act of kindness but a damaging dereliction of duty,” she said, calling on the government to implement the review’s recommendations.

A government spokesperson said that the collection of accurate and relevant data is “vital” in for public services, particularly when it comes to sex.

“We are grateful to Professor Sullivan for her work, which has been shared with relevant government departments and public organisations, including the ONS [Office for National Statistics],” the spokesperson added.

PA Media contributed to this report.