The Sandie Peggie case has revealed the cowardice at the heart of the NHS

Four months, and at least a quarter of a million pounds on since the Supreme Court ruled against Scottish ministers in the For Women Scotland case on the question of what a woman is in terms of the Equality Act, the government and its public bodies continue to go rogue.

With short-life working groups reportedly being set up all across the public sector to consider the apparently taxing conundrum of who can use which facilities and when, Scotland’s public bodies, it seems, went into a tailspin at being told that ‘sex’ in the Equality Act refers to biological sex and that a woman is an adult human female. It’s a clear legal fact that was long overdue and should not have required any practical adjustments to the provision and delivery of existing facilities and services.

But this is what happens when you see everything through the prism of one protected characteristic alone and by dint find yourself on the wrong side of the law when the law is confirmed.

From the astonishing claim by Museums of Scotland that it might have to close some of its establishments because it can’t always guarantee a toilet for trans people to the Scottish Government calling for the Equality and Human Rights Commission to write updated guidance to allow for trans-identifying males access to single-sex spaces provided for vulnerable women who have been victim to domestic violence, sexual assault and trafficking, there is a wilful refusal to accept reality (on so many levels).

It feels like madness to be having to state this in 2025 in a country that says tackling violence against women and girls is a top priority, but single-sex spaces are there for a reason: to protect the safety, dignity and privacy of women against men. Everything else is hyperbole. It’s trying to ride two horses at once.

And it is symptomatic of the shameless audacity of the SNP government that now sees itself above the law as it stubbornly clings to the former first minister’s uncompromising desire for gender self-ID to be the law, a fixation that has been inculcated into the governance of every public body across Scotland, branded opponents bigots, created a culture of ignorance and prejudice – that puts the wishes of men who feel that they are women above those who actually are – and has run roughshod over the constitutional law of the land while proclaiming it is progressive to just be kind.

And it is being played out in real time in the Sandie Peggie vs Fife Health Board and Dr Beth Upton employment tribunal which lays bare the capture of our public bodies by an ideology that puts gender identity above the reality of biology, and at the same time, cocks a snoot at the Supreme Court. 

Never could this have been more ridiculously exposed than in the NHS, where medical professionals have boxed themselves so far into the gender identity corner that they are having to spout lies about their own biology, never mind everyone else’s. The Peggie case has torn back the byzantine layers of management within the NHS and revealed a cowardly culture where well-paid senior staff were operating under the principles of herd thinking, overlaid by an over-enthusiastic willingness to take one side. There was no policy, there was no risk assessment, there was no consent sought, there was just a voracious appetite to readily accept a man’s word over a woman’s without even having the grace to seek the latter out.

If Dr Upton was being used as a trans cause célèbre then all Fife health board has achieved is to prove what women have known all along, that when they say ‘no’ to a man, it is them that end up being punished.

For saying it was wrong that she had to share a female changing room with Dr Upton, a trans-identifying man, Peggie, a nurse with a 30-year unblemished record, was suspended. She was told she could use a toilet to change, could move department, could change from night to day shifts, or work in another hospital. Consultants even debated reporting her to the police. 

In any other scenario, it would have been the police called on when a man insisted on being present in a facility for women. But from doctored notes to broken confidentiality, to rewritten press statements, to ridiculous claims from clinicians about chromosomes, to an exclamation mark being described as a sign of zealotry, and finally, to the scurrilous attempts to brand Peggie a bigot, a homophobe and undoubtedly a racist – where have we heard that phraseology before – this has been an exercise in shaming a woman for requesting her rights be upheld. 

Well. Thank God for Sandie Peggie. The Isla Bryson case may have been the first to bring the consequences of self-ID into the public consciousness, but Peggie has shown how an extraordinary thing could be done to an ordinary woman. And it is the ordinariness of the Peggie case that has jolted the public into the shocking realisation that our government, despite all its many warm words to the contrary, is not on the side of women. 

The whole point of the Supreme Court judgment was to make it absolutely crystal clear that ‘sex’ in the Equality Act refers to biological sex, that a woman is an adult female, and that as soon as you introduce male-bodied people into a single-sex space it is no longer single sex, it is mixed. This isn’t an attack on trans people, but it is about recognising that men are, and always have been, a threat to women and while they are individually welcome to push the boundaries of what it might mean to them personally to be a man, it will never make them a woman. 

As Peggie’s barrister, Naomi Cunningham, put it so eloquently during the tribunal, a man who says he is a woman is not making a request for you to accept him as he is, but he is making a demand for you to accept him as he is not. It is a delusion and never has that felt more incongruous than in a health setting. 

And there is just one salient point here which underpins all that has unfolded – if Upton really was a woman, Peggie would have had no cause to object to sharing a space for women with her and Scotland wouldn’t currently look so much like a fool living in a fool’s paradise, where a former first minister can contend that a man who says he is a woman could “probably forfeit the right” to call himself a woman if found to be rapist. Make it stop.