Why the government must act on the Sullivan Review and fix the sex data problem urgently

The long-awaited report of a review of data, statistics and research on sex and gender commissioned by the government has been published.

The 226-page review by Professor Alice Sullivan of University College London sets out in careful detail the grave problems with official data in areas including health, justice, education and the economy.

The review finds that public data is in a mess. Many public bodies have stopped collecting data on sex, often replacing it with self-declared gender identity or a confused, undefined hybrid of gender identity and sex. This is the result of a series of successive shifts in public administrative records and surveys, with biological sex first labelled “gender” and then replaced by self-identified identity. 

The review includes a four-page summary and independent legal advice that supports its recommendations (appendix 1 of the full review).

The Sullivan Review focuses on the collection of data to support scientific research and effective policy-making. It also highlights the operational risks caused by data systems that confuse sex and gender identity. In some cases, the loss of data on sex poses risks to individuals. 

Sex Matters welcomes the Sullivan Review. Its CEO Maya Forstater says:

“This review is devastatingly clear about the harms caused by carelessness with sex data and a decade-long failure of the civil service to maintain impartiality and uphold data standards. The destruction of data about sex has caused real harm to individuals and research, and undermined the integrity of policy-making.

“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.

“These corrupted data standards have been set by bureaucrats insulated from the impact of their decisions, and competing for Stonewall awards.

“The government should swiftly implement the recommendations of the Sullivan Review in order to restore administrative integrity in every place the state collects data on the sex of its citizens.”

Healthcare 

The review shows that data on biological sex is entirely missing from the NHS patient demographic database.

At birth, every baby’s sex is recorded and the baby is given an NHS number (a CHI number in Scotland). But throughout the UK, individuals can change this marker on request and will be given a new NHS number. There is no requirement for any diagnosis, treatment or surgery.

NHS National Services Scotland confirmed:

“No evidence is required; the patient simply needs to advise either their GP practice or Practitioner Services that they wish to change their gender.”

There is no minimum age for a child’s gender marker and NHS number to be changed. Parents can change the gender marker and NHS number of their child through their GP. 

A paediatrician and safeguarding expert provided the following example:

“There was a paediatrician who brought a case to me for advice as they were having difficulty in engaging Children’s Social Care with a child who was presenting at primary school with behavioural difficulties. The child had been brought up in the preferred gender of the mother which was different to their birth assigned gender. She had gone to the GP and requested a change of gender/NHS number when the baby was a few weeks old and the GP had complied. Children’s Social Care did not perceive this as a child protection issue.”

GP practices are told that when a patient changes NHS number, they should print out the patient’s previous health records, redact the previous name and number, scan all this information and attach to their new NHS number. This slow and cumbersome process creates a significant workload for administrative staff and risks losing crucial health information. Not all health information is shared with GP practices. Patient data connected to the old NHS number will be lost, and this can include information relevant to child safeguarding. 

The NHS’s failure to record biological sex on patient records has led to trans patients not being called in for screening for conditions that may affect them due to their sex. This has potentially fatal consequences for trans people.

Policing

Many police forces record crimes by male suspects as though they were committed by women at the request of the perpetrator or based on how a person “presents”. 

Home Office Standards (ADR 153) on demographic data advise police forces to record sex subject to a gender-recognition certificate. Other mandatory Home Office Standards for police forces state that officers should record perceived gender, as male, female, or “other”.  The NPCC POLE (Person, Object, Location, Event) standard for operational policing recommends collecting data on gender, with a range of identity-based response options.

Police Scotland has confirmed that in cases of rape or attempted rape: 

“if the male who identifies as a woman were to attempt to or penetrate the vagina, anus or mouth of a victim with their penis, Police Scotland would record this as an attempted rape or rape and the male who self-identifies as a woman would be expected to be recorded as a female on relevant police systems.”

The review raises concerns that the classification of a small number of males within the female category may result in a significant artificial increase in female offending rates. Misclassification by sex may also carry operational risks, for example in relation to the accuracy of search fields. The review points out that guidance notes for officers on the Police National Computer (PNC) system note that:

“It is ‘quite possible’ that an arrested person who has acquired a GRC and not informed that police ‘could be released or otherwise dealt with before any link to their previous offending history is known (through confirmation by fingerprints). This is also likely to be true of those who self-declare a different sex and name.”

Organisations do not understand the law

The study commissioned independent legal advice, which confirmed that it is lawful to collect data on sex. 

This directly contradicts a recent statement made by Peter Kyle, Secretary of State for Science, Innovation and Technology, during the ongoing debates about the treatment of sex in digital identity records. The minister said that ensuring that accurate sex data can be verified in the new digital identities system would mean “passing on an excessive amount of personal data” and that this would be incompatible with human-rights law. 

On the contrary, as the independent legal advice says, the current practice of asking questions that are unclear or mix up sex and gender identity exposes organisations to legal risks of breaching data-protection law.

Key recommendations

The recommendations of the Sullivan Review include: 

• Across public services, the default target of any sex question should be sex. The word “gender” should be avoided in the wording of questions, as it has multiple meanings.

• The NHS should cease the practice of issuing new NHS numbers and changed “gender markers” to individuals, as it puts individuals at risk regarding clinical care, screening and safeguarding, and undermines research. This poses a particularly serious safeguarding risk in the case of children, and should be suspended as a matter of urgency.

• The Home Secretary should issue a mandatory Annual Data Requirement (ADR) requiring the 43 territorial police forces of England and Wales and the British Transport Police (BTP) to record data on sex in all relevant administrative systems. Police forces should also cease the practice of allowing individual sex markers to be changed on the Police National Computer (PNC) system.

• Public bodies should strive for transparency, openness and accountability regarding the development of changes in data collection policy and practice. The names of leaders and members of groups working on such questions should be made public. Organisations should maintain a clear audit trail of all those who have been consulted on their data-collection practices, both individuals and organisations: anonymity should be granted to individuals only under exceptional circumstances. Transparency, openness and accountability are particularly important in the case of national statistical bodies, which are seen as developing “gold standard” questions and data.

The government should adopt these recommendations as a matter of urgency, as it has done with the findings of the Cass Review.

Sex and the Data Bill 

The Sullivan Review is a timely input to the Data (Use and Access) Bill, which is currently going through Parliament. 

The bill will legislate to allow a single “information gateway” to be established, which will allow public authorities to share reliable personal data with private-sector digital verification services, based on individuals’ consent. 

The Sullivan Review reveals and describes problems with public data that have been ten years in the making. The problems are distributed across dozens of government departments and public bodies, and will require leadership to solve. Making this happen will require immediate action from the Health Minister, the Home Secretary and many others in government. 

Peter Kyle, whose department commissioned and published the report, now has the opportunity to provide a coherent response via the Data (Use and Access) Bill. He needs to ensure that this new system for collecting and verifying sex data across the public and private sectors is fit for purpose. It is crucial that his department does not ignore the problem that has been so meticulously documented by Professor Sullivan and her team.

Professor Sullivan is a member of the Sex Matters advisory group.