Ambulance workers in the Pride in London parade in July

The London Ambulance Service has called in a handwriting expert to trap NHS staff who scrawled on signs making lavatories, showers and changing rooms gender-neutral.

In addition, the service’s emergency operators have been told not to call people “sir” or “madam” and to refrain from using “Mr” or “Mrs” even if 999 callers request it. Internal forms now include the gender-neutral pronoun “Mx”.

The changes, aimed at helping transgender people, were revealed by Jules Lockett, head of emergency operations centre training at London Ambulance Service, and joint head of its lesbian, gay, bisexual and transgender network, at a conference in the capital.

Lockett said the service had faced down “bravado” to bring in gender-neutral lavatories, showers and changing rooms “across our stations”. She said: “We