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Guidance in brief

Privacy and dignity: eliminating mixed sex accommodation in hospitals

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An outline of the main points from guidance and checklists to help avoid, reduce and manage the mixing of sexes in acute and mental health trusts



The NHS Institute for Innovation and Improvement (2007) developed self-assessment checklists that aim to help individual trusts assess how well they are doing in meeting one of the rights enshrined in the NHS Constitution: that patients have a right to privacy and being treated with dignity.

One key area in promoting these is avoiding having men and women in the same NHS accommodation whenever possible. Mixing of the sexes can often be avoided, usually reduced and can always be managed better. But doing better requires understanding what is happening, and the institute’s checklists identify ways in which nurses can check their trusts are doing all they can to promote patient privacy and dignity.

The guidance outlines 11 good-practice principles, supported by examples of good practice, and these principles are categorised into three broad groups: the commitment of the board of directors; the quality of the care environment; and the actions of individual staff. The checklists - one for acute trusts and one for mental health trusts - follow the same basic groupings. This article summarises general principles for both and key points from the checklist for acute trusts.

A committed board of directors

Improvements in patient privacy and dignity require commitment and action from senior managers as well as from those on the frontline of clinical care.

Active support of efforts to improve patient privacy and dignity requires evidence of commitment by the board of directors. They need to understand what patients want and be aware of the trust’s performance against benchmarks. Boards committed to privacy and dignity need to allocate resources to maintain and improve this for patients and service users.

But managers need to know about any problems, so collating information on mixed sex/single sex accommodation, and other measures of privacy and dignity, is essential. Some trusts record each episode of mixing sexes as an untoward incident. Some analyse admission by gender, specialty and sub-specialty. This can help identify where problems are occurring, and where bed reconfiguration can make things better. In the long term it can help see where different clinical services can develop shared facilities for use as separate accommodation for men and women.

Complaints about privacy and dignity from patients and relatives are also a key indicator of quality in this area. Where trusts categorise complaints and incidents to highlight issues on mixed sex accommodation, this can be reported at board level to influence decision making.

The care environment

The physical environment strongly affects patient privacy and dignity, particularly cleanliness. The guidance stresses that just separating men and women is unlikely to be enough.

A consistently clean, well-maintained care environment, with good physical separation of sleeping accommodation for men and women, and segregated toilet and washing facilities all support patient privacy and dignity.

Simple improvements such as more robust partitions and longer and thicker curtains can all make a difference, and are highlighted in the checklist for acute trusts.

To prevent the overhearing of private details, private spaces should be available where patients can talk to staff or visitors.

Individual action

Nurses (or other staff) should apologise for all episodes of mixing the sexes, and keep patients and visitors informed about what is being done to solve the problem. Where mixed sex accommodation is unavoidable, patients should be moved to single sex accommodation within a specific time limit, ideally within 24 hours, but in any event within 48 hours, although some clinical exceptions are specified in the guidance.

Ward-based nurses in particular are in a good position to identify what is happening on the ground, and to ensure trust managers are aware of the incidence of mixed sex accommodation. Episodes of this should be reported through the appropriate channels, following local exception reporting arrangements.

It may well be nurses who receive complaints from patients and their relatives about mixed sex accommodation. Staff should respond effectively to concerns expressed by patients or visitors about privacy and dignity and mixed sex accommodation.

Using the checklists

The 36-item checklist for acute trusts and 37-item one for mental health trusts can be used to assess and audit trust performance – either of an entire hospital or of individual wards. Those using the checklist are asked whether the standard is always, sometimes or never achieved in their trust, and green, amber and red areas are identified in a “traffic light” system, familiar from other NHS assessment processes:

  • Green: an area of good practice which should be shared across the trust;
  • Amber: further work needed in this area with a recommended six-month re-audit cycle;
  • Red: urgent work required in this area. The issues should be reported through the trust’s governance arrangements. A three month re-audit is recommended.

The privacy and dignity checklist assessment should be led and overseen by a board director, carried out by a multidisciplinary team and should include patients or service user representatives.

AUTHOR Mark Pownall is a freelance journalist


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