With the health secretary effectively fining hospitals that are still using mixed sex wards from 2010, action is needed now to segregate patients says Daloni Carlisle

In January 2009 health secretary Alan Johnson announced a get tough policy on single sex wards. From 2010-11 hospitals will not be paid for care delivered in a mixed sex environment unless there is an overriding clinical justification.

Eliminating mixed sex wards has proved one of the most intractable problems facing the NHS since Labour came to power. But although they are still common there has been strong progress, and there is now a wide range of advice and guidance on how to tackle it.

When the Department of Health claimed in 2006 that 99 per cent of patients were treated in single sex “accommodation” (note the change from mixed sex “wards”) patients did not agree.

A 2007 inquiry by chief nurse Christine Beasley got to the bottom of the disagreement. Trusts were designating bays in mixed wards as single sex, even when they were only separated by a curtain. By this measure, one in five trusts were still treating patients in mixed sex wards. This was confirmed by the Healthcare Commission’s National NHS Patient Survey 2007, which showed that 24 per cent of nearly 76,000 patients reported sleeping in a room or bay beside patients of the opposite sex on their first night in hospital.

Promoting privacy

Ms Beasley’s report set out the DH’s expectations. Practical actions it recommends include:

  • consider creating entirely single-sex wards. This is easiest in large specialties that already have more than one ward;
  • consider combining small specialties to deliver single-sex,mixed-specialty wards;
  • set local targets for transfer of patients from admissions or other units that are mixed;
  • focus on wards with many older patients or where conditions are gender-specific;
  • record and analyse admissions to understand the gender mix;
  • plan ward configurations accordingly;
  • make issues of privacy and dignity fundamental to staff induction and training;
  • use Essence of Care benchmarking to audit and improve privacy and dignity.

When segregation cannot be achieved, Ms Beasley suggests a focus on maximising dignity and reassuring patients everything possible has been done.

Every episode of male and female bed mixing should be explained and apologised for and a greater staff presence ensured. Respect must always be maintained, such as keeping curtains around patients and not entering if curtains are closed.

Men and women should be at opposite ends of the room, the toilets segregated and some single sex bays provided. As well as setting and publishing local standards on mixing and targets for improvement, the organisation should record all episodes of mixing.

Johnson gets tough

When the chief nurse completed her report, she commissioned the NHS Institute of Innovation and Improvement to develop checklists on dignity and privacy that cover mixed sex accommodation and help trusts carry out a self assessment.

The key factors fall into three areas: support from the board, which needs to understand and back the policy; physical environment, which needs to be organised to support privacy and dignity; and actions of individual staff, which need to support privacy and dignity.

It contains good practice examples. For instance, some trusts have analysed admissions by gender and speciality and found they can reorganise beds to provide better separation. Sheffield Teaching Hospitals foundation trust, and Hull and East Yorkshire Hospitals have begun to look at their admission and bed data in this way.

Other trusts have reported each episode of mixing of the sexes as an untoward incident, or categorised their complaints and incidents to highlight issues of gender separation. This can be reported at board level.

Privacy questions

  • Is your board committed to improving privacy and dignity?
  • Does your board understand what patients want and endeavour to deliver it?
  • Does your board understand the trust’s performance and set local goals for improvement?
  • Does your board allocate resources to preserving and improving privacy and dignity?
  • Do all staff follow privacy and dignity guidelines?
  • Do staff apologise for any mixing and keep patients and visitors informed about actions to solve the problem?
  • Do staff have channels to report mixing to the board?

Out of the mix

Maidstone and Tunbridge Wells trust’s new hospital at Pembury will have 100 per cent single rooms when it opens in 2011 - and help to eliminate mixing of sexes on wards in the trust.

Patients who prefer to be in wards with other people will be able to state a preference for bay accommodation at other trust sites. Though the trust will not go fully segregated till the new hospital opens, it has been undertaking building work to improve ward layouts and raise the availability of single rooms.