Huge uncertainty exists over whether trusts will be able to comply with health secretary Alan Johnson's new diktat on mixed sex accommodation.
Mr Johnson announced last week that trusts with mixed sex accommodation - outside of a limited set of exceptions - would be fined a proportion of their income from April 2010.
However, managers told HSJ that where buildings were not suitable and could not easily be adapted it might be difficult and costly to change them.
One director at a foundation trust in the East of England told HSJ that issuing a new national directive was overly simplistic.
"It is so dependent on your building stock," the director said. "I disagree with the way it is being presented nationally. It is being presented as a simple issue."
Buckinghamshire Hospitals trust chief nurse Sarah Watson-Fisher said while the issue was being given "the highest priority", her trust faced difficulties implementing single sex wards at one 1960s-built building.
Less than ideal
Compliant accommodation is being provided on a bay-by-bay basis which is "less than ideal" while the trust explores other options, she said.
NHS Confederation policy director Nigel Edwards said: "I'm not sure we've got a complete understanding of how big the issue is. One of the first things we would like is the DH to get a handle on that.
"No one is arguing this is not a laudable aim but it is complex."
Mr Edwards said trusts increasing capacity to meet the target would face higher revenue costs on top of capital, which were not funded.
The announcement did not necessarily amount to a new target, he said, but added: "It does seem it is a stiffening of the [requirement to reduce mixed sex accommodation in the] operating framework."
Bromley Hospitals trust chief executive Chris Streather said ability to meet the directive would vary: "It is easier for us as we have got a quite nice PFI [hospital], although it is not simple anywhere.
"Some places with a more tired and older estate, or where they have a greater number of highly specialised units, have a bigger problem."
The government has told trusts to submit proposals for meeting the requirement to strategic health authorities, with ringfenced capital funds to be allocated in April.
Mr Johnson said: "I recognise there are real, practical difficulties that some trusts need help to overcome and the new£100m fund will help provide the support they need."
CONQUERING THE DIVIDE
Exceptions include accident and emergency and intensive care.
Sleeping should be segregated by fixed, solid partitions.
Separate toilets and bathrooms should be accessible without passing patients of the opposite sex.
Sight and noise contact between areas should be minimised.
Improved scheduling of bed use could solve the problem without new buildings.
Source: DH 2008