(2) with reference to his announcement of 28 January 2009 on mixed-sex accommodation in the NHS; how many improvement teams there will be; what the size of each team will be; how much will be allocated to each team; what qualifications members of teams will have; and to which hospitals the teams will provide support;
(3) with reference to his announcement of 28 January 2009 on mixed-sex accommodation in the NHS, how he plans to create a greater focus on measuring and improving patient experience of mixed-sex accommodation.
The Government are committed to reducing mixed sex accommodation to an absolute minimum. This means that men and women should not share sleeping accommodation unless this can be justified by their need for treatment. In mental health units, this should never happen.
We have recently announced a package of measures as follows:
a £100 million ‘Privacy and Dignity Fund’ to support improvements—with changes using this money expected to be implemented by no later than June this year;
tough financial penalties for those hospitals who do not deliver, (to be introduced from 2010-11); and
the establishment of improvement teams to go into those hospitals that need more support, to help them focus on improving patient experience in this area.
We know from our success in driving down health care associated infections (HCAIs), that the improvement team approach has a good track record in delivery. We are therefore setting up a short-term central improvement team for mixed sex accommodation with an expected life of around six months. The intention is that thereafter responsibility will be devolved to the NHS. The fine details of who will be employed in the teams, and how they will be deployed will depend on local needs, and are currently being developed.
Funding from the privacy and dignity fund will not be specifically attached to improvement teams, rather it will be distributed against detailed plans drawn up by each SHA. Distribution of resources within SHAs will be based on those schemes that demonstrate the greatest return for the planned investment.
Our existing definitions in respect of the environment are still relevant, and are set out below. However, we have expanded this to move towards a definition based on individual patient experience, rather than on buildings.
It is not acceptable for people to share sleeping accommodation unless it can be clinically justified for each patient. Some of the circumstances in which this might apply are as follows:
patient needs very high-tech care, with one-to-one nursing (e.g. ICU, HDU);
patient needs very specialised care, where one nurse might be caring for a small number of patients and cannot safely leave the room other than for very short periods (e.g. immediately following major surgery); and
patient needs very urgent care (e.g. rapid admission following a heart attack)
Inevitably, applicability of the above circumstances calls for a fine judgement that needs to be made on an individual basis. For instance, in a four-bed bay, it means that mixing must be justifiable for all patients, not just one. It is also a judgement that needs to be revisited regularly—for example, in the very early stages following a stroke, when the patient has reduced consciousness and needs regular observation, then mixing might be justifiable. However, in the later stages of recovery, when the patient is receiving rehabilitation (or palliative care), then we would expect greater segregation.
Men and women should not normally have to share sleeping accommodation or toilet facilities. Irrespective of where patients are, staff should always take the utmost care to respect their privacy and dignity.
Single-sex accommodation can be provided in:
single-sex wards (i.e. the whole ward is occupied by men or women but not both);
single rooms with adjacent single-sex toilet and washing facilities (preferably en-suite); and
single-sex accommodation within mixed wards (i.e. bays or rooms which accommodate either men or women, not both; with designated single-sex toilet and washing facilities preferably within or adjacent to the bay or room).
In addition, patients should not need to pass through opposite sex accommodation or toilet and washing facilitates to access their own.
There are no exceptions to delivering high standards of privacy and dignity. The exceptions established under ‘Mixed-sex accommodation: Health Service Circular 1998/143’ were reporting exceptions only, and no longer apply.