The BBC, like all other news outlets, has let the 'single sex' wards 'scandal' obscure the real problem with hospital wards. Here's the news item:
Row over mixed-sex hospital wards
The government has been accused of failing to meet a promise to scrap mixed-sex wards in NHS hospitals.
The Department of Health said its targets had been achieved, and 99% of trusts are providing single sex accommodation.
But patients groups said they were getting an increasing number of calls from people who think they have been in mixed-sex wards.
There appears to be confusion about the definition of the term.
Katherine Murphy, from the Patients Association, said there had been 25-30 calls in the last month to the charity's helpline, mostly from elderly patients, who had been nursed on mixed-sex wards.
Andrew Lansley said it was not acceptable to claim that partitioned single-sex bays on mixed-sex wards were doing the job.
"It you can be seen by patients of another sex, and they are coming and going past your bed in order to go to the toilet facilities you may not think you have the privacy you want."
The government pledged to scrap mixed-sex wards when it came to power in 1997.
Health Secretary Patricia Hewitt said most trusts offered single-sex wards, but said more could be done.
She conceded that patients' experience did not seem to tally with reports on progress from hospitals.
And she said she had asked Strategic Health Authority bosses to carry out checks.
However, she said it was not feasible to expect hospitals to provide single sex facilities in an medical admissions unit, where doctors assess emergency cases before deciding what action to take.
She said that would increase the risk that a patient in dire need could be turned away, simply because they were the wrong sex.
"Most wards in most hospitals do now provide single-sex accommodation and single-sex bathrooms.
"But it is clearly not happening everywhere, and it cannot happen everywhere in those emergency situations, like medical assessment wards, because we cannot have a situation where you turn away a woman because you have only got a male bed left."
Mrs Hewitt also accepted that the use of partitioned areas on mixed-sex wards was "not good enough" - but increased patient choice would give people the chance to vote with their feet.
"We have eliminated most of the mixed-sex wards that used to exist, but there is still more to be done."
I have experience of both single sex and mixed sex wards. Mixed sex wards do not allow patients as much dignity as single sex ones, especially when you add the 'hospital gown' factor. But there is something else going on here.
At Birmingham Accident Hospital (sorry, can't stop mentioning it!) we had single sex wards throughout, with the exception of the intensive care unit (where patients were unconscious and treated entirely behind curtains anyway), and the Burns Unit (where patients were in individual rooms until they were pretty much recovered). This was partly down to the set up of the wards: they were usually 'Nightingale' wards - those big long wards with beds either side.
This included the 'emergency assessment' wards. I do remember there were very occasional incidents where a patient would be in the ward of the 'wrong' sex for one night, in the same way that very occasionally a child would have to stay overnight in an adult ward. This happened once a year, if that. Certainly there was never any question that someone would be turned away for being the 'wrong' sex.
So how were we able to do this almost 20 years ago, yet it is not possible in the 'new improved' NHS? It all comes down to 'efficiency': meaning 'cuts'.
The NHS in 1997 worked on approximately 80 per cent bed occupancy rates. Now it is officially 85 per cent, probably because this is the occupancy rate that should not be exceeded if infection rates are to be controlled, but anyone who's been in a hospital recently will have seen more gold dust than empty beds. As a result of this (and other genuine efficiency improvements such as better community care and keyhole surgery) bed numbers have fallen by a third: meaning less nurses needed. This also means that single-sex bays within mixed wards have become the norm, because it gives more flexibility when maximising bed occupancy, whilst theoretically not requiring more nursing staff. Even so, most nurses will concede that it isn't unusual to have a person spending a night in a 'wrong sex' bay.
Victorians knew a thing or two about ward design. A Nightingale ward, for all its aesthetic failings, is an efficient environment to treat patients in. All the patients are in full view of the staff: and staff are in the view of their patients, which is comforting for them. (Of course, staff can see eachother all the time too, which turns out to be quite useful when staff are so demoralised that they sag off for a fag or a gossip at the drop of a hat.) Air circulates freely, and minimises droplet infection. There are no difficult nooks and crannies to clean. All this goes out of the all-too-often-jammed windows when you change to bays.
Of course, lack of privacy is the major drawback of Nightingale wards. Single sex wards are therefore a must, as are different types of wards for long-term care. Best practice here is differing sizes of rooms with bathrooms, up to a maximum occupancy of four (of the same sex). Bays, expecially for the elderly, are no substitute.
But for this to happen, nurse numbers would need to increase to maintain the same (currently poor) level of care.
So all this fulmination about mixed sex wards is really missing the larger point that this problem, like that of spiralling infection rates and poor care for the elderly, is down to government 'efficiency' targets.
As far as I can see, the day that Patricia Hewitt and Tony Blair understand and have experience of how to care for a ward full of elderly demented patients is the day that politicians have the right to set an elderly care target. And only when they've each spent a month in a mixed ward (a week on bed rest), wearing a hospital gown, can they can truly judge the effectiveness of their 'single sex wards' 'reforms'.
