NHS England slammed for relaxing single-sex hospital rules after fines for breaches were quietly dropped

Campaigners have accused the NHS of relaxing rules banning mixed-sex hospital wards by the back door, after financial penalties for non-compliance were quietly dropped from care contracts.

A flat rate £250-per-rule-break fine was previously enshrined in the NHS Standard Contract, used when commissioning care for patients in England, meaning hospitals could face steep penalties for consistent flouting of single-sex ward rules.

But the sanctions were quietly dropped from the contracts in a rewrite by NHS England last April – with one charity claiming patients were not asked for their views first.

All other financial sanctions designed to ensure adherence to quality of care measures were also dropped, including on long waits for cancer treatment or failure to check up on patients discharged from mental health facilities.

Mixed-sex wards were banned in England in 2010. There are similar rules in other UK nations.

But the Nuffield Trust, a health think tank, said rule breaches were “unfortunately very common” in the NHS before Covid – a symptom of “hospitals running close to capacity” – and had likely worsened during the pandemic.

It comes as NationalWorld revealed the number of mixed-sex accommodation rule breaches recorded by English hospital trusts last November reached a record high for that month.

The statistics, which are normally published monthly by NHS England, were paused during the pandemic so hospitals could focus on the Covid crisis.

Rachel Power, chief executive of the Patients Association advocacy group, said rule breaches may have been understandable during the emergency, if mixing sexes was “a viable route to saving lives”.

But she said the NHS must now aim to restore services to pre-pandemic levels.

“Permanently downgrading services for patients is not just unacceptable but, if it is snuck through in a quiet contractual change without even asking patients what they think, utterly outrageous,” she added.

“Mixed sex wards are an affront to patients’ dignity, and outside of emergency conditions the NHS must be renewing efforts to eliminate them, not giving up.”

Jemima Olchawski, chief executive of the Fawcett Society charity, said removing the fines “points to a lack of commitment” to single sex wards despite their “vital” importance for womens’ safety and dignity when at their most vulnerable.

“It’s deeply concerning to see violations of rules on single-sex wards rising,” she said.

“We need to see substantial investment in creating single-sex spaces in hospitals and more consideration given to women when it comes to health policy in general.”

While NHS England does carry out a consultation on changes to the contract each year, it has not responded to questions from NationalWorld on how widely the consultation is publicised, and if patient views are sought.

We also asked how it intends to enforce the rules, if hospitals do not face financial sanctions for breaking them.

A document published during the consultation said trusts were already being let off fines for breaching national quality standards, including on single-sex ward rules.

Advocates of single-sex wards have long argued the rules are necessary to protect womens’ safety and ensure the dignity and comfort of all patients at their most vulnerable.

NHS England guidance on maintaining single-sex provision – which still applies, despite the demise of penalties – says it is an “essential” part of the way trusts must operate to prioritise the “safety, privacy and dignity of all patients”.

Healthcare providers are expected to have a “zero-tolerance approach” to the issue, the guidance states.

Under the old system, trusts would have been potentially liable to fines worth £650,000 in November for breaching the rules – if Clinical Commissioning Groups (CGGs), which buy healthcare for an area’s population using the Standard Contract, had actually enforced them.

An NHS spokesperson said: “While continuing to treat both Covid and non-Covid patients safely, trusts across the country are also taking action to reduce or eliminate breaches which remain extremely rare.

“Offering single sex accommodation is a requirement under the NHS Standard Contract.”

Local healthcare commissioners are responsible for ensuring providers comply with national standards for care quality, they added.

This article was updated at 12pm on 28 January with a response from NHS England.

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