HC Deb 05 March 1979 vol 963 cc1056-66

Motion made, and Question proposed, That this House do now adjourn.—[Mrs. Ann Taylor.]

10.58 pm
Mr. David Atkinson (Bournemouth, East)

I am pleased to have the opportunity to raise a matter which has caused considerable concern to many people, namely, the problem of mixed wards in hospitals.

This may not be the most appropriate time for such a subject to be raised when there are over-long hospital waiting lists further aggravated by industrial action by hospital staff. One could argue that patients should count themselves fortunate to be offered any bed in any ward at this time. Nevertheless, there is growing evidence to suggest that the trend towards mixing the sexes in hospitals is taking place today at a speed and in a manner which is not wholly acceptable to the public, as the Minister will know from his own correspondence and from reports which he will have received from community health councils throughout the country.

I am aware that the practice of mixing the sexes in hospitals is not new. It applies to many, if not most, of our hospitals. Some good reasons exist for it. I do not object to them in principle. Mixed wards offer a more flexible system of management of hospital accommodation and a more efficient use of our resources, manpower and equipment, particularly with regard to intensive care units where patients are far too ill to be concerned about the company they are keeping. I agree that positive therapeutic advantages exist as a result of the socialising that it encourages, which helps to stimulate morale and thus provides for a more rapid recovery. In hospitals for the mentally ill, in particular, it provides a positive aid to rehabilitation.

The fundamental point is that entry into such a ward must remain for all time a matter of personal choice. That must be the prime criterion. There exists today worrying evidence that this is not always being applied. There is a real and growing fear and outrage that the proliferation of mixed wards will, in due course, eliminate any margin of personal choice.

Moreover, there are reports, which I believe the House cannot ignore, that, where sexes are mixed, in some hospitals conditions are being experienced and standards are being applied which constitute an affront to human dignity and which cannot be tolerated. Such a situation deserves the fullest investigation and consultation with area health authorities and, through them, the general public before we can allow the trend towards more mixed sex wards in our hospitals to continue.

Last October my local community health council in East Dorset received and discussed a paper on this matter which referred to the fact that Mixed units and wards are being introduced into specialties such as orthopaedics and geriatrics, where it is unacceptable for a num- ber of reasons. Firstly, there is no preadmission warning that patients will be entering a mixed ward or unit. Secondly, there is no choice for patients between mixed and non-mixed wards. Thirdly, some patients experience acute embarrassment performing toilet procedures in mixed wards. Fourthly, geriatric patients are expected to perform toilet procedures in mixed day rooms without adequate privacy, resulting in a loss of dignity for these patients. Finally, elderly female patients may be sensitive and upset by the sight of confused male patients wandering about mixed wards and day rooms partially or totally unclothed. I understand that a petition sharing the local community health council's concern about mixed wards is currently attracting hundreds of signatures in my constituency.

Last year, the Association of Nursing Practice, which is part of the Royal College of Nursing, concerned about the development of mixed wards, and after seeking evidence through the medium of the Nursing Standard in order to present a view representative of its profession, reached the conclusion that patients' attitudes, beliefs and wishes in this matter are not being taken into account and in some instances are even being disregarded. Also last year, the Health Service Commissioner upheld the complaint of a woman patient that privacy was inadequate in the mixed ward to which she had been admitted and said that he was not satisfied that adequate provision was made in the hospital concerned for those who found the arrangement distasteful.

A number of gruesome reports have appeared in the press or have otherwise come to light of violence and other disturbing behaviour in mixed wards, which would be intolerable by any standards and which I hope will always be subject to the most vigorous investigation whenever they appear.

Since it became known that I was to raise this matter tonight I have received many letters, from men as well as women, from young people as well as from the elderly, and not just from my own constituency—and I would not judge any of them as prudes. All the people who have written to me, save one, express gratitude that at last these problems and concerns are being brought to the attention of the House.

Many of them refer to their own experiences in hospital, stressing that never again would they be prepared to be treated in a mixed ward. Some even go so far as to say that they would refuse a hospital bed if it meant that they could not exercise freedom of choice of ward. One can understand their views when all they seek in entering hospital is to try to get well with maximum personal privacy and the preservation of human dignity.

Where there exists between beds nothing but scant screens or semi-transparent curtains, few patients are unlikely to be embarrassed or offended on being overheard discussing, or overhearing discussions on, intimate problems with a doctor or nurse, or by every sound associated with the calls of nature. I do not know whether men are prone to snore more uncontrollably than women or whether women are prone to chat more unceasingly than men, but if one is feeling really low it is a little late to find out from the behaviour of one's neighbour when one has opted for a mixed sex ward.

These are details which some doctors and health officials, and even some politicians, may regard as trivial in comparison with the major problem of a lack of hospital beds. Nevertheless, the House should accept that the practice of mixing the sexes in our hospitals against the wishes of the majority of patients smacks of expediency and is providing a second-best service.

Therefore, I ask the Minister to assure us, first, that no patient will enter a mixed ward without being given a choice and being adequately informed of the conditions and circumstances involved; secondly, that when a patient opts for a single sex ward there will be no threat of delay in treatment; and, thirdly, that where mixed wards exist, adequate partitions will be provided to maintain privacy. I should be glad to know whether minimum standards are laid down by the Department, and, if so, whether they are enforced.

Finally, will the Minister agree now to embark upon a process of consultation with every area health authority on the whole question of mixing the sexes in hospitals, to review the evidence of the problems that have arisen and to ask every community health council to seek and to discuss the views of the public, the consumer whom the hospital is there to serve?

11.10 p.m.

Mr. Tom Normanton (Cheadle)

rose—

Mr. Deputy Speaker (Mr. Bryant Godman Irvine)

Has the hon. Gentleman asked the permission of the hon. Member for Bournemouth, East (Mr. Atkinson) to intervene?

Mr. Normanton

Yes, Mr. Deputy Speaker.

Mr. Deputy Speaker

Very well.

Mr. Normanton

I should like to thank my hon. Friend the Member for Bournemouth, East (Mr. Atkinson) for allowing me to add briefly to his valuable contribution. I do so in the interests not of party political issues but of important social ones.

I wish to reinforce my hon. Friend's comments, and in view of the lateness of the hour I shall do so briefly. I recall the ever-increasing frequency with which my help has been sought by patients who, unwillingly, and without even a "by your leave", have had to face the experience which for some is traumatic in a moment of dire distress, of having to enter a mixed ward.

Unfortunately, many patients are faced with the alternative of a mixed ward or of receiving no medical treatment. Therefore, I readily endorse my hon. Friend's strictures. Will the Minister take it from me that in allowing this practice to continue, and indeed to increase, he is endorsing what many thousands of people, in their moment of dire need, see as an affront? Will the Minister institute the consultations to which reference has been made, not just with the nursing representatives or the area health boards but with authors of journals and magazines who play such a valuable part in promoting the interests of patients and nurses?

I see in this growing practice a classic example of the interests of the patient being prostituted in the cause of administrative convenience. Because of the way in which these matters are interpreted, that feeling is growing fast. It is another example of the kind of social engineering to which we on the Conservative Benches take the strongest possible objection. The aged, the young, the sick and the sensitive await the Minister's reply with more than passing interest.

11.12 pm.

The Minister of State, Department of Health and Social Security (Mr. Roland Moyle)

I am grateful for this opportunity to explain my Department's attitude towards mixed sex wards and also to correct what appears to be a misapprehension toward the position in the constituency of the hon. Member for Bournemouth, East (Mr. Atkinson).

The term "mixed sex wards" is, at best, a convenient piece of shorthand, which conjure up rather a misleading image. I hope to explain what the term means. In recent years there has been a movement towards the systematic grouping of patients according to the degree of illness and dependence on the nurse rather than on simple classification by diagnosis or by sex. New hospital accommodation has enabled this concept to be applied. There is a separate grouping of beds in an overall ward area—such as in bays of four or six beds each. It is possible for men and women to be nursed in the same ward, but in the privacy of a bed area occupied by one sex only. In wards of this kind communal areas, such as day rooms for ambulant and other mobile patients to use if they wish, are frequently combined. I see no reason to discourage this trend.

In some older buildings, accommodation may also be arranged so that men and women may be nursed in the same ward—normally partitioned or otherwise separated from each other—but of necessity both sexes may share some sanitary facilities and whatever day space is available. All such accommodation must be provided in such a way as to maintain privacy and avoid embarrassment. From the information which I have received, this appears to cover the provision in the East Dorset health district, which covers the hon. Gentleman's constituency.

It is easy to see how, in certain circumstances, the use of such purpose-designed or adapted wards for both sexes enables the best use to be made of the resources available. This makes a contribution to the reduction of waiting lists. Preferably such wards should be in purpose-designed accommodation, as indeed they are in modern hospital accommodation. But I admit that older, upgraded accommodation has to be used in many of our hospitals. Where a health authority decides to utilise other accommodation for both sexes, it must of course have regard to the need to ensure that reasonable privacy can be maintained and unnecessary embarrassment to patients avoided.

There are a number of circumstances where there are special advantages in desegregated accommodation. I have in mind, first, critically ill patients in intensive therapy units. The facilities are so specialised and the number of patients treated by them is so small that it would not be reasonable to provide separate accommodation. Most of these patients are unconscious or semi-conscious and there is an acute need for observation by nursing staff, which must take priority. The need of the patient for privacy should, however, be safeguarded as far as possible. Special units such as those for day surgery cases and programmed investigation units are also used by men and women, provided that there are appropriate arrangements to preserve propriety where both sexes occupy the units at the same time.

I should also mention that there have been found to be positive advantages for many patients, particularly for those with long-term or psychiatric illness in the provision of wards in which there is no segregation during the day.

The hon. Gentleman will wish to know that I am fully aware that when patients enter hospital their sensivity is heightened by apprehension. They will already be anxious about their health and worried by finding themselves in strange surroundings. They will be separated from the support of family and friends. During the course of treatment they may have to submit to questions and procedures which may seem to be an invasion of their privacy. For these to take place in the presence of members of the opposite sex may well add to their anxiety.

Most people in their daily lives expect a degree of separation of the sexes and privacy for certain activities. Any departure from these accepted norms can be upsetting. However important the contribution it makes, a therapeutic regime must be introduced to the prospective patient and his relatives with sympathetic understanding.

My Department has therefore drawn the attention of regional administrators, regional medical officers and regional nursing officers to the special need for arrangements to protect privacy in mixed sex wards, particularly during medical examination. It is certainly my view that when a person is to be admitted to a hospital ward which contains patients of both sexes the hospital should give him or her prior notice of the intention. I hope that where patients have expressed themselves to be unhappy about mixed arrangements the hospital will, if at all possible, offer alternative accommodation. But this might lead to a situation where the patient's admission has to be deferred until a bed in a single sex ward becomes available. Therefore, I cannot give the guarantee for which I have been asked. It would be impossible to do so.

In the main, the representations which have reached my Department from various parts of the country have failed to indicate whether the writer has actually been a patient. My experience and that of the Department seems to be at variance with that of the hon. Gentleman in a mixed ward. We do not know to what extent the criticisms stem from personal experience and to what extent they may be based on a possibly erroneous picture of what a mixed ward is like. Nevertheless, as a basis for action, I accept that some people feel strongly about this matter, regardless of the reasons for the mixing of patients in any ward.

It is difficult to arrive at reliable information about the attitudes of patients towards the treatment that they have received, but a survey of over 400 patients, conducted in Manchester—an area where there are a number of mixed wards—showed that only about 12 per cent. of the patients interviewed objected to having been in mixed sex wards. A total of 58 per cent. said that if they returned to hospital they would not be bothered about being in a mixed ward. Just over 26 per cent. expressed a preference for such accommodation. Of course, because this evidence is a one-off survey, it has to be treated with a certain amount of reservation.

As I indicated to the hon. Member for Cheadle (Mr. Normanton), there is no centrally maintained record of the number of hospitals in which the mixed wards system is operated. That is because I regard the use and management of mixed wards as a matter for local decision. I shall not, therefore, be conducting extensive consultations with health authorities and community health councils. I believe that these decisions are best left to local health authorities. It is a matter for local decision. Certainly I should not stand in the way of these decisions being taken if the proper departmental advice and guidance were followed. It is at the local level that administrators and their professional colleagues are best able to weigh up the various factors in deciding how best to use available resources.

In June 1978 the secretary of the East Dorset community health council wrote to the district administrator of the East Dorset health district on the subject of mixed wards. I should like to quote a few sentences from his letter: From discussions with local community groups I detect a growing concern at the practice of mixing male and female patients in hospital units and wards. Most people I speak with appear to accept the mixing of male and female patients in intensive care units —that, at least, is common ground— but consider that mixed units and wards are being introduced in other specialties where the mixture is unacceptable for a number of reasons ". It goes on to say: Stories emanating from local community groups—which, in some instances, are forming the basis of reports being submitted for discussion at national conferences—lead one to feel that the local situation is worthy of a review. I have looked at the letter. It reports a number of allegations, but mostly in general terms without specific instances, names or examples.

In response to that letter the district administrator reviewed the local situation and in August 1978 sent the community health council a detailed note on the mixed sex arrangements in the district. That showed that for the most part these were in intensive care or similar units or in children's wards and that the others—of which there were few—involved the use of wards subdivided into segregated single-sex bays, as I indicated earlier, or, in most cases, entailed no mixing other than in day rooms. However, there was a small number of male wards in which a number of beds—separated as far as possible from the rest of the ward—were set aside for the use of female patients when the pressure of demand for female beds made this necessary.

In his letter the district administrator stressed that, apart from intensive care, coronary care and paediatrics, wards were not routinely mixed, except where special factors made this necessary. It was notably commoner in geriatrics and other provisions where the demand for female beds often exceeded the supply. He made it clear that it was the district management team's policy not to mix patients if it could be avoided but to give them maximum privacy.

The district administrator was obviously unable to confirm or deny any of the allegations in the letter from the secretary of the community health council, but he offered to investigate any specific complaints. I understand that that offer has not yet been taken up. Here is a way in which the secretary of the community health council can process the matter forward. If he will submit specific complaints to the district administrator, he will do his best to investigate and reach a conclusion on them.

In the past five years the district concerned has received only one complaint about a mixed sex ward. That referred to an ad hoc mixing of orthopaedic patients which was briefly introduced to meet a sudden staff shortage resulting from sickness.

On 22 September the Bournemouth Times published a colourful report under the headline Mixed Wards Trend Shocks the Women Patients which attributed to the secretary of the East Dorset community health council the view that "hospital bosses" were pushing forward "the new system" despite fierce opposition from women patients. It seems significant against that background that when the East Dorset community health council considered the question of mixed sex wards in October it did not make any representations to the district administrator or seek further explanations from him.

I gather that someone is organising a petition, but it is difficult for the district administrator to do other than assume that the community health council was satisfied with his explanation of the policy followed in the district, in view of the non-reaction of the council at that stage to his reply to the secretary. Apart from the petition, I am not aware of any new facts that have come to light to support the allegations referred to in the letter from the secretary of the community health council.

On the other hand, the district management team felt that it would be useful to draw up guidelines for arrangements in shared day rooms, and that has now been done, in the hope that it will relieve any sense of anxiety.

What is interesting about this episode is that it started not with specific complaints from patients but with vague allegations based, possibly, on a misunderstanding of the local policy. I hope that the explanations given by the district administrator to the community health council will help to reassure people in the Dorset East health district. Looking at the question nationally, I can only express the hope that, while there are bound to be variations throughout the country in both expectations and individual preferences, what I have said will assure those who may be worried by reports in the press or elsewhere about mixed wards that authorities concerned and their officers are fully aware of the importance of meeting the individual patient's need for privacy.

Question put and agreed to.

Adjourned accordingly at twenty-seven minutes past Eleven o'clock.