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National Health Patient Accommodation Bill [H.L.]

8.13 p.m.

Lord Stoddart of Swindon: My Lords, I beg to move that this Bill be now read a second time.

First, I thank the noble Viscount the Leader of the House for finding the time for the Bill, those who intend to take part in the debate, and those who have assured me of their support, although they are unable to speak. I should take the opportunity also to thank the great many members of the public who have written and telephoned me supporting the Bill. They come from all parts of the country. They have all given accounts of the great distress they, their relatives and friends have suffered as a result of mixed-sex wards. Every letter has been in favour of the Bill. I have them here. There are well over 200 of them.

I have been in this place (the House of Commons or the House of Lords) for 25 years, and that is the largest number of individual letters—they are all individually written—that I have ever received, even during the abortion debates of the 1970s. I imagine that the Department of Health has also received a great many letters. I cannot possibly reply to them individually, but I acknowledge their receipt, and say how pleased I am and how useful they are.

The Bill is a simple one. It is designed to give patients throughout the UK a statutory right to be treated in single-sex wards. One would have thought that that was an unexceptional right. In addition, one would have thought that the only surprise is that the right does not already exist. The timing of the Bill's Second Reading is, coincidently of the best, coming as it does on the very day of the revised Patient's Charter. Unfortunately we were unable to see it until today so we have been unable to assimilate its import completely. However, we

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know that it incorporates the aim of single-sex wards, but unfortunately it does not give the patients the right to be treated in such wards. The Bill seeks to do just that.

Perhaps I may quote briefly from the Patient's Charter. It says:


    "Except in emergencies, you have the right to be told before you go into a hospital whether it is planned to care for you in a ward for men and women. In all cases you can expect single-sex"—

not demand—


    "washing and toilet facilities. If you would prefer to be cared for in single-sex accommodation (either a single-sex ward or a 'bay' area within a larger ward which offers equal privacy), your wishes will be respected wherever possible".

No right is given in today's Patient's Charter for a person to be treated in single-sex accommodation.

My interest in the subject was aroused by our late dear colleague Lady Phillips who was treated in a mixed-sex ward following an accident. She was most upset at the experience, but did not complain publicly in case any complaint was construed as a criticism of the health service or of the nursing or medical staff. That is the tone which goes right through the letters that I have received.

Fortunately, there have been people and organisations prepared to campaign for single-sex wards and to restore choice and dignity to patients in the NHS. The Royal College of Nursing has been especially concerned about mixed-sex wards, and their extension and growth. It has done marvellous work in raising public awareness and highlighting the problems attaching to them for patients and nurses.

Many of the letters that I have received have come from qualified nurses with first-hand experience of the indignity, distress, stress, suffering, and, I fear, danger which arise from the mixed-ward system. As well as the RCN, the Patients' Association, especially Dr. Patricia Wilkie, has done extensive research on mixed-sex wards, which has shown conclusively that they are not satisfactory nursing units and that the majority of patients is opposed to such wards. The College of Health has also done work on this. Again, it is in favour of the Bill. The National Federation of Women's Institutes has received many complaints, and has recorded its opposition to mixed-sex wards. I have had letters from individual women's institutes. Those organisations, working, as they have, so hard, have been fighting a hard and difficult battle, apparently without too much help until some elements of the national media decided to lend a hand. We should be grateful to them for that.

BBC "Woman's Hour", for example, has put on at least two serious programmes about mixed-sex wards, and the public's reaction was positively against them. The Daily Mail also is to be congratulated on devoting a good deal of time, energy and space to the problem. Glaring banner headlines are not always relevant to serious issues, but the headline in the Daily Mail, "Shut the wards of shame", was spot on. So, in fact, was the material that backed it up, including the host of letters from its readers opposing mixed-sex wards. The public reaction was against mixed-sex wards. It was immediate

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and angry, as it was following the publication of another article on the subject in last week's issue of Woman's Weekly.

Without such hard campaigning, we should not have had any action by government, nor would the Bill have been before the House tonight. I wish to pay tribute to all those organisations to whom the credit is due for following the matter up.

We should ask when and why mixed-sex wards were allowed to develop. After all, before the war, when health and hospitals were meagrely financed compared with today, mixed-sex wards would have been unthinkable. Imagine any matron of a hospital allowing mixed-sex wards. I am sure that no one here tonight can imagine that. Apparently, the wards were allowed to be introduced in the 1960s and 1970s in order to make the best use of new high technology equipment. I find that reasoning quite unacceptable. There is more to nursing and medical treatment than high-tech equipment. The state of mind of the patient must be considered and an anxious patient can have his or her recovery seriously retarded by that anxiety.

Furthermore, many people who have never shared a house let alone a bedroom with a person of the opposite sex suddenly find themselves sharing bedroom accommodation in mixed-sex wards and sharing toilet and lavatory facilities without locks on doors. People of the opposite sex wander around half naked, having embarrassing treatments if not in sight certainly within sound.

The Nursing Times in a survey last year revealed some disturbing information. Perhaps I may quote one or two of its findings. I do not wish to bore the House, but the survey was so good that your Lordships should hear about it. It stated:


    "Nurses who had themselves become patients found the experience of being nursed in a mixed-sex ward 'unbearable'. One nurse who had become a patient summed up the feelings of several by stating that while 'not considering herself a prude' she found the whole experience 'totally degrading'".

It continued:


    "One nurse, three weeks after having undergone a mastectomy, was readmitted as an emergency with a pulmonary embolism and found she was the only female in a six-bedded male bay. She was upset and embarrassed by these circumstances. As she states, had it not been for the fact that she was acutely aware of her need for heparinisation, she would have discharged herself".

The study stated:


    "With regard to toilet facilities, 44 per cent. of wards surveyed did not designate the toilets for males or females. Patients found privacy problems also arose when they could not close toilet doors while in a wheelchair...


    "Also, many patients do not appear to be informed before admission that they may be nursed on a mixed-sex ward.


    "Half the nurses surveyed had received complaints about the mixed-sex setting from patients, and almost as many from relatives or friends of patients. Often, patients would talk to relatives about their misgivings over arrangements of the sexes, not wanting to cause a fuss or appear critical of the nurses".

People do not complain because they are pleased with the nursing facilities but not with the accommodation. The study continued:


    "As a result of this, most complaints were informal, being verbally passed on to staff. Patients rarely wished to make their complaints formal ... Arguments in favour of mixed-sex wards

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    include the fact that they reflect the normal pattern of life as the majority of the population live in this type of environment. However, as several staff in the survey stated, individuals in 'normal' life choose with whom to share their bedroom and bathroom. It is particularly distressing for those who have remained single, those from religious orders or some ethnic groups, for example, to be placed in this situation".

Finally, the RCN writes:


    "A single-sex environment during a period of illness and vulnerability can be restful and supportive ... To find an 85 year-old woman lying in her nightdress near a man she does not know cannot be acceptable".

That survey was based upon the shoal of horror stories that I have received and I shall quote from one or two. One lady wrote:


    "Some years ago, I was in hospital after an operation. The ward consisted of three females and a man in a bed by the door. He was slightly 'simple' and kept coming over to my bed, which he was convinced was his. I told him to go away but when I was talking to another patient he came over and got into my bed!".

Another lady writes:


    "I would be horrified to have to be treated amongst men. I am a pensioner and have been single all my life and the thought of having my privacy violated in such a way appalls me".

I have a letter from a retired consultant who stated that, as a university lecturer in clinical medicine, he spent his professional life working for peanuts to prop up the NHS. He continues:


    "My wife was a midwife, health visitor and nurse instructor. Now we are in need of care ourselves we resent the ultimate indignity of being treated like animals. Even in the old NHS, with all its shortcomings, this did not happen".

Finally, I have a letter from someone who went to the local hospital for fairly major abdominal surgery. She states:


    "I received excellent medical care and extremely good food. The ward was a mixed-sex ward however which caused me both embarrassment and stress. Most of the men were recovering from prostate operations and they frequently wandered around the ward, naked from the waist down. On one occasion I was naked in the bathroom (no lock!) when a man barged in and yet another one followed me into the toilet".

Those are one or two of the hundreds of horror stories that I received about mixed-sex wards. They show exactly the flavour of what is happening in our hospitals.

It is clear that NHS patients are not being treated with the respect and consideration to which they are entitled. I fear that they are too often treated as though they are the recipients of charitable services rather than as part owners of their National Health Service. We must always remember that. We must understand that the NHS belongs to the people and that when they are patients in hospital they are entitled to have their dignity and choices respected as well as first-class nursing and medical treatment. This cannot be done unless people are given the right to be treated in single-sex wards. That is fundamental to the maintenance of patients' dignity and choice.

The new standards in the Patient's Charter will go some way towards alleviating the problem. But as the RCN points out in its briefing paper, the new standards are not legally enforceable and it therefore urges support for this Bill.

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Indeed, at present, perhaps as many as 40 per cent. of patients are being treated in mixed-sex wards. That figure is increasing in spite of the present provisions of the Patient's Charter, which provides that there should be respect for privacy, dignity and religious and cultural beliefs.

Indeed, I received a fax this afternoon from the College of Health after it had read the new Patient's Charter. It supports my Bill and says that the new Patient's Charter does not go far enough. The fax states:


    "While the new Patient's Charter ... goes a long way towards accommodating patient choice, it does not go far enough".

Therefore, I believe that we need this Bill. It has become very clear indeed that the public support it. I hope that the House will give the Bill a Second Reading this evening and that following that, it will be given a smooth passage during its remaining stages in this House. I beg to move.

Moved, That the Bill be now read a second time.—(Lord Stoddart of Swindon.)

8.31 p.m.

Baroness Seccombe: My Lords, I feel that I am the first on what some may call a "women only" list. That in itself is an interesting fact and shows how strongly women feel about this matter.

I wish to speak briefly and to give my whole hearted support for the spirit of the Bill introduced so ably by the noble Lord, Lord Stoddart of Swindon. I understand fully the aims of the Bill; namely, to promote the dignity, privacy and choices of patients. As the noble Lord said, it is fortuitous that the Bill is being debated today as those principles are also a central feature of the new expanded Patient's Charter which has been published only today and which contains new standards in relation to the issue of mixed wards. It stresses the importance of patients' own preferences.

I have felt uneasy ever since I heard about the practice of mixed wards in hospitals. I am sure that some young people, and perhaps some older people, accept and may even welcome such a practice. But the majority of those in our hospitals are probably older and have been brought up in a different era. Mixed wards are anathema to many of them and the thought of being an in-patient in such circumstances could possibly make them miserable and, indeed, could be detrimental to their health and recovery. Some may feel that their dignity is being compromised and may long for privacy.

Colleagues have approached me on this subject and I know that that is the experience of other noble Lords too. But the one point which concerns me is that although I applaud people having choice in this matter, whenever possible, I feel that the legislative approach may be too rigid. There may be occasions, for example where people need intensive care when, because of the nature of the condition, it is essential to have a bed immediately. Even for patients admitted from the waiting lists, other factors such as the length of the wait may be extremely important. I am aware that long-established practices cannot be changed overnight. But the NHS has achieved so much in recent years, with

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management becoming much more responsive to the wishes of patients so the public debate on this issue will no doubt be taken on board.

Therefore, although I am extremely sympathetic to the aims of the Bill and I congratulate the noble Lord, Lord Stoddart of Swindon, on bringing the matter before the House, it is important to retain some flexibility. The measures outlined in the Patient's Charter, which are the result of the Government having listened to patients' views, are the best way forward. At this stage, I do not believe that there is a need for legislation to deal with this matter.

8.35 p.m.

Baroness Masham of Ilton: My Lords, I thank the noble Lord, Lord Stoddart of Swindon, for bringing this Bill before your Lordships. I hope that the noble Lord enjoys being a one-man band and I hope also that all noble Baronesses will support the Bill.

Looking back over the years since the practice of mixed wards emerged, I am now surprised that this legislation was not introduced at that time.

Some years ago, before the new National Spine Unit was built at Stoke Mandeville Hospital, and the wards for paralysed people were Nightingale wards, I went to visit a Roman Catholic nun who wished to discuss with me some problems that she had. I found her in a mixed ward placed between two footballers. The two young men shouted across her. It may have been the idea of the nursing staff to put her in that position so that the two young men would behave better. She was a quiet, uncomplaining person who no doubt believed that that was yet another cross which she had to bear.

I hope that this legislation will make the nursing staff more sensitive to the needs of patients. Wherever possible, patients should be given a choice. Hospitals can be extremely intimidating and hospital staff, when overworked and frustrated, may ignore patients' wishes and put their own wishes first.

The Government have brought out charters, including the Patient's Charter, the updated version of which has been published today. But charters are words which may or may not be adhered to. Legislation is more likely to make people act on the contents.

Last year an aunt of mine in Scotland fractured her femur. The pin slipped and she was in great discomfort. She is in her nineties. One night, when there were very few night staff on duty in the hospital, a man got into her bed. She was most upset, as were her family.

I hope that the Minister will take very seriously the Bill which is before us. Hospital security is almost non-existent compared with that in many other organisations. Patients and visitors wander all over the place with no questions being asked. Some people feel most embarrassed and uneasy when placed in a hospital situation among the opposite sex, particularly when they have to share lavatories and washing facilities which are often rather inadequate. Members of both sexes may feel equally uncomfortable. It is not advisable to lock the lavatory door when patients are ill in case they become even more ill or get stuck. Therefore, any kind of privacy is a problem.

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On Monday I told two young Australian girls who are in their twenties and visiting Britain about this Bill. They told me that they did not realise that there could be mixed wards. They were shocked and said "We hope we do not become ill in Britain".

As has been said, there is very strong support for this legislation. I did not realise how strongly people felt about this matter until I asked around. I believe that one should exclude from the legislation accident and emergency departments, intensive care units and even day wards. That could be achieved by amendment in your Lordships' House. I hope that that will satisfy the anxieties of the noble Baroness, Lady Seccombe. In such instances it would be neither practical nor necessary. But for other wards, I believe that a choice is essential if there is to be peace of mind and contentment for patients.

The Royal College of Nursing has brought to our notice how upsetting it may be for someone who has been sexually abused to be placed in a mixed ward. I am glad that the Royal College of Nursing is supporting this Bill. With such a shortage of hospital beds and the really horrific stories of people not getting into hospital when seriously ill—I know the Minister knows about some of those cases—there is immense pressure on hospital staff. That is why this legislation is so important now.

If Parliament passes this Bill it will cost little in money terms but it will please many people. To move a bed around is not difficult although to provide some more lavatories and washing facilities may cost something. I can see no reason why the Government would not want to have this Bill. I hope that it goes through Parliament quickly, but that enough time will be given for hospitals to get themselves organised. Hospitals can become very factory-like with almost a conveyor belt approach. We should not forget that patients are people and personal wishes should be met whenever possible. We are only asking for human dignity to be given to very vulnerable people.

8.41 p.m.

Baroness Nicol: My Lords, I am grateful to my noble friend for introducing this Bill because something like it is certainly needed—although, as the noble Baroness, Lady Masham, says, we may have to look at possible amendments later—because the distress which is caused to patients and to their relatives by the present system is considerable. As far as I could discover there is nothing in the existing legislation, past or present, which prevented the practice we are discussing from happening, but it seems to have grown up very much in the 1980s. No one has ever explained, to my satisfaction, why it has happened. I wonder whether, in her summing up this evening, the noble Baroness could explain the rationale behind it. I cannot believe that this just happened; there must be some reason for it. However, this practice has been unpopular right from the beginning.

I have been unfortunate enough to have had a number of fairly lengthy stays in hospital in earlier years. The lack of privacy in a hospital ward is always the greatest problem. It is always a difficulty for some patients.

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Perhaps there are others who do not mind it, but I believe the majority of patients mind it very much. Sharing wards with members of the opposite sex—this applies to the male point of view and the female point of view—adds to the stress at a time when the patient is most vulnerable. I would ask the Minister not to think that because most of the speakers in tonight's debate are female it is the females who object solely to this matter. I have talked to a number of men about this matter. If one talks to them in a group they feel obliged to take a macho view and say that they do not mind one way or the other. However, if one speaks to them privately, it is quite a different story. They do not like mixed sex wards. They find that just as embarrassing and as difficult as do females.

Objections to the practice go across all age groups. The noble Baroness, Lady Seccombe, suggested that it was mostly older women who objected to mixed wards but that is not so. Often young women feel vulnerable when they are put into a mixed ward, especially one which contains many older men. Objections to the practice of mixed wards go across both sexes and all age groups. As the noble Lord, Lord Stoddart, has made clear to us, the objections are shared by many people in the profession.

I have made a point of talking to everyone I could reach on this matter since this Bill was conceived. I have found a unanimous opinion in favour of the Bill and against the idea of mixed sex wards. The growth in the practice seems to me to be symptomatic of the trend towards treating patients as units of work to be counted, rather than as people. I think that is something we should seek to reverse from this moment on. The Patient's Charter is not an answer to this problem. However, I accept that it draws attention to the problem. Like the noble Lord, Lord Stoddart, I wish to quote from the Patient's Charter. It ends:


    "you have the choice of accepting immediate admission or waiting for single-sex accommodation to become available".

But what choice is that? If one is in discomfort or in pain or if one has a job and one needs to return to it, that is no choice at all. One may well take the option of mixed sex wards and regret it within 24 hours. I applaud the fact that the Patient's Charter has taken this matter on board but that is not enough. Legislation may not be the answer. Perhaps there are other ways of tackling this matter. I agree with the noble Baronesses, Lady Seccombe and Lady Masham, that in certain circumstances, such as in intensive care units and perhaps in casualty wards, one may not have a choice. But why cannot one have a choice in the vast majority of wards where admissions are planned and where patients tend to be grouped according to their complaint, whatever it is? There is no reason at all why the choice which existed before 1980 should not continue to exist. I wish this Bill well and I hope that the House will give it a Second Reading.

8.45 p.m.

Baroness Park of Monmouth: My Lords, we are all grateful to the noble Lord for bringing this Bill forward. I am sure other noble Lords as well as noble Baronesses are with us in spirit at least. I welcome the new

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provisions in the Patient's Charter which require prospective patients to be warned—as they already are in some hospitals—that they may have to go to a mixed ward, so that they have some choice in principle. I welcome the Secretary of State's expressed preference for a patient-led rather than a cost-led regime. Nevertheless, I would argue strongly for a statutory right to be enshrined in legislation. It will be said that this limits the flexibility and the choice of the managers, but I think that can and should be solved by better planning—if the French can do it, why cannot we?—and that patients need choice more than the managers do.

It will also be said that they have that choice now, but do they? Many of them are old and confused and some are young and uncertain of themselves. All are under stress and are very vulnerable. It is only too easy for such people to be daunted when told that if they choose not to go into a mixed ward, they may have to wait for some unpredictable time. They will be anxious and fear waiting. They will be afraid to "make a fuss" or be "difficult".

We are told that mixed wards are necessary, first, because they are the only economical way to use scarce high technology and, secondly, because they create therapeutic conditions aimed at providing a "normal" environment. The first argument is, of course, valid for intensive care units with their special teams of doctors and nurses and their high-tech equipment. There is no other way to care properly for desperately ill patients needing such care. But I find the second argument amazing, except in so far as it relates to day rooms where convalescent patients may spend some time each day. But for patients needing nursing and who are ill in bed and at their most vulnerable, with their resources and resistance at their lowest ebb, I can think of nothing more terrible than to be obliged to undergo clinical procedures, examination, and answer intimate questions where they can be overheard, if not seen, by a number of strangers who may be of the other sex. No one would want this to happen in sight or hearing of members of their own family. Curtains or screens do little to achieve privacy in such situations. Beds are often very close to one another and using bedpans or commodes in such conditions is deeply embarrassing for patients whatever their sex.

There are other major factors to be considered. Misery and embarrassment, especially for people already weakened by illness, must, it seems to me, cause severe clinical stress. It must be very difficult indeed for the nurses to nurse people in this condition, and it must in turn create stress for them. It is said that many people do not complain: it is their families who do so on their behalf. I can believe it. There are many people who would be thankful to have had their operation or treatment and feel obscurely that it was not right to complain, especially with those nice nurses doing their best. But such people, according to the Patients Association—to whom I am indebted for the examples I propose to quote—only too often discharge themselves prematurely as their only way of getting home and achieving the privacy and dignity they should have been able to enjoy in hospital. That cannot be good.

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Now let us consider the therapeutic advantage of a mixed ward as conducive to a normal environment. To quote some examples cited in letters to the Patients Association, how "normal" do noble Lords think it is for women, young or old, to be surrounded by men with catheters and colostomy bags often moving slowly and painfully the length of the ward to the lavatories, or, if they are confused, wandering about at night; or, for a man with advanced cancer to be the only man in a ward full of women; or for a shy young 17 year-old girl to be alone in a men's ward? Many people find nakedness distressing and even offensive, and we all long to be alone, private and unobserved when we are really ill. Illness is a very personal matter. It is just as embarrassing for the patients who are obliged to be privy to someone else's physical ills as for the patient himself or herself. I feel embarrassed when I stay with friends and have to go to the lavatory at night knowing that there is a loudly creaking board outside my host's bedroom door. That is bad enough. How much worse a night in a mixed ward of strangers must be.

I think that I may have said enough about the stress that this policy of mixed wards must cause—convenient though it obviously must be for managers trying to use accommodation sensibly. I know, too, that in at least some hospitals although the ward is open plan the bays afford a degree of privacy.

However, when it comes down to it, we are talking about two things: human dignity and common sense; and they go together on this occasion. The Patient's Charter states that people must be treated with sensitivity and dignity. Human dignity is one of the most important rights and it is compatible with common sense in the Bill. It does not make sense to add to stress for both patients and nurses; and it is nonsense to pretend that the conditions in a mixed ward of possibly confused patients have any connection with a "normal" environment.

To sum up, a real choice must be offered, with none of the element of subliminal blackmail: for example, "If you cannot agree to a mixed ward, it is difficult to say when you can be fitted in". I really believe that the only way to ensure that choice is to create a statutory right.

8.51 p.m.

Baroness Gould of Potternewton: My Lords, first, as other noble Lords have done, I thank my noble friend for introducing the Bill. It is long overdue. Like my noble friend Lady Nicol, I believe that we have allowed a situation to arise which should not have occurred. We should have been more aware of the problem some time earlier. It is also important to stress that the Bill is in no way a criticism of the nursing or hospital staff. We need to repeat that constantly.

I believe that it is easier to understand the logic underlying the introduction of mixed-sex hospital wards. It was expected to be more efficient, to make better use of staffing resources and to ensure the maximum use of expensive and specialist equipment by putting near each other patients with the same or similar complaints irrespective of sex. But when the practice started in the

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1960s and 1970s, it was not envisaged that men and women would find themselves in adjacent beds. That is now the situation in nearly half the wards.

As my noble friend Lord Stoddart and others have said, it is not difficult to appreciate, understand and sympathise with the elderly or not so elderly man or woman who has never experienced being in a state of undress in front of a member of the opposite sex, and the embarrassment that that causes. Recently I asked a man how he felt about the issue. He said that he had not really thought about it until he recently visited an aunt in hospital and realised that she was in a state of shock. She had woken up and discovered that there was a man in the next bed. That illustrated the position clearly to me.

I note and regret that, apart from my noble friend Lord Stoddart, all the speakers in the debate are women. As my noble friend Lady Nicol said, this is not a women-only issue. However, I wondered whether men regarded the issue in the same way that I did. I took some soundings. I asked a group of men of different ages how they would feel if they were to be placed in a mixed-sex ward. Without exception they expressed horror that they might find themselves in that situation. It was clear that privacy is as important to them as it is to women, and that to be in a mixed-sex ward would cause them great embarrassment.

It is regrettable that no noble Lords felt able to speak tonight in support of the Bill. It would be interesting to have another sounding to find out why they are not present. Perhaps their embarrassment is greater than ours in discussing the issue.

I wished also to find out the views of young women. I wondered whether I was becoming older, had not kept up with modern thinking and was somehow out of fashion. I found that young women were equally as concerned about having their privacy invaded. I spoke to my hairdresser on the subject last week. Her immediate reaction was that she really would not care if she were in a mixed-sex ward. About two or three minutes later, she returned and said, "I've thought about the matter now and I don't think I would be happy about it. It may depend what I had gone in for. Certainly if I had gone in for any condition which was sexually related in any way I would feel a great deal of embarrassment". It is when people think about the consequences of the policy that they realise the real difficulties.

The multi-racial nature of Britain means that for some such close contact with a stranger of the opposite sex is against their religion, culture and teachings. We have a responsibility to respect that view. The RCN states that in mental health wards female patients, in particular those who have been sexually abused in the past, may find the close proximity of disturbed males distressing.

I appreciate that unfortunately there is no provision to cover hospitals in the Sex Discrimination Act. I sought to find out why there was no such provision in the Act. I discovered that at the time no one had contemplated that such a situation would ever occur and therefore it was not necessary to include the provision. Nevertheless, the principles within the Act relating to communal accommodation are relevant, in particular with regard to decency in terms of washing and toilet

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facilities. Any circumstance which does not allow privacy, decency and dignity in those circumstances is in breach of the principles of the Sex Discrimination Act.

Noble Lords have referred to the revised Patient's Charter. The fact that there is reference to the issue in the charter means that the Government have acknowledged that it is a matter that has to be dealt with. However, welcome though the provisions of the Patient's Charter are, I agree with others that they do not go far enough. The provision that a patient receiving non-urgent treatment shall be informed in advance as to whether he will be accommodated in a mixed-sex ward does not assist patients in hospital for more urgent treatment. Hospitals are expected to respect the wishes wherever possible of those patients who prefer to be cared for in a single-sex ward or single-sex bay. How many unfortunate patients will be deprived of their wishes because of the phrase "wherever possible"?

I firmly believe that without legislation the Government are rightly identifying the problem but are not putting machinery in place to solve it. Although it may need amendment, the Bill should be enacted in order to satisfy the growing number of complaints and so protect the rights of the very sick and vulnerable.

8.59 p.m.

Baroness Strange: My Lords, we are all grateful to the noble Lord, Lord Stoddart, for introducing the Bill with such courage into what is virtually a single-sex debate—and that not his. He is outnumbered nine to one by the ladies. I am glad to see that there is some minimal male support in the Chamber for him.

The noble Lord referred to Lady Phillips. I remember often visiting her in Westminster Hospital, a shimmering vision in lilac, who muttered to me sotto voce, "Too many men in here, dear".

The Government's new Patient's Charter hopes to respect, wherever possible, the wishes of patients who prefer to be cared for in a single-sex ward, or single-sex bay. The noble Lord, by this very modest Bill, is seeking to enshrine the Government's thinking in legal tablets of stone so that it cannot blow away in the light winds of inconvenience.

I support the noble Lord, as does the Royal College of Nursing. It believes that patient choice and the right to privacy are both key to maintaining an environment conducive to the recovery of health. It is also very concerned about the rising number of complaints about mixed-sex wards. Half of all wards now accommodate both sexes. According to some estimates, there are no separate washing and toilet facilities in two-thirds of these wards. In Nightingale-type wards without alcoves, men may be on one side and women opposite. In some cases, male and female patients are even being placed in adjacent beds. As my noble friend Lady Park said most movingly, patients in hospital are already having to bear pain and illness, while at the same time having to adjust to a non-home environment. To have to face also the loss of personal privacy can be the last straw. Loss of privacy may be particularly upsetting to elderly people who are confused.

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Most of the people whose opinions I have canvassed on the matter and who are strongly in favour of privacy are ladies. However, I should say that my husband—who is neither elderly nor confused, and although he sits in the Peeresses' Box he is not a Lady—says that he would not feel comfortable in a hospital ward surrounded by a lot of strange ladies. Many noble Lords whom I have asked agree with my husband.

The original meaning of "hospital", which comes from old French or low Latin, was a place to entertain guests. Later it extended to mean a school for children or a place to house the sick or the elderly. Now, it usually means a place where people go to be cared for and to get well. To revert to the original meaning, the patients there are all guests, made welcome and tended by the dedicated staff of doctors and nurses. But even the most dedicated of healers cannot make someone well who turns his face to the wall. Personal choice and personal privacy are both vital factors for a patient's recovery.

9.3 p.m.

Baroness Robson of Kiddington: My Lords, I also wish to thank the noble Lord, Lord Stoddart, and to welcome his introduction of the Bill to provide a right to single-sex accommodation for National Health Service patients. His introduction was complete and covered all the aspects and speakers since then have added to the knowledge that we have all gained of what people feel on the subject. There is no doubt that the Government are also aware of it, or they would not have introduced a revised Patient's Charter. But a revised Patient's Charter is not enough, we are all agreed. It is not adequate because it does not give the patient any legal right not to be cared for in a mixed-sex ward. The standards set out in the charter—welcome though they are—are not legally binding.

It was long ago in the 1960s and 1970s that mixed-sex wards were first introduced into the National Health Service. It was done at that time for one reason: to make the best use of high technology equipment, particularly in intensive care units. However, even at that time the intention was to have separate alcoves for men and women. We have heard from all the speakers this evening that now almost half the wards accommodate both sexes without separate facilities for washing or separate toilet facilities for men and women.

We must put ourselves in the position of an ordinary person going into hospital and being put in a mixed-sex ward. We are vocal enough, if we do not like it, to create a rumpus until someone moved us to a ward in which we would like to stay. The majority of people who have to make use of the health service and who go to general practitioners have a fear of offending anyone to do with the health service. Even in discussing the problem with their own GP they are not vocal. They accept what is handed to them, but they suffer in the process. I believe that we need a Bill to give them a statutory right. Then perhaps patients will have the courage to ask for what they want. We in this House are vocal, the majority of people are not.

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As to the use of mixed-sex wards for mental health patients and the elderly, it is defended on the grounds that it helps to provide a more normal lifestyle. How many of us in normal life look forward to sharing our bedroom with a complete stranger? Is that normal life? Of course it is not. There is no excuse for introducing that system in mental health hospitals or in dealing with the elderly. As has already been mentioned by other speakers, many female patients particularly in mental health wards, may have suffered sexual abuse and are frightened of seeing disturbed males walking about, sharing their ward with them.

We realise that there are perhaps occasions, such as emergencies, when the mixed-sex ward has to be used. But it should be a purpose-built unit where there are proper divisions between the male and the female sexes. We accept that. Under the Bill that would be perfectly acceptable. Where a patient, perhaps through an emergency, has to be put into a mixed-sex ward, but subsequently feels uncomfortable, it is essential that the patient should be found a bed in a single-sex ward within 24 hours.

I do not think that anybody who has listened to this debate will have any doubts about the strong feeling that exists all round the country on this matter. I agree with all the former speakers who paid tribute to that gallant gentleman, the noble Lord, Lord Stoddart, who initiated this debate. It is rather interesting to note that the previous debate had only one noble Baroness speaking in it. Here we have only one noble Lord speaking. But that is not because the feeling is less strong among men. I know that from my own personal experience. When my husband was taken into hospital having fallen from his horse, he was immediately concerned about the fact that he was in a mixed-sex ward. But he was vocal, and within a few hours he had been moved to the right accommodation.

Whatever standards are advised in the revised Patient's Charter, they are welcomed. We approve of them. But they are no good unless they are backed by a statutory right. We welcome the Bill.

9.10 p.m.

Baroness Jay of Paddington: My Lords, I congratulate my noble friend on introducing this Bill. With his customary clarity and great force, he has highlighted an issue which is clearly of great concern to many patients, to their relatives and to those who work in the health service. I am particularly pleased that my noble friend tonight deploys his formidable forensic skills to develop an argument with which I can strongly sympathise. As he knows, that has not always been the case when we have debated health policy in this House.

As everybody who has spoken this evening has recorded, the history of the development of mixed-sex wards is very unclear. What is clear is that at no stage, so far as I can discover, was a general NHS policy decision taken to extend the practice indiscriminately; and I could discover no one in the professional, medical or nursing organisations who seems officially to have encouraged and sanctioned the widespread use of mixed-sex accommodation. There were no national

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consultations and no discussions with professional bodies about this destruction on a rather casual basis of people's privacy. The only record that the RCN could find for me of the history of its attitude to the issue, going back several years, was that 15 years ago the Nursing Mirror had reported:


    "There is little doubt that mixed wards have multiplied without a great deal of public awareness or official vigilance".

As we have heard, that situation has gone on and on. It has been exacerbated, I am sure, in the past few years by reductions in the overall number of beds and competition between trust managers to maximise so-called "patient throughput". Bed management has become an end in itself rather than good care for the patients in those beds.

I must say that I was very surprised to learn that now half of all wards accommodate both sexes, and I am particularly disturbed to learn that in two-thirds of these wards there are no separate toilet or washing facilities. I understand that in some large cities, and particularly in London, that percentage is even higher. In view of those facts it is not surprising that, as my noble friend Lord Stoddart recorded, in its recent survey the Nursing Times found that half the nurses who had worked in mixed-sex wards reported strong complaints about accommodation.

We have heard tonight from every speaker powerful evidence of how distressing many people—particularly, as has been said, elderly patients—find this situation. As my noble friend Lord Stoddart and others who have spoken described, people who are physically ill usually feel frightened and vulnerable as well. Personally, I agree with those who said that it applies to all age groups and not just to the elderly.

It must be obvious that anyone who is in hospital to be treated, to be made better, needs reassurance and a sense of security. They should not be asked to suffer from further assaults on what is already a fragile system. However skilful medical and nursing care may be, it can well be undermined if a patient is made anxious and upset by being in a mixed-sex ward. I am particularly alarmed by the accounts of people who have discharged themselves early because they just cannot stand another night on a ward. Such cases may well contribute to the serious growth in emergency readmissions to hospital in the past year.

As many noble Lords have described, there are a few circumstances—such as emergencies and intensive care units—where mixed-sex accommodation can be legitimate for therapeutic reasons. I agree with those who have said that as my noble friend's Bill progresses there may well need to be amendments to take account of those exceptions. But for most instances and for most patients there seems to be absolutely no clinical argument for continuing this system. We have certainly heard none tonight. Instead, we have heard that as well as being medically irrelevant, mixed-sex wards breach the fundamental NHS principle that patients must be treated with dignity and respect. In spite of all the recent policy emphasis on patient choice, hospitals are clearly not responding sympathetically to the wishes of

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individuals. As my noble friend Lady Nicol so graphically put it, patients are becoming units of work to be counted and are not being treated as people.

Many noble Lords have commented on the fact that the Government have today launched the revised Patient's Charter. It has been launched with great fanfare and no little expense. The revised charter includes references to information and choice about single-sex wards and, very importantly, sets better standards for washing and toilet facilities. It would be very foolish not to view the publication as a step forward. I see it as a considerable victory for those like my noble friend Lord Stoddart and others who have campaigned on this issue.

I am sure that when she comes to reply the Minister will say that the problem is now solved. But, as all the other contributors to this debate have said, with the notable exception of the noble Baroness, Lady Seccombe, the question is whether the charter goes far enough and whether it will stick. The Secretary of State has already been reported as saying that she will not accept excuses from those local trusts that do not conform to the new guidelines. However, with nearly 500 independent hospital trusts and very little upward accountability under the new devolved health service, how can she possibly know? What sanctions can be applied when local chief executives, who are competing with their neighbours and facing resource pressures, simply do not implement national guidelines? It is these concerns that drive my noble friend's Bill for statutory rights.

I also hope that we can nurture an effective consumers' movement in the NHS. Several speakers tonight have explained precisely why patients have been inhibited, both by gratitude and fear, from insisting on their rights and complaining. Personally, I believe that that can change. I have been encouraged by my personal experience with two groups of patients: women who are using maternity services and people with HIV disease. Both groups of NHS users have been effective in influencing services, particularly in making them more humane and responsive to their individual needs. After all, we are constantly told that the new NHS is importing commercial methods and standards. Although I deplore a great deal of this, there is no reason why we cannot have the good as well as the bad of the commercial system. If patients can be persuaded to treat the health service like a service industry they will naturally expect and insist on high standards of personal care in all things, ranging from good food to single-sex accommodation. Perhaps my noble friend Lord Stoddart will not approve of this example, but it is precisely that kind of consumer pressure that I wish to encourage in the health service that has led to smoking being banned on airlines, to extended opening hours for banks and—dare I say it—to longer shopping hours.

We must all work to create a strong consumer voice in the NHS. Obviously, this will take time. I believe that in the short term practice can also be effectively influenced through the local contract system. Every health purchasing authority or commissioning agency—whatever you call it—has received a huge number of complaints about mixed-sex wards. Through their local

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contracting/purchasing plans they can change how their local providers, the hospitals, operate. For example, I draw your Lordships' attention to the recent prospectus of so-called commissioning intentions published by the Kensington, Chelsea and Westminster Health Authority in central London. It states:


    "The Agency is aware of the long-standing unpopularity of mixed sex wards ... The Agency wishes to work with its local hospitals to improve this situation over time but"—

and this is the immediate action to be taken—


    "for 1995/96 [the agency] no longer wishes to contract for general medical services, for care of the elderly, or for acute and continuing care psychiatric services which do not have a single sex bay policy—with single rooms available on the ward to make this policy work well operationally".

In other words, it will not buy those services if patient single-sex accommodation is not offered. In the past few days I have spoken to purchasing directors and managers in other parts of the country. I understand that directing hospital management in that way through contractual conditions is becoming more and more common. It seems to me that it must lead fairly rapidly to widespread changes in practice.

In conclusion, I again congratulate most warmly my noble friend Lord Stoddart for introducing the Bill. As I said earlier, he has succeeded in focusing attention on a system which is generally unpopular and has often undermined the high standards of the health service. I do not believe that it is too fanciful to suggest that if my noble friend and other campaigners had not taken up this issue, we might well not have seen today's action by the Department of Health. But through today's U-turn on different sex wards, the Government have acknowledged that the situation deserves urgent national attention.

Like other noble Lords, I welcome the revised Patient's Charter, but I hope that, when the Minister replies, she will not insist that its publication alone is enough to protect the rights of vulnerable patients.

9.20 p.m.

The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege): My Lords, first, I congratulate the noble Lord, Lord Stoddart of Swindon, for bringing the Bill before the House and thank him for the opportunity he has given us to debate an issue which we recognise is causing much public concern. If noble Lords will allow a personal note, as a convent girl steeped in modesty, I have to say that I entirely agree with the aims of the noble Lord's Bill. I can assure him that the Government welcome this debate to improve further the quality of service offered in the National Health Service.

Noble Lords will know that mixed-sex accommodation is not a new idea. As the noble Lord, Lord Stoddart, said, it has been widely used for the past 30 years. The flexible use of beds has played a part in reducing waiting times for admission. In the past five years average waiting times have almost halved. The flexible use of beds has also enabled the establishment of specialised wards, such as for gastro-enterology and cardiology, which enhance the quality of clinical care given by concentrating specialist skills.

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Mixed accommodation has not been at the whim or fancy of the Government. In 1978, the Royal College of Nursing issued guidelines which recognised that in some circumstances mixed-sex wards could have a positive and therapeutic value. Two years ago, in 1992, the Audit Commission's report Lying in Wait advised that it was more important and more clinically effective for patients to be treated in single specialty wards than in single-sex wards.

The noble Baroness, Lady Robson of Kiddington, mentioned psychiatric wards which have mixed accommodation. I feel that the noble Baroness will agree that it is acceptable during the day and evening to have both sexes in the same ward and that it can benefit patients as part of their rehabilitation. But we agree with her that privacy at night must be respected. That is also true of wards for people with learning difficulties and for people whose home is in the hospital and where a more homely atmosphere is sought. But as long-stay wards for people with such conditions are being phased out it is less of an issue and, thankfully, more and more live in ordinary homes in ordinary streets in cities, towns and villages like the majority of the population. That is some of the rationale sought by the noble Baroness, Lady Nicol.

The Royal College of Nursing revised its guidelines in 1993 because the previous guidelines were, in its words, "being too widely interpreted". It is clear from recent complaints that many patients, women in particular, as has been highlighted tonight, object to being placed without warning in a bed next to a patient of the opposite sex and having to share wash and bathroom facilities. Although clinical considerations are paramount, health authorities are already expected, as a general principle, to provide accommodation for men and women in such a way as to preserve the dignity of the individual patient, to prevent embarrassment and at all times to ensure acceptable standards of privacy.

The Government are at one with your Lordships' House in agreeing that acceptable standards of privacy must be maintained. But we have a problem in defining "a ward". There are many designs. For instance, there are Nightingale wards which were designed in Victorian times for different needs. People suffering from diseases such as TB at a time when there were no antibiotics languished in hospital for months or even years. Unadapted Nightingale wards, with no separate bathroom, toilets and washing facilities and with beds separated by flimsy curtains, do not give people the protection, the privacy and the dignity they can reasonably expect. I can reassure my noble friend Lady Park of Monmouth that in our view such wards are only suitable for single-sex use and should not generally be used for both men and women. Fortunately, few remain and those that do have either been adapted or are simply being swept away and replaced by new hospital schemes. No Nightingale ward has been built since 1948 and once the remaining long-stay institutions close, only a handful will remain.

In many hospitals staff cherish old traditions and ward names are among them. But in modern wards—and here I do not mean Nightingale wards—there are no serried

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ranks of beds. There are bays, side rooms, places for one, two, four or six people. The name may be the same for this complex of accommodation but the lay-out provides for flexible use and gives the privacy and dignity we are determined to provide. There is opportunity to offer companionship or privacy, mixed-sex—as a few prefer—or single-sex. We should not be rigid or judgmental about people's preferences but should try to offer them what they want. Nor should we under-estimate the benefits of people requiring the same specialist treatment being grouped together. So, although this accommodation is defined as a mixed-sex ward, it achieves what your Lordships seek with discreet and private accommodation.

I hold in my hand the advice to the Secretary of State on health accommodation for mixed-sex use, produced by the NHS Estates. It shows ways of adapting all types of wards which allow for the separation of the sexes. If we were more sophisticated in this Chamber I should like an overhead projector to enable me to show what they look like. Unfortunately, that sophistication is not open to us and I have therefore placed the book in the Library.

As my noble friend Lady Seccombe and the noble Baronesses, Lady Masham and Lady Nicol, highlighted, there is other accommodation, such as that for intensive care, which it would be impractical to separate and where patients are too ill to be aware of their surroundings. There are children's wards. At what age should they be segregated? Some teenagers are gregarious and like to be together. Occasionally a husband and wife are in hospital together and would prefer to share a room rather than be separated—a situation which occurred when the IRA bombed the Grand Hotel in Brighton.


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