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Delivering Single Sex Accommodation (DSSA) Policy
Version
5
Name of responsible (ratifying) committee
Trust Governance and Quality Committee
Paediatric Standards and Quality Committee
Date ratified
4th February 2014
Document Manager (job title)
Lead Nurse for DSSA and Head of Nursing for
Children and Young People 0-19 yrs.
Date issued
12th March 2014
Review date
January 2016
Electronic location
Management Policies
Related Procedural Documents
Policy for the Management of Adverse Incidents and
Near Misses
Key Words (to aid with searching)
Privacy and Dignity
Version Tracking
Version
Date Ratified
Brief Summary of Changes
Author
5
Feb 2014
Updated references
J Sprack
and
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CONTENTS
QUICK REFERENCE GUIDE
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1. INTRODUCTION
2. PURPOSE
3. SCOPE
4. DEFINITIONS
5. DUTIES AND RESPONSIBILITIES
6. PROCESS
7. TRAINING REQUIREMENTS
8. REFERENCES AND ASSOCIATED DOCUMENTATION
9. EQUALITY IMPACT STATEMENT
10. MONITORING COMPLIANCE WITH, AND THE EFFECTIVENESS OF,
PROCEDURAL DOCUMENTS
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Title of Policy : Delivering Single Sex Accommodation (DSSA) Issue Number 5 Issue Date 12/03/2014
(review date January 2016 unless requirements change)
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QUICK REFERENCE GUIDE
This policy must be followed in full when developing or reviewing and amending Trust procedural
documents.
For quick reference the guide below is a summary of actions required. This does not negate the need
for the document author and others involved in the process to be aware of and follow the detail of this
policy. The quick reference can take the form of a list or a flow chart, if the latter would more easily
explain the key issues within the body of the document
• Mixed sex accommodation will be eliminated, except where it is in the best interests of the
patient or reflects their personal preference.
• A breach occurs at the point a patient is admitted to mixed sex accommodation outside of the
terms of this policy.
• The specialty matron (in hours), out of hours the duty matron or duty hospital manager must
be informed of the potential breach prior to the occurrence.
• The breach and the numbers of patients affected must be declared at the next trust
operational meeting by the patient flow manager for the specialty involved
• A breach form must be completed and a copy sent to the DSSA lead nurse for adults or
Head of Nursing for Women and Children’s CSC if involving a young person.
• Patient to receive a personal visit from their CSC management team and a letter of apology
• Reported breach patients to be moved to single sex facilities within 24hrs or an adverse
incident Form completed.
• Further details on managing emergency and specialty specific patients are found within
Section 8.
To Illustrate the Process
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Decision to admit wrong gender patient made
Escalate to Matron to search for alternatives
Escalate to Duty Hospital Manager who will inform the Duty Executive
Written apology given to the patient (template at end of policy)
Adverse incident form completed, specialty to complete IMR/RCA immediately (template
at end of policy)
Copies emailed to Lead Nurse for DSSA with 48hrs
Lead Nurse to organize panel to agree classification of breach prior to declaring
Once agreed, Lead Nurse to upload details on G drive
Lead Nurse to include in monthly report to commissioners
Title of Policy : Delivering Single Sex Accommodation (DSSA) Issue Number 5 Issue Date 12/03/2014
(review date January 2016 unless requirements change)
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1. INTRODUCTION
This policy details the requirements for the provision of treatment and care for patients in single
sex facilities. The Trust maintains a single sex policy, which has a ‘zero’ tolerance for mixed sex
accommodation across the Trust, and outlines the action and escalation required when a
situation exists. All patients should be nursed in single sex accommodation, unless a young
person expresses a preference to be cared for in a mixed bay or specialised or urgent care for
the patient may take priority over ensuring same sex accommodation.
There are a small number of circumstances where mixing can be justified but these are few and
mainly confined to patients who need highly specialised care, such as that delivered in critical
care units.
The Department of Health recognises that children uniquely benefit from same age
accommodation and this needs to be balanced with the need for same sex accommodation.
There are good reasons why children and young people are grouped together according to age
rather than gender. What is important is taking into account their physical, psychological, clinical
and social needs.
“Children under 16 yrs should not be cared for on adult ward, but on wards that are appropriate
for their age and stage of development. Actual age is less important than the needs and
preferences of the individual child or young person. In particular, the needs of the adolescents
require careful consideration. In general, adolescents prefer to be located alongside other
people of their age . ... the care of young people should be reviewed in the particular
circumstances of each hospital, to make sure that their separate needs, including for
safeguarding, are recognised and met” (C and YP Health Outcome Report 2013)
2. PURPOSE
This policy outlines the processes for ensuring that patients are nursed in single sex facilities,
and outlines the action and escalation required if there is a potential to breach the Trust’s single
sex policy.
Non compliance or breaches are required to be reported nationally via the Unify2 system, to the
Commissioners and to provide assurance with PLACE and the Care Quality Commissions
requirements.
3. SCOPE

This relates to all ward areas and departments accommodating in-patients, with the
requirement to work towards the principles of single sex accommodation in specialised or
urgent care areas.
 The policy applies to all staff.
 Breaches will be declared in a timely way as soon as a patient is admitted into a bay of
other sex patients and will include all affected patients, i.e. those within the bay.
(The policy will be audited on a monthly basis)
‘In the event of an infection outbreak, flu pandemic or major incident, the Trust recognises
that it may not be possible to adhere to all aspects of this document. In such circumstances,
staff should take advice from their manager and all possible action must be taken to
maintain ongoing patient and staff safety’
3.1 Areas affected by this policy
Department of Critical Care and High Care Areas
The patients admitted to these units will be cared for in a manner that is supportive of their
individual privacy and dignity requirements, however the extensive clinical care and support
whilst within this unit is of paramount importance and therefore no guarantee can be given that
the patients will occupy a single sex bay.
Title of Policy : Delivering Single Sex Accommodation (DSSA) Issue Number 5 Issue Date 12/03/2014
(review date January 2016 unless requirements change)
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It is not acceptable when the patient no longer requires level 2 or 3 care, but cannot be placed
in a ward.
Recovery areas
Following theatre or other procedure, the patient’s safe recovery is of utmost importance, hence
the priority will be ensuring the observation and maintenance of their airway and quick
appropriate interventions. All patients will be treated in a dignified way and their privacy will be
safeguarded at all times by their allocated practitioner.
It is not acceptable in recovery units where patients remain until discharge.
Endoscopy and Day Case Suites
It is expected that organisational changes will be made to undertake single sex lists, in the
absence of this, every effort will be made to segregate sexes by the use of cohorts, screens
and process changes to allow for minimal opportunity for patients accidental exposure to the
opposite sex. Toilet facilities should be allocated for single sex use, patients should be kept
clothed as much as possible to reduce dignity issues.
Not acceptable where dignity is likely to be compromised e.g. if bowel prep is needed and/or
patients are required to undress.
Day Units for Children and Young People. While sleeping arrangements do not feature in
day treatment areas, standards of privacy and dignity for patients still apply. The presumption
for most patients should be that they do not have to be cared for in the same room with patients
of the opposite sex; that they will be protected from unwanted exposure if they have to undress;
and confidential conversations with staff cannot be overheard.
However, some patients who attend the same day area regularly (for example for dialysis) may
build friendships, which transcend a preference for same-sex segregation. A balance should be
struck, which may vary from one group to another.
MAU/ SAU/CAU
Admission and assessment areas can be difficult to segregate but there are no clinical
justifications for placing patients in mixed sex accommodation within these areas. Toilets and
bathrooms should be single sex facilities. Breaches to segregation must be declared along with
numbers of other patients affected by the breach. Patients in observation beds should be
segregated and any breach to this must be declared
Not acceptable for organisational convenience or as a routine occurrence
ED/ED Child
Emergency cases to ED must be treated and cared for with respect to their individual privacy
and dignity needs, single sex toilets and bathrooms must be available. Patients within the
observation ward should be segregated and any breach to this must be declared.
General Inpatient wards
There are no clinical justifications for mixing sexes within general wards and any breaches
must be declared and the patient moved to a more appropriate place within 24hrs.
Common sense and discussion should also prevail about arrangements for
adult carers of people with specialist communication needs.
Children and Adolescents’ wards/areas
There are good reasons why children and young people are grouped together according to age
rather than gender. What is important is taking into account their physical, psychological,
clinical and social needs. The flexibility to be able to provide privacy for specific treatments or
personal care is valuable i.e. height and weight facilities.
Common sense and discussion should also prevail about arrangements for parents and
siblings to visit freely and to stay overnight, Staff should ask the child or young person if they
have a preference for age or gender specific accommodation, ideally in conjunction with their
family on each admission.
Title of Policy : Delivering Single Sex Accommodation (DSSA) Issue Number 5 Issue Date 12/03/2014
(review date January 2016 unless requirements change)
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4. DEFINITIONS
These definitions are adopted from the Chief Nursing Officer and Deputy NHS Chief
Executive letter (2010). For clarity, further detailed definitions relating to emergency, day
treatment, critical care, Children and Young People in-patient wards and gender variant
children are within Section 3.
4.1 Single Sex Accommodation and Facilities:
Patients should not normally have to share sleeping accommodation or sanitary facilities with
members of the opposite sex except children if this is their preference. This applies to all
areas of hospital care.
4.2 Breach
A breach occurs at the point a patient is admitted to mixed sex accommodation outside of the
terms of this policy.
5. DUTIES AND RESPONSIBILITIES
5.1 Specialty Matron (within hours)
 The CSC management team must be informed prior to any patient being placed in mixed sex
accommodation to ensure that all other alternatives are explored (Duty Matron and out of
hours Duty Hospital Manager ).
 Patients who by exception are placed in mixed sex accommodation and those affected should
have a breach report completed (Section 8) and be declared at the next operational meeting
by the patient flow coordinator.
 An alternative single sex facility identified as soon as possible and at a maximum within 24
hours.
 All patients who are placed in mixed sex accommodation should receive an apology and
explanation from the CSC management team who will be alerted prior to the event. A root
cause analysis must be commenced by the specialty.
5.2 Duty Hospital manager
 The Duty Executive must be informed prior to the event.
 The DHM must load the patients details into the specific spread sheet on the G drive
 The breach must be declared on the operations report
5.3 Lead Nurse for DSSA
 The lead nurse will ensure that root cause analysis is undertaken by the specialties on all
potential breaches to inform the decision making process.
 The patients who have breached the Single Sex Accommodation policy will be reported to the
commissioners as clinically justified or non-clinically justified. Any that are deemed not
clinically justified are reported nationally via Unify 2 by the Business Intelligence team.
 A 10% random sample of breaches across the trust will be audited monthly to ensure that the
justifications are correct; breaches will be assessed for root causes and actions taken against
lessons learnt. The lead nurse will ensure that this takes place and is available for the PCTs
to monitor.
 A 48hr panel will be held with a member of the executive team to discuss the IMR/RCA and
agree the classification prior to being confirmed and declared as a breach
Title of Policy : Delivering Single Sex Accommodation (DSSA) Issue Number 5 Issue Date 12/03/2014
(review date January 2016 unless requirements change)
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6. PROCESS
6.1 Standards to be followed
 All patients to receive an apology, explanation and written information within 24hrs of breach.
 No patients to be nursed in mixed sex accommodation for more than 24 hours, each patient
plus those affected will be classed as breaches. The rationale needs to be documented in
patients clinical record
 All toilets and bathrooms to be clearly labeled male/ female or disabled unless a single facility
6.2 Breach of this Policy and responsibilities of all staff
 Patients who breach the 24hr policy must have an Adverse Incident Report form and
IMR/RCA (attached) completed for investigation by the specialty Matron and forwarded asap
to the Lead Nurse for DSSA.
 Non-compliance with a Trust policy, procedure, guideline, PGD, protocol or patient
information standard may result in disciplinary action.
6.3 Escalation
If it is not possible to provide single sex accommodation this should be escalated as follows:
 Discussion with Patient Flow Manager where appropriate (in hours).
 Discuss with specialty Matron (in hours) and duty matron out of hours.
 Discuss with Duty Hospital Manager (out of hours).
 The Duty Executive must be informed
 An Adverse Incident Report and IMR/RCA form should be completed
6.4. In the overall best interests of the patient- ie with regard for the patients’ benefit or
advantage
There are situations where it is clearly in the patients’ best interests to receive rapid or
specialist treatment, and same sex accommodation is not the immediate priority. In these
cases, privacy and dignity must be protected- eg by the enhanced staffing in critical care
facilities and the flexibility to be able to provide privacy for specific treatments or personal
care is offered i.e. Height and weight facilities. The patient should be provided with same sex
accommodation immediately the acceptable justification ceases to apply.
6.5 Acceptable Justification i.e. not a breach
1)
Safety: In the event of a life-threatening emergency, either on admission or due to a
sudden deterioration in a patients’ condition. Or segregation would put the patient or
others in danger of harm.
2)
Acuity: Where a critically ill patient requires constant one to one nursing care e.g.
HDU or ITU or where a nurse must be physically present in the room/ bay at all times
(the nurse may have responsibility for more than one patients (e.g. level 2 care) This
would be unacceptable if staff shortages or skill mix were the rationale
3)
Specialist Care or Observation: Where a short period of close patient observation is
needed e.g. immediately post anaesthetic recovery or where there is a high risk of
adverse drug reactions.
4)
Patient Preference On the joint admission of couples, family groups or young people
13-19 yrs, however in all cases individual’s privacy and dignity should be maintained,
and verbal consent should be gained and documented.
Title of Policy : Delivering Single Sex Accommodation (DSSA) Issue Number 5 Issue Date 12/03/2014
(review date January 2016 unless requirements change)
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6.6 Unacceptable Justifications i.e. Breach
 Placing a patient in mixed sex accommodation for the convenience of medical, nursing
or from a desire to group patients in a clinical specialty.

Placing a patient in mixed sex accommodation because of a shortage of staff or poor
skill mix

Placing a patient in mixed sex accommodation because of restrictions imposed by old or
difficult estate

Placing a patient in mixed sex accommodation because of a shortage of beds

Placing a patient in mixed sex accommodation because of predictable fluctuations in
activity or seasonal pressures

Placing a patient in mixed sex accommodation because of predictable non clinical
incident e.g. ward closure

Placing or leaving a patient in mixed sex accommodation whilst waiting for assessment,
treatment or a clinical decision

Placing a patient in mixed sex accommodation for regular but not constant observation
It is not acceptable to mix sexes purely on a basis of clinical specialism.
6.7. Reflecting Patient Choice
 There are some instances when sharing accommodation with the opposite gender
reflects personal choice and may therefore be justified. In all cases privacy and dignity
should be assured. Group decisions should be reconsidered for each new admission to
the group, as consent cannot be presumed. This personal choice should be
documented within the patient’s notes.
6.8 Acceptable Justification i.e. not a breach
 If an entire patient group has expressed an active preference e.g. renal dialysis (This
preference should be made clear in their notes and clear signs displayed explaining
rights to choose)
 If individual patients have specifically asked to share and other patients are not
adversely affected (e.g. children/young people who have expressed an active
preference for sharing with people of their own age group, rather than gender)
6.9 Unacceptable Justifications i.e. breach
 If a patient is asked to choose between accepting mixed sex accommodation, or going
elsewhere.
 If the patient is asked to prioritise same sex accommodation over another aspect of care
(e.g. speed of admission, specialist staff etc)
 The routine mixing of young people without establishing preferences.
 There should always be segregation unless the patients asked specifically to share
 If the patient did not express a preference (it cannot be presumed that they will find
sharing acceptable)
(Annex A DH Gateway 15024)
Title of Policy : Delivering Single Sex Accommodation (DSSA) Issue Number 5 Issue Date 12/03/2014
(review date January 2016 unless requirements change)
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7. TRAINING REQUIREMENTS
Through CSCs and Specialty groups i.e. Trust Adolescent Working Group
Dept Training days where applicable i.e. Paediatric Unit
Team Brief.
Handovers
8. REFERENCES AND ASSOCIATED DOCUMENTATION
Update letter (CNO & Dep NHS CE 2010) available
@http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/professionalletters/Chi
efnursingofficerletters/index.htm
C and Y P Health Outcome Report (2103)
Links to other key Strategies & Policies
 The policy is based on the revised Operating Framework for 2010-2011 expectation that NHS
organisations will eliminate mixed sex accommodation, except where it is in the best interests
of the patient, or reflects personal choice.
 The Policy is supported by Chief Nursing Officer and Director General Finance, Performance
and Operations Update (DH, 2009) on Privacy & Dignity, the RCN Defending Dignity
Campaign, the Dignity in Care Campaign and the Good Practice Guidance.
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Sex audit\Policy 2012\Compliance
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Sex audit\Patient
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audit\Breach
apology
DSSA
letter.doc
reports\Combined
2011.doc
IMR RCA Single Sex Breach.doc
9. EQUALITY IMPACT STATEMENT
Portsmouth Hospitals NHS Trust is committed to ensuring that, as far as is reasonably
practicable, the way we provide services to the public and the way we treat our staff
reflects their individual needs and does not discriminate against individuals or groups
on any grounds.
This policy has been assessed accordingly
All policies must include this standard equality impact statement. However, when
sending for ratification and publication, this must be accompanied by the full equality
screening assessment tool. The assessment tool can be found on the Trust Intranet ->
Policies -> Policy Documentation
Our values are the core of what Portsmouth Hospitals NHS Trust is and what we
cherish. They are beliefs that manifest in the behaviours our employees display in the
workplace.
Our Values were developed after listening to our staff. They bring the Trust closer to its
vision to be the best hospital, providing the best care by the best people and ensure
that our patients are at the centre of all we do.
We are committed to promoting a culture founded on these values which form the
‘heart’ of our Trust:
Respect and dignity
Quality of care
Working together
No waste
This policy should be read and implemented with the Trust Values in mind at all times.
Title of Policy : Delivering Single Sex Accommodation (DSSA) Issue Number 5 Issue Date 12/03/2014
(review date January 2016 unless requirements change)
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10. MONITORING COMPLIANCE WITH PROCEDURAL DOCUMENTS
Minimum requirement to
be monitored
RCAs
relating
compliance
to
non
Lead
CSC
management
team
Tool
Frequency of Report
of Compliance
When a breach occurs
Reporting arrangements
48 hr Panel to be organized and
chaired by exec
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Personal\Mixed Sex audit\Breach reports\Combined IMR RCA Single Sex Breach.doc
This document will be monitored to ensure it is effective and to assurance compliance.
Title of Policy : Delivering Single Sex Accommodation (DSSA) Issue Number 5 Issue Date 12/03/2014
(review date January 2016 unless requirements change)
Lead(s) for acting on
Recommendations
CSC management team