Health: A mixture of fear and embarrassment in hospital: Putting men and women in next-door beds may help health service managers to balance their budgets, but it is unlikely to aid the recovery of patients, says Andrew Cole

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The night that Margaret Jones was admitted to an acute orthopaedic ward with a broken ankle, she awoke to find someone's hand on her breast. When Mrs Jones, 69, fully came to her senses, she was appalled to discover a naked old man, minus false teeth, lying beside her. He had urinated on her, and was in a 'state of great excitement'.

This incident, in her local London hospital, was her first experience of a mixed-sex ward. Mrs Jones (not her real name) had recently been widowed and was extremely distressed. It took some time to gain the attention of the nursing staff, but once she had, she insisted on a move to a single-sex ward.

The case is related by Patricia Wilkie, vice-chairman of the Patients' Association. It is, says Ms Wilkie, one of a number of complaints about a trend in NHS hospitals of placing male and female patients on the same ward.

Mrs Jones' experience is an extreme example. Some patients have no objections to unisex wards. But Ms Wilkie is convinced that many - particularly women, the elderly and some ethnic minorities - feel intimidated or embarrassed by the presence of someone of the opposite sex in a bed nearby.

'People are in hospital for a shorter time these days and so they're usually more poorly. They don't want to have to trouble with always making sure their dressing-gown is done up. If one is in a single-sex ward, no one is going to bat an eyelid, but on a mixed-sex ward it can be very embarrassing.'

In one Surrey hospital, men on a urological ward and women on a gynaecological ward shared toilets and washrooms. Ms Wilkie asked whether this caused embarrassment and was assured that the women liked the situation and even put on lipstick specially.

Ms Wilkie is incredulous. 'If some nurses in 1993 believe that women in a gynaecological ward feel better for having elderly male urological patients around, to the point of putting on lipstick, then God help us]'

For some, the mixed-sex environment can affect recovery. Jenny Fraser, a midwifery sister at Norfolk & Norwich Hospital, says her elderly mother was in a state of constant anxiety when sharing her four-bed hospital room with male patients.

'My mother has Parkinson's disease, and one of her concerns is that she can't do things for herself. Using the commode was almost impossible because she was worrying whether the curtains were properly closed around the bed. One night she was the only woman in the room with three men. She did not sleep for fear that one of them might wander and get into bed with her.'

The contrast when she moved to a single-sex ward was remarkable, says Ms Fraser. 'There were six women in the ward, and they chatted and helped each other in a way that men just wouldn't have done. I'm convinced the sense of comradeship among those women aided and abetted their recovery.'

The unisex ward can take many forms. It can be a straight division into a male and a female section; small single-sex bays, divided by curtains or partitions; or a haphazard mix. In some hospitals patients are assigned to single-sex wards but share bathrooms and toilets.

The Patients' Association estimates that nearly three-quarters of general wards are now mixed in some way. Undoubtedly the motivation has more to do with money than therapy. Toby Harris, the director of the Association of Community Health Councils, says: 'It is obviously cheaper to run one ward, containing both sexes, at full capacity than two single-sex wards where there may be empty beds.'

The drawback is that patients' wishes may be disregarded. Mr Harris points out that the Patient's Charter contains a specific pledge to uphold patients' 'privacy and dignity', but he remains cynical about its ability to deliver. 'I am sure in the last resort health service managers are more concerned about balancing the budget than a detailed interpretation of the Patient's Charter.'

The Royal College of Nursing is so concerned about this trend that it has produced new guidelines for its members emphasising that the patient's privacy and dignity must always be paramount.

It stops short of opposing mixed-sex wards, but does suggest that some hospital designs, such as the traditional Nightingale-style ward, are not suited to accommodating both sexes, and it states that, as a minimum, patients should be entitled to separate washing, toileting, dressing and interviewing facilities.

In addition, it proposes that patients should be told in advance if they are to be admitted to a mixed-sex ward and given the option of alternative accommodation; and that any patient should have the right to ask to be cared for by a nurse of the same sex. Above all, it concludes, 'hospital environments must not give the impression that they are designed for the convenience of management and staff rather than the needs of the patient.'

Most hospitals and staff claim the shift to mixed-sex wards has met with little or no reaction. Ms Wilkie believes this may be because many patients are so grateful to have a bed at all, and often so keen to get out once they have been dealt with, that they are not prepared to make a fuss. There is also the lurking fear that they might be victimised if they complained.

Ms Fraser's experience appears to bear this out. She complained about an aspect of her mother's care and within hours one of the staff had raised it, accusingly, with her mother, who was mortified. As a result, Ms Fraser is reluctant even to insist on single-sex accommodation the next time her mother is hospitalised.

'My mother is no fool. She is a retired company director. But she belongs to that generation that was brought up not to complain or upset anybody. She believes she should fit in with the service and not that the service should fit in with her. Those attitudes are very difficult to change.'