Background
The NHS Constitution includes a pledge to patients that, if admitted to hospital, they will not have to share sleeping accommodation or toilet facilities with patients of the opposite sex, except where appropriate. A mixed-sex accommodation (MSA) breach is any unjustified mixing of genders in certain spaces in the hospital and may be justified in some circumstances where patients need highly specialised care, such as in critical care units.
Occurrences of unjustified mixed-sex sleeping accommodation in hospitals
In April 2011, it became mandatory for NHS Trusts in England to submit monthly data on MSA breaches, and flat-rate fines for MSA breaches were introduced. Between April 2011 and August 2012, the number of MSA breaches decreased by over 93%. Following this, the number of MSA breaches remained low at less than 500 breaches per month, until 2016 when it began to increase again.
Before the pandemic, in January 2020, 2,156 MSA breaches were reported. The MSA breach rate (the number of MSA breaches per 1,000 finished consultant episodes) was 1.2. To release capacity across the NHS during the coronavirus (Covid-19) pandemic, NHS England paused the collection and publication of MSA breaches data between March 2020 and September 2021. After the MSA collection resumed, MSA breaches increased and reached a peak of 4,938 in January 2022. By May 2023, the number of MSA breaches had dropped to 3,473, but was still 60% higher than in January 2020, the latest month for which data was reported before the onset of the pandemic.
About this data
Mixed-sex accommodation (MSA) breach data is collected monthly from all NHS providers and other organisations that provide NHS-funded care (including independent and voluntary sector organisations). Since April 2011, the MSA data return has been mandatory for all NHS providers, and flat-rate fines for MSA breaches have been built into organisations’ contracts.
‘Sleeping accommodation’ includes areas where patients are admitted and cared for on beds or trolleys, even where they do not stay overnight. It therefore includes all admissions and assessment units (including clinical decision units), plus day surgery and endoscopy units. It does not include corridors or areas where patients have not been admitted, such as accident and emergency cubicles.
The MSA breach rate is the number of breaches of mixed-sex sleeping accommodation per 1,000 finished consultant episodes.
In January 2019, 1,123 MSA breaches were reported by Sandwell and West Birmingham Hospitals NHS Trusts. Previously, the Trust had incorrectly reported data to the national collection. In February 2020, 2,637 breaches were reported by Epsom and St Helier University Hospitals NHS Trust, which had also previously incorrectly reported data to the national collection. Therefore, we have excluded these months’ data from the time series.
For more information, please see the policy Delivering same-sex accommodation and the MSA breach rate indicator methodology.