Mixed-sex accommodation breaches

We look at changes in the instances of unjustified mixed-sex sleeping accommodation.


Last updated: 15/10/2020

Capacity and staffing Patient experience Safety
Hospital care


The NHS Constitution includes a pledge to patients that, if admitted to hospital, they will not have to share sleeping accommodation with patients of the opposite sex, except where appropriate. Since April 2011, it has been mandatory for all NHS providers to submit monthly data on the number of occurrences of mixed-sex accommodation (MSA) breaches. An MSA breach is any unjustified mixing of genders in sleeping accommodation. Mixed-sex accommodation may be justified in some clinical circumstances where patients need highly specialised care, such as in critical care units.

To release capacity across the NHS to respond to the coronavirus (Covid-19) pandemic, NHS England has paused collection and publication of some of its official statistics during 2020/21, including MSA breaches. The latest data presented here is from February 2020, before the onset of the pandemic.

How has the number of mixed-sex accommodation breaches changed over time? 15/10/2020

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In April 2011, the MSA data return became mandatory for NHS trusts in England, 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.

MSA breaches tend to peak in winter. In February 2018, the number of MSA breaches peaked at 2,319 and in January 2019, the number of MSA breaches peaked at 2,793 (note that this figure should be treated with caution – see ‘About this data’ for more information). This may correspond to the higher rates of hospital bed occupancy seen in winter, with more occupied beds meaning that patients may have to be placed in mixed-sex sleeping accommodation.

In February 2020, 4,929 MSA breaches were reported. The MSA breach rate (the number of MSA breaches per 1,000 finished consultant episodes) was 3. However, this figure should be treated with caution, as it includes 2,637 breaches (53% of all breaches reported in February) reported by one NHS trust, which had previously incorrectly reported data to the national collection. 60% of acute trusts that submitted data in February reported no MSA breaches. No data on MSA breaches has been published since February, as NHS England has paused data collection to free up capacity to respond to the Covid-19 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). From 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 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 of the 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, the peaks in these months should be treated with caution.

For more information, please see the guidance on Delivering same-sex accommodation and the MSA breach rate indicator methodology.