Mixed-sex accommodation breaches

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


Last updated: 21/08/2019

Capacity and staffing Patient experience Safety
Hospital care


The Revision to the Operating Framework for the NHS in England 2010/11 stated that "mixed-sex accommodation needs to be eliminated, except where it is clearly in the overall best interests of the patient". 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. A MSA breach is any unjustified mixing of genders in sleeping accommodation.

How has the number of mixed-sex accommodation breaches changed over time? 21/08/2019

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The number of MSA breaches in England decreased by over 93% between April 2011 and August 2012. Following this, the number of MSA breaches remained low at less than 500 breaches per month, until 2016 when they began to increase again. In February 2018, the number of MSA breaches peaked at 2,319, which was the highest reported figure since MSA data collection became mandatory for all NHS providers. MSA breaches peaked again in January 2018, however this figure should be treated with caution (see ‘About this data’ for more information).

In June 2019, there were 1,363 MSA breaches. The MSA breach rate (the number of MSA breaches per 1,000 finished consultant episodes) was 0.8.

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 Trust. Previously, the Trust had incorrectly reported data to the national collection. Therefore, the peak in this month should be treated with caution.

For more information, please see the Department of Health's MSA breach rate indicator methodology.