JAG advice for same sex
accommodation standards in
endoscopy
Introduction
This advice is aimed at JAG assessors and endoscopy services operating in England only. It serves as
additional advice to support the correct interpretation and implementation of the NHS England standard
on same sex accommodation (SSA). A series of frequently asked questions has been developed that
address recent cases studies and questions posed to JAG.
Background
All providers of NHS funded care are expected to eliminate mixed sex accommodation, except where it
is in the overall best interest of the patient, in accordance with the definitions set out in the formal
communication to organisations ‘Eliminating Mixed Sex Accommodation CNO/2010/’ (appendix A).NHS
England have confirmed to JAG that elimination of mixed sex accommodation remains a core
commitment. JAG will continue to support and endorse national policies for SSA by incorporating them
into the GRS privacy and dignity requirements and formal accreditation assessments.
As part of your service becoming gender separation compliant, we strongly advise you to work with your
Director of Nursing to ensure high levels of privacy and dignity are maintained throughout the patient
pathway, and that they have assessed your service as compliant, or agree to make the required
modifications. A signed assessment of compliance is being phased in from April 2016 for JAG
accreditation visits.
As part of your service becoming gender separation compliant, we strongly advise you to work with
your Director of Nursing to ensure high levels of privacy and dignity are maintained throughout the
patient pathway, and that they have assessed your service as compliant, or agree to make the
required modifications. A signed assessment of compliance is being phased in from April 2016 for JAG
accreditation visits.
Frequently asked questions
1.
When is gender separation required in an endoscopy service?
Gender separation is required whenever patients are undressed, or in sleeping areas where they are
recovering from sedation. This includes:
 Patients changing from day clothes in any situation
 Any area where patients wait in gowns or nightclothes.
 Any area where patients are on trolleys or beds recovering from sedation
Men may not pass through a female area, or vice versa where patients are undressed or are in sleeping
areas recovering from sedation.
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2.
When is gender separation not required in an endoscopy service?
Gender separation does not apply:
 If patients are dressed in their own clothes and are not recovering from sedation e.g. General
waiting areas, second stage recovery or discharge lounges.
 If patients are moving in the clinical corridor e.g. to the procedure room, toilets, back to
changing area
 In the event of a life threatening emergency
 In Wales, Northern Ireland and Scotland, but it is seen as good practice where it can be
achieved, in refurbishments, and new builds.
3.
What about toilet and washing areas?
If toilet facilities are on the clinical corridor, it is acceptable for patients to be allocated to male or
female use. If a toilet area has more than one toilet e.g., two cubicles behind one main door, the whole
area has to be allocated to one gender.
Patients may not walk through the opposite gender waiting or recovery area to access toilet facilities.
When patients are fully dressed and in a discharge area, they can use the same toilet and washing
facilities e.g. one toilet in a discharge lounge.
4.
What if non-GI endoscopy is also undertaken?
Gender separation is required for all patients and lists within a combined endoscopy service. E.g. a
bronchoscopy list is undertaken alongside a throat spray OGD list: gender separation is still required as
sedated patients are using sleeping accommodation.
5.
What if endoscopy sits as part of a day surgery or procedure unit?
Gender separation applies to Day Surgery environments also. Whenever endoscopy patients are cared
for as part of a combined area, gender separation is required for all patients as above.
6.
Patients in the private sector are often recovered in a mixed sex recovery area that is
part of theatre before they go back to their rooms, does this comply?
A level two recovery area is where patients have immediate high level postoperative observation,
before they reach a state of recovery where less intensive care is required e.g. post general anaesthetic.
These areas may be mixed gender, with the expectation that the next stage of recovery is undertaken in
a gender-separated area. Using level two recovery and then returning to private rooms is acceptable.
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7.
Do gender specific waiting rooms or areas need to have doors?
In primary check-in and waiting areas patients are fully dressed so this does not need to be gender
specific. No doors or separation is required.
Where patients are undressed, the waiting room or area must have a door that is kept closed. Some
waiting rooms areas, such as sub waits, are quite small. It is acceptable in these circumstances that full
height curtains may be used instead of doors. This allows separation and supports patient movement.
The rest of the room structure should have fixed, full height, solid walls.
8.
Can patients pass each other in corridors when undressed?
Yes, clinical corridors are seen as neutral areas for passing. There should be high standards of privacy
and dignity for patients moving around these areas.
9.
What about sub wait areas just outside a procedure room?
If a sub wait is used, these must be gender specific to support patients who are undressed. Privacy and
dignity must be maintained.
10.
What if the service has single sex lists?
If a service chooses to run single sex lists, the following applies:
 All activity within the department for that day or list should be single sex, including non-GI, twoweek wait, and urgent procedures.
 If a patient of the opposite gender need an endoscopy (exception- life saving) a separate
pathway must be arranged. This includes a separate waiting, changing and recovery room and
toilet. (See also Question 11)
 It is never acceptable for patients of the opposite gender to be scheduled to meet:
 Waiting time or surveillance targets
 List availability specifically where there is a need for a complex procedure
 Availability of a specific endoscopist
 The care of non-GI endoscopy patients e.g. bronchoscopy.
 Genuine emergency cases, where the clinical complaint is life threatening may be managed on a
single sex list. Services should support high levels of privacy for all patients in these exceptional
circumstances e.g. recovery within the procedure room.
11.
Can two separate pathways be used?
In some endoscopy units they are able to accommodate two separate pathways for dressed and
undressed/ sleeping accommodation patients.
An example would be a non-sedated list, where the patient remains in their own clothes, bypassing first
stage recovery area and discharged from the procedure room or via second stage recovery.
The service must ensure that there are suitable toilet facilities available, and there is a room and process
for patients to be assessed and managed if they become unwell, and need to lay down on a trolley.
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12.
Can mobile screens be used?
Mobile screens can never be used for gender separation. Screens or partitions must be permanent and
fixed to a wall. Figure 1 provides an example of non compliant screens.
Figure 1-Non-compliant gender separation with screens
13.
What features should gender specific male and female recovery areas have?
Gender specific male and female recovery areas must have in place:
 Separate access to each recovery area
 Full height, fixed walls so the patient feels as if they in a separate room
 No access or view to other recovery area through e.g. clinical base or nurse station
 Access to own toilet
 Curtains between each bedded area for individual patient privacy.
Fixed, full room height concertina partitions are acceptable to divide rooms, allowing an area to be split
into two or more rooms. Each area should have its own access when the main area is divided.
14.
Do gender specific recovery areas need to have doors?
It is acceptable in some units that full height curtains are used as a privacy barrier to the clinical corridor.
These separate to allow access to the recovery area, and should be disposable hygiene curtains. Each
bedded bay still requires its own set of curtains for patient privacy.
15.
What about the use of patient cubicles?
Patient cubicles are individual cubicles for trolleys that have three fixed, solid walls, with a curtain or
sliding door to the front (figures 2, 3 & 4). These may be used to separate male and female patients
within a combined recovery area and are compliant. When mixed gender patients are in cubicles, the
curtains must be kept closed at all times, and close patient monitoring and clinical observation is
required.
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Patient cubicles are not suitable for all environments, and high levels of privacy and dignity for all
patients who may be managed in a small area are required. This may include bed allocation choice for
genders.
Figure 2-Patient cubicle with curtains
Figure 3-Patient cubicle with curtains
Figure 2 and 3 are types of patient cubicles are suitable for:




Non confidential conversations eg taking observations, checking a patient is well
Patient changing and waiting
Recovery post procedure
They are not suitable for the administration of enemas
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16
Where can I have a private conversation?
A private conversation would be: Patient assessment
 Consent
 Giving results or discussing their clinical case
 Discharging patients and providing follow up and health advice
 Listening to patients health related questions or concerns
Such conversations must be held in a room with a door to prevent overhearing.
Figure 4-Patient cubicle with sliding doors
17.
What is a patient pod, and how does it differ from a patient cubicle?
A patient pod is defined by the Department of Health, where each patient has their own trolley space,
and ensuite toilet .It may have a fixed door or curtain to the front. These are suitable for the
administration of enemas.
18.
What about corridors and areas outside patient cubicles or pods?
In general the area outside the cubicles or pods becomes gender neutral. This means trolleys may be
wheeled through the area to collect or return patients, and patients may walk past other cubicles or
pods, even if a patient of the opposite sex is inside. With these models it is expected that the curtains or
doors will be closed. Higher levels of nurse observation is required. Toilets may be positioned within
the general recovery area or nearby to meet patient need.
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19.
If an endoscopy service does not provide NHS funded care, does it need to follow the
requirements for same sex accommodation?
JAG supports the same sex accommodation national standards and uses them to underpin both the GRS
privacy and dignity standard and the accreditation process. Therefore a service must meet the standard
if it wishes to achieve JAG accreditation.
20.
Where can I get more advice?
Email your query to askjag@rcplondon.ac.uk for specific advice regarding individual unit design and
layout.
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Appendix A
1.
Eliminating Mixed Sex Accomodation PL/CNO/2010/3
http://www.gov.uk/government/publications/eliminating-mixed-sex-accommodation
2.
Same Sex Accommodation Standards in Endoscopy Update April 2011. JAG
www.jagaccreditation.org – Knowledge Management System
Accreditation Unit
Royal College of Physicians
11 St Andrews Place
Regent’s Park
London NW1 4LE
Tel: +44 (0)20 3075 1620
Email: askjag@rcplondon.ac.uk
www.rcplondon.ac.uk
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Date Last updated - 13 November 2015
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