This isn’t a case for making allowances for faiths at the expense of patient safety, it’s a means of ensuring that policies work to give the NHS the widest possible pool of talented clinicians
A recent study has suggested that some Muslim female healthcare professionals experience bullying and harassment in the workplace over covering their heads and forearms in surgery. As a doctor who has worked in the NHS for over 15 years, it’s both saddening and surprising that a service which prides itself on diverse “compassionate” leadership, is failing to live up to that promise.
Although the original 2007 guidance published by the Department of Health on uniforms and workwear became known as the “bare below the elbows guidance”, made famous in 2011 when a surgeon interrupted David Cameron’s hospital visit by asking him to roll up his sleeves, it is important to note that the guidance is actually about ensuring hand hygiene.
The guidance was updated in 2010 and included recommendations to make dress code policies more sensitive to the obligations of Muslims and other faith groups whilst still maintaining equivalent standards of hygiene.
There is no conclusive evidence that uniforms and workwear play a direct role in spreading infection, although of course the clothes that staff wear should not impede effective hand hygiene, nor unintentionally come into patient contact.
For example, although exposure of the forearm is a necessary part of hand and wrist hygiene during direct patient care activity, the local trust uniform policy should allow for covering of the forearm at other times.
Disposable over-sleeves, elasticated at the elbow and wrist, may be used but must be put on and discarded in exactly the same way as disposable gloves if needed to avoid clothes coming into contact with patients and after hands have been washed if exposure of the forearm is not possible.
Despite this, the British Islamic Medical Association and The Bridge Institute’s report on the aforementioned British Medical Journal study recently revealed that 56.3 per cent of Muslim women felt that covering their arms was not respected by their NHS trust.
As well as hand hygiene, there appears to be disparity over the guidance of wearing a hijab. Given the importance that many female Muslims attach to the headscarf, there is currently no nationally agreed NHS dress code policy that addresses the wearing of the headscarf on wards or in theatres, but rather, local bespoke guidance is offered by trusts.