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.
This can vary greatly with some trusts allowing the hijab, some prohibiting their staff from wearing a hijab within operating theatres completely and others failing to mention it at all. This has led to over half Muslim female healthcare professionals experiencing problems trying to wear a headscarf in theatre.
Although recommendations by the Department of Health are in place, the dress policies of many hospital trusts fail to take the accommodations into account due to a lack of awareness about existing uniform and workwear guidance for faith groups.
Frontline staff were also reported as preventing Muslim women from adhering to their faith practices of covering. Some women said they felt embarrassed, anxious and bullied due to lack of clarity regarding NHS dress code policy.
No wonder then that some Muslim women avoid pursuing acute medical and surgical careers and instead opt for primary care roles due to pressures in complying with hospital dress codes.
Whilst I welcome more doctors in general practice, it is disappointing that Muslim women are being held back in their careers due to dress code policies, which may be in turn due to a lack of awareness by trusts to follow the guidance completely.
Muslim women are already underrepresented in the workplace and it is well documented that they face a “triple penalty” as per the findings of the women and equalities committee. And with increasing evidence that a diverse workforce contributes to good patient care, it is imperative that the findings of the study are addressed and a clear, inclusive dress code is implemented nationally, rather than open to local interpretation with no compromise on patient care.
This isn't a case for making special dispensation for faiths at the expense of patient safety – that is a gross distortion of the facts. This is a case of ensuring that evidence-based infection control policies and equality commission policies come together to give the NHS the widest possible pool of talented and valued clinicians to choose from – a win for everyone.
There is already a crisis in the NHS workforce and it is vital that we do not lose nor further alienate essential doctors from an already depleted NHS over something that could be so easily rectified. That to me would make no sense at all.