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Privacy, Dignity and Respect Policy

IMPORTANT NOTE

Following the ruling from the Supreme Court in the For Women Scotland Ltd (Appellant) v The Scottish Ministers (Respondent) case published 16 April 2025, NHS England’s Delivering same-sex accommodation guidance, published in 2019, is currently being reviewed.

All providers of NHS-funded care continue to be expected to provide high quality care that meets all patients’ clinical needs, safeguards them from the risk of harm and ensures their privacy and dignity when they are admitted to hospital.

Providers should continue to measure and report breaches of the NHS Constitution pledge on same sex accommodation.

Revised guidance which supports privacy, dignity and safety for all patients in hospital accommodation will be published as soon as possible.

While this guidance is awaited it is important to continue to show respect to all people, taking appropriate steps to ensure their privacy and dignity is safeguarded along with others within the care environment

Version: V9

Ratified by:

Quality Reference Group

Date ratified: 23/10/2025

Job Title of author:

Reviewed by Committee or Expert Group

Equality Impact Assessed by:

1. Introduction

Provide is committed to providing high quality care to patients at all times. This Policy sets out how people using Provide services across the Provide Group are treated in relation to dignity and respect. Dignity and respect must be central to all aspects of care delivery across Provide services.

Under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 10 all healthcare providers must make sure that people using the service are treated with respect and dignity at all times while they are receiving care and treatment. To meet this regulation, providers must make sure that they provide care and treatment in a way that ensures people's dignity and treats them with respect at all times. This includes making sure that people have privacy when they need and want it, treating them as equals and providing any support they might need to be autonomous, independent and involved in their local community.

Providers must also have due regard to the protected characteristics as defined in the Equality Act 2010.

Dignity is concerned with how people feel, think and behave in relation to the worth or value of themselves and others. To treat someone with dignity is to treat them as being of worth, in a way that is respectful of them as valued individuals.

Responsibility for providing this does not lie with one individual or group, but with all staff at every level. Staff should deal sensitively with the various circumstances in which the Service User’s privacy and dignity may be affected.

In care situations, dignity may be promoted or diminished by:

• The physical environment

• Organisation culture

• Attitudes and behaviour of the staff

• The way in which care activities are carried out

When dignity is present people feel in control, valued and confident, comfortable and able to make decisions for themselves. When dignity is absent people feel devalued, lacking control and comfort. They may lack confidence and be unable to make decisions for themselves. They may feel humiliated, embarrassed or ashamed.

Dignity applies equally to those who have capacity and to those who lack it. Everyone has equal worth as a human being and must be treated as if they are able to feel, think and behave in relation to their own worth or value.

A chaperone can act as a safeguard for all parties (Service User and practitioner) where the patient may feel vulnerable and is a witness to continuing consent of the procedure, (see Chaperone Policy CPOL39).

2. Purpose

The purpose of this Policy is to ensure that:

• Service Users experience care in an environment that actively encompasses respect for individual values, beliefs and personal relationships.

• Service Users feel that they matter and do not experience negative or offensive attitudes or behaviour.

• Appropriate staff attitudes and behaviour are promoted including consideration of non-verbal behaviour and body language and the needs of minority groups. All health professional staff should ensure that they adhere to their own professional Codes of Conduct when coming into contact with patient groups.

This Policy focuses on:

• NHS England’s Delivering same-sex accommodation guidance (2019)

• The NHS Constitution 2015

• The Health Care Act 2008 and aligned Care Quality Commission Fundamental Standards for care

• NICE Guidance: Patient experience in adult NHS services Quality standard Reference number: QS15 (2012) Last updated (2019)

This Policy complies with the requirements of the NHS Constitution, Care Quality Commission and legislation within Equality Act 2010, the Race Relation Act (1995) (RRA) and the Disability Discrimination (Amendment) Act (2005).

3. Definitions

For the purpose of this Policy

Privacy refers to:

• Freedom from intrusion and relates to all information and practice that is personal or sensitive in nature to an individual.

Dignity refers to:

• Being worthy of respect.

Respect refers to:

• Treating a person as a human being and as an individual, by others, and this is demonstrated as courtesy, using good communication and taking time, providing privacy in terms of personal space; modesty and privacy in personal care; and maintaining confidentiality of personal information.

• Self- esteem, self-worth, identity and a sense of oneself promoted by all the elements of dignity, but also by all the little things - a clean and respectable appearance, pleasant environments -and by choice, and being listened to.

• Autonomy, including freedom to act and freedom to decide, based on opportunities to participate based on the provision of clear, comprehensive information.

4. Duties

The Group Chief Executive and the Provide Community Boards have responsibility for ensuring the privacy, dignity and respect of patients, relatives and carers is maintained and this function is delegated via Chief Officers to the Directors and service leads. The Designated Dignity Champion is the Provide Group Chief Executive Officer.

Every member of staff has a duty however, to ensure that the privacy, dignity and respect of all Service Users is maintained and is regarded as a high priority and to challenge poor practice. Staff members will treat each other with dignity and respect.

Line Managers Responsibilities:

• Be the designated Dignity Champion for their service

• Ensure the standards set out within this Policy are met

• Ensure all staff are aware of and adhere to the Policy

• Ensure completion of relevant audits and patient surveys within their environment/ area, and that action plans are acted upon to address areas of weakness.

• Monitor and report promptly any breaches of same sex accommodation rules to their respective managers and ensure that a Datix form is completed and remedial actions taken to resolve the situation promptly as set out in Appendix One

• Ensure staff receive appropriate training that pertains to this Policy

All Staff Responsibilities:

• Adhere to the principles, values and standards described within this Policy

• Report promptly any breaches of a patient’s privacy and dignity to their line manager including reporting any breaches of same sex accommodation and work to resolve the situation as set out in Appendix One

• Attending training that is provided to support this Policy

5. Standards of Practice

Principles and Values of Dignity and Respect

Respect and Dignity: Value each person as an individual, respect their aspirations and commitments in life, and seek to understand their priorities, needs, abilities and limits. Take what others have to say seriously. Be honest about our point of view and what we can and cannot do.

Commitment to Quality of Care: Earn the trust placed in us by insisting on quality and striving to get the basics right every time: safety, confidentiality, professional and managerial integrity, accountability, dependable service and good communication. Welcome feedback, learn from mistakes and build on successes.

Compassion: Respond with humanity and kindness to each person’s pain, distress, anxiety or need. Search for the things we can do, however small, to give comfort and relieve suffering. Find time for those we serve and work alongside. Do not wait to be asked, because we care.

Improving Lives: Strive to improve health and well-being and people’s experiences of Provide services. Value excellence and professionalism.

Working together for Service Users: Put Service Users first in everything we do.

Everyone Counts: Use resources effectively and make sure nobody is excluded or left behind. Accept that some people need more help, that difficult decisions have to be taken – and that when we waste resources, we waste others’ opportunities. Recognise that we all have a part to play in making ourselves and our communities healthier.

Human Rights Statement: The Human Rights Act (2000) aims to encourage fairness, respect, equality, dignity and autonomy for all. These principles are fundamental to living full lives with dignity and respect. It is the responsibility of the organisation to respect these rights, when delivering care, making decisions or developing or reviewing Policy.

Dignity is a human right. The Privacy, Dignity and Respect Policy aims to ensure that we always deliver person centred care, therefore treating everyone as individuals with individual choices for their care.

Minimum Standards of Behaviour Expected by Provide Staff

Attitudes and Behaviour

• Staff should ensure that people feel that they matter and do not experience negativity or offensive attitudes or behaviour.

• Staff should be courteous at all times, including times where they are working under pressure.

• Staff should address people by their name and title of their choice.

• Staff should ensure that visitors etc. are greeted and welcomed with minimal delay.

• That no service user will experience discrimination either through religion, culture, race, gender or sexuality or age.

• Service Users are included in decisions about their care, and their consent is obtained prior to carrying out any procedure and consent will be recorded in the clinical record.

• Staff will ensure that their behaviour is professional at all times.

• Staff answering telephones should be polite and state their name and designation.

• Staff on wards should ensure that nurse call bells or requests are met promptly. Where this is not possible, the patient should receive an apology and assurance that they will be attended to as soon as is possible.

• Staff caring for people at home or in supported living environments will deal promptly with people to address queries and provide assistance when requested of needed

• Staff should not use their mobile phones for personal purposes whilst on duty. Work mobile phones should be switched off when meeting with Service Users and relatives.

• Staff will introduce themselves on initial contact with Service Users and relatives, including telephone conversations, by stating their name and role.

• Staff will wear and display photo-identification badges at all times

Personal Boundaries and Space

• A person’s personal space is actively promoted by all staff.

• Staff will knock and wait for permission before entering a home, bedspace or bathroom where people reside or are being cared for unless there is an emergency that needs to be attended to

• The acceptability of personal contact (touch) and personal boundaries are identified and communicated to all team members. Reasonable steps should be taken to gain consent before touching people of their personal items

• Service Users will be given the choice to have students attending them.

• Service users may request a chaperone to accompany them during an examination

• People will be included in their care, especially conversations when care is being delivered.

• All service users on wards or in enablement and care settings will have a designated bed space that has privacy curtains or bedroom doors to enable privacy to be maintained.

• All services users on wards or in enablement and care settings will have access to a quiet space or room when required for personal conversations or to have quiet prayer etc.

• Mealtimes in all care settings should be respected and where possible be kept free of unnecessary activities to enable people to eat meals without interruption and enable care staff to assist people who need help.

Communication

• Communication will take place between staff and Service Users in a manner that respects their individual needs.

• Staff will ask each person how they wish to be addressed and avoid lapsing into over familiarity, using colloquial titles such as dear, love, sweetie unless requested to do so by the person first.

• Confidentiality will be maintained.

• Service Users views will be listened to, with their needs recorded.

• Service Users will have the confidence to make verbal or written complaints regarding their care.

• Service Users will be able to provide feedback on their experience.

• Service Users and relatives should be spoken ‘with’ and not ‘at’ by staff.

• All Service Users will have access to translation services.

• All Service Users who are unable to express their needs will have access to communication aids or assistance.

• Information leaflets used will be reader friendly and arrangements should be made if required in alternative language/format.

• Service User documentation will ensure that communication is maintained at all times between health care professionals.

• Staff who work in communal office spaces or working from home or in a persons own home should be aware of discussions being overheard and ensure service user privacy is respected.

Confidentiality

• Consent should be obtained before any information about Service Users is shared, either with other health and social care professionals or relatives/carers.

• Service Users information should be managed in line with the organisations relevant policies.

• Service User’ records and notes will be managed under Caldicott Principles.

• All Service User data will be secured in line with data protection policies.

• Staff telephone conversations will be made in a quiet area to avoid casual overhearing.

• In care settings confidential or personal service user information will be discussed between staff or handed over in a space where casual overhearing can be avoided

• Handover sheets should be accessed electronically wherever possible and, where printed out, it should be shredded prior to leaving the clinical setting.

• All computers used in the clinical area will have timed screens and staff should ensure they follow Information Governance Policy around securing information.

• Staff should ensure when visiting service users own homes that discussions of a sensitive nature are performed in a private space, e.g. not in a communal lounge or doorway.

• In clinic environments discussions should not be conducted in public spaces such as waiting rooms or reception desks.

• Receptionists should ensure that conversations respect the service users’ privacy.

Privacy, Dignity and Modesty

• People’s modesty will be maintained at all times when care is delivered, and the approach should be culturally appropriate and sensitive

• Staff will knock before entering a room – clinical rooms will have signs indicating care is in progress. Staff will ask permission before entering behind curtains or entering homes, bedrooms or bathrooms and wait, for consent to enter – where people lack capacity staff should consider how best to gain consent or ensure the privacy of the service user is maintained when entering these spaces

• Only essential staff will be in the room whenever a person is undressing, using the toilet or having a treatment completed etc.

• Assisted toilets and bathrooms will have privacy curtains installed to avoid casual overlooking

• Toilets and bathrooms will have locks installed for people to use but which are capable of being opened by staff in case of emergency.

• Toilets and bathrooms will be separately designated for men and women as appropriate. Assisted toilets and bathrooms may be used by both sexes but should have a privacy curtain installed to prevent casual overlooking and should not have to be reached by walking through a bed bay or bedroom occupied by the opposite sex

• Curtains, screens, and blankets should be used to achieve privacy.

• Patients will be asked if they want a chaperone for any intimate procedures.

• Where a person is unable to make informed choice, an advocate should be identified.

• People on wards and in enablement and care settings should be encouraged to wear their own clothes and whenever possible will be encouraged to dress in their own day clothes during the day. Where a person does not have access

to their own clothes’ suitable hospital clothes / gowns that will be provided to ensure dignity is maintained.

• When required people will have access to a designated private area/quiet room that allows privacy for prayer, contemplation or private conversations.

• In all care settings people receiving care in their beds will have their modesty protected by the use of blankets, closing curtains and doors and giving extra consideration to the people in the environment to ensure casual overlooking is avoided and that care is provided away from other residents, visitors, relatives or passers-by.

Respecting the Deceased

• When a person has died, their body will be treated with the same dignity and respect as when they were alive. Relatives/carers will be treated with particular sensitivity and compassion at this time.

6. Same Sex Accommodation

What constitutes same sex accommodation?

Every person has the right to receive high quality care that is safe, effective and respects their privacy and dignity. There are no exemptions from the need to provide high standards of privacy and dignity.

This applies to all areas. High standards involve a presumption that men and women do not have to sleep in the same room or use mixed bathing and toilet facilities. These presumptions are intended to protect people from unwanted exposure, including casual overlooking and overhearing.

Following the High Court Ruling in 2025 that confirmed that a person’s sex is their biological sex that they were born with, people who identify in a way that is different to their biological sex at birth should be treated with dignity and respect and be accommodated in an appropriate room that meets their needs and maintains their dignity but which also considers and meets the needs of other service users in the same care environment.

Principles for Practice in Health Care Settings

In-patients in Community Wards should not have to pass through opposite sex areas to reach their own facilities. This covers situations where patients have to pass between or across the foot of beds occupied by members of the opposite sex e.g. through an occupied room or bay. It also includes wards where patients might perceive that they have passed through the same room as the opposite sex e.g. where there is minimal screening between rooms or bays

People should not have to share sanitary facilities with members of the opposite sexthis applies to all areas of care.

It is acceptable to have toilets and washing facilities that can be allocated to men or women according to need as long as there is good signage to make it clear which sex is designated at any particular time

People’s preference should be sought, recorded and where possible respected. Ideally this should be in conjunction with their family or friends

Decisions should be based on the needs of the individual and not the constraints of the environment or the convenience of staff

Greater segregation should be provided where modesty may be compromised e.g. when wearing hospital gowns /nightwear or where the body is exposed other than extremities

Greater protection should be provided where people are unable to preserve their own modesty e.g. when semi-conscious or sedated

If a person is in a hospital gown and may have difficulty preserving their own modesty due to sedation or anaesthesia, then segregation should be the norm

Staff should use these principles to make sensible decisions that may vary from day to day. For instance, in a day treatment area e.g. IV therapy areas where patients are well established on treatment, wear their own clothes and have formed personal friendships, mixing may be a good thing. By contrast a new patient with a catheter and a hospital gown should be able to expect a much higher degree of privacy.

In exceptional circumstances, such as where the patient needs very specialised or urgent care, this may take priority over ensuring same sex accommodation but in this instance the mixing of sexes should be reported using the Datix Incident Reporting process in Health.

Principles for Practice in Supported Living and Enablement and Care Settings

Extra care should be taken to ensure the privacy and dignity of service users who are less able or unable to protect their own modesty and maintain their own privacy.

All residents should have their own personalised bedroom/bed space with access to an appropriate bathroom designated for their sex and to maximise their privacy when bathing or toileting of when receiving personal care particularly in a mixed sex home environment.

All residents should be supported to dress appropriately during the day in day clothes and at night in night clothes when they prepare for bed.

Where there are any breaches in providing dignified and private care or mixed sex breaches occur these should be reported on the Access System as an incident.

Children and Young People

Privacy and dignity is an important aspect of care for children of all ages and young people. Their preferences should be sought, recorded and where possible respected and where appropriate parent’s wishes should be considered but in the case of young people their preference should prevail

Privacy and dignity should be maintained whenever children and young people’s modesty may be compromised e.g. when wearing hospital gowns and nightwear or where the body other than the extremities are exposed or they are unable to preserve their own modesty e.g. when recovering from anaesthesia or when sedated.

Children and young people find comfort in sharing with others of their own age and this may outweigh their concerns about mixed sex accommodation - young people should be given a choice.

Washing and WC facilities do not have to be designated as same sex as long as they accommodate only one patient at a time and can be locked by the patient with an external override for emergency use only

Transsexual People

Transsexual people, that is, individuals who have proposed, commenced or completed reassignment of gender, have legal protection against discrimination. Good practice requires that care is centred on the Service User and must be respectful and flexible to enable them to maintain their privacy and dignity in the care setting.

Equality and Diversity

All staff should attend mandatory equality and diversity training.

Staff will ensure that they do not discriminate within the care setting. Where discrimination is identified this will be reported to their immediate line manager for action.

Staff will respect and adhere to a patient’s culture and religious needs whilst in their care.

7. Training

• All staff will undertake equality and diversity training.

• All staff will be made aware of the principles set out within this policy as part of their induction.

8. Audit

Adherence to the Privacy and Dignity Policy will be audited in the following ways:

• Patient satisfaction survey.

• Patient comment cards.

• Patient Led Assessment of Care Environments (PLACE - formerly known as PEAT)

• Observational audit.

Appendix 1 – Actions to take when full segregation of sexes is not possible

• Offer an explanation and apology to the patient and their relatives /carers about why segregation has not been possible.

• Consider greater staff presence if mixing occurs – discuss with line manager first.

• Reinforce high standards of respect e.g. ensuring casual overlooking is avoided, not entering closed curtains, ensuring appropriate clothing is worn etc. enhanced screening etc.

• Place women and men at opposite ends of the room.

• Segregate local toilet facilities.

• Record breach in same sex accommodation on Datix incident form.

• Escalate breach to line manager same day, who must in turn escalate up the line so that senior organisation managers are made aware of the breach.

• Senior manager for the Directorate to ensure a Root Cause Analysis is undertaken and remedial action taken to rectify situation.

• Where mixing is unavoidable, transfer to same sex accommodation should be effected as soon as possible and should not exceed 24 hours.

EQUALITY IMPACT ASSESSMENT TEMPLATE

Stage 1: ‘Screening’

The Equality Impact Assessment needs to be completed so that any decisions made are compliant with the aims of the Public Sector Equality Duty – and that any adverse impact for any protected characteristics are identified and resolved.

Policy Title

QSPOL06 Privacy Dignity and Respect Policy

Provide a brief summary (bullet points) of the aims of the Policy Outlines organisation expectation for maintaining Privacy, Dignity and Respect of patients and service users.

EQIA Assessor Name and Job Title

Date of Assessment

Director Nursing and Allied Health Professions September 2025

This stage establishes whether a proposed initiative will have an impact from an equality perspective on any particular group of people or community or whether it is “equality neutral” (i.e. have no effect either positive or negative)

Q1. Will this policy affect one of the following groups more or Less favourably than another?

Group

Age

Consider impact and detail across age ranges on old and younger people. This can include safeguarding, consent and child welfare x

Disability

Consider and detail impact on attitudinal, physical, and social barriers.

Sex

Consider and detail impact on men and women (potential to link to carers)

Gender reassignment (including transgender)

Consider and detail impact on transgender and transsexual people. This can include issues such as privacy of data and harassment.

Pregnancy and maternity

Consider and detail impact on working arrangements, part-time working, infant caring responsibilities.

Details If more or less, explain impact and any valid legal and/or justifiable exception. Include the source of any evidence

Promotes dignity and respect for this group

Race

Consider and detail impact on different ethnic groups, nationalities, Roma gypsies, Irish travellers, language and communication barriers.

Religion or belief

Consider and detail impact on people with different religions, beliefs or no belief. x

Sexual orientation

Consider and detail impact on heterosexual people as well as lesbian, gay and bisexual people x

Carers

Consider and detail impact on part-time working, shift-patterns, general caring responsibilities x

Other identified groups

Consider and detail on different socioeconomic groups, area inequality, income, resident status (migrants) and other groups experiencing disadvantage and barriers to access.

Assessed Impact overall Positive

Guidelines: Things to consider

Promotes dignity and respect for this group

Is the impact of the initiative – whether positive or negativesignificant enough to warrant a more detailed Stage 2 assessment? No

Equality impact assessments at Provide take account of relevant equality legislation and include age, (i.e. young and old,); race and ethnicity, gender, disability, religion and faith, and sexual orientation.

The initiative may have a positive, negative or neutral impact, i.e. have no particular effect on the group/community.

Where a negative (i.e. adverse) impact is identified, it may be appropriate to make a more detailed EIA (see Stage 2), or, as important, take early action to redress this – e.g. by abandoning or modifying the initiative. NB: If the initiative contravenes equality legislation, it must be abandoned or modified.

Where an initiative has a positive impact on groups/community relations, the EIA should make this explicit, to enable the outcomes to be monitored over its lifespan.

Where there is a positive impact on particular groups does this mean there could be an adverse impact on others, and if so can this be justified? - e.g. are there other existing or planned initiatives which redress this?

It may not be possible to provide detailed answers to some of these questions at the start of the initiative. The EIA may identify a lack of relevant data, and that data-gathering is a specific action required to inform the initiative as it develops, and also to form part of a continuing evaluation and review process.

It is envisaged that it will be relatively rare for full impact assessments to be carried out at Provide. Usually, where there are particular problems identified in the screening stage, it is envisaged that the approach will be amended at this stage, and/or setting up a monitoring/evaluation system to review a policy’s impact over time.

QUALITY IMPACT ASSESSMENT TEMPLATE

Stage 2

To be used where the ‘screening phase has identified a substantial problem/concern)

This stage examines the initiative in more detail in order to obtain further information where required about its potential adverse or positive impact from an equality perspective. It will help inform whether any action needs to be taken and may form part of a continuing assessment framework as the initiative develops.

Policy/ Project Title

EIA Assessor Name and Job Title Date of Assessment

EIA Review by Chief Officer name and Job Title Date Of Review

Outcome of Chief Officer Review

Q1. What data/information is there on the target beneficiary groups/communities?

Are any of these groups under- or over-represented?  Yes

Do they have access to the same resources?

What are your sources of data and are there any gaps?

Yes

Q2. Is there a potential for this initiative to have a positive impact, such as tackling discrimination, promoting equality of opportunity and good community relations?  Yes  No

If yes, how? Which are the main groups it will have an impact on?

Q3. Will the initiative have an adverse impact on any particular group or community/community relations?  Yes

If yes, in what way? Will the impact be different for different groups – e.g. men and women?

Q4. Has there been consultation/is consultation planned with stakeholders/ beneficiaries/ staff who will be affected by the initiative?  Yes

Summarise (bullet points) any important issues arising from the consultation

Q5. Given your answers to the previous questions, how will your plans be revised to reduce/eliminate negative impact or enhance positive impact?

Are there specific factors which need to be taken into account?  Yes  No

Q6. How will the initiative continue to be monitored and evaluated, including its impact on particular groups/ improving community relations? Where appropriate, identify any additional data that will be required

Guidelines: Things to consider

An initiative may have a positive impact on some sectors of the community but leave others excluded or feeling they are excluded. Consideration should be given to how this can be tackled or minimised.

It is important to ensure that relevant groups/communities are identified who should be consulted. This may require taking positive action to engage with those groups who are traditionally less likely to respond to consultations and could form a specific part of the initiative.

The consultation process should form a meaningful part of the initiative as it develops and help inform any future action.

If the EIA shows an adverse impact, is this because it contravenes any equality legislation? If so, the initiative must be modified or abandoned. There may be another way to meet the objective(s) of the initiative.