The uniform policy always engenders a range of opinions among colleagues and has been of interest to our patients and the wider public. There is, however, in England a lack of consistency for both uniform and non-uniform guidance and this issue has now become a national one. The Welsh Empowering Ward Sisters/Charges Nurse Ministerial Task and Finish Group (2008) recommended an all-Wales nursing uniform, which has subsequently been implemented. Both Scotland and Northern Ireland have followed suit.
NHS England/NHS Improvement (2020) reiterated national guidance for uniforms and workwear, clearly outlining the objectives of suitable workwear being patient safety, public confidence and staff comfort, along with a range of other elements of guidance such as good and poor practice examples and the area of cultural sensitivities. In the absence of a national policy, all elements of this guidance are currently delegated to local policy leaders to determine application and monitoring.
The current situation is that the buying function in the NHS Supply Chain supports a uniform contract, which provides a compliant framework from which NHS trusts specify the design, style and colours. This has led to significant variation of uniform between different NHS trusts, with over 30 000 varied products in use with many styles, colours, embroidery and rank identifiers. These could potentially be reduced to one shared style for all staff groups differentiated by 15 to 20 colours. NHS Supply Chain (2021) has determined that the annual spend on uniforms across the NHS in England is around £23 million.
In April, NHS England/NHS Improvement with NHS Supply Chain launched a 7-week consultation aiming to implement a national, culturally sensitive uniform, hoping this could potentially bring some major benefits for patients, staff and the public. The driver for this is highly patient focused, reflecting that patients have highlighted that, for them:
‘Contact with several NHS professionals in a hospital and non-hospital setting can sometimes feel confusing, frequently due to not knowing who does which role.’
The case for change focuses on five areas that I personally support. Individually they provide strong reasons for adopting such an approach, and taken together, they give a compelling argument for the introduction of a national uniform:
- Improved patient safety, supporting recommendations made in the 2013 Francis Inquiry
- Greater recognition of staff by patients and the public
- Improved view of professionalism in appearance by staff
- Development of a high performing, ethical and sustainable supply chain, with a single NHS brand across the patient care pathway, providing consistency across the whole of the NHS in England
- The ability to plan for, and react to, increased uniform demand such as those experienced during the COVID-19 pandemic.
The consultation for this proposal is now open, looking to gather views of all nursing, midwifery staff and allied health professionals working in hospital and non-hospital settings across the country on whether a culturally sensitive, national approach to uniforms should be taken and if so, whether all NHS trusts should be required to adopt it. It also asks a set of questions about the garment style and features, to help identify the key aspects felt necessary for a uniform to be well designed and fit for purpose.
A range of workshops with a wide group of stakeholders has already taken place, sharing preferences for colourways and styles for individual roles. A broad consensus was reached on style with the preference being a two-piece uniform, based on the scrub, but with added style features and improved fitting. Trousers, it is suggested, should be a single colour, probably a navy blue from the feedback so far (NHS Supply Chain, 2021).
From a patient perspective, an independent survey commissioned by NHS Supply Chain across several NHS trusts shared that:
- 88% of patients think that the same uniforms should be worn nationally
- 79% of patients think that a strongly defined uniform helps them to identify key workers
- 55% of patients were unable to easily identify senior members of staff from their uniforms.
I have always been extremely proud to wear my uniform and be visibly identified as a nurse. I am wholly in support of the aims of this national work, for all of the reasons that the proposal aims to deliver. There is a wider need for the NHS to invest in fit-for-purpose changing facilities for healthcare staff. I suggest that to agree the wider elements of ‘professional appearance’ such as hair colour and tattoos needs a wider debate, to enable true diversity and modernising the NHS approach—and this is what I will be feeding back into my consultation response.