Leading article: Mixed-sex wards and the lack of political will

The affecting diaries of Mrs Patricia Balsom, who was treated at Hillingdon hospital until just before she died, highlighted the many failings that still blight parts of the National Health Service: poor coordination of services, inadequate transport and a distressingly casual attitude towards the provision of small comforts. But the complaint that has resonated most loudly is the one that should be the easiest to solve: the continued existence of NHS wards in which men and women are accommodated together.

Precisely when and how the practice of mixed wards came into being is lost in the mists of time. It is well within living memory that wards had names like "men's surgical" and "women's orthopaedic". In those days, the very idea that men and women should be nursed side by side was taboo, as it remains in much, if not most, of continental Europe.

What is clear is that the practice - and patients' understandable dislike of it - reached the attention of politicians in the early Nineties. Tony Blair took up the cry, and amplified it, when Leader of the Opposition. His words, it is worth recalling, were these: "Is it really beyond the collective wits of the Government and health administrators to deal with this problem? It's not just a question of money. It's a question of political will."

As indeed it is. For even as ministers claim that 99 per cent of mixed wards have been eliminated, the experience of patients tells another story. Last month, a health watchdog review of more than 150 trusts found that, in some hospitals, two-thirds of patients were being treated in mixed-sex facilities. Far from being phased out, treatment on mixed wards seems to be on the rise. And patients, admitted in an emergency or for a scheduled operation, are in no position to refuse.

The Health Secretary, Patricia Hewitt, told the BBC yesterday that single-sex wards were "not always viable", but said she would ask hospitals to check their figures. This, however, is unlikely to help, for mixed wards have become the latest example not just of Labour's broken promises, but of the way in which words and figures are "spun" to mean whatever ministers want them to.

To most people - but not apparently to a hospital manager or government minister - a single-sex ward means exactly that: enclosed accommodation where the only members of the opposite sex the patient encounters are medical professionals, ancillary staff and visitors. A manager's single-sex ward, on the other hand, may be an alcove open to a common thoroughfare, where the only privacy is afforded by curtains. A further refinement provides for some mixed wards not to be counted as such, because they are for short stays or diagnostic purposes only. Even if a patient stays longer, she is not counted as having been in a mixed ward at all.

A second problem is that keeping separate wards for men and women requires some minimal slack in the system. Yet the pressure of government targets - from time spent in Accident and Emergency to waiting times for operations - dictates that the use of beds is maximised. And the new pressure on costs means that wards are being closed rather than opened. For hard-pressed managers, mixed wards offer a kind of solution.

The truth is, of course, that managers have only got away with passing off curtained alcoves as single-sex wards because they have been allowed to. Had ministers adopted a more exacting definition, and had the complaints of patients been heeded, separate wards for men and women would have very quickly become "viable". Mr Blair was right when he said that eliminating mixed wards required not just money, but political will. Ten years on, the money has been and gone, while the political will has been shamefully lacking.