NHS Scotland National Uniform Consultation

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An NHS Scotland Uniform

There is a high level of agreement for the need for greater simplicity and more consistency in uniforms across Scotland. We know that the uniforms that we are currently purchasing do not meet our needs. We also know that a simple set would allow better management of the contract. We would be able to specify custom products that better meet our needs, and stock a much wider range of sizes - providing improvements in fit and lead times. The fewer the core items, the easier it would be to secure such improvements. We also know that patients and staff are currently confused by the range of different uniforms currently in use. However, it is essential to develop a set that continues to differentiate staff groups and grades, where it is important to do so.

This paper sets out some options for the core items that make up most of our spend. Other items, such as waterproof jackets, would continue to be included in the contract.

We are aware of the demands of diversity and equality issues on the contract, and the contract will continue to include provision for specialist items required to meet religious, ethnic or medical needs.

Questions:

1. In your view, do you consider there is a need for greater simplicity and more consistency in uniforms across Scotland? If not, why not?

The " NHS Scotland Tunic"

This paper seeks views on a single unisex tunic for clinical and non-clinical staff who currently wear a tunic or tunic style dress. The tunic slips over the head, and has no zips or buttons. This would be worn with navy trousers. The tunic would be available in 12 different sizes, which would provide a better range of petite and larger sizes than available at present. We are also considering the possibility of tall, medium and short sizes. The standard tunic will have 2 deep pockets at the bottom of the tunic, and a pen pocket in the breast. The tunic is a custom specification, and will only be available for purchase by NHS Scotland.

Proposed tunic shown here in 3 shades of blue

Proposed tunic shown here in 3 shades of blue

The NHS Scotland logo would be embroidered onto each tunic at the point of manufacture. This considerably reduces the cost of doing so. Each tunic will have a heat seal badge stating name and designation.

A custom specification that could be provided for the tunic style is to make a tunic with no pockets available, or to provide an option with an inside pen pocket. It has been suggested that this style would be more appropriate for people who prepare food. (Though Chef's whites would obviously continue to be available under the new contract).

Questions:

2. In your view, is the style of the tunic appropriate?

3. We anticipate that although staff will require various protective clothing, this tunic will meet the needs of all staff. In your view, are there any groups who require a custom specification for their tunic, and if so, why?

Tunic Fabric

Many of the complaints made by staff about the tunics currently on contract are that the material is unsuitable. Polyester/cotton options that meet our laundering requirements are often criticised as being uncomfortable to wear and too hot for wards. To address these concerns, consideration has been given to alternative textiles. There are currently two silver technology wearer trials planned: one in an acute setting in NHS Ayrshire and Arran, and another planned in the community in NHS Lothian and NHS Greater Glasgow and Clyde.

The silver technology fabric is thermo-dynamic (that keeps one cooler when it is hot, and warmer when it is cold) and anti-bacterial (to fight body odour). It is also reputed to be extremely comfortable to wear. The trial in the acute setting has generated extremely positive early feedback, which demonstrate a step change in staff's levels of satisfaction. Staff in the acute setting feel the tunics are lighter, easy to move in, easy to launder, hold their shape better and are comfortable to wear.

Wearer Trial in NHS Ayrshire - initial results

Wearer Trial in NHS Ayrshire - initial results

We will be better placed to consider how well this textile meets our needs when we have the results of the community trial. Another consideration will be cost. This fabric is more expensive, however, it may be possible to offset these increased costs against savings made by purchasing a simpler uniform set.

Questions:

4. In your view, what factors, including comfort, durability, cost etc., are most important when selecting a fabric for the tunics and trousers?

5. In you view would you consider silver technology fabric to be suitable for uniforms?

6. Do you have any suggestions for other types of fabric that we should consider?

Trousers

All staff would wear navy trousers. We know there is a great deal of dissatisfaction with trousers currently on contract, in terms of fit, style and material. We are looking to address these, particularly through the use of alternative fabrics.

Questions:

7. In your view, what factors, including comfort, durability, cost etc., are most important when specifying for NHS Scotland trousers?

Tunic Colour

Tunic colour has proved the most contentious and difficult issue to develop consensus around.

To maintain improvements in fit we envisage making tunics available in a range of sizes. This means that each additional colour added to our set is not just one extra tunic - but an additional colour in the entire range of sizes, which would then need to be manufactured and kept in stock. This adds considerably to the cost of each tunic, and makes it more difficult to gain service improvements. The more variations in colours and therefore tunics we require, the less likely it is that it will be practical for the manufacturer to stock them and turn orders around quickly.

An equally important consideration is achieving clarity, as we know that patients, visitors and staff find the current array of colours confusing. However, it is clear that some colour differentiation is necessary. NHS Tayside introduced a scrub-style top in a single colour for all staff groups across one of their hospitals in 2005. The staff differentiation was by the wearing of different coloured epaulettes however, most Health boards have moved away from epaulettes for Staff safety reasons. NHS Fife initiated a trial of theatre scrubs in two wards in Queen Margaret Hospital, Fife in March 2007 Evidence from the Fife patient surveys suggest that patients felt the lack of colour differentiation was an issue, as it made it difficult to identify "the person in charge".

To explore these issues further, we commissioned independent researchers, George Street Research, to determine patients' views on a national uniform. Key findings are included at Annex B, a full report is available on the Staff Governance website at: www.staffgovernance.scot.nhs.uk. In line with other research, they found that the current high number of uniforms created significant confusion and uncertainty amongst patients over the nature of staff roles. Patients do however want to be able to distinguish between non-clinical and clinical staff. They also want clear differentiation between certain types or grades of staff. In particular, many respondents in the research expressed a desire to differentiate the person in charge, and between registered and non-registered staff. However, the research also noted that a high number of different colours may result in similar levels of confusion for patients as there is at present.

It is clear that although patients are currently bewildered by the high number of different uniforms, they still wish to be able to differentiate the Senior Charge Nurse/Sister, and registered and non-registered staff. Similarly staff wish to differentiate these different grades.

Colour Option - the group's recommendation

This paper seeks views on a simplified colour scheme which preserves these important differences of role and grade. This colour scheme is based around the concept of a clear clinical team, who would be distinguishable from the non-clinical team by colour. To this end, the clinical team would all wear 3 shades of blue:

  • the most senior staff (Charge Nurse) would wear navy blue.
  • registered staff would wear mid blue.
  • non-registered staff would wear pale blue.

The Group's recommendation (Option 1) - trio of blue tunics for clinical staff

The Group's recommendation (Option 1) - trio of blue tunics for clinical staff

  • Allied Heath Professionals ( AHPs) would wear the trio of blue tunics, dependent on grade.

AHPs can choose tunic or polo shirt

AHPs can choose tunic or polo shirt

  • Clinical staff who currently wear a polo shirt would still have the option of doing so. The polo shirts will be available in the trio of blues.
  • Nurse Practitioners would either wear navy or royal blue, with this decision delegated to local management.

The non-clinical team, including catering and cleaning staff, would wear green (eau de nil), with supervisors in a darker shade of green.

The Group's recommendation (Option 4) - trio of green tunics for non-clinical staff

The Group's recommendation (Option 4) - duo of green tunics for non-clinical staff

More Complex Colour Schemes

The simple colour scheme described above, which was favoured by the Working Group, has the advantage of being easy to communicate to patients and staff, and will be simpler to procure and manage. However, it has attracted some criticism. In particular, we have received a number of comments from Allied Health Professionals that different colours allow service users to easily identify staff groups, and that colours are bound up with professional identity.

To address these concerns, this paper seeks views on some alternative colour schemes:

  • Alternative A: An additional colour in 2 shades for AHPs, for example dark and pale lilac, to denote registered and non-registered AHPs of all Allied Health Professions

ISSUES

  • Whilst there is considerable scope to choose an additional colour, we would need to develop consensus around which colour to choose.
  • It would be confusing to choose 2 further shades of blue, as we would be increasingly expecting staff and patients to distinguish quite subtle shades, whilst instead of shade just indicating grade, it would in this scenario, denote role.
  • Deviating from blue for all clinical staff disrupts the very simple message that would be easy to communicate to patients. It would also be less clear what other clinical staff should wear, for example, doctors wishing to wear a uniform.
  • Two additional colours would add to the cost and impact on improvements to the service levels on the contract.
  • Alternative B:AHPs wear the same trio of clinical blue colours, but are distinguished by a different coloured trim on the uniform. This could include up to 9 different trim options to denote the 9 Allied Health Professions.

ISSUES

  • This scheme would maintain discrete identities for different professions whilst still enabling easy identification of the clinical team in blue.
  • However, as these differences are quite subtle, arguably they may not meet the requirement to be different.
  • 9 different trims in up to 36 different sizes would result in 324 different tunics. Although differentiating by trim colour would keep costs lower, because the manufacturing process would be the same until that point, introducing a range of different trims would mean that stock could not be held. This is likely to mean little or no improvement in lead times.
  • The range of trims would add to the cost and impact on improvements to the service levels on the contract.

Alternative options for non-clinical and catering staff include:

  • Alternative C: Non-clinical and catering staff would wear two different colours, for example, green and yellow, to distinguish between those involved in cleaning and those involved in food preparation/serving etc. This assumes these staff groups are discrete, and would entail 4 different tunics to identify respective supervisors.

ISSUES

  • It has been suggested that the public will be concerned to see non-clinical and catering staff wearing the same uniform, as they will perceive it as unhygienic.
  • This would compromise the simplicity of a clinical blue/non-clinical green colour scheme add to the cost and impact service levels.

Summary of Colour Proposals

Clinical

OPTION 1

Group's Recommendation

All the Clinical Team in trio of blues

OPTION 2

Alternative A

Clinical Team in trio of blues and AHPs in 2 shades of lilac (or other colour)

OPTION 3

Alternative B

All the Clinical Team in trio of blues, but AHPs have different coloured trims.

Non-Clinical

OPTION 4

Group's Recommendation

Non-Clinical Team in 2 shades of green (eau de nil)

OPTION 5

Alternative C

Catering team in green and non-clinical team, for example housekeeper, hairdresser, etc in yellow (for example)

Questions:

8. ,In your view, of the options outlined, which is the most appropriate colour scheme for tunics of clinical staff?

Option 1 Option 2 Option 3 None of these And why?

9. In your view, is there a more appropriate colour scheme for clinical staff? If so, please detail your proposed scheme.

10. In your view, of the options outlined, which is the most appropriate colour scheme for tunics of non-clinical staff?

Option 4 Option 5 Neither of these And why?

11. In your view, is there a more appropriate colour scheme for non-clinical staff? If so, please detail your proposed scheme.

Other Clinical Staff Groups

There are various other clinical staff who wear uniform, such as dentists, dental hygienists, dental nurses, pharmacists, pharmacist assistants etc. The group originally envisaged that these groups would also wear the same tunic style in the trio of blue, however if a more complex colour scheme is selected, they become a less obvious choice.

12. In your view, what needs to be considered in terms of specifying a uniform for dental staff, and why?

13. In your view, what needs to be considered in terms of specifying a uniform for pharmacy staff, and why?

Other Non-clinical Staff Groups

Chef's white will continue to available on the contract, and will meet all Health and Safety requirements.

Porters will wear green (eau-de-nil) polo shirts and navy trousers with a NHS logo in navy blue. It has been suggested that it would be useful to identify senior porters, and we would be interested to hear consultees' views on this issue.

Porter

Porter

Security staff will wear black trousers, white shirt and clip on tie, with a military style jumper or where local policy dictates a black t-shirt and stab vest. Again, it has been suggested that it would be useful to identify senior security guards, and we would be interested to hear consultees' views on this issue.

Security Guard

Security Guard

Options for an NHS Scotland clerical uniform are still being developed. It is however clear that it should convey a smart corporate image for the organisation. An initial proposal is a green (eau-de-nil) shirt or blouse complete with NHS Scotland logo. This could be teamed with an NHS Scotland clip on tie for men.

Clerical staff

Clerical staff

14. In your view, is the porter uniform appropriate?

15. In your view, is it important to distinguish senior porters by means of another uniform? If so, why, and please suggest how this might be done?

16. In your view, is the security guard uniform appropriate?

17. In your view, is it important to distinguish senior security guards by means of another uniform? If so, why, and please suggest how this might be done?

18. In your view, what are the most important considerations in terms of developing a clerical uniform?

19. In your view is the proposed uniform for clerical staff appropriate?

Agency Staff

The new uniforms will apply to NHS Scotland staff who currently wear a uniform, however in many healthcare settings, agency staff work alongside them. With various local uniform arrangements in place, this could undermine some of the benefits of national standardisation.

20. In your view, what practical considerations need to be addressed with regard to agency staff uniforms?

General Questions

21. Do you think that any of the proposals set in this consultation document will raise any specific issues for any of the equality groups (including race, disability, age sexual orientation, gender or religion and belief)?

22. Do you have any other comments you would like to make?

CONSULTATION AND COMMUNICATION

Following this consultation we envisage finalising the NHS National Uniform specification by early September 2008. The contract would then be put out to tender, and be available for Boards to purchase from 1 st September 2009. We will publish a communication strategy in November 2008 to ensure changes are adequately communicated to staff.

Your comments and views are welcomed. Should you have any queries or require any further information about any of the issues raised in this paper, please contact Alan Milbourne atnationaluniformconsultation@scotland.gsi.gov.uk

NHSSCOTLAND NATIONAL UNIFORM

Q&A

Why a national uniform?

A national uniform specification will promote a coherent corporate image, making it easier for members of the public to identify NHSScotland staff. A national contract is also the most cost effective procurement option, maximising financial savings through bulk purchase. Importantly, it will also enable us to focus effort on developing a high quality specification that better meets our needs.

Who is driving the process?

The Cabinet Secretary for Health and Wellbeing has tasked the Scottish Government Uniform Working Group with developing a national uniform specification, which best meets the needs of our staff and patients. The Scottish Government Uniform Working Group includes officials and staff side representation.

Is this a cost-saving measure?

Our principal objective is to procure a uniform which is fit for purpose and best value.

We envisage that standardizing core items will improve quality and service. We know that both these issues are of concern, for example, with staff complaining that uniforms are not fit for purpose, Boards buying off-contracts and numerous reports of long lead times to fulfill orders.

How is the specification being developed?

This process began in October 2007, when NSS Procurement held workshops for representatives nominated by Directors of Procurement to identify key issues. This group comprises people who wear uniform on a daily basis. They have been responsible for identifying key issues, and developing a set of options to consult on.

Will the new uniform take advantage of new technologies, such as silver technology textiles?

We are currently trialing silver technology uniforms in a community and hospital setting. This consultation invites views on these alternative fabrics.

Will the uniform fit better?

Yes - a simplified uniform will enable us to specify garments better suited to our needs and to purchase garments in a broader range of sizes.

What is the timescale?

Following this consultation we envisage finalising the uniform specification by October 2008. The contract would then be put out to tender, and awarded in early 2009. We envisage it would be available for Boards to purchase from 1 st September 2009 at the latest.

Will the new uniform proposals take account of the Senior Charge Nurse Review?

The SCN Review found that the majority of patients have great difficulty identifying both the SCN and other members of nursing staff. The research found that variations in colour across regions created confusion amongst patients, and that they felt that a national standard would help them identify staff more readily.

We envisage that it will be important for the uniform of SCN to be clearly identifiable. This consultation invites views on how this can be best achieved.

Who will the new uniform apply to?

It will apply to everyone. However, we recognise that many staff in a variety of settings do not wear uniform for a range of safety, clinical and other reasons. The new uniform policy will not compel anyone who does not currently wear a uniform to do so.

Is partnership fully involved?

Yes - the Scottish Government Uniform Working Group includes staff-side representation. The group's work is overseen by the Scottish Workforce and Governance Group ( SWAG).

Have patients been consulted?

Designated Directors for Public Involvement at NHS Boards have used their Public Partnership Forums and other networks to make the public aware of work underway to establish a national uniform for NHSScotland staff. We have invited comments from these groups, which have helped inform the initial stages of the process.

We also commissioned independent Research Consultants, George Street Research to gather patients' views on the impact of changes to the national uniform set on patients and their relatives/carers. They have also interviewed a range of organisations who represent vulnerable groups, such as the elderly and disabled.

A summary of the conclusions is included at Annex B in this consultation document. The full report can be viewed on the Staff Governance website at www.staffgovernance.scot.nhs.uk

How will the new uniform by implemented?

Implementation will be mandated via a CEL for maximum efficiency. The new uniform will be phased in as needs require, with a requirement to phase in the new uniform for all staff by 2012. This would avoid one-off replacement costs - estimated in the region of £7m to £10m - associated with a "big-bang" launch.

Are there plans to introduce a dress code?

Yes - we are currently developing a set of common principles for commendation to Boards to inform the development of local policy. The code will reflect the evidence base published by the Department of Health in Uniform and Workwear: An Evidence Base for Developing Local Policy.