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Statistical press notice: Mixed-sex accommodation breach data - March 2011                                                               

Main Points

This notice presents data on all breaches (i.e. occurrences of unjustified mixing) of the Mixed-Sex Accommodation (MSA) guidance relating to English NHS-funded patients in hospital sleeping  accommodation during March 2011.  Revised data for January 2011 are simultaneously being published.  This is the fourth month for which data on MSA breaches have been collected and published on a  standardised basis; during the early months of this collection, published figures should be treated with caution.  With time, data quality is expected to improve as healthcare providers implement and embed  data collection procedures.

  • Providers of NHS-funded healthcare reported 5,446 breaches of the MSA guidance in relation to NHS patients in sleeping accommodation in England during March 2011, compared to 7,583 in February 2011.
  • MSA data were submitted by 287 provider organisations for March 2011, made up of 75 (out of 75) Acute Non-Foundation Trusts, 71 (out of 92) Acute Foundation Trusts, 78 Community, PCT and Care Trust  providers, 46 Mental Health providers and 17 Independent Sector providers.
  • Of the 146 Acute Trusts that submitted data for March 2011, 76 (52%) reported zero sleeping breaches. Acute Trusts accounted for 5,349 (98%) of all reported sleeping breaches.
  • An MSA breach rate is published alongside counts of breaches to enable comparison between provider organisations. This is the number of MSA breaches of sleeping accommodation per 1,000 finished  consultant episodes (FCEs). The MSA breach rate for England in March 2011 is 3.6 per 1,000 FCEs, compared to 5.7 per 1,000 FCEs in February 2011.
  • Provider and commissioner tables can be found at:
     Hospital site-level data is available on the NHS Choices website at:

Revised MSA breach data for January 2011 are being published alongside the March 2011 data.  In total, 12 organisations revised their January 2011 data, resulting in an overall increase to the reported  number of MSA breaches to 8,708 (from 8,160 breaches published previously).  Further details of the impact of these revisions at SHA and organisation level can be found in the January 2011 tables at:
 Statistical Notes

1. Eliminating Mixed-Sex Accommodation

The commitment to eliminate mixed-sex accommodation can be found in the 2011-12 NHS Operating Framework , which states “All providers of NHS funded care are expected to eliminate mixed-sex accommodation except where it is in the overall best interest of the patient”.

A professional letter  (Ref: PL/CNO/2010/3) was sent by the Department of Health in November 2010 to update NHS trusts on requirements with regard to recognising, reporting and eliminating breaches of this policy.

2. MSA Data Collection

National reporting of unjustified mixing (i.e. breaches) in relation to sleeping accommodation commenced on 1 December 2010. MSA breach data is collected monthly from all NHS providers and other organisations that provide NHS-funded care (including Independent and Voluntary Sector organisations).  Data are collected, validated and published in accordance with the Code of Practice for Official Statistics. The MSA data return is mandatory for NHS Trusts but voluntary for Foundation Trusts.

As well as monitoring and reporting all unjustified mixing of sleeping accommodation, the NHS is also required to monitor all justified mixing in sleeping accommodation, all mixed-sex sharing of bathroom / toilet facilities (including passing through accommodation or toilet/bathroom facilities used by the opposite gender), and all mixed provision of day space in mental health units at a local level. For practical reasons, central reporting has been mandated for MSA breaches in respect of sleeping accommodation only.

“Sleeping accommodation” includes areas where patients are admitted and cared for on beds or trolleys, even where they do not stay overnight. It therefore includes all admissions and assessment units (including clinical decision units), plus day surgery and endoscopy units. It does not include areas where patients have not been admitted, such as accident and emergency cubicles.

3. Provider and Commissioner based data

MSA data covers English NHS patients only and is published both on a provider and commissioner basis.

Provider-based reflects data at organisation level for those organisations that provide NHS funded treatment or care, for example NHS Acute Trusts, NHS Community (PCT) providers, NHS Mental Health Trusts, Independent Sector and Voluntary Sector organisations.

Commissioner-based reflects data on a responsible population basis, i.e. Primary Care Trusts (PCTs) that are responsible for commissioning a patient’s treatment. This is defined as:

• all patients resident within the commissioning PCT boundary; plus
• all patients registered with GPs who are members of the commissioning PCT, but are resident in another PCT; minus
• all patients resident in the PCT, but are registered with a GP who is a member of another PCT.

4. MSA breach rate indicator

The MSA breach rate is the number of breaches of mixed-sex accommodation sleeping accommodation per 1,000 Finished Consultant Episodes.

An MSA breach rate indicator was developed because a simple count of the number of MSA breaches does not provide a fair comparison across healthcare providers. Raw numbers alone do not take into account the size of an organisation and it would be unfair to classify large acute providers as “worst performing” compared to other, smaller providers, as they handle larger volumes of admitted patients and therefore the possibility of mixing patients is greater. The MSA breach rate indicator gives us the ability to compare healthcare providers with others, or to compare change over time. It can tell us how a provider is “performing” in relation to other similar organisations, or the national average, and whether they are improving or getting worse.

For more information, see the MSA Breach Rate methodology paper at:

5. Data Quality

MSA breach data was collected by provider organisations for the first time in December 2010 and, whilst collected on the basis of a standard definition, it may take time for the quality of the data to improve as providers implement and embed local data collection processes. Therefore, figures published during the early months of the collection should be treated with a degree of caution, are subject to change and are not directly comparable with previously released figures. 

 6. Revisions to published figures

During the initial months of the collection, revisions to published figures will be allowed on a monthly basis. For monthly revisions, there will be a two-month ‘lag’, with revisions to a previous month’s data published at the same time as the next month’s data. For example, revisions to February 2011 data will be published alongside the initial release of data for April 2011 in May 2011.

Department of Health (DH) statisticians will review the need for a monthly revisions process as the data quality for initial submissions improves during the early months of the collection.

7. Feedback welcomed

We welcome feedback on the content and presentation of MSA statistics within this Statistical Press Notice and those published on the DH website. Please email any comments on this, or any other issues regarding the MSA data and statistics, to:

Additional Information

Details of MSA data for individual organisations are available at:

For press enquiries, please contact the DH press office on 020 7210 5221.

The Government Statistical Service (GSS) statistician responsible for producing these data is:

Mark Svenson
Knowledge and Intelligence
Department of Health
Room 4E63, Quarry House, Quarry Hill, Leeds LS2 7UE
For data queries, email:


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