Implementation of NHS dress code impedes Muslim healthcare professionals in the workplace

Key findings from a new study on Bare Below the Elbows (BBE) policy and head coverings in surgical theatres suggest that some Muslim female healthcare professionals experience bullying and harassment in the workplace on account of their religious observance.

The research was carried out by the British Islamic Medical Association (BIMA) and The Bridge Institute with the results published in the BMJ Open.

Results showed a lack of awareness and implementation of existing Department of Health Uniforms and Workwear guidance for faith groups.  Front-line staff were reported to prevent Muslim women from adhering to their faith practices of covering.  The findings also highlighted the absence of clear national guidance on surgical head coverings in theatres.

Wearing a headscarf was significant to Muslim female healthcare professionals in adhering to their religious dress code, yet over half experienced problems trying to wear a headscarf in theatre.  Some women felt embarrassed, anxious and bullied due to lack of clarity regarding NHS dress code policy.

Women described being discouraged from pursuing acute medical and surgical careers and instead opting for primary care roles due to pressures in complying with hospital dress codes.

The findings reveal that 56.3% felt their religious practice in covering their arms was not respected by their Trust; 74% were not happy with their Trust’s BBE uniform policy alternative, with 16.2% and 14.3% of respondents reporting an impact on their career choice due to BBE policy and surgical head coverings, respectively. 

Dr Emma Wiley, a microbiology registrar and former Healthcare Infection Society (HIS) Infection Control Fellow from University College London Hospitals NHS Foundation Trust said: “It is disappointing that Muslim women are being held back in their careers due to dress code policies.  They feel there are no safe spaces to voice this and no one to speak to if they are being bullied on this issue.  Speaking out about BBE as an individual is challenging when it results in escalation to Trust management and forms part of hospital inspections.”    

Dr Sharif Al-Ghazal, President of BIMA added: “This data from this important research suggests for the first time that dress code policies such as Bare Below the Elbows contribute towards the indirect discrimination of faith groups.  Our research has highlighted the impact on Muslim women, and this may well affect other faith communities as well as our patients.  We need inclusive policy, processes and systems that support women to succeed in their careers rather than holding them back.”

Building on the work with the British Medical Association (BMA); NHS England; NHS Improvement; NHS Employers; HIS and Infection Prevention Society, BIMA and the researchers are calling for the effective implementation of a national dress code policy which meets both infection control and faith requirements.

Key recommendations from the research are:

• A national dress code policy to be implemented with immediate effect.  This must provide clear and inclusive guidance for all faith groups and address surgical head coverings in theatres.

• All NHS Trust Equality and Diversity Steering Groups to review local dress code policies and undertake an equality impact assessment including the provision of specific guidance for faith groups.

• Stakeholders such as Royal Colleges, Health Education England, the BMA, NHS Employers, Trusts and educators to provide and signpost faith-sensitive support for Muslim women affected by these issues.

Dr Abida Malik, Director of the Bridge Institute for Research and Policy, and a tutor in Sociology at the University of Nottingham said: “We do hope that our dress code policy recommendations will be considered and adopted by national stakeholders in order to improve the experiences of staff and students who come from BAME minorities within a healthcare work setting.”

For further information, please contact:

British Islamic Medical Association: info@britishima.org