Uniform and appearance at work and dress code policy – Rotherham Doncaster and South Humber NHS Foundation Trust (RDaSH)

1 Introduction

The aim of this policy is to ensure that all colleagues (both directly and indirectly employed) whilst on duty within Rotherham Doncaster and South Humber NHS foundation Trust are dressed in such a way that maximises colleagues and patient safety, and projects a professional image, whether uniform or personal clothing is worn.

Standards of personal presentation in the workplace are expected to always be high, and any uniform provided to be worn in the prescribed manner. Adhering to the dress code and uniform policy applies to and is mandatory for all trust staff.

If a colleague requires modifications or adaptions to this policy for example for health and wellbeing, cultural or any other reason this should be discussed with their manager with advice from human resources, health and safety and infection prevention and control (IPC) as appropriate on a case-by-case basis.

1.1 Glossary of terms

For the purpose of this policy the following definitions apply:

Patient: this term is used when referring to the NHS population as a whole, also for the purpose of this policy it is used to mean, service user, resident, client et cetera.

2 Purpose

The purpose of the policy is to:

ensure that all colleagues are clear on the standard of dress expected while at work, whether wearing uniform or non-uniform
detail the standards and positive professional image which the trust wishes to convey to all patients or clients, partners and members of the public at all times
ensure colleagues do not present themselves in a manner that might undermine confidence in the trust or its services
enable easy identification of role and profession is maximised through clear and visible staff identification
ensure professional accountability is maintained, as defined by professional bodies or councils

In all cases, the following principles should be supported and promoted, in order to adhere to the recognised legal framework:

health, safety and well-being of patients
health, safety and well-being of colleagues
infection prevention and control

3 Scope

This policy applies to colleagues that are directly employed by the organisation and for whom the trust has legal responsibility for. For those staff covered by a letter of authority, honorary contract, a volunteer or apprentice agreement or work experience, this policy is also applicable whilst undertaking duties on behalf of the trust or working on the trust premises and forms part of their arrangements with the trust.  As part of good employment practice, agency workers are also required to abide by the organisation’s policies and procedures, as appropriate, to ensure their health, safety and welfare whilst undertaking work for the trust.

4 Responsibilities, accountabilities and duties

4.1 Chief executive

The chief executive has overall responsibility and accountability for the health, safety and welfare of the workforce. Through delegated responsibility to the director of people and organisational development the chief executive will ensure there is a system in place for establishing and maintaining this policy and for meeting all statutory requirements and adhering to guidance issued in respect of the procedural document.

4.2 Directors

All directors have a responsibility to ensure that the policy is consistently applied across their directorate or care groups.

4.3 Managers

Managers must ensure that the uniform and appearance at work or dress code policy and procedure is implemented within their area of responsibility. They must act as role models to support the implementation of the policy.

Managers must also ensure that:

a safe and healthy working environment is maintained where dress code, appearance or uniform is appropriate to the duties being undertaken, including the use of personal protective equipment (PPE) or health and safety equipment. Colleagues have access to the correct uniform based upon their job role, from day one of their employment as set out within this policy
any concerns raised by an employee where they believe that their personal requirements or circumstances are not being met in relation to this policy are addressed
immediate action is taken where an employee does not comply with the dress code, appearance or uniform requirements set out in this policy

4.4 Colleagues

It is an employee’s responsibility to:

always adhere to the standards of dress and personal appearance appropriate to their colleague group and job role, including ensuring their uniform is fit for purpose, escalating to line manager if uniforms require replacing
co-operate with the trust in meeting their legal responsibilities in relation to the Health and Safety at Work Act (1974)
ensure personal protective equipment or clothing for their safety is worn, stored, used, decontaminated, maintained and serviced as appropriate and in accordance with the manufacturer’s recommendations (the Personal Protective Equipment at Work Regulations, 1992 and 2002)
inform their manager of any discretionary reason which may mean they need adjustments to be accommodated under this policy

4.5 Human resources

The human resources department will provide guidance to managers and employees on the policy and procedure.

Human resources will also offer support and advice to both managers and colleagues who wish to discuss a deviation from the policy due to cultural or religious or medical or personal reasons.

5 Procedure

5.1 All staff general principles

5.1.1 Personal hygiene

All employees should maintain a high level of personal hygiene.

5.1.2 Hair

Hair must be clean and well groomed.
Facial hair must be kept clean and groomed.
For colleagues in direct contact with patients please see additional information in quick guides in 5.1.17.

5.1.3 Clothing

Dependent on the job role clothing which covers the face may not be permitted. For example, colleagues who are in contact with patients, carers or visitors, or where clear face to face communication is essential. In these circumstances, colleagues who wish to wear a veil for religious reasons can do so when they are not in contact with patients, visitors or carers.

Where a headscarf or a veil is worn, as part of religious observance, colleagues must ensure that the flow of the garment does not interfere with work practice. This must be changed and subsequently washed daily to reduce the risk of cross infection.

Colleagues must not wear neck ties during any care activity which involves direct patient contact. This includes all clinical settings, such as wards and community settings, outpatient clinics and ward rounds. Ties may pose a strangling or ligature risk, in addition to being an infection prevention and control hazard.

When working remotely and taking part in video meetings (for example via Microsoft Teams or Zoom), colleagues’ appearance should be in line with the standards of this policy, particularly when attending formal meetings.

Appropriate clothing and footwear should be worn during relevant training, for example, moving and handling training which allows the learner to move comfortably whilst preserving dignity. Colleagues may be refused a training place and asked to rebook if not dressed appropriately.

Clothing should allow sufficient hip and shoulder movement for the safe moving and handling requirements of the job.

Pens or any other sharp instrument should not be carried in breast pockets in clinical areas as this may cause injury when moving patients.

Specific information for non-uniform and uniform clothing is available in 5.1.14 and 5.1.15.

5.1.4 Footwear

Shoes must be suitable for the work task and in keeping with any requirement of personal protective equipment.

Dependent on the service or corporate area, managers can apply discretion in relation to the above points, but they would need to ensure equity across their service or corporate area and would not apply to colleagues in clinical areas. For colleagues in direct contact with patients please see additional information in quick guides in 5.1.17.

5.1.5 Identification badges

It is important for everyone to know who colleagues are therefore unless determined unsafe following a risk assessment, the ‘hello my name is’ badge must always be worn

Trust identification (ID) badges must also be worn or be immediately available when colleagues are on duty. However, badges should not be visible in public places for both security and identity purposes. Identification badges must only be worn when undertaking work on behalf of the trust and must not be used by colleagues who undertake any private work or volunteering outside the trust. Identification badges must be sticker free. Colleagues can wear their identification badge and one other appropriate badge denoting professional qualifications or memberships.

Colleagues can either wear safety lanyards or a clip-on badge, as appropriate to the area of work. Safety lanyards must be cleaned or replaced if visibly dirty and must have a minimum of a 3-point break. Identification badges must be handed in to managers on leaving the organisation.

5.1.6 Body art

Where these are deemed to be offensive, they should be appropriately and discreetly covered. The trust will deem tattoos offensive if they include pictures of naked bodies; pornographic material; depictions of violence; symbols relating to extremist groups; foul language or swear words; and any content of a discriminatory nature, that incites racist or religious hatred, or homophobic behaviour. New tattoos must be covered with a waterproof dressing until they are healed. While working in an area where bare below the elbows (BBE) is required the covering of the tattoo must not contravene this principle. Henna body art is permitted provided effective hand hygiene is undertaken.

5.1.7 Jewellery

Jewellery should be discreet and kept to a minimum. Colleagues should exercise care and discretion regarding health and safety at work and public image. Colleagues who are required to wear jewellery for religious reasons, for example, a Kara (steel bangle) may do so if it is pushed up the arm and secured in place prior to all direct patient care activity to enable effective hand hygiene.

If medic alert jewellery needs to be worn, this should be worn off the wrist by securing it to the high or mid-forearm area or attached to the clothing. For colleagues in direct contact with patients please see additional information in quick guides in 5.1.17.

5.1.8 Nails

Hands and nails should always be clean. For colleagues in direct contact with patients please see additional information in quick guides in 5.1.17.

5.1.9 Facial and body piercings

Any piercings or jewellery with the potential to snag must be covered or removed; this also includes dermal piercing jewellery, which is not permitted to be worn below the elbow for colleagues in direct contact with patients.

5.1.10 Dress for the environment

All colleagues particularly non-clinical colleagues need to be mindful of the area they will be working within or visiting on a particular day. If they are in an inpatient environment, they would need to comply with their guidance. This would include wearing suitable clothing, including footwear and having the ability to be bare below the elbows.

5.1.11 Charity events

The trust acknowledges that colleagues may wish to support charitable events and fun days where there may be a costume or a particular item of clothing to wear. However, it is the responsibility of ward or service managers to decide the appropriateness of their directorate supporting these events. Please ensure that Health and Safety and infection prevention and control principles are still met.

5.1.12 Smoking

Colleagues must not smoke whilst in uniform, or whilst wearing a trust identification badge, irrespective of whether on duty or not.

5.1.13 Compensation for damage to personal clothing

Colleagues are required to adopt a common-sense approach with regard to the clothing, jewellery, glasses et cetera. That they wear to work in terms of expense. Colleagues must ensure that articles are appropriate to the type of work that they carry out and must also be mindful of any potential for damage to or loss of personal property, which may arise as a result of carrying out their duties.

The trust discourages colleagues from coming to work in overly expensive or “designer” items and where colleagues choose to do so and subsequently make a claim for damage to or loss of such items the organisation reserves the right to impose an upper limit of the amount of compensation it will reimburse.

All claims for compensation for damage to or loss of personal clothing will be reviewed by the director of finance and estates and will be considered in line with this policy. Colleagues will therefore only be compensated for damage to personal clothing or property that was worn in line with the requirements of this policy.

All incidents where personal clothing or property is damaged or lost whilst at work must be reported on incident reporting system. Wherever possible, if a request for reimbursement is to be made this must be clearly documented on the incident reporting form and receipts for the damaged items attached, where available.

5.1.14 Non-uniform colleagues, dress for work

The trust is a multi-professional, multi-disciplinary multi-cultural health care provider. Certain services of the trust employ colleagues who are not required to wear a uniform. All colleague groups who are non-uniform wearers must dress in a manner which is presentable and smart in appearance to inspire patient and public confidence.

Colleagues who wear their own clothes must ensure they are suitable for work purposes; are clean and in a good state of repair. All clothing should be able to withstand higher laundry temperatures in the event of contamination with blood or body fluid. The following must not be worn:

clothes that are revealing and may cause embarrassment or offence, (for example, above mid-thigh length; tops that are low cut, backless; show the midriff or any item where underwear visible)
clothes portraying large advertisements; sports clothing; et cetera. (unless participating in sport related therapeutic activities with patients)
clothing that could be interpreted as intimidating or threatening, (for example, combat fatigues)
ripped or torn clothing
denim clothing
clothing which posses a health and safety risk due to the length of the garment, for example maxi dresses

5.1.15 Uniforms

All colleagues who wear a uniform as part of their role must only wear the uniform provided and agreed by the trust. Any alterations must be undertaken by the uniform hub. Uniforms must only be worn when on duty or acting in an official capacity representing the trust and must not be worn by colleagues who undertake private work or volunteering outside the trust. Uniforms must not be worn in any retail or recreational premises while not at work.

Colleagues must wear a clean uniform daily and ensure they are ironed and presentable. Colleagues should have access to a spare uniform in case of accidental contamination by bodily fluids or any other noxious or toxic substance. The contaminated item must be placed in a red soluble bag. Ideally it should be taken to the laundry for washing rather than taken home.

Wherever possible, employees should change out of their uniform promptly at the end of each shift ideally before leaving the premises. Where there are no changing facilities the uniform, wherever possible, must be covered discreetly for the journey to and from work, between patients or on an allocated break when the employee is off site.

It is acknowledged that some colleagues when working in the community may require to visit shops or petrol stations and this is acceptable however colleagues should not routinely be seen shopping whilst in uniform.

Colleagues may send uniforms to the Tickhill Road Site laundry for washing. This may not be practical for all employees, so if uniforms are washed at the individual’s home, they must be washed separately from other items and on a machine cycle that reaches 71C (for not less than 3 minutes) or 65C (for not less than 10 minutes). The above principles also apply to the laundering of colleagues own clothing if worn for clinical work. Therefore, clothing should be worn that can withstand the above laundering temperatures. Clean and dirty or contaminated uniforms must not be stored or transported together because of the risk of cross-contamination.

Stockings, tights and socks (blue, black or neutral) should not detract from the overall appearance of the uniform. Nurse belt and buckles may be worn by colleagues wearing dresses but should be removed prior to manual handling of patients and cleaned regularly as per the instructions.

There may be circumstances where the wearing of all, or part of, the uniform may cause difficulties to colleagues, for example in extremely hot or cold weather. Changes may be allowed at local level following discussion between colleagues and managers and ensuring that no infection prevention and control or health and safety requirements are breached.

Colleagues experiencing menopausal symptoms may have hot flushes resulting in a sudden and brief increase in body temperature. Reasonable adjustments may be required including the option of lighter weight uniforms (where available) and scrub tops rather than tunics. Where a colleague requests a change to their uniform the manager will adhere to the guidance detailed in section 4.3, managers responsibilities.

5.1.16 Uniform hub services

A far as possible colleagues should feel comfortable in their uniforms and work wear providing the standards set out in the policy are met. To support this a range of uniform styles are available, see appendices A and B. Please check with your directorate regarding what types of uniform are permitted.

The number of uniforms issued to a colleague will be according to contracted hours and shifts worked. Uniforms will only be issued according to professional background or will be team specific if applicable, see guides in appendices A and B. If any new teams or services require a role specific uniform please discuss with the Uniform Hub. Standard lead time for the delivery of uniforms is 4 weeks following the receipt of authorised request documentation.

Where an individual is changing roles within the organisation and requires a new uniform to reflect their new role, the previous uniform must be returned to the uniform hub prior to or at the point in which the new uniform is collected.

Maternity wear will be loaned for the duration of the pregnancy, and the quantity will be dependent on the working pattern of the employee. Following the maternity leave, the maternity wear must be returned to the uniform hub.

5.1.17 Requirements for colleagues working in direct contact with patients or in a clinical environment

All colleagues who undertake hands-on care activities with patients must be bare below the elbow (BBE). In addition, all colleagues who are based on, or visit a ward, colleagues who are involved in cleaning activities and colleagues who are involved in food preparation must be bare below the elbow. Any colleagues who do not undertake hands-on care activities but have direct face to face contact with patients or a clinical environment, such as a treatment room must have the ability to be bare below the elbow during these times.

These principles apply to all colleagues from all professions including nursing, allied health professionals, medical and visiting professionals. It applies in all settings, such as a ward, in a clinic or in a patient’s home and is regardless of whether a uniform is worn or not.

Where it is not acceptable for forearms to be exposed disposable over sleeves may be worn for single episodes of care. Strict adherence to washing hands and wrists must be undertaken before and after use of these. This will support the safety of patients in regard to health and safety law, infection prevention and control procedures, when involved in reducing restrictive intervention, food hygiene regulations and when undertaking moving and handling procedures.

Public confidence is increased when colleagues present themselves in a professional manner and is an important influence on the overall perceptions of the standards of care they experience. See quick guides below:

5.1.17.1 Quick guide for colleagues who work on a ward and for colleagues who provide hands on care with patients in any setting

Hands on care refers to care provided by colleagues in both inpatient and community settings and includes activities where effective hand hygiene is required to protect patients and colleagues. The list is not exhaustive, but hands on care would include the following activities:

giving injections
venepuncture
catheter maintenance
administering medication
undertaking physical observations or assessments
providing personal care
wound care

5.1.17.1.1 Hair guidance

Hair must be tied back if longer than shoulder length.
Where hair clips are worn, they must be plain and not have the potential to injure colleagues or patients.

Rationale:

keeping hair off the collar reduces the incidence of bacterial growth around the collar area
hair of any length can be grabbed but it is harder to intertwine fingers in hair that is tied back

5.1.17.1.2 Footwear guidance

Closed shoes must be made of a material that can be cleaned immediately in the event of body fluid contamination and must have closed toes and closed heels.
Any style of Crocs or footwear without backs must not be worn.

Rationale:

closed shoes offer protection from spills and dropped objects and reduce the risk of injury or contamination for colleagues
inappropriate shoes can hinder mobilisation in the event of a violence and aggression incident

5.1.17.1.3 Jewellery guidance

Plain band or ring can be worn with no stones.
One small pair of plain stud earrings. Ear stretching plugs will count as one pair of earrings.
Necklaces must not be worn.
No wrist or hand jewellery including watches, fitness trackers or bracelets.

Rationale:

wearing wrist and hand jewellery can injure patients during interventions
necklaces and any loose or dangling jewellery can be grabbed
hand hygiene is impeded when colleagues are not bare below the elbows

5.1.17.1.4 Nails guidance

Nails must be short and clean.
Long nails, false nails or nail extensions are not permitted.
Nail polish including gel polish and builder gel is not permitted.

Rationale:

long nails can cause injury to others
long and or varnished fingernails or false nails harbour micro-organisms and can reduce compliance with hand hygiene

5.1.17.1.5 Long sleeves guidance

Long sleeved garments should be removed or where these cannot be removed sleeves must be rolled up to the elbow.
On wards where trust issued fleeces are worn these must be pushed up to the elbow.
Longer sleeves must not be loose or dangling.

Rationale:

cuffs at the wrist become heavily contaminated and are likely to come into contact with patients
hand hygiene is impeded by long sleeves

5.1.17.2 Quick guide for colleagues who have direct face to face contact with patients but do not provide hands on care

Direct face to face contact refers to colleagues in both inpatient and community settings who provide care to patients or who may see patients in their role. For these colleagues there is no or minimal hands-on contact with patients. Examples of activities would include:

face to face patient assessments
talking therapies
audits in clinical settings such as treatment rooms
ward clerks based on a ward
visiting professionals to patient facing areas

5.1.17.2.1 Hair guidance

Hair should be off the collar and tied back if longer than shoulder length when in face-to-face contact with patients.

Rationale:

keeping hair off the collar reduces the incidence of bacterial growth around the collar area
hair of any length can be grabbed but it is harder to intertwine fingers in hair that is tied back

5.1.17.2.2 Footwear guidance

Shoes should be made of a wipeable material and should have closed toes and closed heels.
Any style of Crocs or footwear without backs must not be worn.

Rationale:

closed shoes offer protection from spills and dropped objects and reduce the risk of injury or contamination for colleagues
inappropriate shoes can hinder mobilisation in the event of a violence and aggression incident

5.1.17.2.3 Jewellery guidance

Jewellery must be discreet and kept to a minimum.
Colleagues must have the ability to remove jewellery when in face-to-face contact with patients or when in a clinical environment.

Rationale:

necklaces and any loose or dangling jewellery can be grabbed
hand hygiene is impeded when colleagues are not bare below the elbow

5.1.17.2.2 Nails guidance

Colleagues must have the ability to be bare below the elbow when in face-to-face contact with patients or when in a clinical environment therefore long or false nails are not permitted.

Rationale:

long nails can cause injury to others
long and or varnished fingernails or false nails harbour micro-organisms and can reduce compliance with hand hygiene

5.1.18 Failure to comply with this policy

Where there are instances of colleagues failing to comply with the policy, managers will remind the employee of the contents of the policy and the expectation that they will comply with it. If an employee having failed to comply with the policy on a previous occasion fails to do so on a second occasion, then they may be sent home from that particular shift and not receive pay for the period of time that they did not work due to the failure to follow policy. Disciplinary action may also be considered and in cases of repeated failure to abide by the policy may result in an individual’s dismissal from employment with the trust.

5.1.19 Right to redress

Should any individual object to expectations either set out in this policy or in any supplementary guidance issued at departmental level, this should be addressed in accordance with the trust grievance and dispute policy.

6 Training implications

6.1 Managers

How often should this be undertaken: on revision of the policy or new appointments or promotions.
Delivery method: daily communication or agreed communication channels.
Training delivered by whom: line manager.

6.2 Human resources

How often should this be undertaken: on appointment or revision of the policy.
Delivery method: on the job training mentoring.
Training delivered by whom: Human Resources team managers or head of human resources.

6.3 Staff side

How often should this be undertaken: in revision of the policy and at policy forum.
Delivery method: daily communication or agreed communication channels.
Training delivered by whom: line manager.

7 Monitoring arrangements

7.1 Number of human resource processes in relation to the policy

How: review of human resources processes which link to policy.
Who by: Employee Relations team.
Reported to: trust governance structure.
Frequency: annually.

7.2 Number of grievances in relation to the policy

How: review of grievances.
Who by: Employee Relations team.
Reported to: trust governance structure.
Frequency: annually.

8 Equality impact assessment screening

To access the equality impact assessment for this policy, please see the overarching equality impact assessment.

8.1 Privacy, dignity and respect

The NHS Constitution states that all patients should feel that their privacy and dignity are respected while they are in hospital. High Quality Care for All (2008), Lord Darzi’s review of the NHS, identifies the need to organise care around the individual, “not just clinically but in terms of dignity and respect”.

As a consequence the trust is required to articulate its intent to deliver care with privacy and dignity that treats all service users with respect. Therefore, all procedural documents will be considered, if relevant, to reflect the requirement to treat everyone with privacy, dignity and respect, (when appropriate this should also include how same sex accommodation is provided).

8.1.1 How this will be met

Policy does not relate to patients.

8.2 Mental Capacity Act (2005)

Central to any aspect of care delivered to adults and young people aged 16 years or over will be the consideration of the individuals’ capacity to participate in the decision-making process. Consequently, no intervention should be carried out without either the individual’s informed consent, or the powers included in a legal framework, or by order of the court.

Therefore, the trust is required to make sure that all staff working with individuals who use our service are familiar with the provisions within the Mental Capacity Act (2005). For this reason all procedural documents will be considered, if relevant to reflect the provisions of the Mental Capacity Act (2005) to ensure that the rights of individual are protected and they are supported to make their own decisions where possible and that any decisions made on their behalf when they lack capacity are made in their best interests and least restrictive of their rights and freedoms.

8.2.1 How this will be met

All individuals involved in the implementation of this policy should do so in accordance with the guiding principles of the Mental Capacity Act (2005).

9 Links to any other associated documents

10 References

Department of Health Uniform and work wear (2007) An evidence base for developing local policy
Management of Health and Safety at Work Regulations (1999)
The Health and Safety at Work Act (1974) Section 2 and 3
The Control of Substances Hazardous to Health Regulations (2002)
The Health and Social Care Act Department of Health (2012)
Royal College of Nursing guidance on uniforms and work wear (2020)
The Health and Social Care Act (2008) Code of practice on the prevention and control of infection and related guidance
Department of Health (2006) Safety first: a report for patients, clinicians and healthcare managers, London
Health and Safety Commission (2000) Securing health together, Health and Safety Executive: London
His Majesty’s Stationery Office (1974) Health and Safety at Work Act (1974), London
His Majesty’s Stationery Office (1992) Manual Handling Operations Regulations, London
His Majesty’s Stationery Office (1999) Management of Health and Safety at Work Regulations, London
His Majesty’s Stationery Office (2002) Control of Substance Hazardous to Health Regulations, London
His Majesty’s Stationery Office (2002) Personal Protective Equipment Regulations, London
His Majesty’s Stationery Office (2006) Health Act (2006) Code of Practice, London
Jacob, G. (2007) Uniforms and workwear, an evidence base for developing local policy
Department of Health, London
Royal College of Nursing (2005) Wipe It Out. Royal College of Nursing Campaign on Methicillin-resistant Staphylococcus aureus
(MRSA). Guidance on uniforms and clothing worn in the delivery of patient care, London
National Institute for Health and Care Excellence guidance
NHS England Uniforms and workwear: guidance for NHS employers