Most NHS trusts still bar religious head coverings in theatres, national audit finds

Only 32% of NHS England trusts permit cloth hijabs in operating theatres, and 61% make no provision at all for religious head coverings, according to a national mixed-methods study published in the International Journal for Equity in Health. The study, which audited uniform policies across the service and surveyed Muslim female healthcare professionals, found that national guidance introduced in 2020 has been implemented unevenly at best, with substantial consequences reported for the wellbeing and careers of an already marginalised group of workers.

The 2020 national guidance recommends religious accommodations within uniform policies that do not compromise infection prevention and control. These include adaptations to the “bare below the elbows” (BBE) policy and provisions allowing hijab use in operating theatres. Before this study, the extent to which individual trusts had actually adopted these accommodations, and the effect on the staff concerned, remained unclear.

Researchers from a multi-institution team led by Ushna Qureshi Javed, with senior authorship including Peter H. Scanlon, carried out two parallel investigations. First, they sent Freedom of Information requests to all 211 NHS England trusts and received 200 responses, a 95% response rate. They then reviewed each responding trust’s uniform policy for compliance with the recommended religious accommodations covering hijab use in theatres and BBE adaptations. Second, they ran an anonymous online cross-sectional survey of Muslim female healthcare professionals and healthcare students who had worked or trained within NHS England since April 2020, which 430 people completed. The authors emphasise that the study was designed as a descriptive policy audit and experiential survey rather than an intervention trial.

The policy audit revealed a patchwork of local rules. Beyond the 32% of trusts allowing cloth hijabs in theatres and the 61% making no provision for religious head coverings, the audit of BBE compliance found that 28% of trusts allowed both full sleeves outside direct patient care and disposable oversleeves during direct care, while 49% enforced a blanket BBE policy without any accommodation. In other words, in nearly half of responding trusts, staff were required to conform to the bare-below-the-elbows standard with no religious adjustment whatsoever, despite national guidance suggesting otherwise.

The survey results mirrored the audit. Among the 430 respondents, 72% reported having been prevented from wearing full sleeves when not in direct patient care, and 27% reported having been stopped from wearing hijabs in theatres. These figures indicate that, in practice, many Muslim female healthcare professionals encounter uniform rules that conflict directly with their religious practice, even where national guidance would permit an accommodation.

The reported consequences extended beyond inconvenience. Forty-seven percent of respondents said uniform policies had negatively affected their mental wellbeing, and 32% reported that they had considered leaving the NHS or had already left because of conflicts over uniform policy. The study’s authors frame these outcomes in the context of structural racism within healthcare systems, which they describe as operating through institutional policies that disproportionately disadvantage racialised and religious minority groups. They also note that discrimination affecting healthcare workers is increasingly recognised as an upstream determinant of health, influencing workforce wellbeing, retention, and equitable healthcare delivery.

Muslim female healthcare professionals occupy an intersectionally marginalised position, the authors write, because they may face conflict between uniform policy requirements and religious practice simultaneously on the grounds of gender, faith and race. The survey population of 430 respondents is self-selected and limited to those who chose to complete an anonymous online questionnaire, so the reported percentages describe the experiences of respondents rather than a statistically representative estimate of all Muslim female staff in the NHS. Similarly, the policy audit reflects the 200 trusts that responded to Freedom of Information requests, not the full 211.

Nevertheless, the scale of the reported effects is notable. The authors caution that these are self-reported experiences from a cross-sectional survey, so causal effects on retention cannot be established from this data alone.

The study’s conclusions call for clearer implementation of the 2020 national guidance across trusts and for a review of the evidence informing national standards.

Subject of Research: Implementation of national uniform policy guidance and its mental health impacts among Muslim female healthcare professionals in NHS England

Article Title: Structural inequities in uniform policy implementation and mental health impacts among Muslim female healthcare professionals in England: a national mixed-methods study

Article References: Javed, U. Q., Rila, F. M., Vohra, M., Bhatti, A., Momo, M., Khan, H., Hapeshi, E., Hapeshi, J., & Scanlon, P. H. (2026). Structural inequities in uniform policy implementation and mental health impacts among Muslim female healthcare professionals in England: a national mixed-methods study. International Journal for Equity in Health. https://doi.org/10.1186/s12939-026-03096-3

Image Credits: AI Generated

DOI: 10.1186/s12939-026-03096-3

Keywords: NHS, uniform policy, hijab, bare below the elbows, Muslim healthcare professionals, structural inequities, mental health, Freedom of Information, operating theatres, workforce retention, religious accommodation, England