Among all the media reports of the NHS being destroyed by target-setting and endless reorganisation, and of patients being put last – or nowhere at all – in NHS policy-making, it was good to learn that, from this month, those dreaded hospital gowns are to be consigned to history, with newly designed ones being introduced to maintain patients’ dignity.

I have only ever been astonished that the bum-barers we have known for so long could ever have been approved for use, and have always believed that, as retribution on behalf of patients, the person who designed them should have been required to walk down busy high streets wearing nothing else every Saturday morning for the rest of his or her life; well, alright then, we’d allow him (for it was almost certainly a “him”) a pair of Doc Martens as well.

This change, loudly to be applauded, echoes another one intended to give patients greater privacy and dignity, the introduction of single-sex wards, but without the one size does not fit all pitfall of the latter.

On the face of it, it seems obvious that patients would prefer single-sex wards to mixed-sex ones, and most would. The problem arises when people with skin diseases are admitted to hospital. Non-specialist doctors and nurses have extraordinarily little training in dermatology. Typically, doctors are taught dermatology for no more than about six days during their entire medical training and cannot fail to qualify through paucity of dermatological knowledge; I have heard those six days referred to as the “dermaholiday.” Nurses receive no dermatology training at all. As a result, all the prejudices and misconceptions about skin diseases, so widespread amongst the pubic, are shared by many, perhaps most, of the nursing staff on general wards. They often see skin diseases as trivial, as signs of poor hygiene and perhaps as contagious. Very few of them know anything at all about the proper treatment of skin diseases.

It is for these reasons that several surveys, properly conducted by patient support groups, have shown that most people with skin diseases would prefer to be treated on mixed-sex specialist dermatology wards than on single-sex general ones. As numbers of hospital beds have been reduced over the past ten to 15 years, so have dermatology wards been closed, denying increasing numbers of patients that opportunity – a classic example of the “two steps forward, one step back” syndrome with which the NHS is so widely afflicted.

Whatever the Department of Health may say about being determined to put patients’ interests at the heart of the NHS, the NHS is still a very long way from achieving that, not least because both the Department and NHS managers fear that taking account of patients’ interests would be significantly more expensive than developing and implementing policies designed primarily to reduce costs. The reason why the new hospital gowns have been able to slip through those barriers is that they are no more expensive than the grotesque ones they are replacing.

Peter Lapsley is patient editor, BMJ

Declaration of interests:

The author is patient editor of the BMJ. He was chief executive of the Skin Care Campaign for ten years until March 2007, is an Honorary Member of the British Association of Dermatologists, an Honorary Member and chairman of Trustees of the Primary Care Dermatology Society, and chairman of the Oversight Committee for the All Party Parliamentary Group on Skin.

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