Some Muslim women claim they are being denied the chance of pursuing their dream of a career in surgery as they are torn between their religious beliefs and NHS dress code policies.

A study looking at the experiences of Muslim women with NHS policies such as ‘Bare Below the Elbows’ and those concerning head coverings in surgical theatres suggests some are experiencing bullying and harassment as a result of their religious observance.

Some women have even revealed they have abandoned their dream of working in surgery or a hospital setting as a result of a lack of clarity and feeling uncomfortable by NHS dress codes.

The research carried out by the British Islamic Medical Association (BIMA) and The Bridge Institute, an organisation which aims to build inclusive societies, questioned Muslim women from around the UK working in healthcare and discovered barriers when it came to dress. It was co-authored by a microbiologist and expert in infection care.

Wearing a headscarf was felt to be significant to many of the Muslim female healthcare professionals in adhering to their religious dress code, but more than half – 52% – reported problems when trying to wear a headscarf in theatre. There is no national NHS guidance relating to the wearing of head coverings. In surgical theatres, the default head garment is a semi-transparent scrub cap. 

However, guidance from the National Institute for Health and Care Excellence (NICE) recommend that fully disposable head coverings should be worn in theatre for all individuals

The guidance also states there are alternatives to headscarves that cover the head and neck that can be worn in theatre by individuals where it is required for religious purposes and that it is for individual trusts to ensure that they are available for their staff.

The NHS Bare Below the Elbow policy has also been a source of confusion for Muslim women in healthcare, with conflicting demands to roll up their sleeves and a lack of awareness of national guidance. 

The NHS Uniform and Workwear document states it is good practice to “wear short-sleeved shirts/blouses and avoid wearing white coats when providing patient care”. The reason given is that “cuffs become heavily contaminated and are more likely to come into contact with patients.” However, the document itself states that there is no conclusive evidence that uniforms or other work clothes pose a significant hazard in terms of spreading infection.

Muslim women described being discouraged from pursuing acute medical and surgical careers and instead opting for primary care roles as a result of the pressures in complying with hospital dress codes.

Dr Emma Wiley, a microbiology registrar and former Healthcare Infection Society Fellow from University College London Hospitals NHS Foundation Trust, is one of the co-authors of the study.

She told HuffPost UK: “We had comments from Muslim women saying it had been their dream to go into surgery – some wanted a career in obstetrics or gynaecology.

“But they said concerns and experiences about the dress code in hospitals had made them move into general practice instead.

“Dress code is policed more rigorously in hospitals while GPs work independently in small teams and there are not the same issues around infection control.

“It was heartbreaking to read these comments from Muslim women deterred from going into surgery – particularly when there is a real drive to get more women into surgery.”

Wiley added that while infection control and protecting patients is important, the evidence for the Bare Below the Elbows policy is not strong. She says hand washing and hygiene is what is paramount.

Wiley points out that Department of Health guidance on uniform and workwear policies for NHS employers actually makes reference to the fact that exposure of the forearms is not acceptable to some staff because of their Islamic faith and offers recommendations and alternatives – but says the problem is most hospital trusts aren’t aware of these. 

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

Wiley 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 the Bare Below the Elbows policy 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, said: “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 groups 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.”

‘I didn’t want to feel uncomfortable or compromise my religious beliefs’

Dr Hafsah Quereshi, a trainee GP who lives in Lincoln, experienced difficulties with dress code policy implementation when she worked in a hospital setting.

She told HuffPost UK: “When I was a junior doctor, I was keen on the idea of going into surgery and also fancied ophthalmology.

“But one of the factors that led me to go into general practice was being made to feel uncomfortable with how dress code policies were implemented in hospitals.”

Quereshi, 31, says one of the biggest problems was the lack of understanding of her religious  requirements and the mixed response to the way the dress code was dealt with.

She said: “As a Muslim lady, I choose to wear a headscarf and covering my arms is important to me as I believe it is a requirement of my faith.

“But there were occasions where I was asked to roll up my sleeves when I was sat at a computer far away from any patients or walking along a corridor.

“Some people made more of an issue of it than others and I felt it was unfair to expect me to compromise my religious requirements.

“If there was clear evidence that keeping your sleeves down is harmful to patients, that would be different, but it is just a blanket rule.

“Similarly, in theatres, I had experiences where I was asked to remove my headscarf. It got to the point where every time I went into theatre, I thought I would get told off for wearing my headscarf.”

Quereshi added: “Muslim women should not have to make a choice or compromise between their career and their faith and they should not be made to feel they are being difficult or belligerent when it is part of their religion.”

A Department of Health and Social Care spokesman told HuffPost UK: “We are grateful to the British Islamic Medical Association for highlighting this important issue.

“It is vital that we continue to improve the equality and diversity of our workforce and Muslim women should have access to the same career opportunities in the NHS as everybody else.

“Employers must ensure clinical staff are provided with appropriate clothing to treat and care for patients safely, while taking into account their right to adhere to religious practices.”

The department says it published fresh guidance for NHS employers on uniform and workwear policies in 2007 which included advice from Muslim Spiritual Care Provision in the NHS.

Recommendations to ensure local dress code policies are sensitive to the obligations of Muslims and other faith groups while maintaining standards of hygiene include sleeves being full length when staff are not engaged in direct patient care activity. 

The guidance says uniforms can have three-quarter length sleeves, but any full or three-quarter length sleeves must not be loose or dangling. They must be able to be rolled or pulled back and kept securely in place during hand-washing and direct patient care activity.

Disposable over-sleeves, elasticated at the elbow and wrist, may also be used according to the guidance, but these must be put on and discarded in exactly the same way as disposable gloves.

Strict procedures for washing hands and wrists must still be observed.