In a Nursing Times survey in 2014, almost 60% of staff consulted, indicated that they thought uniforms were an important part of the job. It is, like the uniforms, a multi-layered topic that generates strong opinions.

The Evolve Care Group run 8 care and nursing homes across the South West of the UK. After careful consideration, the team started discussing the pros and cons of not wearing uniforms. They decided that this was a good idea because it was in line with their Household Model of Care and would help them minimise the institutionalisation seen in care homes.

They announced to their Care Teams across the company that they no longer needed to wear a uniform. By and large, the teams were delighted, but a few carers argued against it. One said she thought uniforms were important because they were respected, and simplified identifying senior carers.

At the time, Health Care Assistant, Rose Pearce, from the group’s Gibraltar Nursing Home in Monmouth, said visitors needed to quickly identify who they could talk to about important care issues and argued to keep the wearing of uniforms. Talking with her recently, however, she has changed her mind completely. She said, “It’s not often that I admit that I was wrong, but I was.”

She went on to say that within the first few weeks of giving up uniforms she began to notice the people she cared for, who are referred to as family members by the care teams, started commenting on the clothes she and the other team members wore. “Nobody had ever commented on the uniforms before”, she said, “but since the change, they were regularly hearing comments such as “I love that top” and “That colour really suits you, dear.”

Rose also noted that the care staff and family members seemed more relaxed, which made her realise how divisive uniforms had been, drawing a line between the carers and the cared for.

Being able to choose what to wear for work also meant that staff were able to choose to wear clothes that would be more likely to generate a positive reaction. For example, wearing a particular football top when working with a family member who supported that team, or wearing a T-shirt with a picture of a horse and asking if anyone had ever been horse riding prompted meaningful interaction.

Communication levels between the carer and the cared-for increased, as did the level of well-being. Although uniforms made it easier to recognise care staff, this was primarily benefitting visitors to the home. For the family members, especially if they were living with a Dementia, seeing a uniform was not something they were used to seeing in their own homes and could increase levels of anxiety. Also, from the Care Teams’ point of view, uniforms could be uncomfortable and poorly designed, or cheaply made. It also seemed that some people had an antipathy towards uniforms. This may have its roots in our history of associating them with war, emergency services, or even school bullies.

Nocturnally, the care teams were encouraged to wear night attire, such as dressing gowns and pyjamas, so that if a family member rose in the night and saw a carer in a nightie or pyjamas, this seemed normal, but had the carer been wearing a uniform, this could have become problematic.

Evolve’s bold policy change has won favour with the CQC which rated one of its homes as Outstanding. Inspectors found that no uniforms promoted an “inclusive family environment” and minimised confusion for people living with dementia. Having received top marks and approval from CQC, the Group rolled out its innovative model of care with an ambitious £75m acquisition and new development plan.