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.

Evolve Care Group brings together decades of experience within the adult social care sector. The South West based group are providers of Dementia care who also inspire and educate through their Evolve Care Academy in Bristol. The Academy deliver face-face courses that empowers their team with the knowledge, skills and confidence to support people living within adult social care. The group believe in making positive change within the care sector and creating a true continuation of home for all that live and work with them.

It was this innovative way of looking at making progressive change within the sector that eight years ago led the group to begin discussing the pros and cons of not wearing uniforms. They made this progressive change of a no uniform policy which worked perfectly in line with their Household Model of Care. It would help them minimise the institutionalisation seen in care homes and promote the individualism of their team members. When they shared with their teams across the group that they no longer needed to wear a uniform, by and large, the team members were delighted, but a few argued against it. One said that she thought that uniforms were important because they were respected and it 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 Rose after the no uniforms policy was rolled out, however, she has changed her mind completely. “It’s not often that I admit that I was wrong”, she told us, “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 team, started commenting on the clothes she and the other team members wore to work. “Nobody had ever commented on the uniforms before, but since the change, we were regularly hearing comments such as “I love that top” and “That colour really suits you, dear.”

Rose also noted that the team and family members seemed more relaxed and began to 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 team members were able to choose clothes to wear that would be more likely to generate a positive reaction, such as 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.
Communication levels between carer and the cared for increased, as did the level of wellbeing.

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 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 or the emergency services or even school bullies.

Nocturnally, the night teams were encouraged to wear night attire, such as dressing gowns and pyjamas, so that if a family member woke in the night and saw a care assistant in pyjamas, this seemed normal. If the team member had been wearing a uniform, then this could have become problematic and caused confusion.

Evolve’s bold policy change has won favour with the CQC. Inspectors found that no uniforms promoted an “inclusive family environment” and minimised confusion for people living with a Dementia. Evolve Care Group will continue to push for progressive changes in the sector that improve the quality of life for the people they support.