Tackling sexual misconduct in the NHS will require education and empowerment – not just words

Many were shocked by the recent revelation that more than 35,000 incidents of sexual misconduct, ranging from abusive remarks to rape, occurred in the NHS over the five years to 2022.

Nearly 21,000 incidents involved patients abusing staff, almost 7,500 were cases where patients had abused other patients, and more than 3,000 involved staff abusing patients. There were 902 alleged incidents of staff abusing other staff.

This data, published in a joint investigation by The Guardian and the BMJ, follows data disclosed earlier in 2023 by NHS Resolution showing that the healthcare service had paid £4,020,231 to victims of such abuses from 2018 to 2022. These findings add significant weight to calls for an independent inquiry into sexual misconduct in the NHS.

Without discrediting such important demands for urgent action, there are reasons to doubt the accuracy of the NHS’s incident data. Let’s look at why it might be an undercount, and what can be done to improve the situation.

How can NHS data be incorrect?

A mere 902 reported cases of staff-to-staff sexual misconduct over five years across all English NHS trusts – which would be equivalent to less than one case per trust per year – seems implausible.

In a 2019 survey of healthcare workers, 8% said they had experienced sexual harassment at work in the past year alone. Of these, 78% reported this involved other staff (54% identified a colleague and 24% a member of the wider staff).

With a headcount of between 1.2 to 1.5 million staff in the NHS (this number varies month by month), it becomes clear that hundreds of thousands of incidents, many involving colleagues, should have been reported across the five year period.

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Existing research on sexual harassment and violence tells us under-reporting isn’t uncommon. It’s also not unique to the NHS. A vast number of incidents go unreported or unnoticed. Research in other sectors suggests this is driven by various factors including fear of retaliation, shame, stigma, or lack of faith in the system’s ability to deliver justice.

Research also shows that incidents that are subtly normalised in the workplace culture are often overlooked, even by the victims themselves. When asked in surveys, which are often worded to inquire about particular conduct and give examples to help comprehension, people are more likely to identify what happened to them as a problem.

It’s not unusual to see a disconnect between official figures and the number of incidents identified by self-reporting surveys.

What about policies?

Notably, The BMJ identified that the 20 trusts that had dedicated sexual misconduct policies reported substantially more cases than those that didn’t have policies. Also, trusts disclosing no or low incidents of sexual misconduct generally lacked dedicated policies.

The absence of policies goes some way to explaining why data may be limited. Without awareness and an organisational culture around sexual misconduct that guides people to report, past research suggests healthcare workers may not know how to report or may feel unable to.

Also, the lack of a clear, dedicated policy can lead to gaps and inconsistencies in how incidents are recorded and classified across different trusts. Without guidelines and training on how to document and report such incidents correctly, data may not be collected or may be recorded inaccurately. This is because without a policy much is left to individual discretion about what’s included. The presence of a policy can therefore improve reporting, recording and evaluations.

A male doctor at a laptop.
A clear, dedicated policy on sexual misconduct should be a priority for the NHS.
Branislav Nenin/Shutterstock

But a policy isn’t enough

A policy that creates a clear, comprehensive framework for what constitutes sexual misconduct, eliminating ambiguity and helping people to recognise and report inappropriate behaviour, is certainly needed.

This policy must establish consistent procedures for reporting and investigating incidents. It must boost confidence in the system’s ability to handle these incidents and encourage victims to come forward. It must therefore support and offer protection for those affected, including victims. It must drive the collection of more reliable data through formal and anonymous reporting.

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Also, the policy must make clear the consequences for perpetrators. It must reinforce the message that sexual misconduct will not be tolerated in the NHS. It must signify a whole organisational commitment by the NHS to prevent and respond to sexual misconduct.

A standalone sexual safety policy offers some promise to addressing current issues, but it won’t be a silver bullet. Action, not just words, must follow.

So what else is needed?

Some propose mandatory reporting. However, implementation of this abroad forced victims who did not wish to report to do so. Some identified that this re-traumatised them. Further, reporting is often all too late a response.

Rather, education and empowerment need to be at the heart of an NHS response. Programmes promoting culture change and empowering everyone to call out poor behaviour, abuse and violence should feature. Staff need to know what sexual misconduct is, what options they have if they encounter it, and they must be empowered to safely intervene.

At present, the NHS under-utilises training focusing on being an active bystander, despite results from abroad suggesting such training is effective.

In short, the NHS needs to adopt a holistic, empathic and human-centred approach to sexual misconduct, predicated on education and empowerment. Policies are a first step but not enough. By focusing on education and training, and promoting collective responsibility and action, the NHS can foster a culture of safety and respect.

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