by
Polly Rossetti, Policy Advisor
| Aug 09, 2022
Healthcare is having its very own #MeToo moment, with shocking examples of sexism, sexual harassment, and sexual assault being widely shared by health and care professionals. A recent raft of ‘anecdotal’ examples are increasingly being backed up by research evidence finding that sexual harassment and other forms of abuse are widespread in the health and care sector. As this issue rises up the agenda, it’s time for all of us with a responsibility for professional standards to sit up and listen. Action is needed now to ensure that harassment (and worse) is never tolerated in the workplace, and that when things do go wrong, victims feel safe and supported to raise a complaint. Once a complaint has been made it is vital that the complainant is treated with dignity and respect, does not have to fear adverse consequences for their career, and can have confidence that employers and regulators will deal with their complaint sensitively, seriously, and appropriately.
What is sexual harassment?
So what do we mean by sexual harassment? Here at the Authority we have in the past referred to the importance of health and care professionals maintaining ‘sexual boundaries’ and have defined a breach of sexual boundaries as including:
- criminal sexual acts
- sexual relationships
- other sexually motivated actions such as sexual humour or inappropriate comments.
In terms of the legal position, the Equality Act 2010 defines sexual harassment as unwanted conduct of a sexual nature that has the purpose or effect of violating the other person’s dignity or creating an intimidating, hostile, degrading, humiliating or offensive environment. Sexual harassment is a form of unlawful discrimination and people have the legal right to be protected from it in the workplace.
Sexual assault is a crime under the Sexual Offences Act 2003 and occurs when someone intentionally touches another person in a sexual manner, without that person’s consent.
How widespread is sexual harassment in health and care?
We’ve known for a long time that sexism and sexual harassment is a problem widely encountered by the health and care workforce, but until recently much of our evidence has been piecemeal or anecdotal.
The Authority first started working to raise awareness of this issue back in 2008, when we published a raft of guidance on sexual boundaries. This included: guidance on the responsibilities of healthcare professionals, setting out their duty to maintain clear sexual boundaries with patients and the action they must take in the event of a breach; guidance for fitness to practise panels, highlighting the significant harms caused by boundary violations and factors they may wish to consider in determining a sanction, and; information for patients to help them know how professionals should behave and what to do if they experience any inappropriate behaviour. We also produced a report on education and training aimed at encouraging those involved in the training, development and regulation of healthcare professionals to ensure effective training on clear sexual boundaries.
A review of research undertaken during the development of our sexual boundaries guidance estimated that between 38 and 52% of healthcare professionals reported knowing of colleagues who had been sexually involved with a patient.
Sexual boundary violations between health professionals and patients remains an important area, but in the years since our guidance was published the focus of the debate has moved on. There is now a far greater awareness of the critical problem of sexual harassment perpetrated by a colleague. Thanks in large part to brave individuals and campaigners, particularly within the medical profession, we now have a far greater understanding of the scale and nature of this problem. The BMA’s 2021 Sexism in Medicine report included survey results which found that 91% of female respondents had experienced sexism at work within the past two years, 70% of women felt that their clinical ability had been doubted or undervalued because of their gender, and overall 84% of all respondents said there was an issue of sexism in the medical profession.
The BMA report was followed in the same year by an article published in the Royal College of Surgeons of England bulletin: Sexual assault in surgery: a painful truth which outlined how ‘surgery and surgical training have a problem with sexual harassment, sexual assault and rape’. The article described widespread sexual abuse in surgery, and the myriad problems experienced by those subjected to it, including the fact that perpetrators were often in positions of power and that reporting could result in negative consequences for the victim’s career.
This year has seen the launch of the ‘surviving in scrubs’ campaign, including a website featuring anonymous accounts of sexism, sexual harassment and sexual assault. The stories are shocking, dispiriting, and plentiful. The campaign founders, Dr Becky Cox and Dr Chelcie Jewitt, hope their campaign will lead to the creation of an official anonymous reporting system, and more broadly, help put an end to the ‘culture of misogyny’ in healthcare.
Getting the regulatory response right
As with all intractable problems, there is no one simple solution. Cracking this particularly tricky issue involves all health and care professionals, employers, royal colleges, professional bodies and regulators playing their part both individually and collectively to make clear not only that such behaviour is unacceptable, but that it will be dealt with robustly when it comes to light. Victims should never have to fear that their concerns won’t be taken seriously, or that their career will be adversely affected if they report abuse.
In terms of the role of the health and care professional regulators, we know that many are already taking commendable action to respond to the issues. The GMC’s latest draft of Good Medical Practice (on which it has recently consulted) makes clear not only that medical professionals should not demonstrate uninvited or unwelcome behaviour that could be interpreted as sexual, but also that professionals have a responsibility to act if they witness inappropriate behaviour such as bullying, harassment or unfair discrimination. Making it everyone’s professional duty to speak up when they witness wrongdoing is a key part of achieving the culture-change that is so badly needed in some workplaces.
We know from research we commissioned from the academic Dr Simon Christmas that where behaviour isn’t challenged, it can create a culture where boundary crossing becomes accepted and normalised. Research by Professor Rosaline Searle adds to this evidence base. Her analysis of fitness to practise decisions found that those with a proclivity for sexual misconduct were more likely to cross boundaries where they witnessed others doing so, and that some perpetrators were in effect ‘corrupted’ by the falling standards of their workplace. This shows the vital importance of inappropriate behaviour (including ‘low-level’ behaviour) being challenged before it is allowed to develop into more serious violations and create a toxic workplace culture where perpetrators act with impunity.
In terms of action for which regulators are directly responsible, we’re aware of concerns that some fitness to practise panels haven’t taken sexual harassment as seriously as they should have done, particularly where this was at the lower end of the scale and involved a colleague rather than a patient. Much of the problem here is likely to be a result of a lack of training, as highlighted in the article by Rebecca Vanstone featured in this Professional Discipline & Regulatory Team Bulletin.
Here too we know that regulators, and in particular the GMC and NMC, are taking action. The GMC has been in the process of developing guidance and rolling out training, and the NMC has updated its guidance in relation to the seriousness of harassment and how to charge cases where a professional’s conduct may have been sexual in nature or sexually motivated.
Here at the Authority we’re looking at what more we can do to support regulators to respond to the challenging issue of sexual harassment and assault in the workplace. We appreciate that the hard work of raising this issue up the agenda has been led by professionals themselves, many of whom have worked tirelessly to bring these issues to light. We know we owe it to them, and to patients, to take action to ensure that the regulatory response is the right one. That’s why we’ll be reviewing a range of options for taking our work in this area forward, which could include reviewing and updating our existing guidance, developing shared principles across the regulators, facilitating cross-regulator collaboration or holding an event to explore the issues in more depth.
Information about sexual misconduct, including our research and guidance, can be found on the sexual misconduct page of our website. You can also read a case study about one of our appeals of a final fitness to practise decision. The decision involved a doctor who sexually harassed a nurse on an isolated hospital ward at 3am. Find out more about our appeal and the outcome.