This Me Too moment shames the NHS

This week’s joint investigation by The BMJ and Guardian reveals a culture in the NHS in which sexual assault and harassment are pervasive (doi:10.1136/bmj.p1105bmj.com/me-too-investigation).1 These findings, uncovered after eight months of reporting and five rounds of freedom of information requests, highlight the deficiencies that allow abuse to continue unchecked and are a source of shame for the health service.

In the five years to 2022 more than 35 000 cases of rape, sexual assault, harassment, stalking, and abusive remarks were recorded on NHS premises in England. More than half (58%) of these cases involved patients abusing staff. Shockingly, less than 10% of trusts have a dedicated policy to deal with sexual assault and harassment. Many women—and it is predominantly women who are harmed—spoke to The BMJ, some as traumatised by their employer’s lack of support as by the assaults themselves. Fleur Curtis, a physician associate, quit the NHS after being sexually assaulted by a junior doctor: “The worst thing was how the trust handled my complaint; that had a massive impact on my mental health” (bmj.com/me-too-investigation).1

If anything, the NHS has become more negligent of staff and patients’ sexual safety in recent years. A central body monitoring abuse of staff was scrapped in 2016, and a report by the Care Quality Commission that five years ago raised the alarm over sexual safety in mental health trusts has been all but ignored. Lawyer after lawyer told The BMJ that most NHS employers display “terrifying naivety” and “want to sweep away” complaints. Trusts are reluctant to suspend suspected perpetrators and to report cases to the police, and they prefer to settle cases financially, leaving the accused with no record and free to offend again.

Sadly, we can no longer trust the NHS to get its own house in order, and the Academy of Medical Royal Colleges is sensible to back an independent inquiry. The government’s vague platitudes about listening to staff is not enough; changing a toxic culture is more than just handing out body-worn cameras.

It doesn’t have to be this way. Every trust should have a dedicated sexual safety policy setting out appropriate behaviours and the action needed to prevent harm; every trust should have someone leading on sexual safety so that those harmed can report incidents to a human rather than impersonal electronic systems; and the NHS should have a single system for collecting and reporting data, so we can see the full extent of the problem, as current standards are woeful. There should be mandatory reporting of incidents to the CQC for all NHS organisations and, in serious cases, to the professional regulator of any staff member accused.

Jimmy Savile’s crimes show the vulnerabilities of NHS premises (doi:10.1136/bmj.p1094).2 But, as with Hollywood, unless you interrogate the system it will continue to protect the abusers, and the NHS is no different from any other field: entertainment, education, finance, sport, churches, and politics. Campaigner Simon Fleming, an orthopaedic surgeon, tells us that, in the case of sexual offences, what you permit you promote; it’s the responsibility of all of us to hold predators to account (doi:10.1136/bmj.p1117).3 Our visual summary (doi:10.1136/bmj.p1105) shows that this issue overshadows a vast number of lives: if 35 606 patients, staff, and visitors were brave enough to say “Me too,” how many others have suffered in silence?1