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NHS England Workforce, Training and Education

NHS England Workforce, Training and Education

We are now part of the new NHS England. Our purpose remains to work with partners to plan, recruit, educate and train the health workforce. Formerly Health Education England

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NHS England Workforce, Training and Education

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We are now part of the new NHS England. Our purpose remains to work with partners to plan, recruit, educate and train the health workforce. Formerly Health Education England

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The British Medical Association has 192,000 members, representing practising doctors in the UK and overseas and medical students. BMAtv broadcasts news and the views of senior doctors at the BMA with the aim of keeping doctors and medical students up to date with important issues affecting the profession.

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Ending sexism in medicine with the BMA pledge

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A surgical trainee who was sexually assaulted by a colleague has won an employment tribunal case against her trust after the investigation into the incident questioned her relationships and failed to fully suspend the perpetrator until police told the hospital that he had been arrested for an alleged sexual assault on a girl under the age of 16.

Elizabeth,* who worked as a surgeon at Royal Stoke University Hospital, was assaulted on a late shift at work on 11 June 2020. A colleague asked to speak to her in the urology office before forcibly kissing her face and neck, massaging her back, touching her waist, and blocking her as she pushed him away to leave the room. The perpetrator did not challenge Elizabeth's account of events at the tribunal.

She texted friends to tell them what had happened after her shift and reported the incident to her educational supervisor the next day. What followed was an investigation that her BMA representative said was plagued with "a catalogue of mistakes." One of these mistakes, which the tribunal found amounted to harassment, was that the case investigator asked her colleagues questions about her character and "inappropriate relationships"-questions that were not asked of the perpetrator. The Birmingham employment tribunal ruled on 17 July 2023 that she had been unlawfully discriminated against by the University Hospitals North Midlands NHS Trust on grounds of sex.

The story comes after an investigation by The BMJ and the Guardian found that NHS trusts recorded more than 35 000 cases of rape, sexual assault, harassment, stalking, and abusive remarks from 2017 to 2022, but only one in 10 trusts had a dedicated policy to manage the problem. University Hospitals North Midlands did not have a dedicated policy, the tribunal observed, and when Elizabeth looked online for the Dignity at Work policy, which covered sexual assault, the link took her to a broken webpage.

The tribunal found that the trust's policies were inadequate and that staff were not aware of them or trained in them. Multiple freedom of information requests sent to the trust, which are published on the trust's website, show that her assault was not officially recorded despite it being reported to human resources (HR).

Declined invitations

Elizabeth first had contact with the perpetrator in June 2019 when she was studying for her membership of the Royal College of Surgeons. He got her number from a WhatsApp group and asked if she wanted to revise with him, asked to have dinner, and asked to pick up some textbooks from her home. She said that she declined all these invitations. "I'd twigged that he was creepy, and I didn't really want that much to do with him. But beyond that, I didn't think he was a threat or anything," she told The BMJ in an interview.

Elizabeth felt "absolutely violated" by the assault, she told the tribunal in evidence. "My mind was reeling-what if I hadn't had that burst of strength to break free? What would he have done to me if I hadn't managed to get out of that room? I felt sick," she said.

On 12 June 2020 she reported the assault to her educational supervisor, who, according to Elizabeth's evidence, said that he would seek advice from his wife, who was a doctor at a different trust, and the deanery. Elizabeth told the tribunal that he also suggested that he should have an informal chat with the perpetrator about the incident, saying that "such a complaint didn't have to wreck [his] career," although the educational supervisor disputed this version of events in the tribunal. The employment tribunal's judgment said it was clear that the supervisor was sympathetic to Elizabeth's situation but did not have a clear understanding of what steps needed to be taken under the trust's Dignity at Work policy.

Initially, Elizabeth was reluctant to put in a formal complaint because she "didn't want to be labelled a slut or her reputation to be dragged through the mud," the judgment records, adding that there was a "gossipy environment" in the hospital that was not curbed by the trust. But after seeking advice from the BMA Elizabeth formally complained through the trust's HR email address.

Although Elizabeth had been told by HR that the colleague had been fully suspended, in reality he was suspended only from clinical duties and was able to come to the hospital for research or continued professional development. The judgment states that it is "unexplained" why steps were not taken to exclude him entirely on 16 June when Elizabeth first reported her assault, given its serious nature.

On 22 June, six days after Elizabeth had reported the assault, the perpetrator was offered a conditional extension to his contract, the judgment records. However, this was retracted after the police contacted the trust on 20 June and informed it that he had been arrested for sexually assaulting a girl under the age of 16. The trust then excluded him from clinical practice on patient safety grounds, although he was not fully suspended until 21 July.

After Elizabeth had been informed that he would not be at work for the foreseeable future she noticed that he was still down on the clinical rota, which caused her "significant distress," the tribunal found. She also complained multiple times about the delayed and poor correspondence from HR. Eventually Elizabeth's GP signed her off as unfit to work, which the tribunal ruled was as a result of the trust's failure to protect her.

Intrusive questioning

Ingi Elsayed, a consultant in renal and intensive care medicine, was appointed as a case investigator to look into Elizabeth's claim. The tribunal found that, although Elsayed had no "bad intent," her "total lack of experience in conducting an investigation" resulted in her adopting a line of questioning that was "intrusive" and "well beyond the scope of the terms of reference for the investigation" and "provoked responses that commented upon gossip in the hospital relating to [Elizabeth]'s friendships with consultants that may have been inappropriate."

Elsayed had done only a two hour training course on running investigations and had never run one before, the tribunal heard. Elizabeth gave evidence that she had asked Elsayed not to contact doctors she was friends with or whom she knew in a professional capacity in case it affected her reputation. However, Elsayed did not respect her wishes and began contacting doctors to ask them about Elizabeth's character and relationships. She did not contact the perpetrator's colleagues, as he had asked her not to. One consultant called Elizabeth and told her about the line of questioning. Elizabeth asked for Elsayed to be removed from the investigation, but the complaint manager, who the tribunal found had failed to investigate Elizabeth's claims, refused.

On 27 July a member of the HR department also accidentally downloaded the recording of Elizabeth's account of her assault, and it was shared with three other members who had no connection to the investigation.

Elizabeth was not informed of the investigation's conclusions until 7 April 2021, 10 months after she had first reported her sexual assault. Although Elsayed's original report found that on the balance of probabilities there was not sufficient corroborative evidence to support Elizabeth's complaint, the complaint manager intervened and changed the conclusion to find that the perpetrator did have a case to answer to. By this point he had left the trust, and no action could be taken.

The trust's chief executive, Tracy Bullock, apologised for the failings in the trust's investigation procedures. "We have already put in place additional training and measures to ensure that any concerns raised will be listened to, fully investigated, and responded to appropriately," she told The BMJ.

The General Medical Council has told The BMJ that it is investigating the perpetrator and has put interim restrictions on his licence to practise in relation to treating female patients, after a Medical Practitioners Tribunal Service hearing on 13 January 2023.

Staffordshire Police said that it had arrested a man on suspicion of sexual assault in May 2020. He was released pending further inquiries, but the investigation is ongoing. "We believe he has left the country, and we are working with partners to locate him," a spokesperson told The BMJ.

The effect of these events on Elizabeth meant that she felt unable to continue working as a doctor, as the tribunal judgment records. She had taken a year out to do a masters degree but felt anxious going to a hospital even for personal reasons, let alone work, so she did not feel able to return to medicine. She was given diagnoses of anxiety, depression, and PTSD. She is now working as an administrator at a much lower salary.

"It's kind of heartbreaking, to be honest," she told The BMJ. "I was genuinely committed to surgery, and I was genuinely committed to medicine. I knew there was sexism in surgery. I always knew that. But I genuinely thought that if I worked hard enough, I could beat it."

Elizabeth has another tribunal hearing, which will determine the compensation she will be awarded next year.

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Doctor who was sexually assaulted at work wins case against trust after it asked colleagues if she had "inappropriate relationships"

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A surgical trainee who was sexually assaulted by a colleague has won an employment tribunal case against her trust after the investigation into the incident questioned her relationships and failed to fully suspend the perpetrator until police told the hospital that he had been arrested for an alleged sexual assault on a girl under the age of 16.

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Male doctors assault female colleagues on hospital wards due to "systemic and institutional sexual violence" that is "tolerated" within the NHS, a report says.

An investigation by the campaign group Surviving in Scrubs found that an "embedded and normalised culture of misogyny" was harming patient care and putting safety at risk.

They compiled a report based on the anonymous testimonies of 150 healthcare staff, mainly female doctors, who have experienced sexism, sexual assault or rape in the workplace.

Three quarters of the perpetrators were doctors, most of them male consultants. The report warned that a "culture of tolerance" allows staff who sexually assault colleagues to keep working unchallenged in the NHS.

Senior doctors were described as "untouchable" and able to "act with impunity", with one surgeon referred to as the "Jimmy Savile of the surgical community" because his behaviour was such common knowledge.

Meanwhile, a "power imbalance inherent within medical hierarchies" means that consultants target younger colleagues including junior doctors and medical students.

The report is based on 174 incidents of sexism, sexual harassment and assault reported by victims, including four cases of rape and 43 incidences of sexual assault.
* Sexual assault, crude banter - what it's like to be a female surgeon
* Female surgeons speak out about being assaulted by colleagues
Half of the incidents were in patient-facing environments, such as hospital clinics and hospital wards. One in ten took place in doctors' offices. Nearly half of the perpetrators worked in surgery.

The report said healthcare settings "created potentially opportunities for sexual assault". A large number of women reported being sexually assaulted while being scrubbed in for an operation, meaning "victims were unable to use their hands to protect themselves or move away from the perpetrator".

One recalled being sexually propositioned by a male consultant who was covered in a female patient's blood at the end of surgery,

The report said that sexism within medicine began during training, describing how a gynaecology consultant would tell medical students that the "only purpose of a vagina was for sex".

It said that the sexist culture of "male dominance and superiority" was damaging patient safety and care across the NHS. "Women healthcare workers reported their clinical judgments being questioned, decisions not taken seriously, clinical requests ignored or overly criticised and referrals refused," it said.

Meanwhile, widespread sexism meant that some women were missing career opportunities in the NHS, and were discriminated against when pregnant. Those who complained about sexual assaults said they were made to feel that they should "put up and shut up", and told not to make a fuss.

"Survivors who had experienced sexual harassment or violence reported having to protect their careers, ignoring incidents and continuing their work. They described fearing repercussions with one survivor being told not to say anything that could affect her career. Another described threats to her career from the perpetrator," the report said.

It was written by the NHS doctors Becky Cox, Chelcie Jewitt, and Ellen McIver. Cox founded Surviving in Scrubs after experiencing sexual assault by colleagues. They have made nine recommendations, including for an independent inquiry into the culture of sexism and sexual misconduct in healthcare. They said all students should be educated on sexism and NHS managers should be trained to respond to reports of sexual misconduct.

Professor Dame Jane Dacre, former president of the Royal College of Physicians, said the culture within the NHS must "change urgently".

She told The Times: "It feels as if we are stuck in 1948 when the NHS was set up. The NHS is understaffed and is made up of around 80 per cent women. We should not tolerate sexism and sexual assault which is undermining patient care, exacerbating the gender pay gap, and driving women away."

Dr Jeanette Dickson, chairwoman of the Academy of Medical Royal Colleges, said the report "confirms what many of us suspected was the case", adding: "It is apparent that we are continuing to normalise behaviour that is totally unacceptable anywhere."

The academy's Trainee Doctors' Group is conducting its own investigation into the issue. Dr Matt Clarke, chairman of that committee, said: "We must lead by example and call out not just the sexism and sexual violence, but all the forms of bullying and undermining that we see every day in the medical profession, and be supported to do so.

"Too often we do not feel able to speak up out of fear of reprisals, and it can feel safer to just get on with the job. All forms of harassment are unacceptable and cause lasting impacts on individuals, recruitment and retention. It's for the profession as a whole to make sure we put a stop to it."

The NHS was contacted and invited to comment.

'No one should experience this in the workplace'

It started as hushed conversations between female doctors, then a few brave surgeons chose to speak out in The Times. Now, thanks to the testimony of hundreds of women working in healthcare, the scale of sexism and sexual violence across the NHS is being exposed (Eleanor Hayward writes).

As Surviving in Scrubs' harrowing report shows, in most cases victims are preyed on by their own male colleagues - senior doctors in positions of power, trust and authority. The problem of sexual assault in healthcare was put in the spotlight this year after a study was published in the British Journal of Surgery.

It found that two thirds of women working in surgery had been sexually harassed by a colleague in or around the operating theatre. There were 11 instances of rape reported by the 1,434 surgeons who participated in the study.

It is increasingly clear that sexual assault is not confined to male-dominated specialties such as surgery, with all branches of medicine and healthcare affected. Not only does this cause lifelong trauma for women, sometimes wrecking their careers, the widespread sexism also puts patients at risk.

Health officials are taking action, with Amanda Pritchard, the chief executive of NHS England, promising a "zero-tolerance approach" to perpetrators of sexism and sexual violence. Campaigners say further action, including an independent inquiry, is needed and the voices of survivors must be put at the forefront of bringing about changes.

Dr Binta Sultan, chairwoman of NHS England's National Clinical Network of Sexual Assault and Abuse Services, said: "No one should experience sexism, sexual harassment, or sexual assault in the workplace - it is totally unacceptable. The NHS is taking steps to ensure that healthcare environments are safe for staff and patients."
The Times investigates the crisis facing the health and social care system in England. Find out more about The Times Health Commission.
She said that the NHS's first sexual safety charter, which had been produced with the help of people "with lived experience", would provide "more support and clear reporting mechanisms to those who have suffered inappropriate behaviour".

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NHS 'tolerates sexual violence' as surgeon likened to Jimmy Savile

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Male doctors assault female colleagues on hospital wards due to "systemic and institutional sexual violence" that is "tolerated" within the NHS, a report says.A

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Abstract

This observational study, paired with National Health Service (NHS) workforce population data, examined gender differences in surgical workforce members' experiences with sexual misconduct (sexual harassment, sexual assault, rape) among colleagues in the past 5 years, and their views of the adequacy of accountable organizations in dealing with this issue.

This was a survey of UK surgical workforce members, recruited via surgical organizations.

Some 1704 individuals participated, with 1434 (51.5 per cent women) eligible for primary unweighted analyses. Weighted analyses, grounded in NHS England surgical workforce population data, used 756 NHS England participants. Weighted and unweighted analyses showed that, compared with men, women were significantly more likely to report witnessing, and be a target of, sexual misconduct. Among women, 63.3 per cent reported being the target of sexual harassment versus 23.7 per cent of men (89.5 per cent witnessing versus 81.0 per cent of men). Additionally, 29.9 per cent of women had been sexually assaulted versus 6.9 per cent of men (35.9 per cent witnessing versus 17.1 per cent of men), with 10.9 per cent of women experiencing forced physical contact for career opportunities (a form of sexual assault) versus 0.7 per cent of men. Being raped by a colleague was reported by 0.8 per cent of women versus 0.1 per cent of men (1.9 per cent witnessing versus 0.6 per cent of men). Evaluations of organizations' adequacy in handling sexual misconduct were significantly lower among women than men, ranging from a low of 15.1 per cent for the General Medical Council to a high of 31.1 per cent for the Royal Colleges (men's evaluations: 48.6 and 60.2 per cent respectively).

Sexual misconduct in the past 5 years has been experienced widely, with women affected disproportionately. Accountable organizations are not regarded as dealing adequately with this issue.

Lay Summary

This research examined sexual misconduct occurring in surgery in the UK, so that more informed and targeted actions can be taken to make healthcare safer for staff and patients. A survey assessed individuals' experiences with being sexually harassed, sexually assaulted, and raped by work colleagues. Individuals were also asked whether they had seen this happen to others at work. Compared with men, women were much more likely to have seen sexual misconduct happening to others, and to have it happen to them. For example, most women (63.3 per cent) experienced being sexually harassed by colleagues, as did some men (23.7 per cent). Women also experienced being sexual assaulted by colleagues far more often than men (29.9 per cent of women, 6.9 per cent of men). These findings show that women and men in the surgical workforce are living different realities. For women, being around colleagues is more often going to mean witnessing, and being a target of, sexual misconduct.

Individuals were also asked whether they thought healthcare-related organizations were handling issues of sexual misconduct adequately; most did not think they were. The General Medical Council (GMC) received the lowest evaluations. Only 15.1 per cent of women regarded the GMC as adequate in their handling of sexual misconduct. Men's evaluations were higher, although the GMC was still regarded as adequate by less than half of men (48.6 per cent). Evaluations of National Health Service Trusts were rated similarly low. Only 15.8 per cent of women evaluated them as adequate (44.9 per cent of men). The results of this study have implications for all stakeholders, including patients. Sexual misconduct was commonly experienced by respondents, representing a serious issue for the profession. There is a widespread lack of faith in the UK organizations responsible for dealing with this issue. Those organizations have a duty to protect the workforce, and to protect patients.

Introduction

Sexual harassment, sexual assault, and rape, referred to as sexual misconduct, are unacceptable. Sexual misconduct occurs frequently and appears to go unchecked in the surgical environment owing to a combination of a deeply hierarchical structure and a gender and power imbalance. Sexual misconduct in surgery is not new, and sexual misconduct in wider healthcare is a global issue. Evidence from the UK, USA, Australia, and many other countries indicates that this is also a significant risk to patient safety.

In 2021, sexual misconduct in surgery in the UK was called out by two trainees, which led women surgeons to share their own workplace experiences. Mainstream media attention and statements from a variety of leaders in UK surgery and healthcare followed. Although there are some small-scale surveys on sexual misconduct in focal settings , and others on sexism defined more broadly, the extent of sexual misconduct perpetrated by colleagues within the UK surgical workforce has not been reported to date.

There are reasons for the paucity of data, including under-reporting of sexual misconduct, fear of potential repercussions, and damage to career progression. Following Fleming and Fisher's article, websites such as Project S and Surviving In Scrubs were set up, collating healthcare workers' experiences of being subjected to sexism, misogyny, and sexual misconduct.

In 2022, the Working Party on Sexual Misconduct in Surgery (WPSMS) was established, with the aims of gathering data and promoting sexual safety in the surgical working environment. To facilitate organizational and cultural change, quantitative data were collected on workforce members' experiences with sexual misconduct using an ethically approved anonymous survey. The survey specifically examined sexual misconduct perpetrated by co-workers (not patients). Such evidence regarding the behaviour of co-workers may be particularly actionable for accountable organizations. WPSMS devised this study, supported by multiple stakeholders with power to make working conditions safer for staff, and surgery safer for patients. Key findings from the study are reported here. Additional information is available in the .

Methods

This study had HRA/HCRW approval (Health Research Authority/Health and Care Research Wales; HRA reference 22/HRA/3738) and ethical clearance from the University of Exeter's Faculty of Health and Life Sciences Psychology Research Ethics Committee (REC reference 511842).

Patient and public involvement

Items in this survey were adapted based on feedback from people who had witnessed and/or been targets of sexual misconduct, including members of the UK healthcare workforce.

Data collection

Following ethical approval, including of General Data Protection Regulation-compliant protocols, participants were invited to complete an online survey built using Qualtrics © (Qualtrics, Provo, UT, USA). They were provided an information sheet, consent form, and debriefing page. Participants were signposted to sources of support at the beginning and end of the study, and a trigger warning preceded questions on sexual misconduct. To help mitigate selection bias and capture the widest possible sample, those invited were encouraged to participate regardless of whether they had or had not witnessed, or been targets of, sexual misconduct.

Participants were recruited via electronic lists held and circulated by relevant professional groups including surgical and anaesthetic Royal Colleges, Health Education England (HEE), and others (). Participation was voluntary and not remunerated. Primary unweighted analyses included women and men aged at least 18 years who were on a standard UK medical workforce grade (foundation year 1/2-consultant) and responded to the key measures being analysed (for example on sexual misconduct; ). Weighted analyses, grounded in the National Health Service (NHS) England surgical workforce population data, included a subset of participants who worked at NHS-based organizations in England (within subspecialties for which population data were available). To help maintain anonymity, tracking of Internet Protocol addresses was disabled. When recruitment extended to include relevant online social networks/sites (for example via accounts maintained by professional surgical groups), additional safeguards were built into the survey to prevent multiple submissions. The survey was open from September to December 2022.

Measures

Items assessing sexual misconduct were adapted from previous research, modified based on feedback from healthcare professionals, including those affected, to ensure relevance and fit to this professional context. Participants were given structured guidelines for responding, including definitions of sexual harassment, sexual assault, and rape ().

Sixteen items assessed participants' experiences with witnessing sexual misconduct among colleagues. An analogous set assessed experiences of being a target. For each, participants were asked, 'In the past 5 years (in any work-related context), how often have you witnessed, overheard or been present for [been the target or victim/survivor of]...[item]?'. Responses were given on a scale from 1 (never) to 5 (very often-a few times a week, or more). and provide additional information and verbatim wording.

Participants were also asked to evaluate whether they believed relevant accountable organizations, including the General Medical Council (GMC), NHS Trusts, HEE, the British Medical Association (BMA), and the Royal Colleges, were addressing issues of sexual misconduct adequately. Responses were given on a scale from 1 (no, absolutely not) to 7 (yes, absolutely), with an additional response option N/A (don't know, or not applicable), which was excluded from the analyses. Key demographic questions included participant age, gender, current specialty, and grade.

Statistical analyses

Primary analyses involved multivariable analyses of co-variance to test for mean gender differences. Additional analyses using linear regression tested whether individuals' evaluations of the GMC, NHS Trusts, and other accountable organizations were further explained by the frequency at which they witnessed and/or were targets of sexual misconduct. All analyses were conducted in SPSS ® version 28 (IBM, Armonk, NY, USA) with participant age and grade as co-variates (complete-case analysis). Follow-up analyses also assessed the robustness of findings using additional co-variates, bootstrapping and other non-parametric tests, and multiple imputation. In addition, weighted analyses were conducted. These used population data for the NHS surgical workforce in England to generate case weights for participants from this population (additional information is available in ). This produced a sample for analyses that mirrored the true representation of women and men in the surgical workforce by grade and key subspecialties, and most directly illustrated issues of sexual misconduct within the NHS England workforce.

Results

Participants

Of 1704 participants, 1434 provided sufficient data to be included in primary unweighted analyses. provides additional information on participants. The two largest surgical subspecialties in the surgical workforce were also the largest represented in this sample: trauma and orthopaedic surgery (31.8 per cent) and general surgery (18.5 per cent). Similarly, the two largest grades in surgery were the largest represented in this sample: consultants (63.1 per cent) and specialty trainees (20.2 per cent). Weighted analyses included the 756 participants in the NHS England surgical workforce.

Witnessing sexual harassment, sexual assault, and rape among colleagues in the past 5 years

and show the overall proportions of women and men who had witnessed sexual harassment, sexual assault, and rape in the past 5 years (once or more). Mean frequencies are also provided, for both unweighted and weighted samples, with corresponding tests of gender differences.

Unweighted analyses

Overall, women and men differed in how often they witnessed sexual misconduct. Univariate tests showed that women witnessed sexual harassment, and sexual assault, more often than men ().

Weighted analyses for NHS England

Results of weighted analyses provided further evidence that women witnessed sexual harassment, and sexual assault, more often than men (), even when examined in a sample that mirrored the true representation of women and men in the NHS England surgical workforce population.

Being a target of sexual harassment, sexual assault, and rape among colleagues in the past 5 years

and provide the overall proportions of women and men who experienced being a target of sexual harassment, sexual assault, and rape in the past 5 years (once or more). Mean frequencies are also provided, for both unweighted and weighted samples, with corresponding tests of gender differences.

Unweighted analyses

Overall, women and men differed in how often they were a target of sexual misconduct. Univariate tests showed that women were targets of sexual harassment, and sexual assault, more often than men ().

Weighted analyses for NHS England

Results of weighted analyses provided further evidence that women experienced being a target of sexual harassment, and sexual assault, more often than men (), even when examined in a sample that mirrored the true representation of women and men in the NHS England surgical workforce.

Adequacy of General Medical Council, NHS Trusts, and other organizations' handling of sexual harassment and assault

shows respondents' evaluations of whether the GMC, NHS Trusts, and other organizations are adequately addressing issues of sexual harassment and sexual assault. Women and men differed in their assessments, with women evaluating the adequacy of organizations' handling of sexual misconduct consistently lower than men. Additional analyses () demonstrated that the perceived adequacy of these organizations also depended on the frequency of witnessing sexual misconduct, such that those who witnessed more sexual misconduct evaluated these organizations as less adequate (for example GMC evaluations, weighted analysis: B = −3.47 (95% c.i.: −4.43 to −2.51); P < 0.001, η p ² = 0.10) ().

Discussion

The results of this study on sexual misconduct over the past 5 years among the UK surgical workforce indicate that both sexual harassment and sexual assault may be commonplace in the UK surgical environment, and that rape happens. These are illegal and criminal acts. This study also provides robust evidence that women and men in the surgical workforce are living different realities. When around colleagues, women are both witnessing and being targets of sexual misconduct at higher rates than men. Moreover, results indicate that there is a widespread lack of confidence in the adequacy of key regulatory bodies and accountable organizations in handling these issues. Altogether, this reflects a serious issue within the NHS and broader surgical workforce, with implications for patient safety.

Strengths of this study include its large and diverse sample, with broad engagement from the surgical workforce, partly reflecting strategic efforts to recruit both individuals who have and those who have not experienced sexual misconduct. At the same time, the sensitivity of the survey content raised ethical and legal risks, and thus participant anonymity needed assurance. Therefore, to comply with ethically approved protocols, participants were asked to complete the survey in a single sitting. This may have resulted in some incomplete responses. Recruitment through listservs held by supporting organizations enabled a large and diverse sample, albeit individuals' presence on multiple lists made subsequent response rate determination impossible.

Women remain a minority in surgery, comprising 28.3 per cent across all grades, and 51.5 per cent of respondents in this survey. There is a skew to the responses; specifically, 63.1 per cent of responses were from consultants, who represent only 38.5 per cent of those in NHS England surgical grades. Specialty trainees comprised 20.2 per cent of the present participants and comprise 23.8 per cent of the surgical workforce in NHS England. Participant numbers from specialty and specialist grade doctors and medical grades junior to specialty trainees, including medical students, were very low. These differences are consistent with work from the Royal Australasian College of Surgeons (RACS) in 2015. They attest to the vulnerability and lack of psychological safety for those who are the most common targets of sexual misconduct, even if a survey is anonymous, whereas those who have reached consultant grade may feel more able to speak up.

Most women (89.5 per cent) in this survey had witnessed sexual harassment, and 63.3 per cent had been a target of sexual harassment. Another 29.9 per cent of women had been the target of sexual assault (in the past 5 years). The RACS study, and a large study of US surgical residents, showed that 12 per cent of Australasian trainees (timescale undefined) and 10.3 per cent of US trainees (since beginning surgical residency) had experienced sexual harassment. Both studies included harassment from patients, but senior colleagues were the commonest perpetrators. A small 2021 UK survey reported that 48.8 per cent of UK female surgical trainees experienced sexual harassment by colleagues (during their training). These studies did not analyse sexual misconduct as separate items, simply reporting 'sexual harassment'.

Men are also affected by sexual misconduct. The results here, however, indicate that they are significantly less likely to witness it, or to be the target. For example, men's experiences with sexual assault (17.1 per cent witnessed, 6.9 per cent targeted) is far lower than for women (35.9 per cent witnessed, 29.9 per cent targeted). Recent UK studies in healthcare have shown that sexual misconduct is predominantly carried out by men and towards women.

Both women and men in the present survey indicated exposure to 'banter cultures', yet research has revealed that these jokes are not innocuous, instead offering an important and subtle means for perpetrators to test the boundaries of their activities, identify like-minded individuals, and desensitize others. These results also echo evidence that men tend to be less aware of such talk and its negative impact. These differences, allied with gender disparities at senior levels in surgery, may be a significant contributory factor to the current failure to recognize these issues and bring about transformation.

A major concern arising from these results is the amount of sexual coercion reported by individuals, with women experiencing forced physical contact linked to career opportunities (16.6 per cent witnessed, 10.9 per cent targeted). Research identifies silence and silencing to be central to cultures that facilitate sexual violence. These experiences divert attention from the needs of patients, and result in fear and intimidation, having further adverse consequences by distracting and disengaging learners and reducing performance in safety-critical contexts.

Alongside instances of rape that occurred at work, participants in this survey reported rape by colleagues in other work-related contexts, including teaching spaces, conferences, and after-work events with colleagues. There are relatively few measures in place to protect the potentially vulnerable in settings such as conferences. These are also environments in which people may be away from home, alcohol is often available, and boundaries may be more easily transgressed by a perpetrator.

In the surgical profession, hierarchy mirrors power and responsibility. Arguably, an implicit aspect of becoming part of surgical culture is to not draw attention to sexual misconduct. The surgical workplace is particularly vulnerable to sexual misconduct with its predominantly male senior workforce, use of strongly hierarchical structures, and high-stress environments. Over time, sexualization of the workplace, through unwanted language, breaches of personal space, and physical violation, shifts accepted norms. This normalization of unacceptable behaviour such as sexual misconduct leads current or would-be perpetrators to perceive tacit support for their sexualized behaviour. Without correction, cognitive reframing occurs, and in contexts of high stress and low emotional support, such as the surgical environment, this can undermine a doctor's means of self-regulation. This allows inappropriate sexualized behaviours and misconduct to flourish, where perpetrators target not only colleagues but are more likely to transgress sexual boundaries with patients. The result is an unsafe working environment and an unsafe space for patients.

Exposure to sexual misconduct deeply affects an individual's psychological responses, altering their assumptions, beliefs, and expectations about themselves and others. Sexual misconduct violates a target's dignity and normalizes a hostile and abusive environment, affecting physical and mental well-being. Those subjected to sexual misconduct are more likely to suffer burnout, which increases the risk of harm to patients. Experiences of these illegal and criminal acts manifest in withdrawal from work both psychologically and physically as mental and physical health deteriorate. Even more harmful individual consequences can result, including depression, self-harm, and suicidal ideation. Job satisfaction suffers, and so too does staff retention. These are serious events that potentially deter and derail women from realizing their career goals.

Previous studies have shown women's career decisions to be complex and multifactorial, recognizing the challenges to recruitment and retention posed by masculine environments, dysfunctional cultures, and inflexibility in surgery and surgical training. The proportion of female consultant surgeons in the UK has increased by only 2 per cent since 2015, to 15 per cent. Numbers have risen in the specialty trainee grade, with women still comprising only 31 per cent of current trainees, despite women outnumbering men at UK medical schools since 1996. There are now more women in higher surgical training than at any point previously, yet the consultant body remains largely male. These survey results and the current gender imbalance indicate enduring significant risks of experiencing sexual misconduct.

Excellence in healthcare depends on teams, critically those in which all members feel safe and have a voice. High-quality surgeon performance requires a safe learning environment, and dysfunctional teams are known to have poorer patient outcomes. The failure to achieve diversity in the workforce, and the perpetuation of environments and atmospheres that normalize sexual misconduct in the workplace, pose a significant threat to staff and patient safety. Over time, perpetrators can become bolder, increasing the risks they pose to staff members and patients in their care. Concerns have already been raised about the efficacy of external, fear-based, legal perpetrator controls in this context. The present findings are likely to shake the confidence of the public in the surgical profession, in whom considerable trust is placed.

The UK workforce has not previously been asked about the perceived adequacy of accountable organizations in dealing with sexual misconduct. Concerns about sexism and racism have, however, been raised regarding the attitudes of the GMC, the BMA, and the Royal College of Surgeons of England. In the present study, the percentage of women evaluating individual organizations as adequate ranged from 14.5 per cent (GMC) to 30.6 per cent (Royal Colleges). Individuals who more often witnessed sexual misconduct gave these key organizations even lower evaluations of adequacy, including women and men. This suggests that men who do recognize sexual misconduct also regard it as being handled inadequately. Participants' low opinion is a concern, as research has demonstrated that perceived failure to hear concerns contributes to the decline in reporting, and the institutionalization of sexual violence.

These findings require action. It is vital that the regulators, Colleges, employers, and training authorities come together to improve workforce and organizational cultures, and create adequate mechanisms to deal with perpetrators. This is a deeply serious issue that affects not just surgeons, and not just the UK healthcare workforce. Cultural change in healthcare and accountable organizations is long overdue. Active bystander training, along with understanding and addressing barriers to reporting, are important next steps. Efforts to develop good practices that can reduce the inevitable harm from sexual misconduct are being developed in multiple working environments worldwide, and healthcare needs to learn from such efforts.

The WPSMS proposes adopting a framework of zero tolerance for sexual misconduct in healthcare and robust mechanisms for dealing with perpetrators, modelled on recent work by the WHO. Furthermore, in the UK, sexual safety policies should be implemented in healthcare, including NHS Trusts, with contravention treated as a serious incident and reported to the Care Quality Commission. The authors, on behalf of participants, the NHS workforce and patients, urge that immediate action be taken to make the surgical working environment, and healthcare in general, a safer place in which to work and be treated.

This study provides clear evidence of the differing realities that women and men experience as witnesses and targets of sexual misconduct by colleagues. While the exact prevalence of sexual misconduct in the surgical workforce cannot be determined from these data, this study provides a unique combination of statistically supported insights. These include how often individuals are targets of sexual misconduct among colleagues, how often it is witnessed, and how individuals evaluate the GMC and other organizations' handling of these issues. Robust evidence illustrating similar results across weighted and unweighted analyses strengthens validity of the demonstrated difference in women's and men's realities with sexual misconduct among colleagues.

Future studies, with greater support and long-term investment from surgical and healthcare organizations, should augment this foundational evidence by collecting representative samples of workforce members to better estimate prevalence of sexual misconduct. It will also be vital to track these issues over time, survey specific groups linked to medical schools and deaneries, and examine collaboratively issues of sexual misconduct via NHS staff surveys and GMC 360 revalidation questions.

Funding

The authors have no funding to declare.

Acknowledgements

This study was not preregistered in an independent institutional registry. The authors thank: WPSMS members V. Pegna, R. Grossman, and K. Coyne for conceptualization of the project; J. Skinner, L. Davies, and S. Fleming for general advice on the project; key organizations providing direct support with participant recruitment-HEE, Royal College of Surgeons of England, British Orthopaedic Trainees Association, Royal College of Physicians and Surgeons of Glasgow, British Orthopaedic Association, British Association of Oral and Maxillofacial Surgeons, Association of Surgeons in Training, Society of Women in Oral and Maxillofacial Surgery, Royal College of Anaesthetists, Association for Perioperative Practice, UK Committee of Postgraduate Dental Deans and Directors, University College London Women in Surgery, and Barts Health NHS Trust; and key organizations providing supportive endorsement of this study (for example, to help indirectly facilitate participant recruitment)-NHS England Safeguarding, Royal College of Surgeons of England, British Orthopaedic Trainees Association, Royal College of Surgeons of Edinburgh, Royal College of Physicians and Surgeons of Glasgow, British Orthopaedic Association, British Association of Oral and Maxillofacial Surgeons, Association of Surgeons in Training, Society of Women in Oral and Maxillofacial Surgery, Royal College of Anaesthetists, and Association for Perioperative Practice (additional information is available in ). No funding was provided to these organizations or individuals for their contributions to this study.

Author contributions

Christopher T. Begeny (Lead contributor: Data collection, Formal analysis, Validation; Equal contributor: Investigation, Methodology, Writing-original draft, Writing-review & editing), Homa Arshad (Equal contributor: Investigation, Methodology, Validation, Writing-original draft, Writing-review & editing), Tamzin Cuming (Lead contributor: Conceptualization; Equal contributor: Investigation, Methodology, Validation, Writing-original draft, Writing-review & editing), Daljit Dhariwal (Lead contributor: Conceptualization; Equal contributor: Investigation, Methodology, Validation, Writing-original draft, Writing-review & editing), Rebecca Fisher (Equal contributor: Investigation, Methodology, Validation, Writing-original draft, Writing-review & editing), Marieta Franklin (Equal contributor: Investigation, Methodology, Validation, Writing-original draft, Writing-review & editing), Philippa Jackson (Lead contributor: Writing-review & editing; Equal contributor: Investigation, Methodology, Validation, Writing-original draft), Greta McLachlan (Equal contributor: Investigation, Methodology, Validation, Writing-original draft, Writing-review & editing), Rosalind Searle (Lead contributor: Writing-original draft; Equal contributor: Investigation, Methodology, Validation, Writing-review & editing), Carrie Newlands (Lead contributor: Conceptualization, Project administration, Supervision, Writing-review & editing; Equal contributor: Investigation, Methodology, Validation, Writing-original draft).

Disclosure

T.C. is Chair of the Women in Surgery Forum at the Royal College of Surgeons of England; this is an unpaid role. The authors declare no other conflict of interest.

Supplementary material

Supplementary material is available at BJS online.

Data availability

Data underlying the findings in this article are available at the Center for Open Science ( https://osf.io/q4th5/). To preserve participant anonymity, this publicly accessible version of the data does not contain any free-text responses from participants, and some information has been aggregated or redacted to avoid potential identification of individual participants.

References

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Social Foundations of Thought and Action

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Women in surgery: a systematic review of 25 years

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This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

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Sexual harassment, sexual assault and rape by colleagues in the surgical workforce, and how women and men are living different realities: observational study using NHS population-derived weights

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This observational study paired with National Health Service (NHS) workforce population data examined gender differences in surgical workforce members' experien

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A group of female NHS doctors have said known perpetrators of sexual violence are tolerated or regarded as untouchable.

Victims of abuse within healthcare, mostly female junior doctors, felt gaslit and victimised, a new report by campaign group Surviving in Scrubs has found.

The study looked at 174 incidents of sexism, sexual harassment, assault and rape reported anonymously on its website.
Read more: McDonald's sexual harassment alleged by staff
Over three quarters of the alleged perpetrators were doctors, of whom more than 77% were consultants.

Meanwhile, 62% of victims were doctors, of which 89% were junior.

The report shows how power dynamics are being abused within the NHS, according to Jemima Olchawski, chief executive of gender equality charity, the Fawcett Society.

Speaking to HR magazine, she said: "The NHS is a service that should be safe for everyone. But far too often, we hear stories like the ones in this study about violence perpetrated by men in some of its most esteemed positions.

"Hierarchies of seniority in medical environments should exist to keep people safe; abusing those power dynamics is reprehensible. We can only begin to imagine the scale of talent lost when women are forced out of the medical profession due to sexual misconduct."

Victims reported that perpetrators were notorious, with one described as "the Jimmy Saville of the surgical community".

One victim said: "On talking to another female senior, I was informed that he was known for this behaviour, that he'd got away with so much before and he was capable of ruining careers."

Thomas Beale, a partner specialising in bullying and harassment claims at law firm Bolt Burdon Kemp said the NHS is not doing enough to protect whistleblowers and victims who report assault.

He told HR magazine: "Despite having a whistleblowing policy and hotline in place for those who wish to report misconduct, it is clear that managers within the NHS are not doing enough to protect those who raise concerns.
Read more: CBI sexual misconduct scandal comes as no surprise to HR
"The implementation of independent reporting and investigative mechanisms would be highly beneficial to empower victims to come forward with allegations, without fear of facing repercussions."

Olchawski added that the Worker Protection Act means the NHS has a legal duty to prevent this kind of harassment.

She said: "We were so proud to work with Wera Hobhouse this year on the Worker Protection Act which came into law last month. This act creates a duty for employers, including the NHS, to prevent sexual harassment in their workplaces.

"We urge the NHS, and all employers, to take urgent action to ensure they are preventing sexual harassment in their workplaces so that stories like the ones in this study become a thing of the past."

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HR Magazine - Sexual abusers in NHS 'untouchable', female doctors report

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A group of female NHS doctors have said known perpetrators of sexual violence are tolerated or regarded as untouchable.

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Sexual discrimination and harassment still occur in the clinical workplace. A doctor, who was advised to write anonymously, says that more must be done to find out the extent of the problem and protect those affected

As sexual scandal swirled around prelates, politicians, pop stars, and even school pupils, I read an article in Medical Education about students' most memorable professional dilemmas.1 Most, depressingly, involved witnessing unprofessional and callous behaviour by their clinician teachers. Some involved being bullied; others involved undertaking intimate examinations without valid consent; but one in particular resonated with me.

During a ward round, a young male consultant spotted a female student and said: "You there-the decoration. Why did you ever come to medical school? Do you have a brain in that pretty head? What you need to do is put down that Heat magazine, climb out of bed with your boyfriend, and do some work."

I had hoped that such experiences were a thing of the past. As a student I remember a macho surgeon who took a particular delight in humiliating female medical students. One ward round, smirking, he asked me to examine a male patient who was due to have an operation. The man was asked to undress completely. With obvious reluctance, ...

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I was sexually harassed as a junior by senior doctors: it still goes on, and it needs to stop

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Sexual discrimination and harassment still occur in the clinical workplace. A doctor , who was advised to write anonymously, says that more must be done to find out the extent of the problem and protect those affected As sexual scandal swirled around prelates, politicians, pop stars, and even school pupils, I read an article in Medical Education about students' most memorable professional dilemmas.1 Most, depressingly, involved witnessing unprofessional and callous behaviour by their clinician teachers.

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There is a culture of impunity around sexual violence by healthcare staff in the NHS, with known perpetrators going unchallenged, campaigners have warned.

A report by Surviving in Scrubs, a group of female doctors campaigning against misogyny in healthcare, said staff known to be perpetrators of sexual violence, who are most often senior male doctors, are tolerated or regarded as untouchable.

The study, which analysed 174 incidents of staff-on-staff sexism, sexual harassment and sexual assault anonymously self-reported to the group's website, found those who had been abused - mainly junior female doctors - struggled to get their complaints addressed.

Some women said they faced threats of reprisals from those they were accusing. They reported feeling gaslit by colleagues who they said remained silent and, in some cases, colluded with the perpetrator.

One woman referred to a perpetrator as the "Jimmy Savile of the surgical community", and was told by a senior female colleague that "he was known for this behaviour, that he'd got away with so much before and he was capable of ruining careers".

Of the 209 incidents reported to Surviving in Scrubs since it launched last summer, just over 42% (89) were sexual harassment, a fifth (43) were sexual assaults, nearly 2% were rapes, and almost 37% (77) concerned sexist behaviour. Some incidents were recorded in more than one category.

More than three-quarters of the alleged perpetrators were doctors, of whom more than 77% were consultants. Of the remainder, just over 7% were nurses and more than 5% were managers.

About 62% of victims were doctors, while nearly 12% were medical, nursing and paramedical students. Of those doctors who disclosed their grade, the vast majority were junior (89%).

Of those incidents where the location was disclosed, half took place in hospital wards, operating theatres, and clinics, which the report's authors said also raised concerns about the sexual safety of patients.

In one case, a female doctor described how, after a difficult forceps delivery of a baby that she assisted with, a consultant, covered in the patient's blood, propositioned her to share a shower together.

Another obstetric and gynaecology consultant allegedly paused operations on women to ask medical students what the purpose of a vagina was "until he got the answer he wanted - that their only purpose was for sex".

Dr Becky Cox, the co-founder of Surviving in Scrubs, said a culture of sexism and sexual abuse had become normalised in the NHS.

"When you're [a woman] coming into this profession, you see senior male consultants who are derogatory, use sexist language, and assault you. Male medical students see this behaviour and think that's normal. Then they go up the ranks and continue to perpetrate the behaviour. It's a never ending cycle."

Dr Becky Cox, of Surviving in Scrubs, said a culture of sexism and sexual abuse had become normalised in the NHS. Photograph: Handout

NHS trusts, regulators, and professional bodies were failing to hold perpetrators to account, she added.

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Cox said: "The women who have submitted their stories to us have tried to raise concerns and failed and failed and failed. It's the system that's failing because it's not listening to them."

The report recommends setting up an independent inquiry into the culture of sexism and sexual misconduct in healthcare.

It calls for an independent anonymous reporting system across the NHS to address the under-reporting of incidents, highlighted by a Guardian investigation earlier this year.

The campaigners want to make it mandatory for NHS trusts to report sexual harassment and sexual assault to healthcare regulators.

Dr Latifa Patel, BMA equality lead, said the report's findings were shocking. "[It] includes cases of sexual violence and harassment that have taken place without consequences for the perpetrators, demonstrated the barriers that exist to raising these incidents and how healthcare environments and structures can enable this behaviour."

She added that the BMA would reflect on the accounts to ensure it is doing everything possible to support doctors who experience sexism and sexual misconduct.

Information and support for anyone affected by rape or sexual abuse issues is available from the following organisations. In the UK, Rape Crisis offers support on 0808 500 2222 in England and Wales, 0808 801 0302 in Scotland, or 0800 0246 991 in Northern Ireland. In the US, Rainn offers support on 800-656-4673. In Australia, support is available at 1800Respect (1800 737 732). Other international helplines can be found at ibiblio.org/rcip/internl.html

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Culture of impunity for NHS staff accused of sexual violence, say campaigners

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A report by female doctors campaigning against misogyny found 174 incidents of sexism, sexual harassment and sexual assault

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Freedom to Speak Up Guardian (FTSU)

Guardians support workers to speak up when they feel that they are unable to in other ways.

Read more about to how to find your FTSU Guardian.
Find out more about FTSU.
Guardian of Safeworking Hours (GoSWH)

The GoSWH ensures that issues of compliance with safe working hours are addressed by the doctor and the employer or host organisation as appropriate. It provides assurance to the board of the employing organisation that doctors' working hours are safe. GoSWH are based within the organisation, they may also be the FTSU.
Find out more information about GoSWH.
Health Education England Quality Team

HEE Quality Team assure the Training and Education of all learners. HEE has offices across the country who can offer support and guidance.

East Midlands - Escalatingconcerns.EM@hee.nhs.uk

East of England - qualityframework.eoe@hee.nhs.uk

East Surrey and Sussex - Escalatingconcerns.KSSquality@hee.nhs.uk

London - qrimanagement@hee.nhs.uk

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North West England - Quality.nw@hee.nhs.uk

South West - escalatingconcerns.sw@hee.nhs.uk

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Regulators and Investigatory Bodies

Contact details for Regulators and Investigatory Bodies

Resources and links

The HEE Quality Framework supports both educators and learners, working collaboratively across educational providers in all relevant settings - work-based placements and academic educational providers - and HEE local teams.

Information aiming to raise awareness on the importance of raising concerns, build confidence amongst staff on how to do so and equip managers with the knowledge, skills and confidence to respond adequately, timely and safely. Providing scenarios that highlight broad lessons which can be applied elsewhere, useful contacts, and links to training resources.

Information on how to raise concerns about training and revalidation (including complaints).

On this page you will find a variety of resources including webinars, online learning, podcasts and videos. These are designed for people returning to training.

Information and guidance to raise concerns is available at: https://www.hee.nhs.uk/our-work/whistleblowing.

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Freedom to Speak Up Guardian (FTSU) Guardians support workers to speak up when they feel that they are unable to in other ways. Read more about to how to find your FTSU Guardian. Find out more about FTSU.

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How to be an upstander instead of a bystander | Angélique Parisot-Potter

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Introducing 'Being an active bystander' from Epigeum's new 'Tackling Harassment' programme

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Speak Up Stand Up: Active Bystander Campaign

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Bystander Campaign Video – Online Scenario

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Respect women: call it out–active bystander

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Bystander Campaign Video – Shopping Scenario

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The Bystander Effect | The Science of Empathy

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The Power of Reverse Mentoring | Rachael O’Connor | TEDxUniversityofLeeds

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Reimagining masculinity; my journey as a male sexual assault survivor | Landon Wilcock | TEDxQueensU

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The Power of Us: How We Stop Sexual Harassment | Marianne Cooper | TEDxUniversityofNevada

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Prevention is the Key to Eliminating Sexual Assault | Nicole Huffman | TEDxCalPoly

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5D's of Bystander Intervention - DOCUMENT

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5D's of Bystander Intervention - DELEGATE

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5D's of Bystander Intervention - DISTRACT

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A joint pledge to end sexism in medicine

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Sign our pledge and commit with us to address the cultural and structural factors that cause sexism in order to improve working conditions for medical students and doctors.

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The British Medical Association is the trade union and professional body for doctors in the UK.

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BMA responds to female surgeons sexual assault survey - BMA media centre - BMA

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The implications of decreased emotional wellbeing are detrimental as it can contribute to mental health and stress concerns, it is important to ensure good staff wellbeing by encouraging conversation in the workplace.

How are you feeling NHS? toolkit

This easy-to-use resource has been developed with NHS staff to:

help bridge a gap in understanding and enable us to talk openly and regularly about emotional health

assess the impact emotional wellbeing has on ourselves, our colleagues and on our patients

enable us to action plan to enable more good days than bad.

Staff identified that emotional wellbeing can be explained in three ways. We are either:
Start using the toolkit now to check your own wellbeing or speak to and support colleagues with their emotional wellbeing.

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Our emotional wellbeing toolkit explains the contributors to decreased emotional wellbeing and shows you how to encourage improvements.

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Everything Everywhere All At Once | Official Trailer HD | A24

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#MeToo Movement for Surgery: How UK doctors were sexually assaulted by their colleagues

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NHS surgeons sexual assault: A study has revealed that nearly one in three female surgeons in the UK’s NHS have been sexually assaulted by colleagues in the last five years. Male surgeons have also been a victim of sexual misconduct. The report also found 11 rape incidents and several cases of sexua…

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Health Secretary Steve Barclay said he expected NHS leaders to be "proactive" in protecting its workers after an investigation found that more than 35,000 cases of sexual misconduct or sexual violence were recorded on health service premises in England between 2017 and 2022.

The figures, from a joint investigation published today by The BMJ and the Guardian, have led to calls for an independent inquiry into what witnesses described as an "epidemic" of sexual assaults in the NHS.

The Hospital Consultants and Specialists Association, the HCSA, told Medscape News UK that most employers lacked safeguarding policies and such an inquiry was "long overdue".

Freedom of Information Requests

The statistics emerged after investigators sent freedom of information requests to 212 NHS trusts in England asking for data on how many sexual safety incidents - an umbrella term for a wide spectrum of behaviours, from abusive remarks to rape - had been recorded on NHS premises.

The results disclosed 35,606 sexual safety incidents reported over the 5 years, with 62% of those affecting health service staff. Almost three-quarters of the incidents on NHS premises occurred in mental health trusts.

The NHS statistics showed that 22,143 staff experienced sexual abuse, which included rape, sexual assault, harassment, stalking, and abusive remarks. Of those, 20,928 staff were abused by patients, 902 by other staff members, and 313 by visitors.

There were 12,234 patients affected, of whom 7464 were abused by other patients, 3218 by staff, and 1552 by visitors.

Police Reports

Figures collated during the investigation from freedom of information requests to all 32 police forces in England, and from other sources, revealed there were 180 cases of rape of children under 16 on NHS premises between 2017 and 2022, with four children under 16 being gang raped. Over the 5 years, 56 gang rapes were recorded on NHS premises by 10 police forces, with Leicestershire Police recording 18 cases of gang rape, all but one of which took place in a mental health unit.

Among other incidents compiled from police sources were 186 reports of children under 16 being sexually assaulted, and 127 reports of crimes including grooming, assaulting a child by penetration, sexual communication with a child, inciting sexual activity with a child, and causing a child to watch a sex act.

The investigation found that fewer than 1 in 10 trusts had a dedicated policy to deal with sexual assault and harassment. It said that sexual safety incidents involving patients were currently reported through the national reporting and learning system, but that its remit did not include abuse of staff, and that trusts were no longer obliged to disclose them to NHS England.

Although more than 4000 NHS staff were accused of rape, sexual assault, harassment, stalking, or abusive remarks towards colleagues or patients in 2017-22, "few have faced action from their employers", the report said. In cases where complaints were made against colleagues, there was a "reluctance to suspend perpetrators due to overall staff shortages", Senior Legal Officer from Rights of Women, Deeba Syed, told investigators.

The BMJ said it had been told by the British Medical Association that the Government should produce an action plan to protect health workers, while the Academy of Medical Royal Colleges was among organisations wanting a full independent inquiry into the scale of sexual abuse and how it could be prevented.

Dr Naru Narayanan, president of the HCSA union, said: "A formal independent inquiry is long overdue to expose the scale of this endemic issue and lay out clear recommendations. We have little faith in the current approach from the health service. It speaks volumes that most employers do not even have a policy in place to keep staff safe from sexual harassment and assault. It's time for a joined-up approach to protect health professionals and patients."

The organisation Surviving in Scrubs, which campaigns against harassment and sexual assaults in the healthcare workforce, told Medscape News UK that the figures presented in the investigation "likely under represent the true extent of the problem" and called for a public inquiry and "accountability from healthcare bosses".

Trusts 'Have a Duty of Care'

Responding to the investigation, Steve Barclay, Secretary of State for Health and Social Care, said: "NHS leaders have a statutory duty of care to look after their staff and patients and prevent harassment, abuse, or violence in the workplace. I expect employers to be proactive in ensuring staff and patients are fully supported, their concerns listened to and acted on with appropriate action taken where necessary."

Mr Barclay said the Government had doubled the maximum prison sentence for anyone convicted of assaulting emergency workers and other frontline health staff and was "working closely with NHS England as it takes action to prevent and reduce violence against staff, including through body-worn camera trials and a national violence prevention hub to ensure NHS staff can work in a safe environment".

Navina Evans, chief workforce officer at NHS England, said it had "established a dedicated team to ensure people who experience violence and abuse are supported in the workplace". She added: "All NHS trusts and organisations have measures in place to ensure immediate action is taken in any cases reported to them and I strongly encourage anyone who has experienced any misconduct to come forward, report it and seek support."

'Everyone's Responsibility'

In an opinion article linked to Tuesday's BMJ report, Rosalind Searle, professor at the Adam Smith Business School, University of Glasgow, said the investigation had exposed "shortcomings in the NHS, with inconsistent and inadequate recording making early detection impossible, and inconsistent sanctions leading to further ambiguity".

In another opinion article, orthopaedic surgeon Simon Fleming said that everybody should be responsible for holding perpetrators to account. "Failure to challenge, individually or organisationally, these attitudes is akin to accepting them as 'just how things are'," he argued.

Earlier this month, Isslia Roberts, a national officer at the HCSA union, called for employers to get a grip on the problem, citing a 2019 Medscape report which found that 7% of doctors had experienced or witnessed sexual abuse, harassment, or misconduct, with 1% having been accused of those misdemeanours.

Ms Roberts warned that changes to working practices due to the COVID-19 pandemic and mass adoption of social media had created new opportunities for perpetrators and an "evolution of new forms of harassment".

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'Epidemic' of Sexual Misconduct and Violence on NHS Premises

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Investigation finds there were more than 35,000 cases of sexual misconduct or sexual violence recorded on NHS premises in the last 5 years.

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Settlement agreements were designed to resolve cases of harassment and misconduct, but their confidentiality means they might be inadvertently sustaining the problem, writes Hina Belitz

Harassment and discrimination have been my daily work for over two decades as a partner and employment law solicitor. I advise on it, lead cases at court, and even train employers on how to manage and prevent harassment in the workplace.

Most sexual harassment complaints end in a settlement. This is both good and bad. Settlements resolve complaints but also sweep them under the proverbial carpet. In my career, I have reached two unsettling realisations. First, with every case I settle, the wider problem may continue unabated. Second, settlement not only makes the problem disappear but also hides it from the world. The result is that we are unaware of the real extent of the problem. Is the law rendered impotent by use of this resolution device? Are we unable to truly tackle and eradicate the problem?

These concerns were thrown into sharp relief when I was presented with The BMJ's recent findings that there were over 35 000 sexual safety incidents at 212 NHS trusts in England between 2017 and 2022. 1 It became apparent that my fears might be founded and that the problem of sexual harassment and misconduct in the NHS and elsewhere is being sustained by the very tool designed to resolve it.

In my view, this alarming and widespread problem could be caused by a little known tool for resolving disputes in employment law-the settlement agreement. A settlement agreement is a statutory document designed to allow a person to give up their right to bring a claim against an employer in return for a settlement or pay-off. Anyone presented with a settlement agreement must obtain independent legal advice for it to be legally binding.

Settlement agreements are common but are somewhat secret in employment law, due to their confidential nature. They allow employers to present an offer (usually with a monetary incentive) that leads to the employee giving up claims, often also leaving employment and entering non-disclosure terms as part of the settlement agreement. Some claims, including criminal claims, cannot be waived, but others are settled and "hushed up" in a binding agreement.

The number of misconduct claims reported in healthcare indicates that claims are being settled before they become public. Settlements might therefore create a veil of secrecy that hides the true extent of the problem and hinders the scrutiny that should rightfully be applied to this serious and seemingly endemic problem in the NHS.

I am not anti-settlement agreement. They are a valuable tool that enables the resolution of otherwise corrosive, time-consuming disputes and avoids costly public hearings. Many victims of harassment think that their complaint is adequately dealt with through a financial settlement and want to avoid being hauled through a distressing employment tribunal process. But if the inadvertent effect of these settlements is a complete failure in our awareness of and ability to tackle incidents of harassment, this is unacceptable, and something must be done.

Settlement agreements are here to stay, so the urgent issue is how we can ensure that sexual misconduct in the medical profession is not hidden and enabled because of them. There are various solutions to this. Medicine seems to have found its own #MeToo movement in the form of Surviving in Scrubs-an online campaign by female doctors that raises awareness of and draws people's attention to sexual misconduct in the healthcare sector. 2 This is an area where work can be done, by ensuring that policies enable healthcare staff, especially those who are female or junior, to have constructive, open conversations with their managers.

Sexual harassment policies are essential but won't change behaviour on their own. They must be accompanied by strong leadership, training, and a clear awareness of the effects of harassment and misconduct. Workplace cultures can be a major contributor to positive change. Building a culture of zero tolerance of any form of sexual harassment or discrimination is the aim, but culture change is hard to achieve without a multifaceted approach that promotes support at all levels of an organisation.

Training, in my experience, is key to tackling these issues. NHS trusts should implement training for staff at all levels to ensure that they understand what constitutes workplace sexual harassment. The training courses I run result in measurable improvements in complaints by ensuring a clear understanding of unacceptable standards of behaviour ranging from "banter" to sexually aggressive conduct. The courses also highlight the potentially extreme negative ramifications of any failure to comply with these standards.

A further step would be the active discipline and mentoring of harassers even when the allegations are resolved under a settlement agreement. Legally, in a similar vein, we are seeing a movement away from non-disclosure clauses in settlement agreements in connection with sexual misconduct. Although these agreements provide finality to the parties involved, their confidential nature has clearly allowed perpetrators to avoid accountability for too long.

Footnotes

Competing interests: HB is an employment law solicitor who provides independent advice to employees who are presented with settlement agreements and advises companies and employers about drafting settlement agreements for employees.

This article has been funded by the BMJ Investigations Unit. For details see bmj.com/investigations.

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Harassment in the NHS: could the solution be the problem?

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Settlement agreements were designed to resolve cases of harassment and misconduct, but their confidentiality means they might be inadvertently sustaining the problem, writes Hina Belitz Harassment and discrimination have been my daily work for over two decades as a partner and employment law solicitor.

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A surgical trainee who was sexually assaulted by a colleague has won an employment tribunal case against her trust after the investigation into the incident questioned her relationships and failed to fully suspend the perpetrator until police told the hospital that he had been arrested for an alleged sexual assault on a girl under the age of 16.

Elizabeth,* who worked as a surgeon at Royal Stoke University Hospital, was assaulted on a late shift at work on 11 June 2020. A colleague asked to speak to her in the urology office before forcibly kissing her face and neck, massaging her back, touching her waist, and blocking her as she pushed him away to leave the room. The perpetrator did not challenge Elizabeth's account of events at the tribunal.

She texted friends to tell them what had happened after her shift and reported the incident to her educational supervisor the next day. What followed was an investigation that her BMA representative said was plagued with "a catalogue of mistakes." One of these mistakes, which the tribunal found amounted to harassment, was that the case investigator asked her colleagues questions about her character and "inappropriate relationships"-questions that were not asked of the perpetrator. The Birmingham employment tribunal ruled on 17 July 2023 that she had been unlawfully discriminated against by the University Hospitals North Midlands NHS Trust on grounds of sex.

The story comes after an investigation by The BMJ and the Guardian found that NHS trusts recorded more than 35 000 cases of rape, sexual assault, harassment, stalking, and abusive remarks from 2017 to 2022, but only one in 10 trusts had a dedicated policy to manage the problem. University Hospitals North Midlands did not have a dedicated policy, the tribunal observed, and when Elizabeth looked online for the Dignity at Work policy, which covered sexual assault, the link took her to a broken webpage.

The tribunal found that the trust's policies were inadequate and that staff were not aware of them or trained in them. Multiple freedom of information requests sent to the trust, which are published on the trust's website, show that her assault was not officially recorded despite it being reported to human resources (HR).

Declined invitations

Elizabeth first had contact with the perpetrator in June 2019 when she was studying for her membership of the Royal College of Surgeons. He got her number from a WhatsApp group and asked if she wanted to revise with him, asked to have dinner, and asked to pick up some textbooks from her home. She said that she declined all these invitations. "I'd twigged that he was creepy, and I didn't really want that much to do with him. But beyond that, I didn't think he was a threat or anything," she told The BMJ in an interview.

Elizabeth felt "absolutely violated" by the assault, she told the tribunal in evidence. "My mind was reeling-what if I hadn't had that burst of strength to break free? What would he have done to me if I hadn't managed to get out of that room? I felt sick," she said.

On 12 June 2020 she reported the assault to her educational supervisor, who, according to Elizabeth's evidence, said that he would seek advice from his wife, who was a doctor at a different trust, and the deanery. Elizabeth told the tribunal that he also suggested that he should have an informal chat with the perpetrator about the incident, saying that "such a complaint didn't have to wreck [his] career," although the educational supervisor disputed this version of events in the tribunal. The employment tribunal's judgment said it was clear that the supervisor was sympathetic to Elizabeth's situation but did not have a clear understanding of what steps needed to be taken under the trust's Dignity at Work policy.

Initially, Elizabeth was reluctant to put in a formal complaint because she "didn't want to be labelled a slut or her reputation to be dragged through the mud," the judgment records, adding that there was a "gossipy environment" in the hospital that was not curbed by the trust. But after seeking advice from the BMA Elizabeth formally complained through the trust's HR email address.

Although Elizabeth had been told by HR that the colleague had been fully suspended, in reality he was suspended only from clinical duties and was able to come to the hospital for research or continued professional development. The judgment states that it is "unexplained" why steps were not taken to exclude him entirely on 16 June when Elizabeth first reported her assault, given its serious nature.

On 22 June, six days after Elizabeth had reported the assault, the perpetrator was offered a conditional extension to his contract, the judgment records. However, this was retracted after the police contacted the trust on 20 June and informed it that he had been arrested for sexually assaulting a girl under the age of 16. The trust then excluded him from clinical practice on patient safety grounds, although he was not fully suspended until 21 July.

After Elizabeth had been informed that he would not be at work for the foreseeable future she noticed that he was still down on the clinical rota, which caused her "significant distress," the tribunal found. She also complained multiple times about the delayed and poor correspondence from HR. Eventually Elizabeth's GP signed her off as unfit to work, which the tribunal ruled was as a result of the trust's failure to protect her.

Intrusive questioning

Ingi Elsayed, a consultant in renal and intensive care medicine, was appointed as a case investigator to look into Elizabeth's claim. The tribunal found that, although Elsayed had no "bad intent," her "total lack of experience in conducting an investigation" resulted in her adopting a line of questioning that was "intrusive" and "well beyond the scope of the terms of reference for the investigation" and "provoked responses that commented upon gossip in the hospital relating to [Elizabeth]'s friendships with consultants that may have been inappropriate."

Elsayed had done only a two hour training course on running investigations and had never run one before, the tribunal heard. Elizabeth gave evidence that she had asked Elsayed not to contact doctors she was friends with or whom she knew in a professional capacity in case it affected her reputation. However, Elsayed did not respect her wishes and began contacting doctors to ask them about Elizabeth's character and relationships. She did not contact the perpetrator's colleagues, as he had asked her not to. One consultant called Elizabeth and told her about the line of questioning. Elizabeth asked for Elsayed to be removed from the investigation, but the complaint manager, who the tribunal found had failed to investigate Elizabeth's claims, refused.

On 27 July a member of the HR department also accidentally downloaded the recording of Elizabeth's account of her assault, and it was shared with three other members who had no connection to the investigation.

Elizabeth was not informed of the investigation's conclusions until 7 April 2021, 10 months after she had first reported her sexual assault. Although Elsayed's original report found that on the balance of probabilities there was not sufficient corroborative evidence to support Elizabeth's complaint, the complaint manager intervened and changed the conclusion to find that the perpetrator did have a case to answer to. By this point he had left the trust, and no action could be taken.

The trust's chief executive, Tracy Bullock, apologised for the failings in the trust's investigation procedures. "We have already put in place additional training and measures to ensure that any concerns raised will be listened to, fully investigated, and responded to appropriately," she told The BMJ.

The General Medical Council has told The BMJ that it is investigating the perpetrator and has put interim restrictions on his licence to practise in relation to treating female patients, after a Medical Practitioners Tribunal Service hearing on 13 January 2023.

Staffordshire Police said that it had arrested a man on suspicion of sexual assault in May 2020. He was released pending further inquiries, but the investigation is ongoing. "We believe he has left the country, and we are working with partners to locate him," a spokesperson told The BMJ.

The effect of these events on Elizabeth meant that she felt unable to continue working as a doctor, as the tribunal judgment records. She had taken a year out to do a masters degree but felt anxious going to a hospital even for personal reasons, let alone work, so she did not feel able to return to medicine. She was given diagnoses of anxiety, depression, and PTSD. She is now working as an administrator at a much lower salary.

"It's kind of heartbreaking, to be honest," she told The BMJ. "I was genuinely committed to surgery, and I was genuinely committed to medicine. I knew there was sexism in surgery. I always knew that. But I genuinely thought that if I worked hard enough, I could beat it."

Elizabeth has another tribunal hearing, which will determine the compensation she will be awarded next year.

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Doctor who was sexually assaulted at work wins case against trust after it asked colleagues if she had "inappropriate relationships"

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A surgical trainee who was sexually assaulted by a colleague has won an employment tribunal case against her trust after the investigation into the incident questioned her relationships and failed to fully suspend the perpetrator until police told the hospital that he had been arrested for an alleged sexual assault on a girl under the age of 16.

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After being assaulted at work, a junior surgeon looked up her hospital trust's sexual safety policy and found it lacking. She spoke to The BMJ under the condition of anonymity.

"In October 2019 I had just started a job as a junior surgeon at a London hospital. About two weeks in, I was observing an operation being undertaken by a male registrar when the supervising consultant, who I had met before in handover meetings, came into the operating theatre to check whether he needed to supervise anything. While he was doing that, he stood behind me and started massaging my back.

"I immediately froze, and then I moved away, pretending to get a better look at what my colleague was doing. The consultant left, but later, at the end of the operating list, he came back to see if we needed anything. I was writing up the operation notes when he said goodbye, and then he kissed the top of my head and quickly walked away.

"I was so confused. It was just so strange because there was nothing that I had done to invite any of this. It was very uncomfortable, and I felt very unsafe. If this had happened in broad daylight during an operation, I hated to think about what he would do if the situation was more obscured. From then on, I tried to be very closed off with my body language. I wouldn't look him in the eye. I would be hypervigilant about where he was, avoiding being in the same room and always leaving when he came in.

"At the Christmas party I spoke to 10 other junior doctors with similar stories. The consultant was described as "handsy" by one who said that he touched her without her permission. Another said that he kissed her on her neck. A manager said that he cornered her in the stairwell by putting both of his arms around her to the wall and tried to kiss her, and she just barely managed to escape. Another colleague said that at work social events he would always sit next to her and flirt with her. One night he had grabbed her and kissed her on the mouth when saying goodbye. These things left me feeling scared.

"I thought that if I didn't speak up, it would keep happening to other women. But I also feared that, if I reported him, he would get me fired, and I was dependent on my job. My partner and I needed that income.

"In the end, I told my head of department, a male consultant, about how the other consultant had touched me without permission and what other women had told me. He had worked with the perpetrator for many years. He acknowledged what happened and said that he was really sorry to hear that, but he also said, "He hugs me all the time; he's quite a touchy feely person." He gave me three options: I could speak to the perpetrator directly, he could speak to him on my behalf, or I could make an anonymous complaint, but he'd probably find out that it was me, because it's a small department.

"I decided to look into the hospital policies myself. I printed them out and read them. I looked at the bullying and harassment policy, the Speak Up policy, and the procedure for whistleblowing and raising a concern. I looked at the equality, diversity, and inclusion policy, but it didn't have much relevance. That's all that I found that was potentially relevant.

"I called the Speak Up phone number four different times, but no one answered. I didn't feel comfortable writing an email because I was still working there, so in the end, I left it. I knew he was very popular in the field, and it is a small community. Even if people believed me, there would still be that stain on my image, especially as a female doctor.

"Since then, I have left medicine. But I still worry every time I am near the hospital that he might be there."

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"The trust had no sexual assault policy, and nobody answered the Speak Up phone line"

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After being assaulted at work, a junior surgeon looked up her hospital trust's sexual safety policy and found it lacking. She spoke to The BMJ under the condition of anonymity. "In October 2019 I had just started a job as a junior surgeon at a London hospital.

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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…

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Adam Smith Business School, University of Glasgow, UK

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How many more people will be abused before we act on sexual violence in healthcare?

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Failures to record, investigate, and act on cases of sexual harassment and abuse in healthcare have enabled perpetrators, but three sanctioning mechanisms can help tackle this, writes Rosalind Searle A new investigation by The BMJ and the Guardian provides further evidence of the prevalence of ser…

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It is everyone's responsibility to hold sexual predators in the NHS accountable or risk becoming complicit bystanders, writes Simon Fleming

Growing evidence shows that healthcare in the United Kingdom and worldwide has a problem with sexual violence. Increasing numbers of people who have faced sexual violence, predominantly women, are coming forward to share their experiences. 1 2 3 4

When it comes to sexual predators, what we permit, we promote. Think of people at work who "gave you the ick," "were walking, talking red flags." Many of us will be aware of people who fit this description, and some of us will have experiences of sexual harassment, assault, or rape by such sexual predators.

In England and Wales, evidence indicates that, by the age of 16, one in 20 women will have experienced attempted rape or rape. Moreover, 98% of the perpetrators of rape or assault by penetration are men. 5 In healthcare specifically, the best data we have, allowing for under-reporting, indicates up to a 60% rate of sexual harassment of nurses, with data for doctors reporting endemic, if lower, rates. 6 Rates of 10-15% for sexual assault and 1% for rape have been reported for surgical staff. 7

Rape culture and the hierarchical and patriarchal structures we work in silence and dismiss the voices of people who have been harassed, assaulted, and raped. Rape culture describes the normalisation and underplaying of sexual violence in society. Writer Rebecca Solnit explains, "Rape culture asserts that women's testimony is worthless, untrustworthy . . . who is heard and who is not defines the status quo." The NHS has such a culture of hierarchy, patriarchy, and power.

So here is a question-if reading about sexual violence doesn't fill you with either fury or disgust, why not? This might be due to familiarity with these experiences or normalisation and acceptance of what is toxic, at best, and criminal, at worst. Or it is simply denial, a freedom afforded to those in a place of privilege, because the truth is too uncomfortable?

Sexual Assault in Surgery: a Painful Truth was published in 2021 and was followed by further impactful publications. 7 8 9 It highlighted a global culture of silence, of patriarchy, and of normalising sexual harassment, assault, and rape in surgery. It was the first paper of its kind in the UK. In the two years since, many healthcare organisations have released statements denouncing the attitudes and behaviours described. Many more NHS organisations have remained silent, watching from the sidelines, perhaps hoping that others will take the heat, bring about change, and that it might all simply go away. Some have set up working groups, although the finite timeline of these groups is a concern because it risks performative and pacifying action. Suggesting that the work of changing and maintaining culture will one day be finished shows a fundamental lack of understanding of the scale and severity of the problem we are facing. Making healthcare a safe, fair, respectful, and diverse place isn't the job of a working group alone. It should be a core value, a uniting thread that runs through the fibre of everything we do.

Numerous stories of predatory behaviour in healthcare have been shared with me. Since August 2021 I have heard the following from people working in the NHS. One shared that they work with a consultant who played with the nipples of patients while they were under anaesthesia-the theatre team have started taping down patients' nipples before surgery and removing the tape before they wake up. I've heard someone saying that they think there is no rape or sexual assault in the NHS, and that most sex is consensual, arguing that people who say there is have misunderstood or "don't have a sense of humour." Another complained that they shouldn't have to worry that someone is going to "cry rape" if they put their hand on their thigh, especially if they are laughing or smiling. I've heard a staff member recounting that their colleague is a "well known sexual predator" and that everyone is aware, but if he is kept away from students, "everything will be fine," adding: "You know how it is."

But it doesn't have to be this way. Again, if reading these doesn't fill you with fury or disgust, why not? We do not need any more surveys to see whether there is a problem-evidently there is. We do not need any vague general statements or more silence on the issue. We need decisive action. This means anonymous reporting systems, active bystander training, systems that allow growth and learning but also demonstrate accountability and not reinventing the wheel, and using superlative resources that are still out there, like the Operate With Respect materials from the Royal Australian College of Surgeons.

The culture of healthcare and our attitudes must change. We must face the extent of the problem and tackle it directly. That means not shying away from the fact that it makes us uncomfortable, embarrassed, ashamed, or guilty and acknowledging when we have failed to listen to people who have experienced sexual violence. Nobody is above reproach or challenge, no matter who they are, who they know, what strings they can pull, or how many friends they have. Right now, the hierarchy we exist in allows these incidents to go unchecked and, when reported, allows them to be hushed up and brushed under an increasingly threadbare carpet.

We need to recognise that some people showing predatory behaviour might need a "cup of coffee conversation" and some might need an awareness intervention, but also that some have committed explicit crimes. These conversations can be had by the person experiencing the behaviour, a bystander, a peer, or an ally. 10 Criminal behaviour should be dealt with seriously, regardless of who has committed the crime. Failure to challenge, individually or organisationally, these attitudes is akin to accepting them as "just how things are."

We all have a part to play in changing the culture of healthcare. As many more of us have uncomfortable conversations about how to make the NHS a safer place for patients and healthcare workers and we accept the premise of "what we permit, we promote," ask yourself-what side of history do you want to be on?

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With sexual harassment or assault, what you permit, you promote

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It is everyone's responsibility to hold sexual predators in the NHS accountable or risk becoming complicit bystanders, writes Simon Fleming Growing evidence shows that healthcare in the United Kingdom and worldwide has a problem with sexual violence.

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GMC: Doctors must act when they witness sexual harassment, says updated policy

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GMC: Doctors must act when they witness sexual harassment, says updated policy

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Medicine's Me Too - "shocking" levels of sexual abuse

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NHS: Third of NHS female surgical staff sexually assaulted

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An epidemic of sexual assault: How the NHS can better protect staff and patients

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Almost a third of NHS female surgical staff have been sexually assaulted in the last five years, a new survey has revealed.

The study, published in the British Journal of Surgery (BJS), examined sexual misconduct over the past five years among the UK surgical workforce and found that 63% of women and 23% of men polled have experienced being sexually harassed by colleagues.

Of those, 29.9% of women reported being sexually assaulted - significantly higher than the 6.9% of the male surgical workforce.

The assaults ranged from genitals or breasts being touched or groped to rape.

The report also highlighted the amount of sexual coercion reported, with 11% of women "experiencing forced physical contact linked to career opportunities".

The survey added that females, who remain a minority in surgery, were more likely to report witnessing sexual misconduct (89.5%) and assault than their male counterparts.

1:29

Alongside rape at work, it found that "participants in this survey reported rape by colleagues in other work-related contexts, including teaching spaces, conferences, and after-work events with colleagues".

"There are relatively few measures in place to protect the potentially vulnerable in settings such as conferences," the report found.
Likely junior staff are afraid to speak out
The survey of 1,704 participants included different levels of staff - from consultants all the way down to medical students.

But the vast majority of respondents were consultants and more senior members of staff - which the report suggested was because those more junior were often too afraid to speak out.

It also revealed a major discrepancy between men and women in their belief in the ability of bodies such as the General Medical Council (GMC), and National Health Service Trusts to adequately handle issues of sexual misconduct.

Only 15.1% of women regarded the GMC as adequate in their handling of sexual misconduct.

Men's evaluations were higher, although the GMC was still regarded as adequate by less than half of men (48.6%).

Evaluations of National Health Service Trusts were similarly low. Only 15.8% of women rated them as adequate and 44.9% of men.
Read more:
Third of UK medical students plan to quit NHS to move abroad Concerns over 'sexualisation of the workplace'
Weight-loss jab made available on NHS
In its analysis of the survey data, the report concluded that "in the surgical profession, hierarchy mirrors power and responsibility".

It added: "Arguably, an implicit aspect of becoming part of surgical culture is to not draw attention to sexual misconduct.

"The surgical workplace is particularly vulnerable to sexual misconduct with its predominantly male senior workforce, use of strongly hierarchical structures, and high-stress environments.

"Over time, sexualisation of the workplace, through unwanted language, breaches of personal space, and physical violation, shifts accepted norms."

For staff, workplace harassment could be detrimental to their physical and mental health, the report said, with the worst cases even leading to self-harm and victims contemplating suicide.

The BJS researchers have called for action to improve the culture in the surgical workforce and "create adequate mechanisms to deal with perpetrators".

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Male and female NHS surgical staff are victims of sexual harassment, sexual assault and rape - survey

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The study looked at gender differences in surgical staff experiences with sexual misconduct among colleagues in the past five years. More women consistently reported being victims of various forms of misconduct than men, including rape.

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More than a third of newly qualified doctors are leaving UK medical schools without any education on sexual misconduct specifically relating to the medical profession according to new research published by JRSM Open.

The study by researchers at the University of Cambridge, based on responses by the UK's 34 medical schools to Freedom of Information requests, shows there is no standardisation of training on sexual misconduct across medical universities.

Almost half of medical schools offered no training, or only generalised harassment training that was not specific to sexual misconduct or that was wholly outside the context of being a doctor.

The researchers point to research findings earlier this year that showed training for NHS staff on sexual harassment intervention is lacking, while other reports highlighted 20,000 incidents of sexual misconduct in the NHS, leading to healthcare workers leaving their professions. In August 2023, the General Medical Council issued new professional standards for doctors which, for the first time, included explicit rules on sexual misconduct.

Medical students, as future clinicians, have a crucial and strategic need for education that allows them to perform a critical role in exhibiting good behaviour, and intervening, identifying, assessing and reporting sexual misconduct when they see it happening at work or in wider society, say the researchers.

Lead researcher Dr Sarah Steele of the University of Cambridge and Jesus College, Cambridge, commented: "Our study shows it cannot be assumed that graduates who are working as junior doctors have received training on sexual misconduct before starting their roles. Considering the magnitude of this issue, universities and professional bodies should urgently address this problem."

The researchers point to serious shortcomings within the health sector in preventing and addressing sexual misconduct, with costs in damages to address sexual misconduct in the NHS exceeding £4 million in the last five years.

In the medical schools where compulsory sexual misconduct training was provided, a wide range of delivery methods were adopted, with workshops and lectures being the main delivery approach.

Dr Steele said: "With such significant variations in the context and format of teaching, it is important to research which methods and content are most effective in improving these future clinicians' responses to this form of abuse and discrimination.

"The latest GMC professional standards make it imperative medical schools offer this training. Tomorrow's doctors need to be trained properly if we are to put in place the zero-tolerance approach."

According to the study, the curriculum analysis within the study was significantly hampered by several medical schools refusing to provide information on the basis of it being proprietary knowledge. "The idea that public universities offering medical education in accordance with the General Medical Council requirements are in competition, such that they do not share curricular and do not engage in knowledge exchange, is concerning to say the least," added Dr Steele.
Read the full paper

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Over a third of UK medical students do not receive sexual misconduct training

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More than a third of newly qualified doctors are leaving UK medical schools without any education on sexual misconduct specifically relating to the medical profession according to new research published by JRSM Open.

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The British Medical Association is the trade union and professional body for doctors in the UK.

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BMA responds to female surgeons sexual assault survey - BMA media centre - BMA

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Almost one in three female surgeons working in the NHS have been sexually assaulted in the past five years, according to a survey described as a "#MeToo movement for surgery".

Surgeons who took part in the study, published in the British Journal of Surgery and shared with the BBC and the Times, reported 11 instances of rape.

The survey found the 30% of female surgeons who responded said they had been sexually assaulted, 29% of women had experienced unwanted physical advances at work, more than 40% had received uninvited comments about their body and 38% receiving sexual "banter" at work.

Almost 90% of women said they had witnessed sexual misconduct in the past five years, with 81% of men giving the same answer.

The report concludes: "Sexual misconduct occurs frequently and appears to go unchecked in the surgical environment owing to a combination of a deeply hierarchical structure and a gender and power imbalance. The result is an unsafe working environment and an unsafe space for patients."

Compiled by the University of Exeter from 1,436 responses to an anonymous online survey, the study was commissioned by the working party on sexual misconduct in surgery - a group of NHS surgeons, clinicians and researchers who say they are "working to raise awareness of sexual misconduct in surgery, to bring about cultural and organisational change".

While acknowledging that the "exact prevalence of sexual misconduct in the surgical workforce cannot be determined from these data", the authors stated that the study "provides a unique combination of statistically supported insights".

"Robust evidence illustrating similar results across weighted and unweighted analyses strengthens [the] validity of the demonstrated difference in women's and men's realities with sexual misconduct among colleagues," they wrote.

A Guardian/British Medical Journal investigation in May found more than 35,600 "sexual safety incidents" had been recorded in NHS hospitals in England over the past five years. That promptedthe General Medical Council to call on doctors to show "zero tolerance" of sexual harassment.

Tamzin Cuming, a consultant surgeon who chairs the Women in Surgery forum at the Royal College of Surgeons of England, said the report presented "some of the most appalling facts ever to come out" about the field and "represents a #MeToo moment for surgery".

Writing in the Times, she said: "Our research reveals an environment where sexual assault, harassment and rape can occur among staff working in surgery but allows it to be ignored because the system protects those carrying it out rather than those affected.

"We need urgent change in the oversight of how healthcare investigates itself."

She called for the creation of a national implementation panel to oversee action on the report's recommendations and for incidents of sexual misconduct to be independently investigated.

She said: "No one should need to call for a code of conduct that says, in essence, 'please do not molest your work colleagues or students', and yet this is one of the actions our report recommends.

"The report is measured, its recommendations achievable, but this shouldn't disguise the anger and frustration felt by many in our profession."

The results have been presented to NHS England, the General Medical Council and the British Medical Association.

The BBC spoke to a surgeon who was sexually assaulted early in her career by a senior surgeon who pushed his face into her breasts in the middle of a procedure under the pretence of mopping sweat from his brow.

When he did it for a second time, she offered to get him a towel, and he replied "no, this is much more fun".

The BBC was told the most common scenario was a junior female trainee abused by a senior male perpetrator, who was often their supervisor.

Dr Binta Sultan, from NHS England, told the BBC the report made "incredibly difficult reading" and action was needed to make hospitals safe for all.

She said: "We are already taking significant steps to do this, including through commitments to provide more support and clear reporting mechanisms to those who have suffered harassment or inappropriate behaviour."

Tim Mitchell, the president of the Royal College of Surgeons of England, said such behaviour had "no place ... anywhere in the NHS".

Describing it as "abhorrent", he added: "We will not tolerate such behaviour in our ranks."

This article was amended on 20 September 2023 to add remarks from the study's authors acknowledging that the "exact prevalence of sexual misconduct in the surgical workforce cannot be determined [from the survey data]". An earlier headline omitted to state that the findings of prevalence are suggested by the survey, not proven by it.

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Nearly one in three female NHS surgeons have been sexually assaulted, survey suggests

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Survey represents '#MeToo moment for surgery', says head of Women in Surgery forum

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Conduct guidelines for UK doctors are being updated to spell out what constitutes workplace sexual harassment, amid concerns abuse is going unchallenged.

The General Medical Council, which regulates doctors to ensure they are safe and fit to care for patients, says it is adopting a zero-tolerance policy.

The new advice explains it is not just physical acts that can be a breach.

Verbal and written comments or sharing images with a colleague count too.

It is difficult to say precisely how common sexual harassment is within the NHS and private medical practice, because, as in other workplaces, not all cases are reported.

A recent survey of 2,500 doctors by the British Medical Association (BMA) found a third of female and a quarter of male respondents had experienced unwanted physical conduct in the workplace.

Dr Amy Attwater, an accident-and-emergency doctor in Warwickshire who is the lead for equality, diversity and inclusivity at the non-profit campaign group Doctors Association UK, said: "Sexual harassment is always serious and it can have a long-term impact on people.

"The level of which it's happening is hugely under-reported. It is very infrequent that people actually report sexual harassment."

Speaking out about her own experience for the first time, Dr Attwater told BBC News: "I've been a doctor now for 12 years and as a medical student and as a doctor, particularly earlier in my career, I have unfortunately experienced sexual harassment myself.

"To be honest, it is actually quite difficult to talk about, because, as you get older, you feel very naive and you think, 'Why didn't I report it?'

"My first thought was that I didn't want to talk about this - but I feel I have a duty to speak out against these things and hopefully help other people to speak out.

"Early in my career, I was sent sexual text messages by a senior colleague and I wasn't sure what to do, as they were senior.

"There was also a male nurse when who would touch me inappropriately without asking me, including massaging my shoulders and making comments about my body. He has since been fired.

"Then, there was another time, when I worked in a department where there wasn't a lot of space, and at times, I would be standing there, for example writing notes, and a more senior male doctor would come behind me and almost slowly rub their genitals against my bottom and then say something like, 'I enjoyed that.' It was seen as a joke - but it's not OK."

Baby killer

The new guidance sets out what doctors should do if they witness bullying or harassment, including:

offering support to the victim, including letting them know the behaviour witnessed is unacceptable

challenging the behaviour by speaking to the person responsible, either at the time, if safe to do so, or at an appropriate time and place

reporting the behaviour in line with workplace policies, making sure the person targeted is aware of and supports that intention

And it says leaders and managers must make sure bad behaviours are addressed, dealt with promptly and escalated if necessary.

There have been calls to overhaul the NHS whistleblowing system in the wake of the Lucy Letby trial, after it emerged hospital bosses had ignored senior doctors who had raised concerns about the baby killer.

Existing guidance already warns doctors must not act in a sexual way towards patients or use their professional position to "pursue a sexual or improper emotional relationship".

The GMC says it heard from thousands of doctors, patients and members of the public during a consultation on the guidelines.

Supporting victims

The new guidance will not come into effect until the end of January, after a five-month familiarisation period for staff. And some say there is still a long way to go.

Dr Chelcie Jewitt, an emergency-medicine doctor who is part of the Surviving in Scrubs campaign group, which aims to raise awareness of sexism, harassment and sexual assault in the healthcare workforce, said: "We have spoken with the GMC about the guidelines and we do think that they are a step in the right direction - but there is still a long way to go on this journey to eradicating the culture of sexual misconduct within healthcare.

"The GMC has the potential to make a real difference and we need to see them supporting victims when they report perpetrators.

"We need their reporting processes to be transparent and clearly explained to victims.

"We need cases to be thoroughly investigated rather than dismissed.

"And we need appropriate, proportionate sanctioning of perpetrators."

Prof Phil Banfield, BMA council chair, said: "Encouraging individuals to speak up and report bullying and harassment, for example, will not be effective if doctors do not trust those who they are complaining to or if complaints are not taken seriously when people do."

Provide guidance

Dr Caroline Fryar, from the Medical Defence Union, which represents doctors over medical and legal matters, said: "We are calling on employers to ensure they give medical professionals time to digest it and the GMC to do all they can to make sure doctors can easily understand the main changes.

"Doctors shouldn't be getting homework at a time when they are already working incredibly hard, around the clock, to deliver safe and effective patient care."

The GMC offers support and information on addressing sexual misconduct in the workplace at its dedicated ethical hub.

Those affected by sexual harassment in the workplace can also call its confidential helpline on 0161 923 6399, between 09:00 and 17:00 Monday to Friday.

It says: "We can provide guidance on how to raise concerns you might be struggling with and you can remain anonymous.

"Although our staff aren't trained to provide legal or counselling support in relation to sexual misconduct, they can signpost you to other organisations."

The BBC Action Line website has information and support for anyone affected by sexual abuse.

The BBC is not responsible for the content of external sites.

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Updated guidance spells out expected behaviour and how to raise concerns about colleagues, amid concerns of abuse.

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Female surgeons say they are being sexually harassed, assaulted and in some cases raped by colleagues, a major analysis of NHS staff has found.

BBC News has spoken to women who were sexually assaulted in the operating theatre while surgery took place.

The study's authors say there is a pattern of female trainees being abused by senior male surgeons, and this is happening now, in NHS hospitals.

The Royal College of Surgeons said the findings were "truly shocking".

Warning - this story contains some graphic detail. There is support for anyone affected here.

Sexual harassment, sexual assault and rape have been referred to as surgery's open secret.

There is an untold story of women being fondled inside their scrubs, of male surgeons wiping their brow on their breasts and men rubbing erections against female staff. Some have been offered career opportunities for sex.

The analysis - by the University of Exeter, the University of Surrey and the Working Party on Sexual Misconduct in Surgery - has been shared exclusively with BBC News.

Nearly two-thirds of women surgeons who responded to the researchers said they had been the target of sexual harassment and a third had been sexually assaulted by colleagues in the past five years.

Women say they fear reporting incidents will damage their careers and they lack confidence the NHS will take action.

There is a nervousness to talk openly. Judith asked that we use only her first name. She is now an experienced and talented consultant surgeon.

She was sexually assaulted early in her career when she was the person with the least power in the operating theatre - and a senior male surgeon was sweating.

"[He] just turned round and buried his head right into my breasts and I realised he was wiping his brow on me.

"You just freeze right, 'why is his face in my cleavage?'"

When he did it for a second time Judith offered to get him a towel. The reply came back "no, this is much more fun", she says, "and it was the smirk - I felt dirty, I felt humiliated".

Even worse for her was the total silence of her colleagues.

"He wasn't even the most senior person in the operating theatre, but he knew that behaviour was ok and that's just rotten."

This happened to Judith in the middle of the operating theatre, but the sexual harassment and sexual abuse extends beyond the hospital.

'I trusted him'

Anne - we cannot reveal her real name for legal reasons - wanted to talk to the BBC because she believes change will only happen when people speak out.

She doesn't choose to describe what happened to her as rape, but is clear the sex that took place was not consensual. It happened at a social event tied to a medical conference - a meeting of doctors within the same speciality.

In a familiar pattern, she was a trainee and he was a consultant.

"I trusted him, I looked up to him," she says.

He played on that trust saying she didn't know the other people there and that she couldn't trust them.

"So, he walked me back to the place I was staying, I thought he wanted to talk and yet he just suddenly turned on me and he had sex with me."

She said in that moment her body froze and "I couldn't stop him".

"It's not what I wanted, it had never been what I wanted, it was totally unexpected."

When she saw him the next day she was "barely able to hold myself together".

"I didn't feel I could make a fuss, I felt like there was a very strong culture of just putting up with whatever was done to you."

The incident had a lasting impact, first leaving her emotionally numb and years later "the memory would come flooding into my mind like a horror, like a nightmare" at work, even as she was preparing to operate on a patient.

Shaking confidence in surgeons

It is widely accepted there is a culture of silence around such behaviour. Surgical training relies on learning from senior colleagues in the operating theatre and women have told us it is risky to speak out about those who have power and influence over their future careers.

The report, which is being published in the British Journal of Surgery, is the first attempt to get a sense of the scale.

Registered surgeons - men and women - were invited to take part completely anonymously and 1,434 responded. Half were women:

63% of women had been the target of sexual harassment from colleagues

30% of women had been sexually assaulted by a colleague

11% of women reported forced physical contact related to career opportunities

At least 11 incidents of rape were reported

90% of women, and 81% of men, had witnessed some form of sexual misconduct

While the report shows men are also subject to some of this behaviour (24% had been sexually harassed), it concludes men and women surgeons are "living different realities".

"Our findings are likely to shake the confidence of the public in the surgical profession," said Dr Christopher Begeny, from the University of Exeter.

Meanwhile a second report - called Breaking the Silence: Addressing Sexual Misconduct in Healthcare - is making recommendations for what needs to change.

The pair of reports suggest the relatively lower proportion of women surgeons (around 28%), combined with surgery being deeply hierarchical, gives some men significant power and this combines badly with the high-pressure environment of surgery.

"That leads to people being able to behave with impunity and much of this goes unchecked," Prof Carrie Newlands, consultant surgeon from the University of Surrey.

She was motivated to tackle such behaviour after hearing the experiences of her junior colleagues.

She told the BBC: "The commonest scenario is that a junior female trainee is abused by a senior male perpetrator, who is often their supervisor.

"And that results in a culture of silence where people are in real fear of their future and their careers if they do speak up."

'Incredibly upsetting'

Another theme that emerged in the data was a lack of faith in bodies such as NHS Trusts, the General Medical Council (which manages the UK's register of doctors allowed to practice) and the Royal Colleges (which represent specialities in medicine) - to tackle the problem.

"We need a major change in investigation processes so they become external and independent, and are trusted in order for healthcare to become a safer place to work," says Prof Newlands.

The British Medical Association called the findings "atrocious". Dr Latifa Patel, BMA equality lead, said: "It is appalling that women in surgery are being subjected to sexual assault and sexual misconduct from their colleagues, at work and often whilst they are trying to care for patients. The impact this will have on their wellbeing for years to come as well as their careers is profound."

Tim Mitchell, the president of the Royal College of Surgeons of England, told the BBC the survey's findings are "deeply shocking and will be a source of great embarrassment to the surgical profession".

He acknowledged it is "clear it is a common problem" that has not been addressed.

"We need to put in place a culture of zero tolerance to ensure that there are mechanisms that mean people who are affected feel confident they can come forward, report these incidents and they will be taken seriously,"he said.

Dr Binta Sultan, from NHS England, said the report made "incredibly difficult reading" and presented "clear evidence" that more action was needed to make hospitals "safe for all".

She said: "We are already taking significant steps to do this, including through commitments to provide more support and clear reporting mechanisms to those who have suffered harassment or inappropriate behaviour."

The General Medical Council last month updated its professional standards for doctors.

Its chief executive Charlie Massey said "acting in a sexual way towards patients or colleagues is unacceptable" and that "serious misconduct is incompatible" with continuing to practise medicine in the UK.

But is surgery a safe place for women to work today?

"Not always. And that's a dreadful thing to have to admit," says Judith.

Follow James on X.

How have you been affected by the issues raised in this story? You can get in touch by emailing: haveyoursay@bbc.co.uk.

Please include a contact number if you are willing to speak to a BBC journalist. You can also get in touch in the following ways:

If you are reading this page and can't see the form you will need to visit the mobile version of the BBC website to submit your question or comment or you can email us at HaveYourSay@bbc.co.uk. Please include your name, age and location with any submission.

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Female surgeons sexually assaulted while operating

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Trainees are being abused by senior male surgeons, a major analysis given to the BBC reveals.

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The British Medical Association is the trade union and professional body for doctors in the UK.

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DHSC (Department of Health and Social Care) have released Mend the Gap: The Independent Review into the Gender Pay Gap in Medicine. It provides detailed analysis of the pay gap, looking at different grades and elements of pay, and uses analysis to identify the main contributing factors.

The review aims to make recommendations on the changes needed to achieve equality in the profession.

You can view our briefing on the findings and our response to the review in the commentary below.

What the gender pay gap in medicine looks like

In England, women hospital doctors earn on average 18.9% less than men (based on a comparison of full-time equivalent mean pay). Women GPs earn on average 15.3% less than men and clinical academics 11.9% less than men.

The total non-adjusted gender pay gap is 24.4% for hospital doctors, 33.5% for GPs and 21.4% for clinical academics. These figures are higher than those above because a significant amount of the gender pay gap can be explained through women, on average, working fewer contracted hours.

Influencing factors

According to the review, the pay gap is mostly because of the under-representation of women in the highest paid positions, grades and specialties.

However, even after adjusting for age, seniority and a range of other factors, a gender pay gap remains.

The review identifies additional causes that are 'multiple and complex', though include the following.

The unequal impact of caring responsibilities on careers

Women doctors are more likely to take time out or have periods of working or training LTFT (less than full time) to care for others. This has a disproportionate impact on their pay even after accounting for the reduced hours worked and periods of leave.

Medical careers have failed to evolve with changing demographics and working patterns

The structure of medical careers was designed originally for a predominantly male workforce, with the expectation of full-time work for a long career and an ability to take on extra commitments. This has resulted in a lower average salary for the female workforce.

Women are segregated into lower paid career paths - particular roles and specialties

This is due to the difficulties working LTFT (less-than full time), or the structure of careers in some specialities. This results in pay penalties, especially relating to non-basic pay additions, such as CEAs (clinical excellence awards).

Men in the profession are more likely to be older and been in practice for longer. This leads to them occupying the highest paid positions (consultants, associate specialists, GP partners, professors).

Learning from the review

The structural and institutional factors that lead to the gender pay gap should be removed as soon as possible. The cultural factors should have plans put in place that will guarantee effective change.

To ensure progress is being made the gender pay gap must be checked against protected characteristic intersectionality to give accountability that the issues identified in this review are being addressed.

Covid-19 has changed the working environments, but the workforce need is greater than before and retention of women in medicine is a priority for the healthcare sector.

The structural and attitudinal issues identified in the review may become exacerbated if there is no action to address them now. We will continue to influence and promote the findings of this report and the recommendations.

The recommendations

We welcome many of the recommendations. However, there are still three significant issues to raise:

1. some of these recommendations would clearly require contractual change and potentially changes to pay structures

2. due to the time that has passed since the research was initiated the data may no longer be relevant and current BMA policy positions may not align with recommendations as they stand

3. there have been significant changes to the health system due to COVID-19, and we must view all the findings with consideration of the current environment.

Some recommendations need to go further

There are some areas where the recommendations lack specificity or we believe the review could have gone further, for example in efforts to change culture. Some areas were overlooked, for example the unfairness of LTFT pension contributions. The intersection of gender with other protected characteristics also needs further investigation.

COVID-19

Doctors continue to face significant pressures through the ongoing pandemic. We believe this should be considered when looking at how to prioritise the gender pay gap review recommendations (made prior to the pandemic). It is more important than ever to act to improve retention and the career progression opportunities for women.

It seems like every time somebody has a baby in the NHS, everyone's completely surprised, as if it's never happened before... Well over 50% of the medical workforce is female, and yet we still have not made it possible for women to combine motherhood and being doctors.

Participant in DHSC review

What we're calling for

More to be done to support doctors when they have children or other caring responsibilities and to minimise the career costs of caring.

In mixed-sex couples, men should also be encouraged to take time off work and play more of a role in caring to help challenge stereotypes around gender, work and care and minimise the disproportionate impact for women.

Enhanced pay for shared parental leave must be extended to all doctors.

Gender pay gap monitoring and reporting to be standardised.

More work must be done to understand the differences in the gender pay gap with the intersectionality of different protected characteristics eg race and disability.

Poor behaviour, stereotypical attitudes and bullying cultures must be tackled to create a welcoming environment for all doctors.

Structural inequality such as treating LTFT (less than full-time) doctors differently without justification must stop immediately.

Increase provision of NHS nurseries and other support for childcare including access for doctors working in primary care, to accommodate out-of-hours and shift working.

Fixing the gender pay gap in medicine

A panel discussion led by BMA's network of elected women and Medical Women's Federation to discuss what can be done to bridge the gender pay gap in medicine.

Watch the video

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Review of the gender pay gap in medicine

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DHSC has commissioned an independent review of the gap between men's and women's earnings in medicine. It aims to pinpoint the causes of the gender pay gap, and how they can be addressed.

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Sexual harassment is a serious public health problem and workplace hazard The high prevalence and significant adverse effects of workplace sexual harassment have become increasingly clear in the wake of the #MeToo movement. In the linked prospective study, Magnusson Hanson and colleagues convincing…

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Medical students stand up to sexual harassment

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Medical students stand up to sexual harassment

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What sexual harassment is, what you can do if you're affected by it at work, and how employers should handle sexual harassment complaints.

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We define sexual harassment, legal protections against it in the workplace, and the impact it has on doctors and medical students.

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The British Medical Association is the trade union and professional body for doctors in the UK.

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The BMA can help you as an International Medical graduate (IMG) or international medical student, from when you first arrive in the UK to supporting your career progression, BMA membership is here to support you every step of the way. Browse our key member services below.

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The BMA can help you as an International Medical graduate (IMG) or international medical student, from when you first arrive in the UK to supporting your career progression, BMA membership is here to support you every step of the way. Browse our key member services below.

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The British Medical Association is the trade union and professional body for doctors in the UK.

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BMA - Maternity, paternity and adoption advice and support

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If you are considering starting a family or are pregnant we strongly advise you to contact us for individual advice. You can call one of our BMA advisers on 0300 123 1233.

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The British Medical Association is the trade union and professional body for doctors in the UK.

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Purpose and remit of the forum

This national forum, which is supported by regional fora, seeks to:

explore and highlight relevant issues and experiences faced by Black, Asian and minority ethnic doctors and medical students in their places of work and study

act as a consultative forum, by contributing to the BMA's policy work for members and the wider medical workforce to ensure the Black, Asian and minority ethnic perspective is included

act as representatives and advocates for the BMA's work on improving race equality in medicine

review and provide guidance on BMA products and services (such as employment advice) that support Black, Asian and minority ethnic members

influence and support external stakeholders to improve support for minority ethnic and IMG (international medical graduates) doctors and students

raise the profile of the contribution of Black, Asian and minority ethnic doctors to the NHS and the BMA

support the BMA's efforts to build ethnic diversity in its membership and elected structures

help to connect and network with grassroot members, bringing their lived experiences, knowledge, and diverse ideas to the forum and to the wider BMA.

Who can join

BMA FREE is made up of elected representatives from the UK branch of practice committees, UK council, representatives from the devolved nations and regional fora to ensure that we hear from our members across all parts of the BMA about the issues that face them in their places of work and study.

Join your regional forum

Join your regional forum and help us to drive positive change for Black, Asian and minority ethnic doctors.

The networks offer a space for Black, Asian and minority ethnic BMA members to network and support each other, raise issues, and influence how they can be better supported, and influence the BMA's national policy and campaigning on these issues.

Regional FREEs have hosted guest speakers, organised webinars and even put on conference - their work contributes to the BMA's commitment to improve and better tailor our member services support to minority ethnic members.

If you would be interested in joining your regional forum, please email your regional coordinator using the details found below:

What's happened so far

We have a long history of campaigning for race equality in the medical profession and have actively responded to the disadvantage and discrimination experienced by those from Black, Asian and minority ethnic backgrounds.

We have:

held a launch event on 26 January 2021, chaired by BMA council chair Chaand Nagpaul, with talks from key speakers like Baroness Doreen Lawrence, Doyin Atewologun and Roger Kline

called for ending racial harassment in our NHS, which is experienced from the outset of a career in medicine, through our charter against racial harassment in medical schools

called on the government in early April 2020 to act on the damaging and disproportionate impact of COVID-19 upon BAME NHS staff, key workers and communities, and we have continued to robustly lobby to protect our ethnic minority members from harm

engaged with NHSE WRES (NHS Workforce Race Equality Standard) in October 2021 on the development of its race equality strategy

developed buddy and mentoring schemes to help IMGs settle into their roles, in their geographical areas and to adjust to the transition of working in the NHS.

BMA Welsh FREE

Find out more about the forum in Wales and how you can get involved.

The forum will elect two members to the UK's BMA FREE on an annual basis, in order to represent the views of members in Wales.

Contact us if you wish to join BMA Welsh FREE.

BMA Scotland race equality forum

If you wish to find out more about getting involved in BMA Scotland race equality forum, please email Scott Anderson.

The forum will elect two members to the UK's BMA FREE on an annual basis, in order to represent the views of members in Scotland.

Should you have any further queries about BMA FREE, please email us.

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BMA FREE (forum for racial and ethnic equality)

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Created in response to calls from our members for greater support for doctors and medical students from Black, Asian and minority ethnic backgrounds.

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The British Medical Association is the trade union and professional body for doctors in the UK.

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What is discrimination?

Direct discrimination

This occurs when someone is treated less favourably than another person because they have a protected characteristic or because they are perceived to have a protected characteristic (discrimination by perception).

Direct discrimination also occurs when a person is being treated less favourably because they are linked or associated with someone who has a protected characteristic. This kind of discrimination is sometimes referred to as discrimination by association. This has been extended, from race, religion or belief and sexual orientation, to cover sex, gender reassignment and disability.

An example of direct discrimination

An anaesthetist refuses to work with a colleague because they believe the colleague to be gay, irrespective of whether the colleague is gay or not (discrimination by perception).

A consultant is overlooked for promotion because their partner has undergone gender reassignment (discrimination by association).

Indirect discrimination

This occurs when there is a rule, policy or practice that applies to everyone but which particularly disadvantages people who share a particular characteristic.

An example of indirect discrimination

An employer who requires staff to commit to working from 8pm to 11pm every evening indirectly discriminates against women, who are more likely to be primary carers of children.

Indirect discrimination has been extended to include disability and gender reassignment. Moreover, indirect discrimination can be justified only if it can be shown that it is necessary to meet a legitimate objective in a fair, balanced and reasonable way.

Consideration should be given to whether there is any other way to meet the objectives that would not have a discriminatory effect, or that is less likely to disadvantage people who have a protected characteristic. Although pregnancy and maternity are not specifically included, any policy or practice that would put pregnant women or new mothers at a disadvantage could constitute direct discrimination on the basis of sex.

Harassment

This is defined as unwanted conduct related to a protected characteristic, although, the protected characteristic does not necessarily have to belong to the victim. Harassment can also be unwanted conduct that is sexual in nature.

In both these cases the conduct must have the purpose or effect of violating a person's dignity or creating an intimidating, hostile, degrading, humiliating, or offensive environment for them.

An example of unwelcome physical contact

This may range from unnecessary touching or brushing against another person's body, physical assault, coercing sexual intercourse, physical threats, insulting or abusive behaviours or gestures. This may also encompass invading someone's personal space; by standing very close to him or her where this is unnecessary.

An example of unwelcome written, visual or physical interaction

This may include sending unwelcome emails, notes or pictures, displaying or sending offensive material (for example, displaying pin-ups of males or females in states of undress), making obscene or offensive gestures, persistently sending unwanted gifts, or following, spying or stalking someone.

An example of unwelcome verbal conduct

This may include the making of remarks and comments about appearance, lewd comments, sexual advances, innuendo and banter, the making or repetition of offensive or stereotyped comments, jokes or songs, the making of threats or the making of patronising comments (for example, comments which repeatedly draw attention to a person's disability or impairment).

The definition of harassment has been extended so that it now prohibits harassment based on association with, or perception of, a protected characteristic.

Examples of harassment based on perception or association

A GP partner makes offensive remarks and jokes about people with autism to another GP partner who has a son with autism (harassment based on association).

A nurse spreads rumours and makes offensive comments because they believe a colleague is Muslim, irrespective of whether the colleague is a Muslim or not (harassment based on perception).

Victimisation

This occurs when someone is treated badly because they have been involved with an action in relation to the Equality Act. Examples include making or supporting a complaint or raising a grievance about discrimination or because it is suspected that they have done, or may do, these things.

A person does not have protection under the Act from victimisation if they have made or supported a malicious, false or knowingly untrue complaint.

An example of victimisation

A Trust manager gives a specialty doctor unrealistic or impossible deadlines after they have made a formal complaint of discrimination.

A consultant talks negatively about a junior doctor behind his back and makes disparaging, ridiculing or mocking comments after he complained of bullying.

The protection against victimisation has been strengthened. The victim is no longer required to show that they were treated less favourable in comparison to someone else who was not involved in an action under the Equality Act; the victim only needs to show that they were treated badly.

What does the law say?

Equality legislation has been simplified with over 116 separate pieces of legislation brought together into a single Act, the Equality Act 2010 which came into force on 1 October 2010.

The nine main pieces of legislation that have merged are:

The Equal Pay Act 1970

The Sex Discrimination Act 1975

The Race Relations Act 1976

The Disability Discrimination Act 1995

The Employment Equality (Religion or Belief) Regulations 2003

The Employment Equality (Sexual Orientation) Regulations 2003

The Employment Equality (Age) Regulations 2006

The Equality Act 2010 makes it unlawful to discriminate on the basis of any of the protected characteristics.

What are the protected characteristics?

The Equality Act 2010 covers the same groups that were protected by the previous equality legislation but extends some protections to groups not previously covered, and also strengthens particular aspects of equality law.

The 'protected characteristics' in the Act are:

Age

Disability

Gender reassignment

Race (this includes ethnic or national origins, colour and nationality)

Religion or belief

Sex

Sexual orientation

Marriage and civil partnership

Pregnancy and maternity

Making a complaint

Claims submitted to Employment Tribunals must be received within the three-month period immediately after the alleged act of discrimination occurred.

For example:

If the act of discrimination happened on 1 March, the claim must be received by the tribunal on or before 31 May.

If the act of discrimination happened on 5 March, the claim must be received by the tribunal on or before 4 June.

This is a statutory time limit and has been set by Her Majesty's Courts and Tribunal Service. Therefore, it is advisable that individuals take the first alleged act of discrimination from which to calculate their time limit.

This is particularly important in harassment complaints. If the time limit is calculated from the last alleged act of harassment, then the previous acts will be out of time for consideration by the tribunal and this could limit compensation, unless the Tribunal rules that it is a continuing act.

The three-month deadline means it is essential that there is no delay in contacting the BMA for support.

The employment adviser will listen carefully to the member's concerns and will advise accordingly. The member will be advised, not only of the legal position but also on the best strategy for addressing the member's concern.

Learn about the conditions for BMA membership
Learn about the benefits of being a BMA member

I don't want to make a complaint. Can things be resolved informally?

Sometimes. In our experience it is preferable for all concerned if a complaint of discrimination can be resolved informally. It is important to note that informal resolution must be speedy to be effective.

Our objective in the first instance will, therefore, be to try to resolve issues without the need to pursue a formal complaint, including an application to an employment tribunal, alleging unlawful discrimination.

The time limit of three months less one day from the date on which the act of discrimination occurred means that it may be necessary to submit an application to the tribunal to ensure that the member's interests are fully protected.

How do I submit a formal complaint to my employer?

In certain circumstances it may not be possible, or appropriate, to seek an informal resolution of the member's complaint.

In these circumstances the matter will be referred, in the first instance, to the employer's procedure for dealing with complaints of alleged discrimination. Serious allegations of harassment are normally dealt with under the employer's bullying and harassment policy or disciplinary policy.

Not all employers have exactly the same procedure but the following features should be common to all disciplinary policies.

Common features of employers bullying and harassment or disciplinary procedures

The investigation into the complaint will be confidential, as far as is compatible with a thorough investigation.

There will be different procedures for addressing complaints that employees make against fellow employees, patients, visitors, employees of other organisations, etc.

The complaints procedure will be separate from the employer's grievance procedure, but there will be rights of representation in line with the provisions of the grievance procedure.

There will be specific provision to deal with complaints against a person who, directly or indirectly, manages or is managed by the complainant.

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Guidance on what discrimination is, what to do if you are being discriminated against, and how to make a complaint.

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The BMA DLN network for elected members is a network for elected members with disabilities, long term conditions, neurodiversity.

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The British Medical Association is the trade union and professional body for doctors in the UK.

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Our purpose

The BMA network of elected women (NEW) is a group of BMA elected women members who will champion and strengthen female leadership and advance diversity for the benefit of our Association.

We recognise that the collaboration of different voices at all levels and from all backgrounds is key to unlocking our collective potential.

Our aim is to:

focus on inspiring continuous personal and professional development of our elected women members

support members to develop the skills and confidence needed to become effective medico-political leaders, committee representatives and ambassadors for the BMA's work on gender equality

hold networking events

act as a hub where we listen to each other and engage with our membership, colleagues and partners in a common endeavour

team with partner organisations that share our vision and connect with the wider community.

Knowledge sharing

Who can join the network of elected women?

Membership of NEW is open to any women BMA members who hold elected or appointed positions on BMA committees and regional structures, and those elected or appointed to attend BMA conferences.

Email us at [email protected] to find out more about the group or to express an interest in joining.

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The BMA Network of Elected Women (NEW) is a BMA-wide group which helps and supports elected women members.

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[Full Episode] Sophia Bush on I Weigh with Jameela Jamil | Activism & Finding Hope for Change

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Have you ever been in a situation where you want to challenge someone's behaviour - but you didn't know how to do it or what to say?

As part of NHS EnglandsAnti-racism strategy, we have commissioned 12 x 90 min virtual Active Bystander Training workshops, facilitated by the 'Active Bystander Training Company'.

Please see below for further information. If you have any questions, please contact eandtevents.eoe@hee.nhs.uk.

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Active Bystander Training | East of England

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Have you ever been in a situation where you want to challenge someone's behaviour - but you didn't know how to do it or what to say? As part of NHS EnglandsAnti-racism strategy, we have commissioned 12 x 90 min virtual Active Bystander Training workshops, facilitated by the 'Active Bystander Training Company'.

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Podcast: The future of gender equity - A discussion with Peggy Clark and Japleen Pasricha

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In this Women’s Day special episode ICRW President Peggy Clark and FII Founder-CEO talk about the future of gender equity and more!

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What Is Gender Equity And How Is It Different From Gender Equality?

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Although gender equality is the ultimate goal, it is only through gender equity that it can it be achieved.

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Deconstructing Privilege: Equality, Equity & Justice

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More often than not, when we are at a privileged position in the society, we fail to acknowledge it as what it is: a privilege.

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What is Benevolent Sexism? | Feminism In India

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Let's talk about Men and Masculinities | Feminism In India

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What is internalised misogyny? | Feminism In India

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S01E07: Where do men fit in the Feminist movement? | Intersectional Feminism—Desi Style!

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How is Feminism Political? | Feminism In India

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S01E10: How is Feminism Political? | Intersectional Feminism—Desi Style!