Abuse and Sexual Assaults in the NHS: Investigations

Tuesday 16th May 2023 Westminster Hall

11:00

[Dr Rupa Huq (in the Chair)]

I will call Daisy Cooper to move the motion and then the Minister to respond. There will not be an opportunity for the Member in charge to wind up, as this is a 30-minute debate.

[Daisy Cooper (St Albans) (LD)]

I beg to move,

That this House has considered the adequacy of investigations into abuse and sexual assaults in the NHS.

It is a pleasure to serve under your chairship, Dr Huq. Today’s topic is one that I never in a million years thought I would have to table for debate, but because of two brave constituents and two investigative journalists, I am here to share their stories and shine a light on the shocking scale of the problem.

It should go without saying that hospitals should be places where all patients, visitors and staff should feel safe and be safe. Vulnerable patients entrust themselves and their care to strangers in an unfamiliar environment. Overworked nurses and other NHS staff work long shifts in understaffed buildings, often arriving or leaving their place of work in the hours of darkness. Patients, visitors and staff can find themselves isolated in cupboards, clinics or car parks out of public sight, and it is seemingly in those places that thousands of instances of sexual assault, misconduct and rape are perpetrated every year.

A brave constituent of mine—let us call her Joan, which is not her real name—told me that she was a survivor of sexual misconduct by a medical professional during her treatment. Soon after it happened, Joan disclosed it to her GP, who raised a complaint to the specific NHS trust. The complaint was treated by the NHS trust’s human resources team as an employer-employee dispute. What was Joan’s status in this? Not a victim, not a complainant. She was relegated to being nothing more than a third-party witness: a third-party witness who not only was treated appallingly by the medical professional’s council, but was not even entitled to know the outcome of the case—the case in which she was the victim.

Joan did not know whether any other complaint mechanisms were available to her or what the scope or limitations of each one might be, and she was not medically fit enough to find out. She trusted that the NHS trust would do the right thing. Thanks to her GP, Joan was then contacted by the General Medical Council, which wanted to investigate the professional concerned, but Joan was not mentally or medically in a position to progress the case. She tried to progress it about seven years later, but she was prevented from doing so by the GMC’s five-year rule, which prevents the GMC from investigating a professional’s fitness to practice if the case is older than five years. The GMC can, of course, still investigate where there are exceptional circumstances in the public interest, but the GMC told me that Joan’s case did not meet the threshold. It would not tell me how it defined “exceptional circumstances” and refused to disclose the legal advice that it had received about the definition.

Joan attempted to raise the case with the Parliamentary and Health Service Ombudsman. The PHSO replied that its remit is more procedural and administrative, and that it would not be the appropriate organisation. It redirected Joan to other organisations that were better suited to investigate—the GMC and the trust’s own disciplinary process, both of which she had used and both of which had failed her. The Professional Standards Authority oversees the GMC and other health regulators, but it too said that it could not investigate the case itself. Separately, Joan had a personal injury case against the hospital and secured a significant payment as a result, but we believe that the medical professional concerned is still practising.

Since 2020, I have sent 14 letters to different organisations, including three to the Government, and have tabled a number of written parliamentary questions to work out how this could have gone so badly wrong. What we have uncovered is shocking. First, there is no tailored support available for patients reporting incidents of a sexual nature. Patients are unclear about which organisations they can complain to, with NHS trusts, the GMC and the PHSO sometimes suggesting that each of the others is better placed to investigate. The GMC’s five-year rule continues to be a major barrier for investigating the fitness to practise of medical professionals perpetrating sexual misconduct on patients or other medical professionals.

Secondly, there has been no discernible progress on implementing the recommendations of three inquiries and reports from the Professional Standards Authority. Thirdly, no clear or systemic collection of data of reports of sexual abuse and misconduct within the health service is available for public or parliamentary scrutiny. Fourthly, the recent revelations by investigative journalists, which were published in Byline Times, of thousands of rapes and sexual assaults across the NHS mean that immediate action is needed to make our hospitals safe from sexual predators.

On the first issue—the staggering lack of support for survivors and the opaque reporting process—the NHS directs all patients to the patients advice and liaison service for complaints in the first instance. However, the route to escalate a complaint of sexual misconduct is not straightforward. A search online fails to direct individuals to NHS or Government resources that are instantly and clearly available. The options that do exist to address sexual abuse and misconduct often have limitations that patients are unaware of when embarking on a complaint, meaning that they discover them only in the course of trying to make such a complaint.

I have already explained through Joan’s case how the NHS’s disciplinary hearings, and the processes of the PHSO and the GMC all have shortcomings. We urgently need a simple and clearly signposted process that is designed for complaints of a sexual nature. We also need the five-year rule to be scrapped. Any case of sexual misconduct in the NHS should meet the tests of being both exceptional and in the public interest to investigate, but that is clearly not how the rule has been interpreted.

Two years ago, in 2021, the Department of Health and Social Care held a consultation on proposed regulatory reform of the GMC that would include the removal of the five-year rule. That would rightly reduce barriers to the investigation of serious cases of sexual misconduct where patients may not have felt in a position to report them at the time or where they were simply unaware that they could do so. The GMC itself is in favour of scrapping the five-year rule but, two years later, the Government refuse to say when they will respond and scrap the five-year rule, which I hope they will do. Perhaps the Minister will be able to tell us in this debate.

The second major problem that I identified was the repeated failure to follow up on three inquiries and the Government’s own report. Each inquiry found systemic failures in the NHS’s handling of reports of sexual misconduct. One called on the Government

“to develop and publish specific accessible information for patients on what they should and should not expect in consultations and who they can speak to for advice and assistance in relation to disclosures of alleged abuse.”

But to the very best of my knowledge and research, there has been no subsequent publication or announcement by the Government or any other responsible agency that seeks to act on the recommendations of those three inquiries.

The third problem on which urgent intervention from Government is needed is the shocking lack of data that prevents anyone from identifying the real scale of the abuse in health services. I tabled a series of parliamentary written questions over the past two years about the recording and monitoring of sexual abuse in the NHS. The Minister may remember the responses she gave on 9 November 2021 and 17 February 2022. She advised that

“all National Health Service organisations must prepare an annual report covering the number of complaints the organisation received”.

She later confirmed:

“While there is no specific requirement in legislation to categorise complaints by allegations of sexual abuse, NHS organisations are required to record the subject matter of complaints. NHS organisations must ensure that their complaints annual reports are available to any person on request.”

However, when I asked NHS England about accessing that data, it said that

“there is not a specific code for complaints of a sexual nature. Therefore in order to extract this data would require us to review every complaint received. In each year we receive between 6,000-8,000 complaints. If this information was requested under the Freedom of Information Act, this would most likely be exempt as it would exceed the threshold for time taken to provide a response.”

That is gravely concerning, first and most obviously because the Government are currently unable to gauge the scale of the problem, and, secondly, because local organisations tasked with commissioning much-needed advocacy support services simply are not able to do so. Will the Government mandate NHS England to create a specific code for complaints of a sexual nature?

Tenacious investigative journalists have uncovered some data. Sian Norris and Sascha Lavin have revealed that more than 4,000 patients, visitors and NHS staff were raped or sexually assaulted in hospitals in England and Wales during the past four years. However, this data could not be collected from the NHS trusts themselves. Instead, it had to be gleaned from police force records, because—incredibly—the NHS does not collate this information.

I am sure the Minister will be aware of a survey for Nursing Times in 2021 that found that three in every five nurses had been sexually harassed at work, with barely a quarter of these incidents being reported to employers, because nurses just do not believe it will get them anywhere. I mentioned at the beginning a second constituent who is a medical professional. She raised a complaint with her managers, only to come to the same conclusion—namely, that her complaint just would not go anywhere.

Although all of this is incredibly shocking, none of it should be news to the Minister here today. She will know that I put all of this detail to the former Secretary of State more than a year ago, on 13 May 2022. I did not receive a response for several months, but when I did I am afraid to say that it simply regurgitated all of the routes that I had complained about in my original correspondence. In further letters to and fro, the replies told my constituents and me nothing that we did not already know, and a promised ministerial meeting, which was rearranged four times, never came to pass. Although my constituents are not physically in attendance, they are following this debate closely on parliamentlive.tv. I have no doubt that many more survivors of these abhorrent crimes will be listening, too. They all want to know what the Government will do.

I have a series of questions for the Minister. First, will the Government finally respond to the GMC consultation and scrap the GMC’s five-year rule, which allows perpetrators of sexual misconduct to evade investigation after five years and continue working in the NHS? Secondly, will the Government create a specific and clearly signposted complaints system for complaints of a sexual nature, so that patients, visitors and staff can report allegations within health services and are able to identify which organisations they should approach in order to do so?

Thirdly, will the Minister make a statement about the handling of sexual abuse cases in the NHS and say whether any recommendations from the previous three inquiries and the PSA reports will be incorporated into the existing systems? Fourthly, will the Government mandate the NHS to create a specific NHS complaint code to register, collate and monitor data on sexual abuse and misconduct within health services, which can be made readily available for public and parliamentary scrutiny, and for local bodies that commission advocacy services for victims?

Finally, but most urgently, will the Minister set out what action she has taken or will take to make our hospitals a safe place for patients, visitors and staff, free from the sexual assaults, misconduct and rapes that are seemingly happening in our NHS every single day?

11:15

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

It is a pleasure to serve under your chairmanship, Dr Huq, and I thank the hon. Member for St Albans (Daisy Cooper) for securing this important debate. First and foremost, I want to express my utmost respect for the bravery and resilience shown by all those individuals, whether patients, staff or visitors, who come forward to report sexual safety concerns in the NHS. None of those incidents is acceptable, and I reassure hon. Members that we are taking this matter extremely seriously. We have been doing significant work in this space for a while, and sexual abuse is one of the key priorities in the women’s health strategy published last year. We believe sexual abuse and violence is a health issue.

The Secretary of State and I held a meeting a few weeks ago with health leaders from across the NHS to discuss how sexual misconduct, harassment and abuse in the NHS are being dealt with. We discussed the actions that the Government are taking in collaboration with the NHS to combat the problem. We expect every NHS trust to take action to ensure the safety of patients, staff and visitors on its premises.

I will come back to the data in more detail, but we know that victims and perpetrators can span a mix of patients, staff and visitors, and that the highest number of cases occur in mental health settings. We take that very seriously indeed. A rapid review is happening at the moment. It is looking at in-patient mental health settings and, specifically, sexual abuse and the data around it. We will respond to the review shortly.

Tackling sexual violence and abuse, and ensuring that all patients and staff who experience sexual violence and abuse are supported, are top priorities for NHS England. Domestic abuse and sexual violence are more likely to be disclosed to a healthcare professional than to any other professional, and often, some data that records sexual violence is not always about sexual violence that happens within the trust, but if a report is made to a healthcare professional—by a fellow member of staff, a visitor or a patient—it is reported through NHS data systems. That is not to say that abuse does not happen within the setting itself, but it does explain why the figures are sometimes significantly higher—healthcare professionals have a duty to report any complaints they receive.

Sexual safety covers a range of inappropriate sexual behaviours with different legal and operational definitions, including language of a sexualised nature, sexual harassment, sexual assault and rape, but every one of those is unacceptable.

The hon. Member asked what we are doing. We are taking action. We expect local NHS employers to be proactive in fully supporting staff and patients, and ensuring that their concerns are listened to and acted on. We encourage anyone who has been a victim to come forward and report that, in the knowledge that the report will be taken seriously. Every organisation within NHS England systems, whether community trusts, hospital trusts or any other setting, has robust systems in place not just for reporting allegations and concerns, but for following them up. All reports must be recorded, investigated and dealt with by NHS providers. That includes, where necessary, taking action against the perpetrator, but also involving the police.

While local leaders of NHS organisations have a statutory duty to look after their staff and patients, we are taking action in this space nationally. NHS England has expanded the remit and scale of the domestic abuse and sexual violence programme to co-ordinate work on sexual safety in healthcare settings, and it has recently appointed the first national clinical director, Dr Peter Aitken, to make our NHS safer, with a focus on areas such as data collection and reporting, prevention, and early intervention and support for those who have experienced sexual violence and abuse within the NHS.

Data is important, and data on sexual safety is being recorded. We can see that through the national reporting and learning system, which takes all the data from local datasets. Where local risk management systems from trusts around England are reporting in, that is fed through to the national reporting and learning system, so that we have oversight of the scale and types of problems that are being seen.

Building on commitments in the women’s health strategy, NHS England is collecting more consistent and granular information on patients who experience sexual violence and domestic abuse. The domestic abuse and sexual violence programme is consolidating NHS England’s data improvement actions into a single cross-cutting project. Data is important so that we know the type of incidents that are happening, where they are occurring and in which settings. It means we can quickly pick up any single perpetrator who may be acting in one or multiple trusts and can ensure safeguards are put in place as quickly as possible.

Data collection is not the only tool we have; this is also about reporting. The data is only as good as the information that is reported, and that is why we are encouraging people to come forward if they have been a victim or if they have witnessed an incident about which they have concerns. Unless we know about it happening, the action that can be taken to prevent incidents happening again is limited.

The hon. Member spoke about professional regulators. If staff, patients or visitors go to a trust and either feel that the complaint was not taken seriously or that action has not been forthcoming, there are also professional regulators. She talked about the GMC and I will come to the five-year issue in a moment. Professional regulators take action and have complaint systems in place that allow anyone to report a concern. We also have freedom to speak up guardians, particularly for staff. They can whistleblow if there are concerns about the culture or behaviour in a particular setting, so that staff can feed in concerns without having to go to their line manager or a member of their team. That will be treated confidentially.

We are committed to making it easier for patients to report historical concerns and are looking at modernising the GMC’s five-year rule. There was a consultation recently on regulating healthcare professionals. The Government responded to that in February and said they would take that forward, so there are plans to modernise the GMC’s five-year rule on complaints. I will happily update the hon. Member on timelines after the debate. The patient safety commissioner, who looks after patient safety across the board, is in post, and I am happy to discuss with her how we can co-ordinate responses from trusts and regulators so that they are joined up and so patients and staff feel their responses are not being passed from one organisation to another.

However, better data collection and good reporting is not enough on its own. We have to take action to stop sexual safety incidents happening in the first place. That is why NHS England has committed to a number of preventive actions, including creating a gold standard for policies, support and training relating to staff who experience sexual violence. That is being rolled out across ICBs, trusts and royal colleges, because it is important to create a culture where people feel safe to come forward and where, if their complaints are not taken seriously, they have someone else to go to who will listen to them and their complaints will be responded to.

In particular, in mental health settings, the NHS patient safety strategy is running a mental health safety improvement programme specifically focused on sexual safety. It is important to ensure that safeguards are in place to protect vulnerable patients who may not be able to say no but do not have the capacity to consent.

Where sexual incidents do occur in the NHS, the right support must be available. NHS England has commissioned 48 sexual assault referral centres across England, which are open 24/7. They provide medical, practical and emotional support to victims, whether their sexual assaults occurred outside the NHS, but they are reporting it to NHS practitioners, or the incidents occurred within the setting.

We have rightly focused on patients, but I want to make the point that the data shows that staff are the most common victims of sexual assault, so work is being done to support staff and to make their workplaces safer. We have a high number of patient-on-patient incidents, too, so it is not always staff-on-patient incidents. We absolutely need to take robust action against any staff who assault or commit sexual violence or abuse on any patient, but we also need to ensure that patient-on-patient abuse is identified as quickly as possible, that safeguards are in place and that our staff are protected from violence from patients or visitors.

In the short period of time that I have had, it has been difficult to go through all the initiatives we are putting in place to adequately and accurately record the scale of the problems. We want people to come forward and we want numbers to be recorded. We need to ensure that the reporting processes are in place and that action is taken at a national level, by each individual trust and by the healthcare regulators. Delivering on this agenda is a top priority and I cannot overstate my personal commitment to progress in this space. Again, I recognise the bravery of every patient and staff member who has witnessed or been the victim of sexual abuse. I am happy to keep Members updated on the progress we are making in this space over the coming weeks and months.

Question put and agreed to.

11:26

Sitting suspended.