Abuse and Sexual Assaults in the NHS: Investigations

(Limited Text - Ministerial Extracts only)

Tuesday 16th May 2023 Westminster Hall

[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.