Abuse and Sexual Assaults in the NHS: Investigations

Daisy Cooper Excerpts

Tuesday 16th May 2023 Westminster Hall

[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?