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Why it’s wrong to wait for an inquiry on sexual misconduct in the NHS…

New research published by JRSM Open, the open access companion journal to the Journal of the Royal Society of Medicine, reported that only one NHS Trust in England offers standalone training on sexual harassment intervention. Here one of the study authors, Dr Sarah Steele of the University of Cambridge, calls for immediate, active intervention to address the pervasive issue of sexual misconduct in the NHS.

The NHS has an alarming prevalence of sexual misconduct cases, encompassing a range of troubling incidents of sexual harassment, abuse, assault, and rape.(1)  A recent investigation identified 35,606 such incidents recorded by NHS trusts in the past five years.(2) Yet, these figures seem questionably low considering the size of the NHS workforce and its patient populations. Self-reporting surveys suggest around 8.1% of healthcare staff alone have experienced sexual harassment in the last year while at work.(3) With sexual misconduct affecting an individual’s physical and mental health, while also significantly impacting workplace morale, staff retention, and patient care, the issue is pressing. Added to this, NHS Resolution reports GBP£4,020,231 was paid out for sexual misconduct between 2018-2022,(4) suggesting misconduct is also diverting critical NHS resources. Consequently, there are growing calls for an independent inquiry into sexual misconduct within the NHS. (5)

Changing NHS culture

But there are options for immediate action now.(6) Our findings, published by JRSM Open, suggest that, at present, the NHS is under-utilising one such strategy – active bystander training (ABT), also known as active intervention training.(7) Simply winding ABT out around sexual misconduct alongside other poor behaviour could go a long way to changing the NHS culture of tolerating sexual misconduct. Such training not only empowers individuals to know their options and take action when they witness incidents, but also encourages reporting and supporting. Added to this, such training encourages us to think about collective responsibility and systemic issues, rather than seeing misconduct as just the result of a few bad apples.(8)

Active bystander training

ABT, long championed as a potent tool against harassment, has been widely adopted across numerous sectors, now even featuring as part of national and local government strategies to end harassment and violence.(9,10) These programmes aim to foster a culture of identifying and addressing inappropriate behaviour, transforming those who encounter poor behaviour from passive observers to active intervenors.(11) But when we surveyed 213 NHS Trusts, enquiring whether they offer ABT and the specifics of these programmes, we found a mere 35 currently offer such training, and only one trust offered training focused on sexual misconduct as its remit. Even more alarming is that these training sessions are not mandatory, but rather provided on an opt-in basis, resulting in low participation rates.

Training - Promo

What is ABT and why might my workplace consider it?

ABT, also called active intervention training, includes learning around recognising a situation of potential issue, deciding to intervene, and on the options for responding safely.

Training covers options for intervening, such as directly confronting the situation, redirecting attention elsewhere, seeking help from others, checking in on the affected person after the situation, and/or making a record of the incident accurately for future reference or reporting.

The training can be stand alone or integrated into other learning opportunities like simulation. Training can be focused on harassment from patients as well as from staff.(11–13)

Self-perpetuating cycle

With only one Trust offering a standalone module on sexual harassment, a strikingly low figure given the pervasiveness of the issue, we sought to explore content looking for potential opportunities for including sexual misconduct in training, but we could not. A majority of ABT programmes are not handled in-house but outsourced to private providers, especially in London. This outsourcing further muddles the issue as private providers often prohibit Trusts from sharing their training materials, even internally, a policy that significantly impedes content analysis and evaluation, as well as learning from colleagues. Furthermore, this lack of transparency and rigour in evaluation not only stymies local efforts to improve training programmes but also stalls global knowledge sharing across health systems. We are thus faced with a self-perpetuating cycle, where the lack of robust data undermines the potential endorsement and implementation of ABT within the NHS.

Notably, we also found that among the 163 Trusts without any ABT programmes in place, only 23 have any plans to implement such training, barely scratching the surface of the need. The conclusion drawn from these findings is clear: ABT is a significantly underused resource within the NHS, despite its proven effectiveness in other countries in their hospitals.(11,13) The gravity of the situation cannot be overstated. The pervasive issue of sexual misconduct needs immediate, active intervention.

Mandatory training

For this, the NHS needs to swiftly implement widespread ABT, including standalone modules on sexual harassment, and to make such training mandatory rather than optional. The involvement of private providers should not serve as a barrier to transparency and evaluation. More robust monitoring and evaluation processes must be put in place, and the NHS needs to actively engage in knowledge sharing across global health systems. We should also explore the wider integration of ABT within other training opportunities like simulation exercises and examinations, for medical professionals, trainees and students.(14)

The issue of sexual misconduct cannot be tackled with a few token measures. It demands wholehearted commitment to change from all stakeholders within the NHS. By integrating ABT into the core of their professional development strategies, the NHS can not only address this immediate concern but also foster a more respectful, supportive working environment for all staff.


  1. Bagenal J, Baxter N. Sexual misconduct in medicine must end. The Lancet. 2022 Mar 12;399(10329):1030–2.
  2. Bawden A, Batty D. NHS staff report 20,000 claims of patient sexual misconduct over five years . The Guardian [Internet]. 2023 May 23 [cited 2023 May 23]; Available from:
  3. UNISON. Health staff are suffering serious sexual harassment at work [Internet]. UNISON News. 2019 [cited 2023 May 23]. Available from:
  4. NHS Resolution. FOI 5761 [Internet]. London; 2023. Available from:
  5. Bawden A, Batty D. England hospitals under-reporting sexual misconduct, say experts . The Guardian [Internet]. 2023 May 23 [cited 2023 May 23]; Available from:
  6. Choo EK, Byington CL, Johnson NL, Jagsi R. From #MeToo to #TimesUp in health care: can a culture of accountability end inequity and harassment? The Lancet. 2019 Feb 9;393(10171):499–502.
  7. Robertson A, Steele S. A cross-sectional survey of English NHS Trusts on their uptake and provision of active bystander training including to address sexual harassment. JRSM Open [Internet]. 2023 Apr 4 [cited 2023 May 19];14(4):205427042311666. Available from:
  8. Fleming S. With sexual harassment or assault, what you permit, you promote. BMJ [Internet]. 2023 May 23 [cited 2023 May 23];381:p1117. Available from:
  9. Home Office. ENOUGH: What is abuse? [Internet]. GOV.UK. 2023 [cited 2023 Mar 8]. Available from:
  10. Mayor of London. Have A Word With Yourself, Then With Your Mates [Internet]. 2023 [cited 2023 May 23]. Available from:
  11. Relyea MR, Portnoy GA, Klap R, Yano EM, Fodor A, Keith JA, et al. Evaluating Bystander Intervention Training to Address Patient Harassment at the Veterans Health Administration. Women’s Health Issues. 2020 Sep 1;30(5):320–9.
  12. Byerley JS, Dodson NA, St Clair T, Walker VP. Creating Work and Learning Environments Free of Gender-Based Harassment in Pediatric Health Care. Pediatrics [Internet]. 2022 Sep 1 [cited 2023 May 23];150(3). Available from: /pediatrics/article/150/3/e2022058880/188902/Creating-Work-and-Learning-Environments-Free-of
  13. Fenwick KM, Potter SJ, Klap R, Dyer KE, Relyea MR, Yano EM, et al. Staff and Patient Perspectives on Bystander Intervention Training to Address Patient-Initiated Sexual Harassment in Veterans Affairs Healthcare Settings. Women’s Health Issues. 2021 Nov 1;31(6):576–85.
  14. Aitken D, Shamaz H, Panchdhari A, Afonso De Barros S, Hodge G, Finch Z, et al. Twelve tips for developing active bystander intervention training for medical students. Med Teach [Internet]. 2023 May 19 [cited 2023 May 23];1–8. Available from:
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