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What is NES Doing to Tackle Sexual Harassment in Healthcare?

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What is NES Doing to Tackle Sexual Harassment in Healthcare?

As part of my Scottish Clinical Leadership Fellow position with NES, I have been involved in establishing a Shadow Leadership Board. Here, trainees can raise important issues which affect their personal, professional lives and training experiences and contribute to active change. We recently discussed the repulsive findings of the Working Party into Sexual Misconduct in Surgery. At a recent Medical Directorate Reference Group meeting, current work in this area by senior leadership, was discussed. We as a shadow board, feel that it is pertinent that trainees are informed of the current position of NES and what is being done to address the findings of this appalling report. Below is an update written by Mr Alastair Murray, Consultant Orthopaedic Surgeon and Deputy Postgraduate Dean, who is currently leading on some of this work. Support links are also attached at the end of this letter.

Few should now be unaware of the shocking findings of the Working Party into Sexual Misconduct in Surgery (WPSMS) which were published in September last year. Based on survey findings from over 1,400 respondents, they reported that two thirds of women and a quarter of men had experienced sexual harassment at work. More than 80% had witnessed sexual misconduct with 10% feeling that they had been coerced into inappropriate interactions. Tragically 30% of women and 7% of men had been victims of sexual assault.

This report was not the first to highlight this issue and perhaps the most upsetting aspect of its impact was that many, mostly female, colleagues expressed little surprise and indicated that the findings were consistent with their lived experiences working in our healthcare system. Many others, mostly male, were shocked by the findings having felt unaware of these behaviours evidently prevalent around them. This apparent diversity of experience and awareness highlights another major finding from the WPSMS that most people who are subject to sexual misconduct chose not to report their experiences. For the few that did, most felt that the result was inadequate.

While the WPSMS focussed on the surgical workforce in England, it would be disingenuous to hope that their findings are not relevant to the entire healthcare workforce across the UK. Not only is it abhorrent that many colleagues feel unsafe at work but it is well understood that these behaviours impact on patient safety as they impair our abilities to perform our roles to the best of our abilities.

The WPSMS made a number of recommendations which were endorsed by the statutory education bodies (including NES), unions, Colleges and NHS employers.

NES has developed the following work streams to contribute to delivering on these recommendations in Scotland:

1. Policies and procedures

All Scottish Health Boards, including NES, operate with a “Once for Scotland” set of policies. These include a policy on Bullying and Harassment (B&H) which is intended to cover sexual harassment. Some concern was expressed that this policy may not have offered sufficient guidance on handling disclosures of sexual harassment where a different, trauma informed approach was required. NES has been involved in discussions with partners including HR directors and the Scottish Government to seek enhancement of this policy with provision of additional material specific to sexual harassment and this work is now underway.

NES has also been promoting exploration of guidance around asymmetric relationships at work. Many industries have policies in place to mitigate against such relationships as they are seen as a potential for conflict of interest or coercive behaviours. The WPSMS report would seem to support that such coercive activity is one of the enablers of sexual misconduct in healthcare. NES has taken the independent step of issuing guidance to its medical staff requiring disclosure to line managers of any intimate relationships which could be perceived as asymmetric to allow appropriate safeguards to be put in place. Whether this is adopted more widely by NHS Scotland is subject to discussion.

2. Support

One of the most harrowing aspects of the WPSMS report’s findings was that most people don’t disclose what has happened to them and therefore do not access support. NES wanted to ensure that healthcare staff in training were able to see the Trainee Development and Wellbeing Service (TDWS) as somewhere that they could come to seek independent help. The TDWS has invested in training for its team to enhance their skills at supporting those affected. It has also been working on developing supportive material and links on its web pages and to promote self-referral to the TDWS when help and advice is needed.

3. Education

This is always a fundamental part of changing culture. Recent years have seen a great improvement in the availability and uptake of helpful educational material in this area. NES has been working on developing additional material on sexual harassment at work which will be added to a newly developed hub on TURAS on Equality, diversity and cultural learning resources. Training Programme Directors have also been asked to support trainees to demonstrate evidence of appropriate and effective learning on these topics as required by the Generic Professional Capabilities in all, current medical curricula. We wish to see trainees and trainers have a greater awareness of sexual safety at work and to have learning on how to act to address these behaviours and promote cultural change.

4. Reporting and monitoring

It is hoped that the developments with TDWS and the work in many of the employing boards will promote reporting of sexual misconduct to allow access to help but also promote awareness. NES will from this year include a question in the Scottish Trainee Survey asking if someone has experienced or witnessed sexual misconduct at work. This will provide information to the Quality Management team to inform their interactions with boards where problems are reported.

Changing a culture which for too long has been permissive of appalling behaviours requires a great deal of work and wide engagement. It is hoped that the actions outlined above will contribute to achieving the safe and supportive culture that we, and our patients, deserve. Above all it requires the highest standards of leadership from the medical profession. We must always be aware of our responsibilities as role models and our obligation to speak up, not walk past, when we see behaviours which are unacceptable. Only then will we succeed in creating the culture we so desperately need.

Alastair Murray, Consultant Orthopaedic Surgeon and Deputy Postgraduate Dean, NES.

Mr Alastair Murray, Consultant Orthopaedic Surgeon and Deputy Postgraduate Dean
Dr Priya Sharma, Scottish Clinical Leadership Fellow  

What is NES Doing to Tackle Sexual Harassment in Healthcare?

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