Nearly a third of female NHS surgeons have been sexually assaulted by a colleague over the past five years, the largest survey of its kind has found.
Sexual misconduct is rife and appears to go unchecked in the profession, according to a research paper being published in the British Journal of Surgery today. Its authors warn that a misogynistic culture in hospitals poses a significant risk to patient safety.
Overall, two thirds of women working in surgery report having been sexually harassed by a colleague in or around the operating theatre. There were 11 instances of rape reported by surgeons who participated in the study.
The findings will raise further questions about the hierarchical structures and lack of accountability within parts of the NHS. The report says that sexual coercion is a major concern, with 11 per cent of female surgeons saying they have experienced “forced physical contact linked to career opportunities”.
In an article for The Times, Tamzin Cuming, a consultant surgeon and chair of the Women in Surgery forum at the Royal College of Surgeons of England, says that this is a “MeToo moment” for surgery. She calls for a “seismic change in the culture of healthcare”.
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The survey was commissioned by the independent Working Party on Sexual Misconduct in Surgery and supported by the Royal College of Surgeons, Health Education England and the Association of Surgeons in Training. The results have been presented to NHS England, the General Medical Council (GMC), which regulates doctors, and the British Medical Association.
The study was the largest of its kind ever conducted into the surgical profession. Researchers from the Exeter University and the University of Surrey analysed 1,434 responses to an anonymous online survey of surgeons. They concluded: “Sexual misconduct occurs frequently and appears to go unchecked in the surgical environment owing to a combination of a deeply hierarchical structure and a gender and power imbalance.”
Almost 90 per cent of women and 81 per cent of men had witnessed some form of sexual misconduct at work over the past five years. More than 40 per cent of women had received uninvited comments about their body from a colleague, 29 per cent had experienced unwanted physical advances and 38 per cent had endured sexual banter at work. An overwhelming majority of female surgeons had little or no faith in their NHS trust, the GMC or the Royal Colleges to protect them.
The paper warns that patient safety is being compromised by the apparent normalisation of sexual behaviour in and around operating theatres. Perpetrators who target colleagues “are more likely to transgress sexual boundaries with patients,” it states. “The result is an unsafe working environment and an unsafe space for patients.”
This year The Times Health Commission heard reports of sexual assault and harassment as part of a “boys’ club mentality” in surgery. That evidence is substantiated by the survey, which found that women lived ”different realities” from men in the male-dominated profession, more likely to witness and experience sexual assault. Only 28 per cent of surgeons are women.
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Dame Jane Dacre, former president of the Royal College of Physicians and a member of the Times commission, said the pervasive sexual misconduct was part of “an old-fashioned culture” that made women unwelcome. “It undermines professional relationships and results in a fearful and distracted female workforce. The patient should be at the centre of clinical activity, otherwise errors are more likely.”
Professor Carrie Newlands, a consultant surgeon and one of the report’s authors, said there was an urgent need to reform the way sexual misconduct was reported and investigated. “It is vital that regulators, colleges, employers and training authorities come together to take a zero-tolerance approach,” she said. “The system simply isn’t working.”
Tim Mitchell, president of the Royal College of Surgeons of England, insisted that there was “no place” for sexual harassment or assault in operating theatres or the wider NHS, describing the findings as truly shocking. He said NHS trusts and regulatory bodies needed to “take a long hard look” at whether their sexual misconduct policies and procedures were fit for purpose.
Charlie Massey, chief executive of the GMC, said updated professional standards for doctors set out a “zero tolerance” of sexual misconduct and the regulator would tend to take the view that serious sexual misconduct was “incompatible with registration”.
The Department for Health and Social Care said: “The health and social care secretary is clear that sexual violence or misconduct of any kind is unacceptable and has no place in the NHS. He is working closely with NHS leaders to root out this unacceptable behaviour and ensure services are always safe for staff and patients. In partnership with the royal colleges, staff, regulators and trade unions, the NHS recently launched the healthcare system’s first organisational sexual safety charter. Signatories commit to taking and enforcing a zero-tolerance approach to any unwanted, inappropriate and/or harmful sexual behaviours within the workplace.”
‘I didn’t make a fuss ... we were about to operate’
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Philippa Jackson, a consultant plastic surgeon from Bristol, was discussing a patient with a male colleague when he moved in to give her a hug. “He made some noises and rubbed himself against me,” she recalled. “And then, as he backed away, he said ‘You probably felt my erection then,’ and he also told me he could see down my top.”
The encounter seemed so at odds with the sterile, clinical setting of the hospital that she wondered whether she had misunderstood the situation.
“I didn’t make a fuss because we were about to go into theatre and I don’t think I had properly registered what had happened,” she told The Times Health Commission in April. “I thought, ‘That’s creepy’, but it didn’t mean I couldn’t do my job. So I did what I had to do.”
Later that evening she was back with the same colleague for an emergency operation. This time his behaviour was even more overt. After offering to tie up her gown — which is standard procedure among surgeons — he said, ‘Now you’ve given me permission to tie you up under any circumstances’ and he kissed me on my neck from behind.”
Again they were about to go into surgery so she put it to the back of her mind. “You feel trapped in the circumstances. I don’t think any of us really wants to believe that we’re vulnerable,” she said.
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Eventually, Jackson wrote to the hospital detailing the incident but was discouraged from making a formal complaint. “They did an investigation, which was quite superficial. The questions to me were very much focused on ‘Did you say no? Did you push him away? Did anyone see it?’ You’re made to feel it’s your fault.”
The man was not suspended and shortly afterwards Jackson left for another job. “You survive, then move on to the next place and just hope it doesn’t happen again,” she said.
Surgery is male-dominated
Roshana Mehdian-Staffell, a trainee trauma and orthopaedic surgeon, described a “boys’ club mentality”. One male doctor suggested to her that full-time surgery was “not an appropriate career choice” for mothers.
“I’ve been sexually harassed lots of times,” she said. “I’ve had people come into the sluice room [where waste is disposed of] and stand behind me and grind themselves on me. There was one time when someone walked in and said, ‘You’ve got your short trousers on — make sure you always wear them because your ankles are really sexy’.”
Surgery is still one of the most male-dominated parts of medicine. Although women make up more than half of the places at medical school, only 28 per cent of surgeons are female. The numbers are even smaller at the top of the profession and only 15 per cent of consultants are women.
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There are high drop-out rates among female trainees. Surgical trainees rotate around different hospitals every year, making it hard to combine the job with family life. Flexible working is frowned upon and sometimes impossible. Female surgeons have higher than average miscarriage and infertility rates.
Even the surgical instruments are designed for male hands. Joanna Maggs, a consultant orthopaedic surgeon in Devon, described how she had to balance on a stool during some parts of an operation. “The operating table height doesn’t go down quite low enough for me,” she said. “When you’re using big power tools, it can feel quite precarious.”
Liz O’Riordan, who retired as a consultant oncoplastic breast surgeon in 2019, said that she had experienced sexual harassment in two thirds of her surgical jobs in a career spanning more than 20 years.
“It was usually in theatre, when you’re operating next to your boss, your superiors, and your peers,” she said. “You’re wearing thin cotton scrubs and you have full body contact. It was knuckle brushes on your breasts, touching your bum, comments about your sex life, lewd suggestions to make you blush. And when it happens, no one else in the theatre responds.”
She did not feel comfortable speaking about her experiences until she had stopped working as a surgeon.
“There was one occasion when I did say something, and I had a very uncomfortable meeting with a boss and someone from HR. I had to work with that man for the next few months and I backtracked. There is a fear of speaking out when your job depends on the training and references from the person harassing you.”
Jackson said that she had “no faith in the system” to protect her from men such as the colleague who assaulted her. “It’s absolutely devastating because people put their lives in our hands,” she said. “They trust us at their most vulnerable moments and there are people out there taking advantage. I’ve been a patient and it frightens me now to think what’s happening when I’m unconscious because not everybody is there with good intentions.”
• Sexual assault, crude banter — what it’s like to be a female surgeon
Regulators have taken note, but there’s more to be done
The surgical profession is starting to have a difficult, open conversation about a problem that female surgeons have long shared in whispers between themselves (Kat Lay writes).
A review by the human rights lawyer Helena Kennedy KC of diversity and inclusion in surgery, commissioned by the Royal College of Surgeons of England in 2021, concluded that racism, sexism and homophobia were widespread in operating theatres, including “jokes” being made about rape and sexual assault.
Then a few brave women put their heads above the parapet last year to share the sexual harassment and abuse they had experienced in NHS surgery. They also set out how, when they had attempted to report the culprits, little was done and no support was offered.
Anger at the revelations provoked what has become a MeToo movement in surgery. Regulators have taken notice, with the General Medical Council adding a clause to its professional guidance this year noting that doctors must not “act in a sexual way towards colleagues with the effect or purpose of causing offence, embarrassment, humiliation or distress”.
While surgery has been a male-dominated specialism, few think other parts of the health service are immune.
This month the NHS launched a “sexual safety charter” for hospitals and GP surgeries, requiring them to take a “zero-tolerance approach” to tackling sexual misconduct, including “appropriate and timely action against alleged perpetrators”.
Today’s survey results show how much work needs to be done.
• The Times investigates the crisis facing the health and social care system in England. Find out more about The Times Health Commission
