Principles

Trusts are responsible for their patients’ and staff's welfare and safety, and cannot assume that everyone knows or is committed to the idea that sexual or other harassment of patients or staff is unacceptable. The first step therefore is to make this clear. The importance of being proactive, apart from the intrinsic morality and duty to prevent harm, is that sexual harassment of a variety of kinds is common, and can go on for years without being acted against. It is not enough to rely upon ‘professional codes’ and their regulatory enforcement, although these may help. Recent guidance from the General Medical Council (GMC) on this topic – Maintaining Boundaries (2006) – is strongly recommended, as are the recommendations of the Council for Healthcare Regulatory Excellence (2008).

Sexual harassment and abuse of patients by doctors can fall into any, or all, of the following categories of transgression:

All have their own methods of investigation and sanctions, which unfortunately may be at cross-purposes with each other, and so clear liaison links and responsibility are vital. While College and GMC guidelines have been revised, and the legal situation changed with the Sexual Offences Act 2003 (Home Office, 2004), the employer has a primary responsibility for setting clear standards and ensuring enforcement. Trust policies should apply to all staff, not just clinicians, and be explicit about what sorts of behaviour are acceptable and which are not acceptable. They should include what sorts of ‘touch’ are allowable, whether exceptions about sexual relationships are permissible with ‘former patients’ and, if so, how this could be defined. If there has been a pre-existing, or there is a current, such relationship with a patient or carer, it should be the responsibility of the member of staff to discuss this with a manager. Other boundary issues, such as socialising or financial transactions, also need discussion, as they can be part of a ‘slippery slope’. In addition, supportive ‘whistle-blowing’ policies are essential so that staff, regardless of their status, can safely report concerns about other staff's behaviour.