International Women’s Day Spotlight
international studies, it is useful to remember this. Sexual harassment is unwanted behaviour of a sexual nature. The law in the UK is the Equality Act 2010, which protects people at work against sexual harassment. Those protected specifically are: l Employees and workers. l Contractors and self-employed people hired to personally do the work.
l Job applicants.
To meet the description in law, the harassment or unwanted behaviour must have either violated someone’s dignity, whether it was intended or not, or created an intimidating, hostile, degrading or humiliating environment whether it was intended or not. Sexual harassment can include sexual jokes or comments, physical behaviour, including unwelcome sexual advances or unwanted touching. It also includes displaying photos or drawings of a sexual nature or sending messages, emails or other communications with sexual content. With the context of the operating theatre very
much in mind, as this author writes, there is a great deal of banter in surgery at appropriate times, much of which could be misconstrued or interpreted to be of a sexual nature. This may offend and meet the above descriptors. It is also a reinforcement of the hierarchy which exists in healthcare, with the perpetrator of the behaviour as the senior medical professional in theatre. The literature cites that the main reason for lack of reporting of the events which have offended is fear of repercussions on the career of the reporter and equally a belief (often realised) that nothing will be done. Sexual assault is defined in different ways
across the UK. Sexual assault is defined in a statutory way under the Sexual Offences Act 2003 and includes indecent exposure, sexual threats and unwanted touching and rape or assault by penetration, including attempts by any person, a partner or family member. In Scotland, Violence against Women
encompasses, but is not restricted to, physical, sexual and psychological violence occurring in the family, within the general community, or in institutions – including domestic abuse, rape, incest and child sexual assault. Rape is by a person (A) who commits an
offence if he intentionally penetrates the vagina, anus or mouth of another person (B) with his penis. B does not consent to the penetration and A does not reasonably believe that B consents.9
UK experience Apart from the anonymised stories on the Surviving in Scrubs website, a study undertaken at the University of Exeter reports academically on the data collected by WPSMS. The study shows that there is a widespread lack of confidence in the adequacy of key regulatory bodies and accountable organisations in handling the issues, which reflects a serious flaw when considering the changes in culture required to reduce incidents. There is also a useful title of ‘active
bystander’ - i.e. everyone in the team must take responsibility to be part of the change required. Nurses and other perioperative staff, including the anaesthetists, can have a considerable impact if they are supportive of the victim and help to make change happen in the environment. It is recognised that this takes considerable action and robust mechanisms in the Trust or hospital concerned.
One year on from ‘Breaking the Silence’ WPSMS have followed their original report with a further one,10
report in red, amber and green to indicate how well their recommendations are being acted upon. There is much work left to do but there is now a formal structure to report behaviour into the Ministry of Health and Social Care. They also state that there are mandated policies now for every Trust on sexual violence and sexual safety and also that the CQC requires reports of incidents. The Royal College of Surgeons of England identifies that they have introduced a new Code of Conduct which sets out expected behaviours of its members and includes tackling sexual misconduct. This author has some concern that,
altogether, there has been little recognition that the environment where most of these incidents take place (according to the data), is on the wards and in the operating theatre. There is a tight knit team surrounding surgical operators in theatre and it is of concern that there has been little mention of how supportive these team members can be. Usually in the face of this behaviour, the victim feels isolated and demeaned, but acknowledgement and assistance from other witnesses could provide knowledge of how to report and personal support to the individual. It would be helpful to have active support
a year after the first, to
examine progress on their recommendations. The authors provided a colour coded progress
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www.clinicalservicesjournal.com I March 2025
from anaesthetic colleagues who are frequently also witnesses. Turning a blind eye is no longer acceptable. In addition, the WPSMS has recommended that education is an important aspect of changing the culture and calling out the perpetrators of the worst behaviours. The education should be available and undertaken by all members of the surgical and perioperative team.
NHS England has worked up a zero-tolerance policy, as well as a variety of surgical specialty
Dragana Gordic -
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