Safeguarding against sexual misconduct: essential information for NHS boards

Our chief executive Andrew Corbett-Nolan sees all too familiar root causes have prompted NHS England to issue new guidance of preventing misconduct. Boards must recognise that sexual misconduct is a governance issue, intertwined with risk management, culture and assurance.

In the wake of harrowing revelations about sexual misconduct within the NHS, the recent publication of updated guidance from NHS England alongside a high-profile criminal investigation serves as a stark reminder of the urgent need for robust governance in this area.

Because of GGi’s work supporting public-purpose organisations like NHS trusts to strengthen their leadership and assurance frameworks, we have seen firsthand how effective board oversight can transform organisational culture. In December 2025 NHS England published An Update on Actions to Prevent Sexual Misconduct in the NHS as details emerged from a criminal probe into assaults at a Midlands trust.

This demands immediate attention from every NHS board. This article outlines what board members need to know, the actions they must take, and draws on best practices from other sectors and international health systems. It also explores the Care Quality Commission's (CQC) perspective, emphasising that complacency is no longer an option in fostering safe environments.

The catalyst: recent guidance and investigations

NHS England's December 2025 updated guidance, published in December 2025, builds on previous efforts to eradicate sexual misconduct, defined broadly to include harassment, assault, and exploitation. It reports progress: every NHS trust and integrated care board (ICB) now has a sexual misconduct policy, and to date 76% offer anonymous reporting mechanisms. But that means 24% do not.

The guidance calls for greater consistency and introduces new mandates to address gaps. Key actions include nominating staff for specialised investigation training starting from March 2026, establishing review groups to assess concerns with safeguarding input, and updating chaperoning policies. All organisations must complete a sexual misconduct audit by February 2026, with primary care providers required to sign the Sexual Safety Charter and self-assess against a checklist by the same date. Boards, particularly chief executives and chief people officers, bear responsibility for implementation with NHS England monitoring via audits.

This guidance coincides with a chilling criminal investigation into sexual assaults at University Hospitals of North Midlands NHS Trust, specifically at Royal Stoke University Hospital. Staffordshire Police's probe, culminating in charges against a former doctor for offences against 38 patients — including sexual assault and attempted assault by penetration — highlights systemic vulnerabilities.

The Crown Prosecution Service (CPS) announced the charges in December 2025, following reports of incidents spanning years. While the investigation focuses on individual criminality, it exposes broader governance failures such as delayed responses to complaints, inadequate oversight of clinical practices and a culture where concerns may not have been escalated promptly. As The Guardian reported in 2023, over 20,000 claims of patient-on-staff sexual misconduct were logged across 212 NHS trusts in five years, underscoring that this is not isolated but a pervasive risk requiring board-level intervention.

For NHS boards, these developments signal a shift from reactive measures to proactive, zero-tolerance strategies. Sexual misconduct erodes trust, harms individuals, and exposes organisations to legal, reputational, and financial risks including potential compensation claims and regulatory sanctions. Also, the root causes are all-too familiar failings of good governance and instantly recognisable as more broadcast cultural problems for NHS boards to tackle – delayed complaints, inadequate oversight and a culture of failing to escalate concerns in a timely manner.

What NHS boards need to know

Boards must recognise that sexual misconduct is a governance issue, intertwined with risk management, culture, and assurance. Under the Health and Social Care Act 2008 and the Worker Protection (Amendment of Equality Act 2010) Act 2023, employers have a legal duty to take ‘reasonable steps’ to prevent harassment, including sexual forms.

The guidance emphasises that boards cannot delegate this away; they retain ultimate accountability. Sexual harassment and assault ruins lives. Board members of all NHS bodies must step up to the plate and ensure they preside over safe working and care environments.

Key knowledge points include:

• Prevalence and impact: NHS data reveals thousands of incidents annually, affecting staff morale, retention, and patient safety. In mental health settings, where vulnerabilities are heightened, the CQC has documented more than 1,120 sexual safety incidents in a three-month period in 2018 alone.
• Regulatory expectations: The CQC's well-led framework assesses how organisations promote safe cultures. Inadequate handling of sexual misconduct can lead to ‘inadequate’ ratings, as seen in trusts where boards failed to ensure effective reporting.
• Intersection with safeguarding: Misconduct often overlaps with safeguarding duties under the Care Act 2014, requiring referrals to the Disclosure and Barring Service (DBS) for those posing risks to vulnerable groups.
• Cultural dimensions: Boards must address power imbalances, particularly in hierarchical environments like hospitals, where fear of retaliation silences victims.

Ignorance is no defence. Boards must stay informed through regular briefings and integrate this into their risk registers.

Actions NHS boards must take now

The guidance provides a roadmap, but boards and governance professionals working in the NHS should act decisively. Immediate steps include:

• Policy review and implementation: Audit existing policies against the national framework. Ensure chaperoning aligns with new principles (e.g., patient choice, documentation). Primary care boards (via ICBs) must support providers in completing the Sexual Safety Charter checklist by February 2026.
• Training and capacity building: Nominate investigators for national training. Mandate e-learning on sexual safety for all staff, and train boards on oversight roles.
• Reporting and assurance mechanisms: Embed anonymous reporting, review groups for initial assessments, and clear escalation paths to police and regulators. Conduct the required audit by February 2026, using findings to refine board assurance frameworks.
• Cultural transformation: Foster open dialogues through staff surveys and ‘speak up’ guardians. Lead by example by modelling zero-tolerance via communications.
• Monitoring and evaluation: Specifically consider sexual safety as part of any cultural reviews and signal that this matters through quarterly reports of any incidents, resolutions and lessons learned. External reviews, like those GGi offers, can provide independent validation.

These actions align with GGi's ethos of developmental governance with the emphasis of turning compliance into cultural strength.

Best practices from other sectors and overseas

NHS boards can learn from beyond healthcare. In the UK, the Advisory, Conciliation and Arbitration Service (ACAS) and Equality and Human Rights Commission (EHRC) advocate risk assessments with clear policies and training to prevent workplace harassment across sectors like education and finance. The 2023 Worker Protection Act's ‘reasonable steps’ include anti-harassment training, confidential reporting and regular policy reviews mirrors this new NHS guidance but with emphasis on proactive risk mitigation. For instance, financial firms under FCA oversight use mandatory e-learning and whistleblowing hotlines, reducing incidents by fostering accountability.

Overseas, the World Health Organization (WHO) policy on preventing sexual misconduct (2023) offers a global benchmark mandating zero-tolerance, survivor-centred responses and compulsory reporting. It stresses integrating prevention into HR processes such as vetting and inductions, which is applicable to NHS recruitment. In the US, the Federation of State Medical Boards (FSMB) guidelines on physician misconduct recommend clear boundaries, chaperone mandates and board-level oversight of complaints, with sanctions for failures. RAINN (Rape, Abuse & Incest National Network) advises healthcare organisations on recognising abuse signs, patient education, and trauma-informed investigations. Iran's nursing studies highlight peer support networks and policy enforcement as key preventives, while UNDP's approach in humanitarian sectors emphasises cultural audits and survivor support.

Adopting these measures, such as WHO's survivor focus or FSMB's boundary training, can enhance organisational resilience.

The CQC's stance on sexual misconduct

The CQC has long flagged sexual safety as a priority, particularly in its 2018 report on mental health wards which called for national guidance after uncovering widespread incidents. Its Brief Guide: Sexual Safety on Mental Health Wards (PDF) provides inspectors with tools to evaluate protections, including risk assessments, staff training and incident reporting. In broader healthcare, the CQC's Promoting Sexual Safety (Issue 11, 2025) urges providers to safeguard against all sexual incidents, integrating this into key lines of enquiry under the ‘safe’ and ‘well-led’ domains.

Recent CQC inspections of trusts rated ‘inadequate’ for well-led do cite poor handling of sexual misconduct linking this to cultural failings. The regulator expects boards to demonstrate assurance through data on incidents, staff feedback and improvement plans. With the Health Services Safety Investigations Body (HSSIB) 2024 report on sexual safety implications, CQC aligns with calls for systemic changes reinforcing that boards must prioritise this to meet fundamental standards.

Conclusion: a governance issue

The convergence of NHS England's guidance and the Midlands investigation is a watershed moment. NHS boards must act not just to comply but to lead cultural change, ensuring every interaction is safe and respectful. Boards should look to some of the root causes such as poor culture, slow escalation and not being on top of complaints. If any of these sounds like your organisation, then your staff and patients are at risk.

References:

• NHS England (2025): An Update on Actions to Prevent Sexual Misconduct in the NHS
• NHS England (2025) Criminal Investigation into Sexual Assault in the Midlands
• Care Quality Commission (2025) Promoting Sexual Safety
• World Health Organization (2023): Policy on Preventing and Addressing Sexual Misconduct
• Federation of State Medical Boards (n.d.): Physician Sexual Misconduct Guidelines (PDF)
• Advisory, Conciliation and Arbitration Service (2024): Preventing Sexual Harassment.