“Witness to Harm” NIHR research inputs into the Royal College of Surgeons of England supporting and Reporting event

London, United Kingdom, 16th October 2024

An event was held at the Royal College of Surgeons of England (RCS) entitled ‘Supporting and Reporting’. This event was designed to mark the year since the publication of a paper outlining research on sexual harassment and abuse within the surgical workforce (Begeny et al., 2023). It included leaders of various health professions, employers, legal counsel, those involved in training health professionals, regulators, and trade unions.  The programme was co-developed by RCS’s Working Party of Sexual Misconduct in Surgery and Prof. Rosalind Searle, who drew on research from the “Witness to Harm” project (NIHR 131322) to advance understanding of sexual harassment and abuse reporting journeys.

One of the prime inputs from the NIHR project was in an opening panel that considered the future of reporting building on the research and experiences of raising concerns to professional regulators and shortcomings. Two members from the Witness to Harm research team were included: Patient Public Engagement lead Richard West, and Co-investigator Prof. Searle. In their contributions to this panel, they drew on insights from the project’s research to focus on two key issues - trust and harm.

Trust emerged as a critical matter in the journey to reporting as there was often a failure to recognise that individuals raising concerns with professional regulators had already had direct experience of crisis and trauma through the origin experience. For members of the public this is likely to have comprised personally traumatic events while receiving health care with deeply affective content, while professional colleague witnesses may also have direct experience of traumatic events in their employment. Both are likely to have already experienced NHS complaints and investigations processes, which necessitated their re-engagement with the original event, but more critically added further negative experiences. These new experiences may have led them to question their confidence and trust in these internal investigations, impacting their confidence in the workplaces that have tolerated the original harms.

Harms - the investigations at the local level and then by the regulator were found to be often protracted. Thus, depriving individuals of the means of achieving closure and resolution (e.g. grieving). They necessitated witnesses having to remain in a period of limbo which could often extend over a number of years. The delays and stop-start processes of investigation and then the Fitness to practise (FtP) hearing were not only deeply unsatisfactory, but actually added further harm by creating lacunas which required witnesses to remain engaged with their prior trauma. Such experiences undermined their sense of well-being, and added new trauma.

Witnesses, therefore, do not come to reporting through a neutral route, but instead are likely to have had a range of prior experiences that have left them feeling unsupported at best, but more commonly, more harmed. These traumas are added to in their regulatory journey. We found reporting to a regulator was often disappointing and distressing.

Critically, despite regulators often having a policy on safeguarding and supporting witnesses, our study showed the experiences of those reporting concerns added new and additional harms to their existing traumas. This is especially apparent in cases which proceed to a professional regulatory FtP hearing. We found FtP focuses on the registrant, and not the interests of the witness. It is a process concerned with whether the registrant was fit to remain on the register and in practice, so not about providing justice for injured parties. However, the FtP process fails to recognise witnesses’ prior trauma. This was very notably from witnesses’ experiences of cross-examination by the defence legal counsel, which left witnesses unable to give their best evidence of events, nor to describe its impacts on their lives.

Trust in the regulator has already been raised as a concern in 2023 by the British Medical Association, the trade union for doctors, who stated they had no confidence in the General Medical Council. Our study identified the accumulated harm for witnesses as they raised their concerns to different parties. We found they were often not heard or were silenced by others, with each such experience adding a further betrayal that extended the harm beyond the original event through the subsequent layers of the processes. Each of these events could undermine their trust and amplify the harm. In this way trust breaches extended from the interpersonal dyad of the origin event to include different groups of professionals they receive care from, and in the investigating and reporting processes, the wider health and social care bodies, including professional regulators.

Our study raised important, and previously hidden experiences of those whose concerns were being raised by them for altruistic reasons – to try and ensure that their experiences were not repeated for others. Instead, we found witnesses were often treated without respect and care. These experiences failed to recognise them as someone who had experienced prior trauma.

A further way that we were able to use our “Witness to Harm” finding was in this event’s round table session. These round tables included leaders of various health professionals, employers, legal counsel, those involved in training health professionals, regulators and trade unions. We used some of the determination cases and witness experiences to devise aggregated anonymised scenarios for these discussions. Each table had a scenario that participants were asked to reflect on and consider how their own organisations would support witnesses and promote reporting. The scenarios included a range of origin events; some occurred within the workplace, or at a conference, or outside work. Feedbacking their responses highlighted distinct groups of witnesses who were more likely to be vulnerable. It revealed shortcomings in different organisations’ reporting processes and offered insights into where more support was needed.

Working with the Royal College of Surgeons of England and others in this event demonstrated the relevance of our findings and recommendations and their value in improving awareness of reporting journeys and enhancing understanding of how employers and professional regulators could better support colleagues and witnesses.

Prof. Rosalind Searle, Adam Smith Business School, University of Glasgow, UK

This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR 131322). The views expressed are those of the author, and not necessarily those of the NIHR or the Department of Health and Social Care.

Footnotes:

Begeny, C. T., Arshad, H., Cuming, T., Dhariwal, D. K., Fisher, R. A., Franklin, M. D., Jackson, P. M., McLachlan, G. M., Searle, R. H., & Newlands, C. (2023). Sexual harassment, sexual assault and rape by colleagues in the surgical workforce, and how women and men are living different realities: Observational study using NHS population-derived weights. British Journal of Surgery, 110(11), 1518–1526. https://doi.org/10.1093/bjs/znad242