Male physician touching female colleague's shoulder, sexual harassment at work place
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Only one in five NHS Trusts in England provide active bystander training to address workplace harassment – including measures against sexual harassment

Bystander training encourages individuals to recognise and respond to poor behaviour and harassment by equipping people with the skills to intervene.

Workshops and training programmes typically involve role-playing, case studies, and group participatory discussions to tackle unacceptable behaviour like bullying and racism, if seen in the workplace.

However, in most NHS trusts, this training is either non-existent, lacking in quality or optional for workers.

Researchers at the University of Cambridge, who conducted the study, note that a failure to implement active bystander training could prevent NHS attempts to tackle sexual harassment.

What contends as harassment in the workplace?

The Home Office has been actively promoting active bystander training interventions to reduce sexual harassment and violence against women and girls more widely.

Since 2017, when the #MeToo movement gained momentum around the world, sexual harassment in medicine has been recognised as both pervasive and harmful.

Harassment can include a range of verbal, online and physical acts, ranging from poor-taste jokes to unwanted touching to rape. It can have a major impact on the individuals it affects and on the healthcare workforce itself, researchers write.

‘both pervasive and harmful’

An analysis of data from Freedom of Information (FOI) found that even where some NHS trusts do have the training – the majority of which were in London – most did not deliver content specific to sexual misconduct and participation was voluntary.

Of the 199 trusts that responded, only 35 offered active bystander training

Only five of the trusts said their training addressed sexual harassment in some form, with the remaining 30 trusts saying their training taught participants to challenge antisocial behaviour only in a general context.

Among the 164 Trusts not offering active bystander training, only 23 Trusts had plans to implement it in the future. One Trust stated that they were actively developing plans to develop sexual safety training that will incorporate active bystander training.

14 of London’s NHS Trusts offered no training whatsoever, despite the training being paid for by NHS England, not individual Trusts.

Only one trust delivered content that specifically tackled sexual harassment in the workplace.

However, in a 2019 survey by UNISON, researchers found that 8% of respondents had experienced sexual harassment while at work during the last 12 months, with 54% of these acts being perpetrated by co-workers.

8% of respondents have experienced sexual harassment while at work

In their paper, researchers write: “Most ABT (active bystander training) programmes address undesirable behaviour and harassment in a general way only. This is deeply concerning considering the continued prevalence of sexual harassment in the healthcare sector and the staunch support of ABT by gender-based violence experts to reduce and prevent it.”

The authors call upon NHS leaders and policymakers to recognise the issues around training, including but not limited to its outsourcing to private providers. They say: “Without access to training materials for external evaluation, there is no means to assess the training adequacy and to share knowledge across NHS bodies.

“Policymakers should heed caution before winding out further training and recall that private companies have commercial interests to protect.”

“The NHS is failing to take advantage of a very effective training tool to address workplace harassment”

Dr Sarah Steele, of Jesus College, Cambridge and Cambridge Public Health said: “The NHS is failing to take advantage of a very effective training tool to address workplace harassment, sexual harassment and other forms of unacceptable behaviour such as bullying and racism.

“We found low uptake of active bystander training among NHS Trusts in England, particularly outside of London, and very little of the training that was on offer focused on sexual harassment. This is deeply worrying, given the continued problem of sexual harassment in the healthcare sector.

“In the face of a lack of workplace training, I’d encourage individuals to look at courses, like the one we offer at Jesus College, to equip themselves with these essential skills.”

Dr Steele is considering behaviour change interventions amongst healthcare staff for wider NHS adoption of ABT.


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