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“We reduced sexual safety incidents with better reporting systems and talking to patients about sex”

  1. Adele Waters, freelance journalist,
  2. Ingrid Torjesen, freelance journalist
  1. London

Sexual safety leads Sally Ashton and Emma Furlong share their story as part of The BMJ and Guardian’s investigation into sexual assault in the NHS

“When you make reporting clearer, you get an increase in reported incidents because people understand what they are reporting,” says Sally Ashton, a nurse who leads on sexual safety at Gloucestershire Health and Care NHS Foundation Trust, a mental health and physical care provider. The trust introduced a sexual safety policy in January 2022 and changed the way that sexual safety incidents were reported so that staff understood what to report and what incidents were happening on wards.

“If you didn’t have that context you might think, ‘Oh, incidents are going up—that’s not good.’ But actually it’s because people understand what they are reporting and the need to report it,” she says.

Ashton is a member of the Sexual Safety Collaborative,1 a programme of work commissioned by NHS England to improve sexual safety in mental health trusts in England. The collaborative discovered that one way of managing sexual safety incidents in the NHS is for staff to recognise and normalise the sexual needs of their patients and for staff to be trained to talk to patients about appropriate ways to express themselves sexually.

“We have to recognise that when someone becomes a hospital inpatient, their sexual needs tend to be the last thing that staff think about,” says Emma Furlong, sexual safety lead at East London NHS Foundation Trust and a member of the Sexual Safety Collaborative. “And we thought we needed to completely demystify that, along the lines of saying, ‘Look, you’re a human being with sexual needs.’ Service users have all got their own individual bedrooms, and, if they want to masturbate, they can ask for a bit of private time.”

Furlong says that a real “stand out” success is the work the trust has done on a ward for male adults with mild to moderate learning disabilities. “There was a really high incidence of sexual safety incidents on the ward. We used a quality improvement approach and methodology to reduce that rate. We put in place interventions like having meetings on the wards with patients where they could talk about sex, their sexual needs, and how to address those needs in simplified language. It was about being really open: discussing the impact of their behaviours, telling them they were able to watch soft porn within our service and negotiating quiet time to access that porn without being disturbed.

“We tracked incidents every single day, so month by month we would track whether incident rates were going up or down. Initially, the floodgates opened, and the number of incidents was very high, as people started to talk about it more and discuss the behaviours and the consequences of the behaviours.

“Over a sustained period of time, the number of incidents started to reduce and then reduce further so now it’s running at below three sexual safety incidents per month. At the outset, we were looking at between 20 and 30 per month.

“We are talking mainly about sexually inappropriate behaviours like staring, following people and touching them, brushing up against staff, and making inappropriate comments. And predominantly, that came from the patients towards staff or to each other.”

A chief barrier to this work is staff lacking confidence when talking about sex, Ashton says. “If you’ve got a patient who is openly exposing himself on a ward and masturbating in front of other patients, you have to say: ‘This isn’t appropriate; you need to go to your bedroom, you need to pull your trousers up and remove yourself from the communal area,’” she says. “It’s about being very clear and emphasising that it’s not appropriate.

“But if you think about the workforce, we’ve got a very diverse workforce with a range of different backgrounds and cultural differences. And talking about those things is not going to be easy for many people, so they too will feel uncomfortable talking about them.”

Both sexual safety leads have focused their work on mental health inpatient settings but say that their knowledge should be shared with other hospital trusts. “This approach should be rolled out to general settings because staff in general hospitals get sexually assaulted too,” said Furlong. “I think it would be brilliant if it could be.”

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