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Trust in healthcare undermined by ‘bad apples’ ground-breaking research reveals

Research based on analysis of 6,714 cases of professional misconduct by health and care professionals and published today has identified three different types of perpetrator:

  • the self-serving ‘bad apple’
  • the individual who is corrupted by the falling standards of their workplace, and
  • the depleted perpetrator struggling to cope with the pressures of life.

The study1 led by Professor Rosalind Searle at Coventry University’s Centre for Trust, Peace and Social Relations examined 6,714 fitness to practise determinations from the Authority’s database2 covering doctors, nurses, social workers and paramedics amongst others.

Professor Searle and her team applied cluster analysis to identify how different kinds of misconduct group together for the different professions. They also looked in more detail at cases involving sexual boundary violations and dishonesty.

Chief Executive, Harry Cayton says: ‘This research is the most ambitious project yet undertaken to use the information contained in the Authority’s database of fitness to practise determinations. In this report, Professor Searle offers us a rich and fascinating discussion of the complex and subtle interplay between individual professionals, teams, workplaces, gender and culture.’

Professor Searle who proposed this ground-breaking approach to the Authority, is a professor of organisational behaviour and psychology, says: ‘In shining the spotlight on professional practice in the health sector, we’re examining relationships that are often intimate in nature and based on trust and confidence between health workers and service users. It’s crucial, therefore, for us to analyse where and how these taken-for-granted notions are being undermined through misconduct, and to take steps towards reducing instances of such behaviour. The findings in our report represent important progress in understanding and tackling the issue, and in ensuring trust and confidence in the health professions is preserved.’

The findings from the study have much broader implications and go beyond the regulatory process.  We look forward to discussing them widely, looking at how they can be used to support preventative interventions in future by regulators, employers, and others.

The report: Bad apples? Bad barrels? Or bad cellars? Antecedents and processes of professional misconduct in UK Health and Social Care: Insights into sexual misconduct and dishonesty (2017) is available here.


Professional Standards Authority for Health and Social Care


Christine Braithwaite

Director, Standards and Policy

Reception: 020 7389 8030


Notes to the Editor 

  1. The Professional Standards Authority for Health and Social Care oversees nine statutory bodies that regulate health and social care professionals in the UK.

  2. We assess their performance and report to Parliament. We also conduct audits and investigations and can appeal fitness to practise cases to the courts if we consider that sanctions are insufficient to protect the public and it is in the public interest.

  3. We also set standards for organisations holding voluntary registers for health and social care occupations and accredit those that meet them.

  4. We share good practice and knowledge, conduct research and introduce new ideas to our sector. We monitor policy developments in the UK and internationally and provide advice on issues relating to professional standards in health and social care.

  5. We do this to promote the health, safety and wellbeing of users of health and social care services and the public. We are an independent body, accountable to the UK Parliament.

  6. Our values are at the heart of who we are and what we do. We are committed to being impartial, fair, accessible and consistent in the application of our values.

  7. More information about our work and the approach we take is available at


1Bad apples? Bad barrels? Or bad cellars? Antecedents and processes of professional misconduct in UK Health and Social Care: Insights into sexual misconduct and dishonesty (2017). This research was conducted by Professor Rosalind Searle, Dr C Rice, and Dr A A McConnell of the Centre for Trust, Peace and Social Relations, Coventry University with additional input from Professor Jeremy Dawson, University of Sheffield. The research was funded by the Professional Standards Authority. Press enquires for Coventry University should be directed to Alex Roache at; queries about the research should go to Professor Searle at

2Fitness to Practise determinations are the summary records of final hearings in fitness to practise cases. Each regulator notifies final fitness to practise decisions to the Professional Standards Authority and this data is contained on a database. Our power to do this comes from the NHS Reform and Health Care Professions Act 2002. See note 2 below for more details or go to: