Tackling and preventing sexual misconduct in health and social care - a Q&A

Q: Why did the PSA decide to focus on preventing and responding to sexual misconduct in health and care settings?

A: Sexual misconduct is a serious issue for both patient safety and public confidence. It can cause significant harm to patients, service users and professionals, and it can undermine trust in health and care services. The PSA considered it important to create space for discussion about what effective prevention and response should look like across the system, hearing from experts working on this issue in different ways and from different perspectives.

Q: What framework emerged from the webinars to help people think about prevention?

A: One of the most important themes of the sessions was that in order to effectively prevent sexual misconduct, it needs to be addressed from a number of different angles at the same time. This aligns with the “lines of defence” model that we have discussed in our policy work, including in our recent new version of Right-touch regulation. The lines of defence model provides a practical way of understanding prevention as a shared responsibility across the system. It emphasises that different people and organisations, from individual professionals to national bodies, each have a distinct role in reducing risk, identifying concerns early and supporting an effective response when issues arise.

Q: What is the first line of defence?

A: The first line of defence is the individual professional. This includes maintaining professional boundaries, reflecting on how pressure or stress may affect behaviour and safe care, and recognising when a colleague’s conduct may be giving cause for concern and acting on that.

Q: What role do teams play as part of the first line of defence?

A: Teams are an important part of creating and sustaining safe cultures. They can support prevention by maintaining open discussion about professional standards, reflecting on how risks may arise in practice in their specific setting, and responding promptly when behaviour or wellbeing gives cause for concern. Teams also need to foster an environment in which raising concerns is supported and acted on appropriately, and where colleagues feel comfortable and supported in speaking openly with each other.

Q: Why are employers considered the second line of defence?

A: Employers play a central role in shaping the organisational conditions in which misconduct is either more or less likely to occur. That means putting in place clear policies, trusted reporting routes and fair processes for responding to concerns. It also means recognising sexual misconduct as a serious patient safety issue, including where both perpetrator and target are health or care professionals, or other members of the workforce. Support for those who have been affected is essential.

Q: What is the role of regulators and national bodies as the third line of defence?

A: Regulators and national bodies have an important role in setting expectations, promoting consistency and supporting improvement across the system. This includes making clear that sexual misconduct is unacceptable, helping to ensure that regulatory and organisational responses are compassionate, trauma-informed, fair and effective, and supporting a better shared understanding of warning signs, impact and good practice in prevention.

Q: What is the main message the PSA hopes people will take from this work?

A: The main message is that preventing sexual misconduct requires coordinated action at every level of the system. Individual professionalism, supportive team cultures, and effective organisational processes all matter. A layered approach strengthens prevention, improves the likelihood that concerns will be identified early, and helps ensure that responses are fair, timely and focused on safety.