One year after a sex attacks scandal, are Scotland's hospitals getting safer?

"The first lot we got, we were horrified,” says Mary Howden of Women’s Rights Network Scotland (WRNS). “Then we were equally horrified by the rest.”

It has been a year since the former social worker and other volunteers uncovered a scandal in Scotland’s hospitals: sex crimes committed in the health estate. Harm caused in places dedicated to healing. And their initial findings were only touching the surface.

What they were seeing in black and white responses – lists of sexual assaults and rapes – gave Howden and her WRNS colleagues reason to pause as they pulled together research for their landmark report, How Safe Are Our Scottish Hospitals? It collated data on sexual offences conducted within healthcare settings over the five years from 2019 to 2024. The figures were obtained from Police Scotland via freedom of information (FoI) requests and revealed 276 assaults and 12 rapes across 57 sites. Just over half of the incidents ended in a criminal charge.

As if that wasn’t troubling enough, the responses showed that data was simply unavailable for the vast majority of Scotland’s hospitals – breakdowns for just 57 of 198 sites were provided.

“What we realised is that what we were talking about is people who have been sexually assaulted when they are at their most vulnerable. We thought, should we be doing this? Will it put women off going into hospital? Of course, we don’t know,” she says.

The result caused headlines and strong conversations in parliament. But what WRNS really wants is change: guarantees that decisive action will make hospitals safe for all. 

A year on, Howden isn’t convinced that’s happening. “If you were taking your patient safety seriously then why would you not be very clearly getting messages out to the public that you are on top of this – ‘we want you to be safe, we know who is committing these offences and the circumstances in which they are happening’,” she asks.

As for deterring women from accessing healthcare, medical ethicist Dr Leila El Alti, of Edinburgh Napier University, contends that many patients already weigh up that option. A researcher whose work covers normative ethics, nursing theory, obstetric violence, person-centred care and mental illness, El Alti says “mistrust in medical systems” is “for good reason”. “I don’t think it’s irrational,” she says. “You can be raped in a hospital ward. You can be assaulted in psychiatric care.”

The WRNS report, which includes analysis by Carolyn Brown, a former deputy principal educational psychologist, follows a similar production two years earlier by the English arm of the organisation and covering England and Wales. That paper, authored by criminologist Professor Jo Phoenix, found that more than 6,500 rapes and sexual assaults were recorded in hospitals in England and Wales over nearly four years, with just four per cent of suspects known to have been charged. One in seven of these happened on wards, and several included attacks on children under the age of 13.

It was a sickening picture which Phoenix said proved that health bosses were “failing in their duty to protect both patients and staff”. “There appears to be ingrained inertia in dealing with this safeguarding and policing failure,” she said.

It is tempting to attempt a like-for-like comparison with Scotland. But the publicly available data for Scottish hospitals is so bad that this would not be credible. In FoI requests for 133 hospitals, the data requested could either not be given or was not held. In eight others, it was refused on privacy grounds. 

And within what we have, we don’t know how many patients, staff or visitors are involved as victims or perpetrators. Never mind their ages, we don’t even know their sexes. 

But what we do know is that the true scale of such offending is likely to be far higher than currently understood – not only due to data gaps, but also because sexual offences are often underreported. “It is happening, whether it is reported or not,” says El Alti. 

Howden and colleagues, who published a partial-year review in December, are working on an update of their report. But FoI responses to queries submitted in September are running months late, delaying that work. “They’ve started to come in now,” says Howden. “The most frustrating thing about it is that this isn’t my day job, but there are people whose day job it actually is, and they don’t seem to be doing anything about it.”

We are so far away from a solution because we don’t understand what is happening

The Scottish Government has said “health boards have a legal duty, and reporting systems in place, to record data on sexual assault, violence and aggression” and staff are strongly encouraged to make such reports. “All instances should be reported and escalated to Police Scotland as quickly as possible for consideration of necessary action,” the government said.

But WRNS says that approach is clearly not working, and wants a systemic change to address the matter: single-sex wards “wherever clinically feasible”; mandatory reporting of the sex of both victim and perpetrator in all sexual assault incident reports; the publication of annual national figures for sex offences in NHS Scotland facilities, broken down by sex; a stronger line on the provision of same-sex intimate care, where requested by patients; mandatory staff training on dignity, consent and same-sex care preferences; a cross-party working group; an independent national inquiry on sexual violence in healthcare settings. “It’s like they have abandoned any thoughts about the protection of women,” Howden says.

From the available data, almost six in 10 sexual offences in hospitals took place on a ward. At 20 incidents, Stobhill Hospital in Glasgow had the highest number of sex assaults, with Edinburgh Royal Infirmary at 18. Thirteen were recorded at private facility Cygnet Wallace in Dundee. Maternity, paediatric and palliative care facilities were also listed. “Given all established research on sexual assaults identifies women and girls as the victims, it can be readily assumed that most of the victims of sexual assault recorded in this report will have been women and girls,” the report said. 

Labour MSP Claire Baker, who has raised the report in parliament, says the need to rely on assumptions is part of the problem, along with a lack of institutional interest in the matter. “We are so far away from a solution because we don’t understand what is happening,” she says. “Somebody somewhere should have been saying, ‘we need to interrogate this’.”

From the part-year review, WRNS found only three health boards – NHS Greater Glasgow and Clyde, NHS Tayside, and NHS Forth Valley – had made changes to their incident recording systems, and four – Borders, Grampian, Lothian and Tayside – said they had policies in place on the provision of intimate care to female patients by male staff. 

Getting information hasn’t been easy, says Howden a former head of education and workforce development at the Scottish Social Services Council, with appropriate health board contacts hard to find, and she’s concerned by what she sees as a lack of urgency in responding. “If you’re operating a system that puts your patients at risk, then why wouldn’t you make sure that your patient safety was top notch? 

Everyone has the right to access healthcare or their workplace without fear of assault

“First of all, you have to know where your patients are – they don’t. Then you have to be committed to putting in place things that would change that. A recording system would give you that understanding, but it’s not necessarily going to stop it unless you’ve got someone sitting looking at it and saying, ‘this is what we need to do’.”

Health secretary Neil Gray has said that the government is taking WRNS’s findings “incredibly seriously”. “Rape and sexual assault occurring in our hospitals, or anywhere else in our society, is unacceptable. I expect all health boards to uphold their legal duties as employers to keep staff, patients and visitors safe,” he said in response to a question from Conservative MSP Tess White. 

“Everyone has the right to access healthcare or their workplace without fear of assault. The safety of patients and staff remains our absolute priority. That is why a national network has been created to bring together health boards and partner organisations to explore and share approaches to preventing sexual harassment across the National Health Service in Scotland. That includes reviewing approaches to data, reporting and training, sharing resources and best practice, and providing support for staff and employers.”

And yet, says El Alti, “violence is so normalised against women”, and “healthcare can’t be removed from its social context”. “I know that makes a lot of people uncomfortable,” she says. “It’s very hard to face.”

El Alti says chaperoning policies are a “Band-Aid solution” to preventing assaults by healthcare practitioners because “the chaperone is part of the system”. “If something unethical happens there are still a lot of obstacles in the way of whistleblowing,” she says. 

“If it’s a healthcare provider who is abusing their authority or power over patients, even if you have laws around it, we have to remember they are supported by whole institutions. That doesn’t mean there are no cases where people get caught and prosecuted, and they lose their license or registration. But the kind of violence that happens against patients is a reflection of society at large and often goes underreported. When it is reported, a lot of survivors go through very long processes that are just as traumatic as the event.”

It is shocking and depressing that it remains the case that there is violence, including sexual violence, at the hands of men wherever women live and work

Even single-sex wards “wouldn’t target the root cause of the problem, which is misogyny”, she says. “At face value it can reduce the chance that certain male predators would have the same opportunity to target vulnerable females, but I don’t think it removes the issue of violence against women within healthcare.”

What we have to do, she says, is start from the foundations, improve training, tackle toxic attitudes, fix reporting and recording practices, and ensure consent isn’t a “fleeting, non-standard concept”.

And while much wrongdoing is currently obscured, recent court cases give some indication that all is not well. Anaesthetist Ju Young Um was jailed for 18 months for voyeurism after using hidden cameras to record intimate footage of colleagues in staff accommodation at Dumfries and Galloway Royal Infirmary and elsewhere. Um blamed body dysmorphia for the offending.

And the Scottish Ambulance Service launched a poster campaign at its bases last year after the conviction of former Paisley paramedic Gavin Boa, who exposed himself to a colleague and performed a sex act. Boa, a senior staff member, told his trial at Paisley Sheriff Court last May that sexualised behaviour was a part of the service’s “culture”. “Any form of sexual misconduct is completely unacceptable and will not be tolerated in the Scottish Ambulance Service,” a spokesperson for the service said.

But such behaviour is not confined to those cases. Tess White told parliament that one of her constituents had, while undergoing in-patient treatment for postpartum psychosis, been “repeatedly subjected to another patient exposing himself” at the specialist Carseview Centre in Dundee. “She was terrified and traumatised, she was separated from her support network, and she was scared for her safety on a mixed-sex ward. How can that be?” White asked. “Where was the duty of care? For women giving birth or accessing support for serious mental ill-health or learning disabilities, safeguarding has to be of paramount importance.”

“It is shocking and depressing that it remains the case that there is violence, including sexual violence, at the hands of men wherever women live and work,” women’s health minister Jenni Minto said during the same debate. “Since 2005, we have expected NHS boards to ensure that their facilities comply with guidelines on the elimination of mixed-sex accommodations,” she said. “In all new hospital developments, there should be a presumption that there will be 100 per cent single rooms, and where existing accommodation has been refurbished, that the figure will be as close to 100 per cent as possible”, with exceptions for intensive care units and some other areas.”

A standardised policy combatting gender-based violence and sexual harassment is due soon, she said, and the government is working with Healthcare Improvement Scotland to improve recording and reporting of incidents.

It is hoped that the next report by WRNS will include more detail and help to produce a clearer picture: sexes and ages of victims and perpetrators would be a crucial step forward. WRNS is proud to be making an impact through its work. “It’s been higher profile, politically,” than in England and Wales, Howden says. “The Scottish Government now considers us stakeholders. We’re part of the conversation. It’s quite big, really.”