Pauline Brewer, 77, was ill. So ill she'd been admitted to hospital for urgent investigations after developing chest pain. She'd been waiting two days for an angiogram — a type of heart scan — and, feeling tired and uncomfortable in the stuffy women's ward, decided to freshen up.
Pauline, a retired administrator from Birmingham, slowly made her way to the washroom for a shower.
As she recalls: 'I locked the door, took off my clothes and was about to step into the shower when there was a thud at the door.
'I thought perhaps someone had knocked, realised that it was occupied and gone away — but seconds later a man burst through the door. He'd broken the lock and was lunging towards me.
'I was horrified. I'm less than 5ft tall and it felt like he was towering over me. He was much younger than me — I'd say in his early 30s — and came straight at me, saying something very sexual about what he wanted to do to me.
'It all happened so fast, but as he reached forward to grab me, I put my hands up to protect myself. He grabbed hold of my arm.
'Somehow — and I'll never know where I got the strength from because he was so much bigger than me — I punched him, which startled him and I was able to make a run for it.
'I ran down the corridor completely naked to the nurses' station, with him chasing me.
'One of the female nurses jumped up, put herself between him and me and another nurse covered me up, while two male nurses grabbed him and took him down the corridor to what I suppose was the men's ward.
'I couldn't stop shaking. No man has ever seen me naked apart from my husband, and I've been married to him for over 50 years. It was very upsetting.'
Recounting her experience at a hospital in the East Midlands four years ago, in September 2020, Pauline (who's asked to use a pseudonym) says: 'The nurses encouraged me to complain, with one saying: 'This sort of thing happens all the time, so you must try to report it.'
'But while my husband and I did speak to PALS [the patient advice and liaison service], nothing much came of that.
'The whole thing shook me up for a very long time. For months after I couldn't sleep, and had to take sleeping tablets.
'The incident makes me very wary and frightened of going into hospital again.'
Upsetting and distressing, but far from unusual: figures show there are thousands of sexual attacks and violations — so called 'sexual safety incidents'— in UK healthcare settings every year.
In an examination of UK NHS hospitals published last year, Jo Phoenix, a professor of criminology at Reading University, found shockingly high levels of sexual abuse, with 33 rapes and sexual assaults committed in hospitals in England and Wales every week, according to data extracted from police records over a 46-month period. The vast majority of victims were female.
'One attack of this kind in what is assumed to be a place of safety should be of concern, but the fact that sexual assaults and rapes are occurring with such alarming frequency shows a systemic failure in safeguarding,' Professor Phoenix concluded in the report, commissioned by the campaign group Women's Rights Network.
Her findings were echoed in a separate analysis, also published last year, by the BMJ, which found more than 35,000 such incidents — ranging from verbal abuse and harassment to rape — in NHS Trusts in England alone, in the five years up to 2022.
At least 20 per cent involved rape, sexual assault, or kissing or touching that a person did not consent to — though not all trusts provided a breakdown of incidents they record.
The data, from police reports collected over this time-frame, included 180 cases of rape of children (under 16) and four cases of child gang rape.
The BMJ investigation found that patients are the main perpetrators of sexual crimes in hospitals (58 per cent of incidents involved patients abusing staff, 20 per cent were patients abusing other patients — so-called patient-on-patient attacks — and staff-on-patient abuse accounted for 9 per cent).
In fact, all these figures are likely to be a gross underestimate of the extent of the threat, Professor Phoenix warned, due to poor reporting rates and mechanisms.
Indeed, the BMJ discovered that just one in ten trusts had dedicated policies that set out how to safeguard patients, staff and visitors from sexual harm and what processes to follow when incidents are reported.
Last year, NHS England recommended that all trusts adopt such policies. But as Professor Phoenix told Good Health, there is little sign things have changed: 'Since writing the report, I see that NHS Trusts are declaring zero tolerance of sexual safety incidents. That's great, but what does that mean exactly? I have yet to see any new set of mechanisms put in place to tackle this issue.
'It's blindingly simple: the first obligation for a hospital is the safety of its patients and staff — and if sexual safety incidents are occurring, they are failing in their duty of care. Having the right data can help them identify the circumstances around that failure and put it right.'
As well as better reporting mechanisms for sexual safety incidents, and surveillance of healthcare settings through CCTV, in her report Professor Phoenix recommended the provision of single-sex wards.
Mixed-sex wards were banned in 2010 — except in limited circumstances, such as urgent admissions for critical care. The NHS Constitution, which sets out the values which underpin the work of the NHS, already pledges that no patient should have an overnight bed on a ward with patients of the opposite sex.
And under new proposals set out by the Conservative government in April, patients would be able to request same-sex wards and ask that any intimate care is carried out — where reasonably possible — by someone of the same biological sex.
The consultation document is now sitting with the new Health Secretary. Yet it was reported in April that there were a shocking 44,000 breaches of the mixed-sex wards rules in the last year.
A separate but worrying issue is when such incidents are reported, how rigorously regulators then pursue staff accused of abusing patients or other staff.
Last week, a damning review of the nursing regulator, the Nursing and Midwifery Council (NMC), revealed how patients were being put at risk because of a huge backlog of fitness to practise (ie disciplinary) cases. This meant nurses who posed a danger to the public were allowed to continue to practise.
In one case, a nurse had been accused of sexually assaulting patients and raping a colleague after spiking their drinks. The case was closed on the basis that the rape was outside of work and the sexual assault on a patient was outside of a hospital, as the nurse had instigated a meeting.
The nurse had also been accused of asking patients to go on dates and requesting their phone number. Seven years after the NMC first received complaints, the nurse was finally struck off in 2024.
Last month, a slew of judgements in high-profile cases highlighted the appalling extent of sexual attacks on women in healthcare settings — in both NHS and private sectors. One woman was raped by a healthcare assistant while she lay in her hospital bed at Whiston Hospital, an NHS hospital near Liverpool, in January.
On June 19, the perpetrator — 29-year-old Sidharth Nair — was jailed for 13 years for sexual assault and rape.
Liverpool Crown Court heard how he took advantage of staff changeovers to carry out his abuse when other staff were busy.
In another recent case, 37-year-old Ella Janneh sued her former therapist, Michael Lousada, for rape and sexual assault.
He abused her in August 2016 at his private clinic in Belsize Park in London, but the Crown Prosecution Service refused to pursue the case due to the likelihood of success (there is a higher burden of proof in criminal cases), so she had pursued a civil claim. The High Court awarded her more than £200,000 in damages.
Also last month, physiotherapist Purnoor Bawa, who had a private clinic, Riverview Therapies in Gravesend, Kent, was jailed for six years for the abuse of multiple women between 2013 and 2018.
Sarah Johnson, 41, an education consultant from Meopham, Kent, was sexually assaulted by Bawa, after she was referred to him for painful back and sternum injuries she'd sustained in a road traffic accident.
Speaking to Good Health, Sarah recalled how she'd gone to the first three sessions with her husband and nine-year-old daughter.
'Bawa took a full history, examined me and gave me exercises to do. Everything was fine.
'On the fourth session, I had to go on my own and it was very different.
'He asked me to take off my top and he asked me if it was OK for him to work on my breast tissue.
'I said yes, if it would help the pain. He didn't reply but started to massage my breasts.
'I remember thinking it was a bit weird, but I was in so much pain I just wanted it to go away. I thought he must know what he was doing.
'I went back for a fifth appointment and the same thing happened — only this time he used massage oil.
'Also when he asked me to remove my top, he didn't leave the room.
'Normally, you go behind a curtain and you are given a towel for decency, but he just watched me change and I used my white T-shirt to cover myself.
'After he'd massaged both breasts, he abruptly ended the session.'
Sarah says it took her a few weeks to realise she had been sexually assaulted.
'I think there is a bit of disassociation when something like that happens,' she says. 'You doubt yourself and think, well maybe I'm making a fuss. But it came as a shock one day when I realised.
'After reporting it to the police in 2018, it has taken all this time to see him convicted, and in between he continued to abuse women until his professional regulator had struck him off in November 2019.'
Looking back, she says it was clear some of the victims were confused about how to complain and to whom.
'There are so many regulators,' says Sarah. 'One woman complained to the doctors' regulator — the General Medical Council — instead of the Health and Care Professions Council (HCPC), which regulates physiotherapists.'
After Bawa was reported to the HCPC, it imposed restrictions on his practice until the date of his hearing. First, he was required to have a chaperone with him and, when he ignored that, he was subjected to an interim suspension order.
He was found to ignore that, too, and went on to abuse again, until he was finally removed from the register.
Sarah's lawyer, Alison Millar, a partner at Leigh Day, says in terms of the profile of sexual predators and where they work, her caseload reflects all settings, the private sector and the NHS, and typically where the lack of compulsory regulation of some healthcare practitioners (such as psychotherapists) and poor enforcement by regulators means that there are gaps in the protection of the public.
She adds that many cases involve women and girls who have been targeted because they have been identified as more vulnerable, due to pre-existing health issues, and less likely to be able to effectively to raise complaints.
Patients in psychiatric units are also vulnerable to assaults, says Elizabeth Duncan, partner at legal firm Slee Blackwell, a specialist in sexual assault cases on behalf of patients and staff.
'They tend to be there for longer, there is more opportunity for grooming, there is more opportunity for offences.
'Plus, of course, those patients are particularly vulnerable in a way that someone in A&E with a broken leg is not,' she says.
Another vulnerable group are older female patients.
Researcher Amanda Warburton-Wynn, who works for Cambridgeshire & Peterborough Domestic Abuse & Sexual Violence Partnership, has investigated sexual violence and assault against older people in hospitals in England for the charity Hourglass.
She says because sexual assault is not about desire, it's about having power over someone, elderly female patients are particularly at risk.
'An older person who is in hospital, taking medication and possibly with dementia or other issues affecting memory and perception, is a "perfect victim",' she says.
'Will they speak out at all because of the shame? Or maybe they won't remember it, and if they do tell someone, it can be easily blamed on the effects of medication or illness.'
As with the other investigations above, her research has revealed a lack of consistency in the way sexual safety incidents are recorded — so one NHS trust might log an incident as a 'patient safety issue' and another as a 'safeguarding incident', which would trigger different actions.
She says that in most cases, because the victim is often regarded as unreliable either due to mental capacity or ill health, this can mean incidents are not formally investigated by hospitals or the police.
The Office for National Statistics recognises that under-reporting is particularly problematic for sexual assaults, with many more offences committed than are reported to and recorded by the police.
This is no less true for assaults that take place in a medical context, says Leigh Day's Alison Millar.
She adds: 'A criminal prosecution may not be possible but the incident still leaves the victims and survivors having to cope with the after-effects of the sexual assault.
'The process of bringing the perpetrator to justice can also be traumatising. One of the women assaulted by Bawa told me that she would not have gone through with the court case had she known how bad it would be.'
Too often when victims do report an assault, getting the authorities — hospital staff or police — to act is difficult, say the victims who spoke to Good Health.
Pauline reported the attack on her while she was still in hospital and even though the police told her they would investigate, they did not take a statement, saying they had already got one from the hospital.
'That's the last we ever heard from the police,' she says. 'There was no follow-up from the police or the hospital. I've no idea if anything ever happened to the man who attacked me.'
A spokesperson for NHS England told Good Health: 'Any form of sexual harassment, abuse or violence is completely unacceptable and will not be tolerated in the NHS.
'Everyone deserves to work and receive care in a safe environment where they are treated with dignity and respect, and we are rolling out better reporting mechanisms, training and support as part of the NHS Sexual Safety Charter.'
Signatories to the charter have committed to a zero-tolerance approach to any unwanted, inappropriate and/or harmful sexual behaviours towards their workforce. But while more than 90 per cent of NHS trusts have signed up so far, charities and lawyers insist that healthcare providers must do better.
The charity Sex Matters insists that single-sex wards and spaces are key, while Alison Millar says there needs to be a 'zero tolerance' approach to misogynistic behaviour, so-called 'low-level' harassment, 'because it can lead to a more serious threat, and all levels of sexual violence'.
'The reporting systems must be easy to use,' she says.
Some of the patients treated by Bawa had been referred to him by health insurance companies.
'Insurance companies and others who arrange treatment need to make sure that their systems properly audit those to whom they send patients and seek regular patient feedback,' she adds.
While campaigners and experts demand urgent and systemic change, countless thousands of patients, mostly women, are living with the consequences of healthcare providers not doing better.
Sue Evans, 75, a mother of five, was molested in the bathroom of a hospital in the North East two days after being admitted in the middle of the night following a severe stroke.
She was wheeled to the bathroom by a male member of staff. 'I sat on the loo and suddenly this man leaned down and put his hand between my legs and roughly shoved his finger into my vagina,' she told Good Health.
'I yelped in shock and swore loudly at him to get off me, pushing him away as best I could but I was shaking.
'He grabbed my arm, dislocating my shoulder, wheeled me back, not saying a word before throwing me on the bed.
'Then he ran off. That was the last I saw of him.'
It took two years before Sue, who asked to speak under a pseudonym, could even tell her husband and one of her daughters about the assault.
'I didn't want to upset my family by telling them that this man — whoever he was — had assaulted me,' she says, five years later.
'But I kick myself now for not reporting it officially.
'When something like that happens, you feel as though you shrink somehow into an even smaller person. I felt utterly ashamed for a long time after and I am sorry I didn't report it.
'And I still ask myself and worry whether he did this again to other women.'
