A ‘macho’ culture within ambulance trusts is leading to widespread abuse of female staff.
HSJ has been told of multiple cases including sexual misconduct, harassment or abuse against staff in the last two and a half years. These include:
- women being told that giving sexual favours would help them get on to paramedic training;
- a woman who was told she would pass her driving course if she gave oral sex to a superior;
- a student on placement who could not take off her jacket without comments being passed on her breasts, and therefore would wear it even on the hottest days; and
- a student given a lift by her supervisor who then proceeded to rub his hands up and down her legs during the journey.
In a freedom of information request, the 10 ambulance trusts in England were asked for the number of incidents in which allegations of sexual misconduct, harassment or abuse had been made against staff.
The trusts reported 221 cases since April 2019, of which at least 27 resulted in dismissal and at least 44 resulted in other disciplinary action, with some cases still under investigation.
South East Coast Ambulance Service Foundation Trust and South Central Ambulance Service FT did not provide breakdowns of the number of cases that ended in dismissal or disciplinary action.
In most cases, another member of staff was the person who was assaulted or harassed, but in around 50 cases a patient was the victim. In other cases, members of the public and hospital staff were involved.
More than 50 cases were reported to the police but in many cases the ambulance trust making the referral did not know the outcome of these.
Professor Duncan Lewis, a researcher at Plymouth University who has investigated issues at several trusts, has said recently: “What was very stark, to me at least, was the highly sexualised banter and sometimes more explicit behaviours reported to me by frontline ambulance staff. I would say I encountered more of these types of event in the three ambulance organisations I have worked with than all other organisations I have studied over 25 years.”
East of England Ambulance Service Trust, which accounted for 49 of the reported cases, appears to have particular issues and was recently required to sign a legally binding agreement with the Equality and Human Rights Commission governing how it would protect staff.
The Care Quality Commission has also raised concerns about the trust. In one case a paramedic was convicted earlier this year of raping a patient, and later struck off.
The BBC later reported that the paramedic in this case had been reported to police by the trust in 2010, but was able to return to work after the investigation concluded there was insufficient evidence to proceed to prosecution.
But there is also evidence sexual harassment against fellow staff members is significantly underreported. A report to the trust’s board in September suggested 84 per cent of cases were not reported formally.
Tom Abell, chief executive of the East of England trust, said: “We know that there have been times that the trust has not dealt with sexual harassment appropriately and we have commissioned an independent review of historical sexual harassment cases so we can learn and improve.
“The safety and wellbeing of our people and patients is my top priority, and we are working to embed a positive workplace culture in the trust. I’m sorry to those individuals who the trust failed – we will do better.”
The College of Paramedics, a national professional body, has said it is holding a series of webinars on professional behaviour after several student paramedics raised issues about their treatment on placements.
Its chief executive Tracy Nicholls said: “The fear and anxiety that our students feel was really clear. It was like a klaxon to us. There has to be a responsibility on people not to walk past this. We have to call out people who are walking on to say this is not okay.”
She said it was hard to be sure of the scale of this behaviour, but it was not restricted to one trust and was “everywhere”.
The college also held a joint webinar recently with the Association of Ambulance Chief Executives on abuse of positions of trust, prompted by the rape case in the East of England.
Meanwhile, a report published by North East Ambulance Service FT in 2019 referenced “unhealthy, mostly male-based power relationships” within ambulance providers.
Carol King, a former South West Ambulance Service FT employee who took the organisation to an employment tribunal which partially upheld her claim, has set up a campaign group called Ambulance Service Action and Support Group, which consists of almost 500 members and campaigns against all kinds of harassment.
She said many allegations of abuse or harassment are not followed up by trusts and may even be turned against the victim.
“As soon as you raise your head, you are the problem, not the victim,” she said. “A lot of people are frightened of saying anything. Do you want to spoil your career?”
She puts some of this down to ambulance trusts still having a “macho” atmosphere, despite more female staff over the last few years. Many ambulance staff are also alone with a single crew member for much of their shift, meaning actions are often unwitnessed.
Earlier this year a report to the South East Coast Ambulance Service FT board referenced the issues in the East of England and said there were “similar areas of concerns within SECAmb”, and that a third of the safeguarding cases involving sexual harm “had already come to the attention of the trust for similar allegations in the past”.
A 2017 report on culture in the trust, by Professor Lewis, said there were “serious questions of sexual harassment and sexual grooming” in parts of the trust, often involving newly qualified women. It detailed “overt and covert sexualised behaviour” extending from former senior leaders through to frontline managers and the general workforce.
A similar report at South Western Ambulance Service FT, from late 2018, found a “culture where sexual banter was/is commonplace” and the suggestion there was a group of managers seeking sexual favours in return for admission to a social group and career advancement. Some of this behaviour was historical, the report said, but had become “embedded”.
Ambulance trusts responded by stressing their commitment to safeguarding the welfare of staff, and the public, saying they encouraged staff to raise concerns and allegations were then investigated and action taken when necessary – including referral to the police and regulators.
They also stressed that unacceptable behaviours had no place in their organisations and the highest standards of behaviour were expected from staff.
Some pointed out that not all allegations were proven, or might not meet the threshold for formal disciplinary action, and might be handled through education and training instead.
Years of sexual harassment
A former ambulance assistant has described how years of sexual harassment culminated in a serious assault, which later led her to attempt suicide.
The female assistant, who asked to remain anonymous, said she joined an ambulance trust in 2006 and faced repeated sexualised behaviour, banter and sexual assaults from male colleagues, often older than her and effectively her superiors. The most serious incidents included groping, “dry humping”, and suggestions from an officer she should perform oral sex, she said.
Some of this behaviour was witnessed by other male staff who did not intervene and “just laughed it off,” she said. The perpetrators have largely remained in the service or are now lecturing on university courses, she said.
In 2014, she said a male paramedic locked her in the back of an ambulance and reached into her shirt and grabbed her breast as she “froze through fear”. She later resigned, and said the perpetrator resigned before a disciplinary hearing and remains on the Health and Care Professions Council register. She later spent five days in an intensive care unit after trying to take her own life.
She said the culture of the service at the time meant she did not report the initial incidents to the trust, although she reported the 2014 assault. The trust said that it made “all the necessary ongoing referrals to external agencies in order to follow our safeguarding policies and processes”.
She was paid £25,000 as a personal injury claim by the trust, but is concerned the culture has not changed.
She said: “Women were looked at like pieces of meat. It was just sexism all the time… There had been complaints from other women about the man who assaulted me, but they were just brushed under the carpet. I had to walk away from a career I absolutely loved. I ended up with PTSD. Now when I see an ambulance I have to turn around and go another way.”