Hospitals are meant to be places of safety, for patients and for the people who care for them. Yet inside parts of the NHS, another story is whispered in corridors and behind closed office doors. Staff describe fear, silence and retaliation when raising sexual safety concerns about senior colleagues. In these environments, speaking up can feel less like professionalism and more like self sabotage, with careers quietly derailed for telling uncomfortable truths.
For chief executives and chief operating officers, this is not a niche HR headache or a reputational sideshow. It is a direct threat to operational stability and organisational credibility. When staff believe allegations of harassment or inappropriate behaviour will be diluted, delayed or discreetly buried to protect hierarchy, trust collapses faster than any recovery plan can rebuild it. The mechanics are predictable. Reporting routes exist on paper but feel unsafe in practice. Guardians and policies are present but perceived as decorative. Energy that should go into patient care is instead spent calculating personal risk. People choose silence over exposure. The most conscientious staff leave first. Sickness absence creeps up. Agency costs rise. Teams fracture. Once that happens, every strategic priority, from elective recovery to digital transformation, slows down. Culture, not capital, becomes the binding constraint. Leaders who underestimate this dynamic often discover too late that they are managing symptoms rather than causes. By the time regulators ask questions or headlines appear, the real damage has already taken root in workforce confidence. What looks like a people issue is actually a delivery issue in disguise.
A recent review of speaking up arrangements at Black Country Healthcare Foundation Trust exposes how quickly this erosion can occur. Staff reported feeling they had a target on their back after raising concerns. They described cover ups, informal networks protecting colleagues and a sense that reporting issues about senior managers or doctors was futile. Crucially, many said they were comfortable escalating patient safety problems but afraid to raise concerns about behaviours and sexual safety. That distinction is telling. It signals that the system protects clinical risk more reliably than personal dignity. Allegations were said to drift through long investigations with little transparency or feedback. Some employees reported inconsistent application of HR policies, from leave to flexible working, that left complainants feeling disadvantaged. Non medical staff spoke of fears that concerns about medical colleagues would be dismissed or treated differently. Bank staff worried they might simply stop being offered shifts. Over time, the message hardens into a simple rule. Stay quiet. Do your job. Do not challenge power. For any board serious about governance, that is the moment the alarms should start flashing.
Because sexual safety failures are not isolated moral lapses. They are structural weaknesses that spread through an organisation like hairline cracks in concrete. They begin small, a poorly handled complaint, a friend informally investigating a friend, an uncomfortable conversation quietly parked to avoid embarrassment. Each choice appears pragmatic in isolation. Collectively they signal something far more dangerous. Status matters more than standards. Seniority protects. Silence is safer than honesty. Once that belief takes hold, behaviour shifts everywhere. Staff self censor in meetings. Junior colleagues stop offering challenge. Line managers avoid escalation. People leave rather than fight. The organisation looks calm on the surface but hollow underneath. From a CEO or COO vantage point, this hollowness shows up as slower execution, endless grievances, defensive management and rising attrition among exactly the talent you most need to retain. You can launch strategy days, invest in systems and publish values on posters, but if employees think the rules do not apply equally to everyone, none of it sticks. Culture quietly vetoes every initiative. The financial consequences follow. Recruitment becomes harder. Litigation risk grows. Partnerships wobble. Insurance costs climb. Commissioners hesitate. The trust becomes known not for clinical excellence but for internal drama. Reputations, like porcelain, rarely survive repeated drops.
What makes sexual safety particularly corrosive is the power gradient involved. Healthcare remains hierarchical. Consultants, senior clinicians and executives hold enormous informal authority. Challenging them can feel career limiting even in the best of cultures. In weaker ones, it feels reckless. Add stretched HR capacity and competing operational pressures and investigations easily drift. Delays are interpreted as indifference. Confidentiality is mistaken for secrecy. Staff begin to assume that nothing will change. At that point, reporting mechanisms become symbolic rather than functional. A flat line in speaking up data may look reassuring on a dashboard but often signals fear, not harmony. Ironically, an increase in reports can be a healthier sign because it indicates trust. Silence is rarely a victory. More often it is the quiet before a very public storm.
Executives who treat these signals seriously tend to reframe the issue away from compliance and toward risk. Sexual safety belongs on the corporate risk register alongside finance, quality and cyber. It affects all three. It drives turnover costs. It undermines quality by discouraging candour. It damages digital and operational programmes that depend on collaboration. Once framed that way, it becomes clear that delegating it to an annual training module is insufficient. Boards must own it directly. They must ask hard questions about independence of investigations, timelines, outcomes and protections for those who raise concerns. They must demand evidence, not reassurance. Data on who reports, how long cases take and what actions follow should be as routine as waiting time metrics. Anything less is theatre.
Independence is critical. If allegations about senior staff are investigated by people socially or professionally tied to them, credibility evaporates instantly. Even the perception of bias can be fatal. External or structurally separate investigators send a different message. Speed matters too. Months long processes communicate that the organisation values convenience over justice. Transparency, within the bounds of confidentiality, is equally important. Staff do not need every detail. They need to know that action happened and standards were enforced. And protection is non negotiable. If those who speak up lose shifts, opportunities or relationships, word spreads fast. Fear multiplies.
Language also shapes culture. Euphemisms dilute seriousness. Calling harassment an “interpersonal issue” or assault a “misunderstanding” tells staff leadership is uncomfortable with the truth. Plain language signals resolve. It says the organisation will not hide behind jargon. When leaders speak clearly, people believe them. When they hedge, people assume minimisation.
There is a deeper philosophical shift required as well. Many healthcare organisations still romanticise the indispensable individual, the rainmaker clinician or charismatic leader who is too valuable to challenge. That mindset is dangerous. Talent without integrity is liability disguised as brilliance. Modern systems cannot afford protected classes. Standards must be universal or they are meaningless. The moment someone becomes untouchable, the culture has already lost.
For COOs tasked with delivery, the link between sexual safety and performance is brutally direct. Teams that feel safe speak up early about everything, from process flaws to near misses. That saves time and money. Teams that feel unsafe hide problems until they explode. That costs both. Psychological safety is therefore not a soft concept. It is an operational accelerator. It determines whether issues surface in days or months. Whether lessons are shared or buried. Whether change happens quickly or not at all.
The review in the Black Country should be read not as a local story but as a warning shot for the entire system. Every trust has similar pressure points. Every board should ask whether staff truly believe concerns about senior figures will be handled fairly. If the answer is uncertain, assume risk is already present. The absence of headlines does not equal absence of harm. Often it simply means people have given up trying.
None of this requires grandstanding. It requires consistency. When a senior figure breaches standards and consequences are visible, trust grows rapidly. Staff watch actions more closely than communications. One decisive, fair outcome can repair months of scepticism. Conversely, one protected individual can undo years of progress. Culture has a long memory and little patience for hypocrisy.
Healthcare leaders like to say culture change is like turning a tanker. Perhaps. But ignoring the iceberg is worse. If staff are telling you they fear raising sexual safety concerns, listen the first time. Because by the time the story reaches the front page, the narrative is already written and control has slipped away.
The organisations that succeed over the next decade will treat dignity and safety at work as core infrastructure, as fundamental as infection control or financial governance. They will measure it, fund it and talk about it openly. They will understand that trust is not a communications strategy but a daily practice. And they will recognise a simple truth that every effective executive eventually learns. Silence is never neutral. In healthcare, it is usually a warning. Wise leaders hear it early. Foolish ones wait for the sirens.
