• Embed in NHS digitalisation strategies the right for people to choose between digital or offline access when using health services, ensuring that digitalisation does not replace the option of non‑digital contact.
• Include in GP contracts a condition that analogue routes remain available by making non‑digital access a protected component of health digitalisation policy, so that no one is required to go online to receive care.
• Ensure older people are directly involved in shaping digital health policy and service design, so decisions reflect the needs and experiences of those most affected.
• Centrally collect and publish data from Integrated Care Boards (ICBs) and health boards on both digital and analogue access, broken down by age, gender, disability and ethnicity, to make the impact of digitalisation visible and identify any groups disproportionately affected.

The report highlights that:

• 1 in 3 (one third or 32%) of those aged 90 and older are waiting 12 hours or more in A&E to be admitted or discharged home in 2024/25.
• The number of instances of ‘corridor care’ of 12 hours or more has increased 525-fold since 2015/16.
• Between 2019/20 and 2024/25 the number of attendances to A&E that resulted in a 12-hour wait for a bed increased by nearly 2000%.
• Last year, 532,451 people experienced corridor care of 12 hours or more.

It calls for the Government to implement the following package of measures:

• Urgently produce a funded operational plan to reduce the number of long A&E waits and end Corridor Care, with specific deadlines and milestones.
• Establish a robust system to collect and publish regular data on Corridor Care (as well as long A&E waits), and their impacts on the public, including by age and ethnicity.
• Make a Minister in the Department of Health and Social Care accountable for reducing long A&E waits and ending corridor care and require them to report on progress to Parliament every six months.
• Turbo-charge a peer learning programme for hospitals and local health organisations (Integrated Care Boards) to share proven solutions, tackle barriers to discharge and protect and support NHS staff.
• Work at pace to implement the 10 Year Health Plan, especially the ‘hospital to home’ shift and creation of a Neighbourhood Health Service, ensuring social care and the VCSE (Voluntary Community and Social Enterprise) are fully involved – so fewer older people need to go to A&E in the first place.

A key finding was that among patients over the age of 75, there was insufficient screening for three common conditions which primarily affect this age group:

1. Only 16% of patients were screened for delirium – a reversible condition which can be associated with mortality, characterised by a sudden change in mental function.
2. On average less than half (48%) had screening to assess the risk of falling.
3. An average of 56% underwent screening for general frailty – which if detected can trigger early intervention and support in hospital and in the community.

Despite a year-on-year improvement from 2023, these patients are enduring the longest waits in A&Es and are bearing the brunt of an Urgent and Emergency Care system in crisis.

Older people are often more likely to suffer with complicated or multiple health issues. This, combined with the wider issues related to a shortage of in-patient beds, mean they can often end up enduring extreme long waits in A&E – often on trolleys in corridors.

Motivated by a patient death

I undertook my first research into sexual assaults against older people by hospital staff in 2021, after reading about the horrific case of an older patient who died from internal haemorrhaging due to severe vaginal injuries. A member of staff was arrested on suspicion of rape, but ultimately was not charged.

I found it staggering that more people weren't aware of what happened to this lady. After placing a post saying as much on social media, I received messages indicating that this wasn't the isolated case I assumed it was. 

I was curious to know how often older people in hospital are being sexually assaulted by staff - people in positions of trust who should be caring for patients.

So, I decided to find out for myself. 

The findings: increasing numbers, bias and poor support

As I don't receive any funding for my research, I had to rely on freedom of information (FOI) requests to get data from NHS England trusts. I looked at the number of incidents reported to staff and recorded on the hospital’s incident system over a 5 year period, from 2016/17 to 2020/21 (financial years).

My first paper highlighted at least 75 incidents of sexual assault against patients aged 60+ in NHS Hospitals in England, where the alleged perpetrator was a member of staff. I was surprised by the numbers but also at the responses to the follow-up questions I asked about support for these survivors. In the vast majority of cases, there was no referral to specialist services.  Only 21% (16) of the incidents recorded were reported to police. Of these 16, all but two had ‘no further action’ taken. I don’t have the data on how the other two progressed so it is unclear whether any convictions were made.

I was keen to review the data to see if anything had changed, so I undertook a similar research project in early 2024. This time, the number of reported incidents was much higher over a shorter reporting period (at least 274 incidents over three years). Once again, the number of victims being referred to Sexual Assault Referral Centres or specialist support was very low.

Responses to both sets of FOI requests included anecdotal comments from professionals making worrying assumptions about the reliability of people with dementia when disclosing sexual assault. It was also interesting to note that male victims in reported incidents had a higher prevalence than male victims of sexual assault in general - potentially highlighting an increased risk of sexual assaults against older men in hospital.

Limited data but a sad fundamental truth

Due to lack of funding for my research, I was able to merely touch the surface and report only quantitative data. That means I am unable to determine if the increase in the number of reported incidents is due to more sexual assaults against older people happening. Or if improved reporting and data recording methods can account, either fully or partially, for the increase. However, what is clear is that older patients in hospital are at risk of sexual assault from the very people who should be assuring their well-being and safety.

Opportunity for positive change to reduce harm

The main aim of my research is to raise awareness of the issue among front-line professionals. Whilst this can include the potential perpetrators, most will be the people who are best placed to stop such incidents, and to ensure an appropriate response when an incident is reported. 

NHS England has strengthened its approach to domestic abuse and sexual violence in recent years with duties placed on staff to record and report incidents. There may still be some complacency about how genuine patient reports are though, and therefore less emphasis on support. 

It's also important for both health care staff and the general public to be aware that sexual assaults in hospital do happen. More awareness of the issue will hopefully lead to more survivors being able to disclose and getting the right support when they do.

I would like to develop some training for health and social care staff around responding to disclosures of sexual assault and violence from older people - this will likely be in an eLearning format - but I am keen for access to the training to be free. Too much essential knowledge sits behind paywalls making it prohibitive for the target audience to access. I have the content, but if anyone can help with a platform for hosting and developing online training it would be great to hear!

You can contact me at info@awdaconsultancy.com if you would like to hear more about my research or the online training. 

Hopes for the future

I would like all health and social care workers to be much more aware of sexual assault against older people - not just in hospitals but in care homes and the community too. Funding for services needs research and data to back it up - my research only touches the edge of the issue and it would be great if more research and eventually specialist support for older survivors of sexual violence can lead on from it.

I’d just like to add that I'm really grateful to Hourglass for publishing my research to help get the word out as wide as possible. And, of course, to Patient Safety Learning for giving me the opportunity to share the findings too.

Related reading

• Sexual violence and assault against older people in NHS hospitals in England (2024)
• Doctors practising despite sexual assault and rape allegations
• Hundreds of social care residents allegedly sexually assaulted, watchdog reveals

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• More people than in 2022 get to an appropriate ward and receive the care of a team with an orthogeriatrician, though these figures are still poorer than pre-Covid.
• As in past years, four out of five patients get out of bed by the day after surgery.
• The number shown to be free of delirium has improved to nearly two thirds.
• More people than ever are returning home and successfully being supported to continue with osteoporosis treatment to prevent future fractures.

Recommendations

NHS England and the Welsh Government should use NHFD data to monitor hospitals’ delivery of three key stages of care to ensure that:

1. hospitals are ready for the people they know will present each day
2. hospitals provide both prompt surgery and optimal peri-operative care
3. rehabilitation and recovery is planned and started early, and continues beyond the hospital.
4. they take a standardised approach to the collection of ethnicity data across all patients’ pathways and provider organisations.
5. people with other injuries benefit from the improvements that have been pioneered among those with hip fracture.

Interview with Dr Elena Mucci, Consultant Geriatrician at East Sussex Healthcare NHS Trust