Female NHS ambulance staff have revealed being hounded for sexual favours in return for promotion in a critical report highlighting widespread bullying at a trust.
Other women at South East Coast Ambulance Service NHS Foundation Trust (Secamb) spoke of being groped, of "highly sexualised gazing" in front of patients and of "sexual predators" who "groomed students" for sex.
Researchers were told that sexualised behaviour was embedded in parts of the management structure, but some senior staff interviewed believed those responsible had left the Trust.
The revelations emerged in an independent report, commissioned by Secamb, following concerns raised in the Trust's staff survey and last year's Care Quality Commission (CQC) report.
Some 2,000 staff took part in the research, with more than 40% of those who responded revealing they had experienced bullying in the last 12 months.
Part of the 69-page report said: "The researchers heard from several sources about overt and covert sexualised behaviour within Secamb.
"This extended from beliefs held about former senior leaders through to front-line managers and the broader workforce.
"Some senior staff interviewed believed such a culture existed with those who had since left Secamb but the researchers were assured this was embedded in some parts of the organisation at management levels.
"For example, female staff talked about sexual favours being sought in return for career progression whilst others were hounded by managers seeking sexual favours for personal reasons.
"Several female staff felt that such behaviours were the norm, with some stating 'my arse was slapped regularly' and others who felt they were demeaned by highly sexualised gazing in front of colleagues and even patients.
"Some female respondents talked about 'sexual predators' amongst male colleagues who 'groomed students' for sexualised ends. Some managers felt there was a history of comments being turned to lewd remarks but slowly these were being addressed."
The report, produced by Professor Duncan Lewis from Plymouth University, said researchers were "shocked" at the levels of staff reporting a range of poor behaviour and it was a serious problem.
It said: "The researchers were extremely distressed to hear of the experiences of several female Secamb employees.
"The Trust may not of course be aware that such a culture exists as employees are often extremely fearful of speaking out against such practices.
"However, as has been shown time after time, ignorance is no defence and too many British institutions have demonstrated failure to take matters seriously when it comes to sexual abuse.
"This report now brings to the attention of the executive that further investigations will be necessary and action must be taken as an urgent priority to protect employees who are living in fear daily."
Secamb, which covers Kent, Surrey, Sussex and north east Hampshire, was put into special measures in September last year after the CQC ranked it inadequate.
The report said there was a consistent view that a "boys club" operated in parts of the Secamb. Groups of male managers, whose careers had progressed together, upheld a culture that was "stubbornly resistant" to change, it said.
And some senior officers were considered "gradist" in that they would only talk to people of equal or higher grades, and were opposed to women filling senior ranks.
Women employees often felt there was a lack of female role models among the senior officers. And "time after time" researchers said they were told of employees' fears about speaking out on bullying and harassment issues.
Staff reported being shouted at publicly or bellowed at, of being belittled in front of others, and of being dismissed and ignored in front of others, the report went on.
One employee said: "Standing up against bad behaviour puts you on a manager's radar - excessive monitoring, more work, more pressure."
The report concluded that "there is indeed a culture of bullying and harassment" facing many employees in Secamb, and it made a series of recommendations.
Secamb chief executive Daren Mochrie said he was "truly disappointed and upset" that so many staff had faced bullying and other bad behaviour - and added it would not be tolerated.
He said: "In the time since my appointment in April this year, it has been very clear to me that Secamb is full of extremely dedicated and professional people who are concerned about caring for their patients as well as each other.
"However, I was also aware that the Trust is facing a number of challenges and areas where vital improvements need to be made.
"One such area was high reported levels of bullying and harassment evidenced by our staff survey and from last year's CQC inspection.
"We chose to commission this independent report to help us address this worrying issue. The behaviours it describes are completely unacceptable and will not be tolerated, in any sense and at any level, moving forward."
The GMB said detailed internal investigations should now follow and any person found to have perpetrated bullying and harassment should be dealt with.
Jason Dicker, GMB branch secretary in Secamb, said: "The report produced by Professor Lewis and his team underpins GMB's evidence continually provided by their membership, that Secamb's workplace has been a breeding ground for a bullying and harassment culture.
"GMB welcome the appointment of Daren Mochrie and the subsequent commissioning of this report. GMB further welcome the CEO's request that the unions in Secamb will take a pivotal role in the planned task groups to identify and eradicate this culture from Secamb.
"However, in order to ensure there is a zero-tolerance culture towards bullying and harassment in Secamb GMB must demand that this report elicits detailed internal investigations, as a result, any individual found guilty of bullying and harassment must be dealt with in line with Secamb policy and, if applicable, under the terms of any individual's registering body, such as the HCPC (Health and Care Professions Council) or NMC (Nursing and Midwifery Council)."