Unwillingness to challenge senior staff and fears over how managers respond is stopping NHS staff raising concerns about child abuse perpetrated out by their colleagues, a public inquiry has been told.

The Independent Inquiry into Child Sexual Abuse’s interim report includes findings on the NHS and raises concerns over lack of national policies, training of healthcare staff and culture in the NHS preventing concerns being raised.

It said constraints on NHS funding were preventing trusts from using properly trained chaperones.

The inquiry called on the Department of Health and Social Care to create national policies on the use of chaperones with child patients and for the Care Quality Commission to assess them.

Explaining its focus on the healthcare sector, the inquiry said “a significant number of NHS organisations” were investigated following incidents of child sexual abuse. It cited the cases of Jimmy Savile and paediatrician Myles Bradbury, who was jailed for 18 years in 2014 after being convicted of sexual offences against his patients.

The public inquiry was established in 2014 by Theresa May when she was home secretary, in response to widespread concerns over how UK institutions protect children from abuse.

The interim report, published last month, said the current arrangements to protect children from sexual abuse in healthcare settings could be improved.

In July 2017, the inquiry received evidence from more than 50 health organisations about measures to prevent child sexual abuse in hospitals, general practice and other settings. Over two days in September, experts and senior leaders gave evidence.

It was told factors that stop people speaking up about sexual abuse include “an unwillingness to challenge the actions of senior workers and fears of an unsupportive response from managers and colleagues”.

The report said: “The role of leaders and senior managers in creating a culture where workers are encouraged and expected to raise concerns was regularly raised in written submissions and emphasised throughout seminar discussions.”

It will consider these issues as part of its work this year.

Issues around education and training of staff were also highlighted and the inquiry was told “education and training tend to focus on equipping healthcare workers to recognise signs of abuse and neglect in the children they treat. Respondents… suggested that training should be improved to help workers detect and respond to child sexual abuse that takes place within healthcare services, including child sexual abuse by colleagues.”

It said children were “particularly vulnerable” when receiving treatment in the same settings as adults. Better arrangements should be in place to prevent unsupervised or inappropriate access to children during their treatment.

The inquiry was told the use of chaperones reduces the risk of sexual abuse but “awareness remains low” in some organisations and there are no national chaperone policies.

It said: “The inquiry has confirmed that national policies for the NHS and other healthcare services in England and Wales are not available.

“The inquiry considers that national policies for the training and use of chaperones across healthcare services would help to ensure that chaperones are used consistently and effectively to protect children from sexual abuse during treatment.

“A consistent approach would also help to provide clarity for children and their parents or carers about when they can expect a chaperone to be present.”

A DHSC spokeswoman said: “The Independent Inquiry into Child Sexual Abuse interim report contains a series of recommendations. We welcome the report and are now considering the inquiry’s recommendations very carefully. We will respond fully in due course.”