R v Cox [2025] EWCA Crim 1625: Sentencing Historic Sexual Abuse by Medical Professionals – Use of Modern Guidelines, Consecutive Sentences and Totality

R v Cox [2025] EWCA Crim 1625:
Sentencing Historic Sexual Abuse by Medical Professionals – Use of Modern Guidelines, Consecutive Sentences and Totality

1. Introduction

The decision in R v Cox [2025] EWCA Crim 1625 concerns a former general practitioner convicted of a series of indecent assaults on female patients in the 1980s and 1990s. The case is notable for three interlocking reasons:

  • it addresses how courts should sentence historic sexual offences committed under earlier legislation but sentenced today,
  • it considers the use of current sentencing guidelines where the historical maximum penalties were lower, and
  • it applies and reinforces the principle of totality in the context of multiple sexual offences involving a gross breach of medical trust.

The appellant, a GP practising in Berkshire during the 1980s–1990s, was convicted in 2024 of twelve counts of indecent assault under section 14(1) of the Sexual Offences Act 1956. The assaults were committed against seven female patients (C1–C7), several of whom were particularly vulnerable, including one who was a child of about 14 at the time. Some assaults involved digital penetration of the vagina and touching of breasts; in others the appellant pressed his penis against the complainants.

Following conviction, the trial judge imposed an aggregate sentence of 22 years’ imprisonment. The appellant appealed both sentence and conviction. His appeal against sentence challenged the length and structure of the sentence, especially:

  • the way modern sentencing guidelines were applied to historic offences,
  • the imposition of consecutive sentences, including for offences against the same complainant, and
  • whether the total sentence was manifestly excessive and breached the principle of totality.

The appellant’s renewed application for leave to appeal conviction rested primarily on an attack on the jury’s evaluation of the evidence and an allegation that they misapplied the standard of proof.

The Court of Appeal (Criminal Division), constituted by Mrs Justice Thornton, dismissed the appeal against sentence and refused leave to appeal conviction (and an associated extension of time). In doing so, the Court reaffirmed and clarified important principles about:

  • sentencing historic sexual offences using current guidelines,
  • the permissibility of robust aggregate sentences through consecutive terms in serious breach-of-trust cases, and
  • the proper limits of appellate intervention in jury verdicts based on credibility assessments.

At the outset, the Court also confirmed that the Sexual Offences (Amendment) Act 1992 applies, protecting the anonymity of the complainants (para 1). Any report or commentary must therefore not contain information likely to identify the complainants.

2. Summary of the Judgment

2.1 Outcome

  • Appeal against sentence: dismissed.
  • Renewed application for leave to appeal against conviction: refused.
  • Application for extension of time: refused as unnecessary in light of the above.

2.2 Key holdings

  1. Historic sexual offences and modern guidelines.
    The Court reaffirmed that:
    • Defendants must be sentenced by reference to current sentencing practice and guidelines.
    • However, the maximum sentence applicable at the time of the offending must not be exceeded (here, 10 years per count for indecent assault under the 1956 Act).
    • Where current maxima exceed historic maxima, the guideline starting points and ranges should be “adjusted in a measured way” (R v H; R v Forbes), but this scaling is not mechanical and must account for the seriousness of the case.
    • It is not an error of principle to refrain from scaling down a modern guideline starting point where the facts (here, the extreme breach of trust in a doctor–patient relationship) would justify an equivalent uplift in any event.
  2. Consecutive sentences and totality.
    The Court held:
    • Consecutive sentences of 8 years each on the two most serious counts (C1 and C7, both involving digital penetration) were permissible because they involved different victims and were separated by 7–9 years.
    • An additional consecutive term (3 years) for another offence against the same complainant (C1) was also permissible to reflect the wider course of conduct.
    • While there were other admissible ways to structure the sentence, the overall sentence of 22 years was not manifestly excessive and properly reflected the seriousness, persistence and breach of trust.
    • Application of totality is a matter of substance, not form (R v Bailey), and the Court was satisfied that the sentencing judge had calibrated the sentence justly and proportionately.
  3. Appeal against conviction: deference to the jury.
    The Court endorsed the single judge’s refusal of leave:
    • No criticism was made of the summing-up, which had been described by defence counsel at trial as “a model of fairness, balance and clarity”.
    • The appellant’s arguments essentially invited the Court to re-try the facts and second-guess the jury’s credibility assessments. This is not the function of the Court of Appeal absent some legal misdirection or serious irregularity.
    • There was no basis to suppose that the jury applied a civil standard of proof, ignored directions, or acted inconsistently in finding some counts proved and others not proved.
    • The verdicts, reached after four days of deliberation and by majority, were safe.

3. Factual and Procedural Background

3.1 The offending

The appellant was a GP practising in Berkshire during the 1980s and 1990s (para 4). Over a period of nearly a decade he exploited his professional position to commit sexual assaults on female patients, often under the guise of legitimate medical examinations. The indictment at the retrial contained 16 counts of indecent assault under section 14(1) of the Sexual Offences Act 1956. The counts relevant to the final sentence were:

  • C1 (Counts 1–9; convictions on 4–8 only):
    A woman aged 23–24 at the time. The offending spanned five consultations. The conduct included:
    • touching her breasts,
    • pressing his penis against her body, and
    • on count 4, digital penetration of her vagina (which would today be charged as assault by penetration).
  • C2, C3, C4 (Counts 10–12):
    Women aged 20, 30 and 19–20 respectively. The appellant was alleged to have touched their breasts and nipples.
  • C5 (Count 13):
    A very young complainant, “no more than 14 years old”, where the appellant stroked her thigh, asked for a cuddle and rubbed her back.
  • C6 (Counts 14–15):
    Another woman on whom the appellant touched her nipples and pressed his erect penis against her hand.
  • C7 (Count 16):
    A woman in her late 20s. The appellant was alleged to have digitally penetrated her vagina, again conduct which would now be charged as assault by penetration.

The prosecution position was that the appellant systematically used his role as a GP to abuse patients sexually. The Crown relied on:

  • the complainants’ own evidence (some live, some via ABE interviews),
  • evidence from family members, and
  • expert GP evidence explaining appropriate standards for breast and vaginal examinations and assessing whether the described conduct was clinically justified (para 7).

The defence was a flat denial that these incidents occurred as alleged. In relation to one complainant (C7, count 16), the appellant advanced an alibi, claiming not to have been at the practice on the relevant day. He also relied on his own expert GP evidence, broadly aligning with the prosecution expert on when such examinations would be clinically warranted (para 8).

There was common ground that for some counts – including counts 7, 8, 12, 13 and 14 – there was no medical justification for the alleged conduct; the sole issue for the jury was whether the conduct occurred as alleged (para 9). For other counts – 4, 5, 6, 10, 11 and 15 – the jury had to determine whether each examination:

  • was clinically justified, or
  • was conducted in circumstances that were indecent and intended as an indecent assault (para 10).

For count 16, the key issue was whether the appellant was indeed the doctor who examined the complainant (para 11).

3.2 Trials and verdicts

The procedural history is important:

  • First trial (February 2023):
    The appellant was tried on an eight-count indictment concerning six women. He was acquitted on one count; the jury could not agree on the remaining seven, and was discharged (para 4).
  • Retrial (October 2024):
    After further police publicity, the appellant was retried on a 16‑count indictment (para 5). The jury:
    • convicted him on counts 4–8 and 10–16, and
    • acquitted him on counts 1, 2, 3 and 9 (para 12).

3.3 Sentencing at first instance

The trial judge’s remarks stressed:

  • a gross breach of trust by a GP – a profession “amongst the most highly respected and trusted in our society” (para 13),
  • that the conduct “struck at the heart of everything the medical profession stands for”,
  • that the appellant selected vulnerable or young patients, and
  • the serious and lasting impact on the complainants.

The judge directed herself in accordance with the law on historic sexual offences, referencing R v H and Others [2011] EWCA Crim 2753 (para 14). She accepted that:

  • she must not exceed the statutory maximum in force at the time of the offences – here, 10 years per count under section 14(1) of the 1956 Act, and
  • she should sentence by measured reference to the modern Sexual Offences Definitive Guideline.

Applying the modern guidelines by analogy:

  • Counts 4 and 16 (digital penetration of the vagina):
    Treated as equivalent to assault by penetration. They were placed in Category 2A:
    • starting point: 8 years,
    • range: 5–13 years (para 15).
  • Counts 5, 6, 7, 8, 10, 11, 12, 13, 14 and 15 (breast and other sexual touching, including against a child):
    Treated under the guideline for sexual assault (and, for count 13, recognising particular vulnerability as a child). These were also categorised as 2A:
    • starting point: 2 years,
    • range: 1–4 years (para 16).

The judge:

  • decided it would be double counting to aggravate further for particular vulnerability where that was already part of the categorisation (para 17),
  • noted the appellant had no relevant previous convictions and very little mitigation, and
  • expressly referred to the principle of totality.

The structure imposed was:

  • For C1 (counts 4–8): total 11 years (para 18):
    • Count 4 (digital penetration): 8 years.
    • Count 5: 3 years, concurrent.
    • Count 6: 3 years, consecutive.
    • Counts 7 and 8: 2 years each, concurrent.
  • For counts 10–15 (other adult complainants including the child complainant):
    A 3-year term consecutive to the sentence for C1 (para 19).
  • For count 16 (C7 – digital penetration):
    8 years consecutive (para 20).

The aggregate sentence was therefore 22 years’ imprisonment.

4. Issues on Appeal

4.1 Grounds of appeal against sentence

The appellant advanced three principal grounds (para 19):

  1. Error in making count 6 consecutive to count 4.
    It was argued that these offences formed a series of the same or similar kind against the same victim (C1) and should have been made concurrent.
  2. Inflated starting points.
    The judge allegedly took starting points that were too high, given that:
    • the historic maximum was 10 years per count,
    • the Court was using modern guidelines derived from higher modern maxima, and
    • consecutive sentences were imposed.
  3. Totality and proportionality.
    It was contended the judge failed adequately to reduce the aggregate sentence for totality, rendering the overall term unjust and disproportionate.

In oral submissions, these were refined into more specific arguments (para 21):

  • Whenever consecutive sentences are imposed, the judge should reduce individual terms to reflect totality; the judge allegedly applied the guideline “mechanically” without such reduction.
  • Given that counts 4 and 16 used a modern guideline (assault by penetration) with a higher modern maximum, the judge should have scaled down the 8-year starting point to reflect the lower historic maximum.
  • It was said to be wrong in principle to impose a consecutive sentence on count 6 when:
    • count 4 already attracted a high sentence (8 years),
    • both counts involved the same complainant (C1), and
    • C1 had continued to see the appellant for years after the incidents, allegedly casting doubt on the need for so severe a sentence.
  • The judge allegedly double-counted breach of trust, already built into the 2A categorisation for the other counts.
  • The sentence was said to be manifestly excessive given the historic nature and passage of time; a sentence around 15 years was suggested as the upper justifiable limit.

4.2 Grounds of appeal against conviction

The conviction grounds (para 22) focused heavily on the jury’s fact-finding and can be summarised as:

  • The jury allegedly did not follow the judge’s directions to assess each count separately and to apply the criminal standard of proof.
  • It was said that:
    • the alibi in relation to C7 (count 16) was not properly weighed,
    • there was possible confusion of consultations and lack of documentary substantiation in relation to C1,
    • the appellant’s explanations (good medical practice or innocent reassurance) should have raised reasonable doubt.
  • The acquittals on counts 1–3 were said to undermine C1’s reliability and render the remaining convictions against her inconsistent.
  • The jury supposedly applied a civil standard of proof, particularly troubling in “historic” cases with a lack of forensic evidence.
  • It was asserted that convictions based solely on allegedly unreliable testimony and contradicted by notes were unsafe.

The single judge had refused leave on these grounds; that refusal was renewed before the full Court.

5. Precedents and Authorities Cited

5.1 R v H and Others [2011] EWCA Crim 2753

R v H is a key authority on sentencing historic sexual offences. The Court of Appeal in H laid down that:

  • Defendants are sentenced under the sentencing regime applicable at the date of sentence, not under the historical regime in force at the time of the offence, subject to:
    • the prohibition on imposing a sentence that exceeds the maximum sentence that could have been imposed when the offence was committed.
  • Courts should make “measured reference” to the current guidelines for equivalent modern offences.
  • Where the modern maximum is higher than the historic maximum, guideline starting points and ranges should be appropriately adjusted (“scaled down”) to reflect the lower historic maximum.
  • It is unrealistic and unnecessary for the court to try to reconstruct what sentence would have been given at the time of the offence; instead, the focus should be on current sentencing practice and the seriousness of the conduct.

In Cox, the Court directly quoted and applied these principles (para 24), confirming that they remain the governing approach.

5.2 R v Forbes [2016] EWCA Crim 1388

Forbes re‑emphasised the approach in H and cautioned against mechanistic or overly rigid adherence to historical sentencing tariffs. The key points, as reflected in Cox, are that:

  • Sentencing judges should:
    • respect the historic statutory maximum, and
    • otherwise sentence in accordance with contemporary guidelines and attitudes.
  • “Scaling down” is a matter of judgment, not a fixed mathematical exercise; the judge must evaluate the seriousness of the offending in a modern context but within the historic statutory ceiling.

The Court in Cox cites Forbes alongside H to reinforce that its approach – using modern guidelines but limiting each count to the 10‑year historic maximum – complied with established authority (para 24).

5.3 R v Bailey [2020] EWCA Crim 1719

Bailey concerns the principle of totality in sentencing. It emphasises that:

  • When sentencing multiple offences, the court must ensure that the overall sentence is just and proportionate to the total criminality.
  • Totality is a question of substance rather than form; appellate scrutiny focuses on whether the final aggregate sentence fairly reflects the offending, not on whether the sentencing structure could have been differently arranged in theory.
  • The Court of Appeal will be slow to interfere where the sentencing judge has clearly considered totality and the outcome is within the appropriate range.

In Cox, the Court uses Bailey to frame its review of the 22‑year aggregate sentence (para “21” [mis‑numbered]). It acknowledges that there are various legitimate ways to structure individual sentences (concurrent or consecutive), but the controlling question is whether the overall term is just and proportionate (paras 25–27).

6. The Court’s Legal Reasoning

6.1 Historic sexual offences: modern practice, historic maxima

The Court reaffirmed the core principle (para 24):

In sentencing for historic sex offences, the offender must be sentenced in accordance with the sentencing regime and practice applicable at the date of the sentence. The particular circumstances in which the offence was committed, and its seriousness must be the main focus. … Any sentence must be limited to the maximum sentence available at the date of the commission of the offence but otherwise it is wholly unrealistic to attempt to assess what the sentence would have been at the time. There should be measured reference to modern sentencing guidelines. Where the maximum sentence at the time of offending was lower than at present, then the starting point and category ranges have to be adjusted in a measured way to reflect the lower maximum sentence at the time.

Key elements of this reasoning:

  • The Court gives primacy to current sentencing practice and guidelines (reflecting modern societal attitudes to sexual offending), rather than historic norms.
  • However, the court must not increase the maximum penalty retrospectively; this is both a matter of principle and of legality.
  • Measured adjustment of the guideline ranges is required where the modern guideline is anchored in a higher modern maximum (for example, life imprisonment for assault by penetration under the 2003 Act, compared to 10 years historically for indecent assault).

Thus, the Court confirmed that the general methodology in H and Forbes remains binding and appropriate.

6.2 Use (and non‑scaling) of modern guideline starting points

The central controversy on sentence was whether the judge erred in using the modern Category 2A starting point of 8 years for the two most serious counts (4 and 16), without scaling it down to reflect the lower historic maximum.

The Court rejected the appellant’s argument (para 22). It noted that:

  • The judge had explicitly acknowledged the principle that modern guideline starting points should be scaled down where the modern statutory maximum is higher.
  • However, she explained that she had chosen not to reduce the 8‑year starting point because:
    • the high degree of trust intrinsic to the doctor–patient relationship,
    • the particular vulnerabilities of the complainants, and
    • the extent and gravity of the abuse
    were such that even after any theoretical scaling-down she would, in her sentencing judgment, have taken an equally high starting point to reflect these aggravating features.
  • There was therefore no error of principle in her approach.

This is an important refinement of the scaling‑down requirement. The Court confirms that:

  • Scaling is not a rigid formula that must always produce a lower number; it is a reasoned, context-sensitive exercise.
  • If, on a proper evaluation of seriousness and aggravating factors, the judge would in any event have increased a scaled starting point back to 8 years, it is sufficient that:
    • the judge has grappled with the concept of “measured adjustment”, and
    • has kept each individual count below the historic maximum (which she did).

In effect, the Court approves an approach in which:

  1. the judge considers the appropriate modern guideline category and starting point;
  2. recognises that historic maxima require careful adjustment; but
  3. explains, with reference to the facts (here, abuse of a GP’s trusted position and serious sexual intrusions), why an 8‑year term is justified despite the historical cap at 10 years.

This endorses robust sentences at or near the historical maximum in professional breach-of-trust sexual cases, provided the reasoning is explicit and principled.

6.3 Consecutive sentences and different victims

The Court considered the imposition of consecutive 8‑year terms on counts 4 and 16 (para 23). The key reasoning was:

  • Counts 4 and 16 involved:
    • different complainants, and
    • offending that occurred some 7–9 years apart.
  • They constituted distinct episodes of serious sexual offending, each involving digital penetration.
  • In those circumstances, the judge was entitled to make the sentences consecutive.
  • Each term (8 years) was substantially below the historic maximum of 10 years, preserving compliance with the no-retrospective-increase rule.

This reinforces the general principle that:

  • Where an offender commits separate, serious sexual offences against different victims, especially over a prolonged period, consecutive sentences are often appropriate to mark the separate harm and wrongdoing to each victim.
  • The question is then whether the aggregate sentence remains proportionate in light of totality.

6.4 Consecutive sentence on an additional count against the same victim (C1)

The appellant’s most specific challenge was that count 6 (3 years) should not have been consecutive to count 4 (8 years) as they related to the same victim, C1. The Court dealt with this at para 24.

Even assuming that counts 4 and 6 could be seen as part of a “series of offences of the same or similar kind, committed against the same person” (as the appellant argued), the Court reasoned as follows:

  • Count 4 (digital penetration) was the most serious incident concerning C1 and merited a starting point of 8 years.
  • However, the appellant’s conduct towards C1 reflected:
    • a course of behaviour over a two‑year period, involving multiple visits to the surgery, and
    • “other action” committed on the same occasion as count 4.
  • C1 was particularly vulnerable, having recently been in a women’s refuge following an abusive relationship.
  • These features required an uplift over and above what would be appropriate for a single standalone offence of digital penetration on one occasion.
  • The judge could have chosen to build that uplift into the sentence on count 4 alone, by going closer to the 10‑year maximum, but instead chose to express it by:
    • imposing a consecutive sentence on count 6, while keeping count 4 at 8 years.

The Court concluded that this was a legitimate way to structure the sentence. It emphasised (para 25) that there are different permissible ways to reflect the same overall criminality; the core issue is whether the aggregate sentence is just and proportionate, not the precise distribution of that sentence among counts.

6.5 Totality and proportionality of the 22‑year sentence

The Court applied the principle of totality as framed in Bailey (para “21” and paras 25–27). It observed that:

  • The sentencing judge had presided over both trials, and was therefore well placed to assess the seriousness, the impact on victims, and the appellant’s conduct over time (para 26).
  • The offending was “shocking”, spanning nearly a decade, involving:
    • twelve indecent assaults on seven patients,
    • repeated behaviour for sexual gratification,
    • a high degree of breach of trust,
    • two instances of digital vaginal penetration,
    • humiliating sexual contact by rubbing his penis against complainants, and
    • one victim who was no more than 14 years old.
  • The consequence for victims was “serious and lasting”.

Acknowledging that the sentence was “long”, the Court nonetheless held that it was not manifestly excessive (para 27). The sentence:

  • reflected multiple serious offences,
  • appropriately marked the breach of trust inherent in a GP’s exploitation of his patients, and
  • stayed within the statutory maxima applicable at the time of the offending.

The Court was therefore satisfied that the principle of totality had been properly applied in substance, and that no intervention was warranted.

6.6 Appeal against conviction: deference to jury fact-finding

On conviction, the Court effectively adopted the single judge’s reasons and added nothing further (paras 28–29). Those reasons stressed:

  • The defence did not allege any misdirection of law or error in the summing-up, which had been praised by defence counsel at trial as a model of fairness.
  • Allegations that the jury:
    • failed to assess each count separately,
    • applied a civil standard of proof, or
    • ignored the judge’s directions,
    had no evidential or legal foundation.
  • The jury were fully entitled to:
    • accept the complainants’ evidence and reject the appellant’s explanation,
    • reach mixed verdicts on different counts for the same complainant (C1), and
    • reject the alibi in relation to count 16.
  • The fact that the jury took four days, returned majority verdicts, and acquitted on some counts while convicting on others, indicated careful and conscientious deliberation, not arbitrariness.

The Court underscored the established principle that:

  • The Court of Appeal does not re-try the case and will not overturn a conviction merely because the appellant continues to deny the offences or because alternative factual interpretations are conceivable.
  • Absent legal misdirection, material irregularity, or a conviction that appears unsafe on the whole of the evidence, the jury’s verdicts stand.

The renewed application for leave to appeal conviction was therefore refused as “wholly without merit”.

7. Impact and Future Significance

7.1 Historic sexual offences and medical professionals

Cox is significant in confirming that:

  • Courts may impose very substantial sentences for historic sexual offences by medical professionals, even when the statutory maxima at the time of the offences were lower than for equivalent modern offences.
  • The doctor–patient relationship attracts especially strong aggravating weight:
    • Patients are often vulnerable, ill or distressed.
    • They are required to undress and submit to intimate examinations.
    • They are entitled to assume the highest degree of professional integrity.
  • Where that trust is flagrantly and repeatedly abused for sexual gratification, courts are justified in approaching the top end of historic maxima for serious offences, even after “measured adjustment” of modern guideline starting points.

The case will be of particular relevance to sentencing in cases involving:

  • doctors, nurses or other healthcare professionals,
  • therapists or counsellors,
  • teachers and carers, and
  • other professionals in positions of intimate, repeated and trusting access to vulnerable persons.

7.2 Refining the “scaling down” of modern guidelines

Cox subtly refines the approach in H and Forbes by demonstrating that:

  • “Scaling down” of guideline starting points is not a mechanical numerical exercise.
  • What is required is:
    • a clear understanding of the difference between modern and historical statutory maxima, and
    • a reasoned explanation of how the sentence remains appropriate and proportionate within the historical cap.
  • If a judge recognises the need to scale but then, on a holistic assessment of seriousness and aggravation (especially high breach of trust), concludes that an 8‑year term is still the correct sentence, the Court of Appeal will not interfere provided:
    • each count remains below the historic maximum, and
    • the reasoning is coherent and rooted in the guideline structure.

This gives sentencing judges a degree of flexibility, whilst maintaining the essential safeguard against retrospective enhancement of maxima.

7.3 Totality in multi-count sexual cases

The case also reinforces how totality should operate where:

  • there are numerous counts over a long period,
  • multiple victims are involved, and
  • some counts involve particularly grave conduct (here, digital penetration) while others are in the lower or middle range of sexual assault.

Cox confirms:

  • It is appropriate to:
    • treat the most serious counts as anchors for the sentence, often with consecutive terms where they concern different victims.
    • add a moderate consecutive term to reflect wider offending across other complainants.
  • There is no rigid bar against some consecutive element for offences against the same victim, where this is needed to mark:
    • prolonged abuse, or
    • distinct episodes that cannot adequately be encompassed within a single sentence.
  • The Court will respect different legitimate ways of structuring concurrency and consecutivity so long as:
    • the overall sentence fairly reflects the full criminality, and
    • the judge has plainly addressed totality.

7.4 Appellate approach to jury verdicts in historic sexual cases

On conviction appeals, Cox reaffirms the limited scope for challenging verdicts in historic sexual cases:

  • The mere fact that convictions rest primarily on the complainants’ testimony, sometimes without forensic corroboration, does not render them unsafe.
  • Arguments that “the jury must have applied the civil standard” or that they “could not have believed” the complainants amount to no more than disagreement with the verdict; they do not constitute an appealable ground.
  • Mixed verdicts (some counts proved, some not) may indicate careful scrutiny of each allegation, and do not in themselves prove inconsistency.

The decision underscores that, provided the jury is properly directed, the assessment of credibility and reliability is for the jury, and the Court of Appeal will not readily interfere.

8. Complex Concepts Explained

8.1 Indecent assault vs assault by penetration

  • Indecent assault (1956 Act): At the time of these offences, the primary relevant offence was “indecent assault on a woman” under the Sexual Offences Act 1956, with a maximum penalty of 10 years. It was a broad offence covering any assault in circumstances of indecency.
  • Assault by penetration (2003 Act): Under the Sexual Offences Act 2003, this is a much more specific and serious offence, focusing on non-consensual penetration of the vagina or anus with a body part or object, and carries a maximum sentence of life imprisonment.

In Cox, the digital penetrations of C1 and C7 (counts 4 and 16) were historically charged as indecent assault, but for sentencing purposes the judge (and Court) appropriately treated them as analogous to assault by penetration under the modern guidelines.

8.2 Historic offences and non-retrospective sentencing

The law prohibits retrospective punishment in the sense of:

  • imposing a penalty that exceeds what was legally possible at the time of the offence.

However, sentencing today for old offences involves:

  • using current sentencing practice and guidelines, which reflect modern views of seriousness,
  • while strictly respecting the historic statutory maximum.

That is why in Cox:

  • the court considered the modern Sexual Offences Definitive Guideline,
  • but ensured each sentence for indecent assault stayed below the historic 10‑year cap.

8.3 Totality

The principle of totality requires that where a defendant is sentenced for multiple offences, the combined sentence:

  • must be just and proportionate to the overall offending, not merely the sum of individual starting points.

Courts give effect to totality by:

  • running some sentences concurrently (at the same time), and
  • reducing the length of some individual sentences where necessary.

In complex sexual cases:

  • The main serious counts (e.g. penetration) often drive the overall sentence.
  • Lesser counts may be concurrent or attract shorter consecutive terms to recognise additional harm without making the total disproportionate.

8.4 Consecutive vs concurrent sentences

  • Concurrent sentences: Served at the same time. Used where offences are closely linked in time and character, often arising from a single incident.
  • Consecutive sentences: Served one after another. Used where offences:
    • are distinct in time or nature,
    • involve separate victims, or
    • would not be adequately reflected if punished concurrently.

In Cox, the Court approved:

  • consecutive sentences for serious offences against different victims separated by years, and
  • a further consecutive element to reflect a course of offending against the same complainant (C1).

8.5 Breach of trust as an aggravating factor

In sentencing sexual offences, a position of trust – such as teacher, doctor, carer or clergy – is a recognised aggravating factor. It reflects:

  • the power imbalance between offender and victim,
  • the special vulnerability of victims who rely on the professional, and
  • the wider impact on public confidence in that profession.

In Cox, the Court regarded the breach of trust inherent in the doctor–patient relationship as exceptionally serious, justifying high sentences near the historic maximums.

8.6 Sexual Offences (Amendment) Act 1992 – anonymity

Section 1 of the Sexual Offences (Amendment) Act 1992 provides that where an allegation is made that a sexual offence has been committed against a person:

  • no matter may be published that is likely to lead to that person being identified as the victim during his or her lifetime, unless anonymity is lawfully waived or lifted.

The Court in Cox opened its judgment by reaffirming this protection (para 1). The complainants are therefore anonymised as C1–C7, and that anonymisation must be maintained in all publications.

8.7 Standard of proof and majority verdicts

  • Standard of proof: In criminal cases, the prosecution must prove the defendant’s guilt “beyond reasonable doubt” (often expressed as “so that you are sure”). This standard applied in Cox, and the judge clearly directed the jury accordingly.
  • Majority verdicts: Under the Juries Act 1974, a jury of 12 may, after an appropriate period of deliberation, return a majority verdict (e.g. 10–2 or 11–1) if unanimity cannot be achieved. The jury in Cox returned majority verdicts after four days of deliberation, which the Court took as evidence of careful consideration rather than haste.

9. Conclusion

R v Cox [2025] EWCA Crim 1625 is a significant sentencing decision in the field of historic sexual offences involving professional abuse of trust. Its main contributions can be summarised as follows:

  1. It reaffirms that historic sexual offences must be sentenced by reference to modern guidelines and practice, with “measured” adjustment for lower historic maxima, rather than attempting to replicate historical sentencing approaches.
  2. It clarifies that the requirement to “scale down” modern guideline starting points is flexible. Judges may legitimately impose high sentences (near the historic maximum) where the facts – particularly extreme breach of trust in a doctor–patient setting – justify it and the reasoning is clearly articulated.
  3. It confirms that consecutive sentences are appropriate:
    • for distinct serious offences against different victims over time, and
    • in some circumstances, to mark a sustained course of offending against the same victim.
    The controlling test is whether the overall term complies with the principle of totality and is not manifestly excessive.
  4. It highlights the judiciary’s strong condemnation of sexual abuse by medical practitioners, emphasising that such conduct “strikes at the heart of everything the medical profession stands for” and warrants severe punishment.
  5. On conviction, the decision reinforces the limited role of the Court of Appeal in reviewing jury verdicts: absent legal error or clear unsafety, challenges that simply dispute the jury’s assessment of credibility or invite re-interpretation of the evidence will not succeed.
  6. Finally, by expressly invoking the Sexual Offences (Amendment) Act 1992, the Court reiterates the continuing importance of protecting the anonymity of complainants in sexual cases.

In combination, these elements make Cox a significant authority on the sentencing of historic sexual offences committed by professionals in positions of profound trust, and a reaffirmation of both the flexibility and the discipline inherent in the modern guideline and totality framework.

Case Details

Year: 2025
Court: England and Wales Court of Appeal (Criminal Division)

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