CQC calls for a culture of openness towards sexual needs and sexual harm

The Care Quality Commission (CQC) is calling for leaders across adult social care to work together to create a culture of openness where people using services feel empowered and supported to be open about sexuality and relationships – while ensuring they are protected from sexual harm

This is an edited version of an article first published by the CQC.

Promoting Sexual Safety Through Empowerment draws the connection between an environment which allows people the basic human right to express their sexuality, and an open culture where people feel able to raise concerns around safety where necessary.

Through engagement with numerous stakeholders including families, staff and providers the report looks at what can be done to support people in adult social care to have safe sexual relationships. This review includes findings from extensive conversations with people who use services, their families, as well as care providers and other stakeholders, such as advocacy groups and members of the public. CQC also reviewed over 650 notifications of sexual incidents or alleged sexual abuse that took place in adult social care services and were reported by providers to CQC.

The 661 statutory notifications of sexual incidents that were reported to CQC between 1 March and 31 May 2018 detail 899 sexual incidents or incidents of alleged sexual abuse that took place in adult social care services such as residential and nursing homes. This reflects 3% of all the abuse notifications received by CQC during this period. Almost half of the incidents (48%) have been categorised as allegations of sexual assault. The second most common type of incident (11%) was that of indecent exposure and nudity. Sixteen percent of all notifications made allegations against employed staff or visiting workers and 5% of reported instances were detailing cases of consensual sex.

The report also highlights examples of care providers developing ways of working to initiate an open conversation where people are supported to express sexuality.  This support was found to not only help people express their sexual needs, but potentially prevent incidents before they happen or ensure they are reported when they do.

Following engagement with people who use adult social care – including those who have been involved in sexual safety incidents – CQC has outlined recommendations to improve the sexual safety of people using adult social care and empower them to have fulfilling relationships.

These recommendations include:

  • Providers and leaders across adult social care should develop a culture that encourages people and staff to talk about sexuality and raise concerns around safety. Staff should be empowered to have the confidence to discuss issues around people’s relationships and their sexuality, which will also keep them safe from sexual harm
  • Co-produced guidance for care managers and staff that focuses on how to protect people using adult social care from sexual abuse and how to support them to develop and maintain relationships and express their sexuality should be developed.
  • CQC should continue to improve the system of provider notifications and how they deal with reported incidents ensuring  staff are enabled to deal with these difficult and sensitive issues in a timely way. Through regulation Inspectors should consider how open cultures are to discuss sex and sexuality and ensure that care plans give appropriate consideration to people’s needs around sexuality and relationships.

Kate Terroni, chief inspector of adult social care at the Care Quality Commission, said:

“Supporting people as individuals means considering all aspects of a person’s needs, including sexuality and relationships.

“We know that an open culture, where staff feel they can share concerns without fear of reprisal, where people and families are empowered to speak about their wants and needs in a sensitive way, and where managers and providers proactively enable conversations about sexuality to take place are the conditions that lead to people being empowered to stay safe and supported.

“However, our report also shows all too starkly the other side of this – the times when people are harmed in the very place they should be kept safe. This is utterly devastating, both for the people directly affected and their loved ones.  While we are aware that sexual incidents in services are not common, we know from speaking to those affected that the impact and consequences can be life-changing. Their message to us is that more needs to be done to prevent sexual abuse happening.

“It is not good enough to put this issue in a ‘too difficult to discuss’ box. It is particularly because these topics are sensitive and complex that they should not be ignored. We are clear that abuse in any form can never be accepted and we must act on the findings of this report to help providers and care staff protect people from sexual harm, while enabling people to continue or develop intimate relationships. We are confident that with the right commitments across the sector we can achieve both.”

This report, which aims to initiate an open conversation across adult social care and the wider system, follows on from the Relationship and Sexuality in Social Care guidance – published in 2019. This guidance, developed alongside providers and key stakeholders helps care services and staff recognise and offer support to the sexual and relationship needs of those they work with, as well as to enable conversations that can help develop trust and improve care planning in this area.

Veronica Gray, deputy CEO of action on elder abuse, said:

“We at Action on Elder Abuse very much welcome the CQC even looking at the issue of sexual safety, and we wholeheartedly support their call to initiate an open culture in adult social services around sex and sexuality. It is critical that this issue – so often hidden from view – is brought out into the open.

“However, while we endorse the CQC’s message of supporting people in expressing their sexuality whilst in care, more needs to be done to protect those most vulnerable to sexual abuse. The first priority of adult social services must be the safety and wellbeing of those in their care.”

Dr Claire Bates, founder of Supported Loving, said:

“Supported Loving believes that people with learning disabilities and/or autism should be able to enjoy the same sexual freedom as everyone else. This human need has often been ignored in social care services, which are meant to support people to lead ordinary lives. However, we acknowledge that sexuality can be a difficult and challenging area for social care and CQC as regulators. Consequently, we welcome this report and the attention it brings to an important area of life. A consensual sexual or intimate relationship can bring great joy and value to people’s lives, but the lack of support or education in this area can make developing one unlikely, or worse, make instances of sexual abuse more likely.”

A full copy of Promoting Sexual Safety Through Empowerment is available here.

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