Culture change needed for healthy sex and relationships in adult social care

Author: Caroline White

A culture change is needed in adult social care to promote healthy sex and relationships, concludes a report* by health and social care regulator, the Care Quality Commission (CQC).

The fact that sex is still something of a taboo subject disallows a basic human right to express sexuality and helps to keep abusive relationships hidden because people don’t feel able to raise concerns.

The report drew on feedback from services users, families, staff and providers as well as reviews of 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 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%) were categorised as allegations of sexual assault. The second most common type of incident (11%) was that of indecent exposure and nudity. Some 16% of all notifications made allegations against employed staff or visiting workers and 5% detailed cases of consensual sex.

The report highlights how a supportive environment not only helps people express their sexual needs, but also potentially prevents incidents or ensures they are reported when they do.

The report makes a raft of recommendations. These include that providers and leaders across adult social care should develop a culture that encourages people and staff to have the confidence to talk openly about sexuality and raise concerns around safety.

Guidance for care managers and staff should be developed that focuses on how to protect people in adult social care from sexual abuse and how to support them to develop and maintain relationships and express their sexuality.

CQC should continue to improve the system of provider notifications and how they deal with reported incidents ensuring staff feel able to deal with these difficult and sensitive issues in a timely way.

Through regulation, inspectors should consider how open cultures are and ensure that care plans give appropriate consideration to people's needs around sexuality and relationships.

Kate Terroni, CQC chief inspector of adult social care, said: "Supporting people as individuals means considering all aspects of a person's needs, including sexuality and relationships.”

The report shows how 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,” she said.

"It is not good enough to put this issue in a 'too difficult to discuss' box. It is precisely 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."

Veronica Gray, deputy CEO of Action on Elder Abuse, said the charity wholeheartedly supported the call for a change in culture. "It is critical that this issue – so often hidden from view – is brought out into the open,” she said.

"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."

Andrea Sutcliffe, chief executive and registrar of the nursing regulator, the Nursing and Midwifery Council (NMC), said: “For too long sex and sexuality have been ignored and treated as taboo subjects in adult social care. As CQC’s important report shows, the failure to have open, honest conversations leads to a lack of respect for this basic human need and an environment where sexual harm can happen with devastating consequences for those affected.

“Nurses in adult social care have a vital role in supporting those they care for to safely explore and express their sexuality, while protecting them from sexual abuse. This is entirely consistent with the NMC code and standards which require nurses on our register to show both clinical excellence and a commitment to kindness, compassion and respect, and to provide person-centred care that respects people’s diversity,” she said.

She added: “While CQC only regulates health and social care services in England, there are important lessons here that adult social care nurses in all four UK countries can take on-board.”

*Promoting sexual safety through empowerment. A report prepared by the Care Quality Commission, 27 February 2020.