Sexual Safety through empowerment 1 – Findings
The CQC has recently published “Promoting sexual safety through empowerment’ (the ‘Report’), which looks at:
- how adult social care services keep people safe from sexual harms and;
- how services can support individuals to express their sexuality.
The CQC has drawn on conversations with providers, service users, families and other stake holders and has used information from notifications to explore the issues in the Report.
The Report builds on the ‘Relationships and sexuality in adult social care services’ guidance produced for CQC inspectors and providers issued in 2019 and ‘Sexual safety on mental health wards’, which we have summarised in this earlier briefing.
- Stakeholders told the CQC that sex is often seen as a ‘taboo’ subject. The perception is that sex should not be discussed and lack of openness affects well-being but also means that predatory behaviour can be overlooked or normalised. The CQC also takes the opportunity to reinforce that people are less likely to speak out in ‘closed cultures’.
- Review of statutory notifications received between March and May 2018 found that almost half of the reported incidents were categorised as sexual assault. The second most common type was exposure and nudity and one in 12 incidents was categorised as sexual harassment, for example a woman lifting up her dress and trying to coax a male resident. There were 47 (5%) allegations of rape and the incidents categorised as ‘Undefined or other ‘included grooming and provision of intimate care without appropriate dignity. 5% of incidents in the notifications contained consensual activity even though there was no reference to lack of capacity or abusive behaviour. This may indicate staff do not fully understand the issues potentially leading to infringement of human rights.
- In 26% of notifications sexual orientation was recorded as ‘unknown’. This is notably high given that CQC’s guidance is clear that sexual orientation is an important part of a person’s needs assessment. This may support feedback from LGBT+ representatives that people from the LGBT+ community are not always asked or do not always feel safe to disclose their sexual orientation.
- Older women were disproportionately affected. 45% of all incidents affected women over 75. Stakeholders told the CQC that in wider society older women are not always listened to, or able to communicate concerns. They said this is heightened within adult social care because older women can be further marginalised and isolated from knowledge and support. In some of the worst cases of sexual abuse, staff did not know what to do when sexual assaults occurred or they normalised these behaviours – for example, staff dismissing behaviour as a personal character trait – ‘oh that’s John, don’t worry he does that’. Low self-esteem was noted to increase likelihood of sexual harm for women of all ages.
- There are emerging concerns about use of social media, mobile phones and the internet in sexual abuse. The CQC heard that young people with learning disabilities are particularly vulnerable to grooming on social media. One example was of a young girl who felt lonely, but couldn’t distinguish harmful sexual attention from the attention she desired and craved. She would use social media to meet men and have sex with them.
- Provider responses on the whole detailed the interventions to stop and prevent sexual behaviour. Monitoring and observation was often put in place and restraint and detention was said to be required only rarely. On occasion providers had given people notice to leave.
- Joint working with other agencies is key to keeping people safe. Providers must work closely with other agencies in their response to sexual safety incidents. Clearer guidance could improve working between different agencies such as police, providers and local safeguarding teams to give the right level of support for victims and this is recorded as recommendation.
- Stakeholders informed the CQC that the type of package of care could affect the time and focus that might be available to support sexuality and sexual safety. Comment was received to the effect that particularly for council-funded home-care packages there simply isn’t time to support a person’s sexuality or how they may wish to express it. Providers will need to consider how best to work with commissioners to ensure that the needs of the people they support are met in full.
- The CQC recommends that Skills for Care update their guidance ‘Supporting personal relationships’ to incorporate learning by Spring 2020 and that this should be co-produced with a wide range of stakeholders. The CQC comments that this should be a practical guide to make sure staff understand how to protect people and how to support people to develop and maintain relationships.
- The CQC should continue to strengthen processes to ensure protection of human rights and that people are safe from abuse and exploitation.
- Providers and leaders across the sector should develop an environment, process and culture to support people’s sexuality, keep them safe and promote their human rights.
We summarise the CQC’s guidance for providers in relation to this issue in a further briefing.
This briefing is for guidance purposes only. RadcliffesLeBrasseur LLP accepts no responsibility or liability whatsoever for any action taken or not taken in relation to this note and recommends that appropriate legal advice be taken having regard to a client's own particular circumstances.