Sexual Safety through empowerment 2 – Guidance for Providers
The CQC recently published ‘Promoting sexual safety through empowerment’ (the Report).
There was a broad consensus on the key themes and action needed to improve sexual safety, and there was a strong request that national guidance is developed and co-produced to support this.
We have set out the key findings in an earlier briefing, and now summarise the areas where guidance for providers is likely to be developed as follows:
Service users, their families and carers should feel confident to speak out about their experiences and should be supported to do so. A culture of openness among service users and staff should be encouraged.
It is the leader’s job to shape a culture which is intolerant of unacceptable sexual behaviour and is open in encouraging staff and service users to discuss both incidents and sexuality and relationship needs.
As part of inspiring and facilitating high-quality, person-centred care, leaders must encourage best practice to prevent, report and proactively respond to sexual safety incidents, and work closely with staff to support relationships. To develop this environment, staff themselves must feel safe from unwanted sexual behaviour and confident that if they raise concerns they will be acted on appropriately. They should also feel that they would be supported fairly if allegations of abuse were raised against them.
Care planning and risk assessment
Staff should not treat consensual sexual activity as harmful. Care plans and risk assessments should indicate that people’s needs have been considered and that support and education has been offered where appropriate. Providers should ensure that the approach is holistic and individualised.
Those individuals with a learning disability or with autism may have limited knowledge about sex or sexuality so rely on staff to be proactive in helping them receive advice and education. Access to support and information should be ongoing and must be in an accessible format and reflect culture and diversity.
Some stakeholders were not confident that providers were learning from incidents, particularly in understanding risk assessment policies to protect people. They advised that more information should be shared more effectively between agencies and providers such as in relation to the Violent and Sex Offenders Register.
People who use services, particularly those with learning disabilities, spoke of staff or others walking into their room without permission. They felt staff should monitor access to rooms and thought that technology could perhaps assist in this regard. It is also noted that where staff mainly work on their own, it can be difficult to corroborate conflicting accounts of incidents.
Providers should consider the needs and mix of other residents or household members when supporting a person to use the service.
It is important to have a clear policy as well as individualised care plans. Without this guidance, staff may make personal judgements based on their own values and experience rather than in accordance with the organisation’s prescribed approach. This can lead to a lack of consistency, which may fracture trust and moreover infringe people’s rights.
Staff training and development
All groups spoken to raised concerns regarding insufficient training and policy on sexual safety and how to support people’s sexuality. The CQC comments that staff should feel confident to support people and to speak up if they are worried about harmful behaviour. Providers and staff need an in-depth understanding of preferred communication methods.
It is acknowledged that establishing capacity to consent can be complex and providers are reminded that they should ensure they understand the principles of the Mental Capacity Act 2005.
Mental capacity should be assumed unless proved otherwise but this is a complex and sensitive area. The CQC refers to few instances reported where mental capacity assessments had been carried out as a result of an incident taking place, and fewer still that included assessing people’s capacity to consent to a sexual act. Providers are referred to the CQC’s sexuality and relationship guidance for further detail to inform their policy and protocols.
Staff should be strongly encouraged to access practical learning. Providers will need to carefully consider how they test the effectiveness of any training provided by way of supervision, competency assessment or otherwise.
Stakeholders felt common principles were needed to support learning more widely, with a recognition that different settings and different groups may require bespoke approaches.
Providers may also be assisted by the following resources references in the Report:
- Alzheimer’s Society has developed a workshop on sex, intimacy and dementia which deals with consent, practicalities of sex in care homes and policies.
- Supported Loving is a human rights campaign and network which works closely with individuals with learning disabilities and providers to help support relationships.
We will provide a summary of the forthcoming updated Skills for Care guidance in due course.
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.