Inside CQC

Debbie Ivanova, Deputy Chief Inspector of Adult Social Care at the Care Quality Commission (CQC) explores the regulator’s latest guidance around supporting people’s sexuality in care services.

The last time I wrote for ‘Inside CQC’ , I talked about CQC’s equality and human rights approach to regulation. In particular, how we use our equality objectives to focus on areas where we think we can encourage the sector to grow in confidence in how it supports difference and equality.

In this column, I want to share the latest example of how we’re doing this – our guidance on Relationships and sexuality in adult social care services.

The idea for this guidance came from conversations we’ve had with people who use services, providers and our own inspectors about how people should be supported to express their sexuality and have relationships when they are using care and support services.

Firstly, as is often the case with sex and relationships, there is an element of taboo and embarrassment around talking openly about this. We wanted to develop some guidance that talks about the issues in a straight-forward way to support providers to start their own conversations within staff teams and with people using their services.

Secondly, we know that there is nervousness about getting it wrong when it comes to sex and relationships, in particular around establishing capacity and consent in relation to sexual activity. It’s not surprising that some providers have told us they feel cautious about sex and relationships – they want to protect people from harm and abuse – but it’s very important that people have the right to express their sexuality and have relationships supported. We have designed the guidance in an FAQ style to clearly answer all the ‘questions you were too embarrassed to ask’ and help providers feel confident that they have the information they need to navigate these issues.

Finally, this is a very live topic. Providers are supporting people with increasingly complex needs, including people living with dementia; this and other damage to the brain can lead to some people being less sexually inhibited in their speech and behaviours. Staff supporting people with neurological impairments need to understand how the brain is influencing their behaviour and how they can support them.

It’s also crucial that providers understand sexual orientation and gender identity in order to support the increasing number of LGBT+ people using services. If providers do not understand what LGBT+ means and are not proactive in how they support people to be themselves when they receive care and support, then, as the film Gen Silent puts it, the generation that fought hardest to come out will go back in to survive. That can’t be right, so services must promote LGBT+ inclusive practices to prevent people from being faced with that choice.

None of this will be rocket science to Care Management Matters readers. After all, being person-centred is the foundation of good care. But we know there are still barriers to people being properly supported to form and maintain personal, loving, intimate and sexual relationships and at CQC we believe we have a role in sharing information that supports providers and staff to do this well.

Related to this guidance, we have been carrying out work to better understand how safety incidents of a sexual nature occur within adult social care settings. This has involved analysing notifications data submitted to CQC by providers and engagement with people who use services, providers, registered managers and frontline care workers to understand the issues.

Over the next month, we will be co-producing recommendations on how we can improve sexual safety – keep an eye on our monthly newsletters for information on how to get involved.

When we publish the report of this work in the summer, we won’t only be talking about what we’ve found and our recommendations. We will be sharing case study examples of some of the great work happening within services to protect people from sexual harm whilst still promoting people’s rights. We hope that this, along with the guidance, will offer providers clarity and direction around this sensitive and complex area.

Debbie Ivanova is Deputy Chief Inspector of Adult Social Care at the Care Quality Commission. Share your thoughts and feedback on Debbie’s column below.

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