In an earlier edition of Inside CQC, my colleague, Debbie Ivanova mentioned that we would soon be publishing a report looking at sexual safety and sexuality in adult social care. The report – Promoting sexual safety through empowerment: A review of sexual safety and the support of people’s sexuality in adult social care – can now be read in full on the CQC website.
Following a similar report into sexual safety incidents in mental health wards in 2018, we have worked with families and people who receive social care who had experienced sexual assault or sexual abuse to develop the themes of this report, along with our inspectors, provider organisations and charities. As this report was developed with stakeholders, there was a clear need to also highlight the fantastic work that is happening around the country in supporting people to have conversations about sex, sexuality and relationships, and how social care providers are creating the conditions for this to happen. This report also builds on our Relationships and Sexuality guidance that we published for social care providers early in 2019.
We hope that by creating this report we are initiating a conversation in adult social care that will lead to a more 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 people who work in social care proactively enable conversations about sexuality to take place.
The starting point of the report was to analyse 661 statutory notifications describing sexual incidents or alleged abuse across all adult social care services from a three-month period. These 661 notifications made up 3% of the notifications that we received during the three-month period, showing that sexual incidents in adult social care settings are not common. The percentage of people affected in social care is also broadly in line with other data which shows the occurrence of sexual assault and abuse in everyday life.
When analysing the notifications, we found that almost half of the incidents (48%) have been categorised as allegations of sexual assault, and the second most common type of incident (11%) was that of indecent exposure and nudity. Our analysis showed that sexual incidents are nearly four times more likely to be carried out by men and that women were three times more likely to be affected by sexual incidents. In the majority of cases, we found providers had taken steps to ensure people were safe and involved, and had informed the relevant authorities.
Working in adult social care is an incredibly hard but rewarding job and the majority of people using services are looked after by caring and skilled staff. To highlight this, the report also contains examples of good practice and has an equal focus on promoting sexuality and empowering people to have healthy relationships if they want to. We want this to be the start of an ongoing conversation about a sensitive topic that many people report feeling uncomfortable or poorly equipped to discuss.
Recommendations in the report include providers and leaders across adult social care developing a culture that encourages people and staff to talk about sexuality and raise concerns around safety; the development of co-produced guidance for the workforce; and improving our own systems at CQC about how we regulate this important area of care.
The courageous families who worked with us on this report did so in the hope that sharing their painful stories would lead to an improvement in care for others. This difficult issue can’t be ignored. We want this report and its recommendations to impact positively on people’s lives. We want to ensure people are supported to express their sexuality and have sexual relationships, should they wish. People should also be able to raise concerns and be confident that they will be responded to appropriately, and people kept safe. The only way this will happen is if we work together to make the necessary changes.