Everyone, regardless of their sexual orientation or gender identity, deserves equal access to opportunities and services, and their safety should always be protected. It is a basic human right for people to express their sexuality and, where needed, people should be empowered, offered support and protection when they use health and social care services.
The Care Quality Commission's (CQC) (2020) report regarding sexual safety through empowerment considers how adult social care services can keep people who use them safe from unwelcome sexual incidents. It also examines how service providers can offer support to people so as to express their sexuality. The report reveals that the CQC received and analysed 661 statutory notifications of 899 sexual incidents or incidents of alleged sexual abuse that took place over a 3-month period in 2018 in adult social care services in England. The data cited are only incidents that have been reported; these statistics should be the catalyst necessary to stop such abhorrent abuse from continuing or at the very least reducing incidence.
Between 1 March and 31 May 2018 most incidents were alleged to have been carried out by people who use services, and most of those affected were also service users. In 16% of cases, the alleged incidents were carried out by employed staff or visiting workers and, in 8%, by friends or relatives (CQC, 2020).
All nurses are required to take allegations of abuse seriously (Nursing and Midwifery Council (NMC), 2018), and they must adhere to the laws of the country in which they practise. The nurse must work with local partners to prevent abuse and ensure the wellbeing of anyone affected; this expectation also applies to all health and social care organisations.
People are not always protected from sexual harm or provided with support in order to express their sexuality. The CQC (2020) report makes three recommendations and acknowledges a need for change in various settings across adult social care; and for this to occur will require the support of the whole local system. A lack of awareness and understanding of good practice in sexual safety and sexuality has the potential to place people at risk of harm. There is a need to develop a culture within which people and staff feel that they have been empowered to talk about sexuality and to raise concerns regarding safety. The CQC and regulators, such as the NMC, have a clear role in ensuring that people using services receive protection and support.
The CQC report calls for cross-system improvements. Its key aim is to encourage open conversations across adult social care and the wider system to dispel myths. This can lead to greater confidence and awareness of what can work to keep people safe from sexual harm and empower them to express their sexuality to lead full lives determined by their own choices, needs and wants.
Guidance for all staff, including those working in adult social care, is in dire need of improvement. Staff need to know how they can help protect people from sexual abuse and enable them talk about or show their sexuality, if they so wish. In environments that empower staff, where conversations about sexuality are encouraged to take place, where staff feel they can share their concerns without fear of retaliation, and where people and their families are supported to speak about their wants and needs in a caring way, people will feel safe, stay safe and feel empowered. The people who manage adult social care services should make sure that their staff use guidance to ensure people and staff are safe and can talk openly about sexuality.
Abuse in all its forms can never be accepted; when bad practices are unchallenged, it can result in dire outcomes for service users. Staff working in any care setting have a responsibility to ensure that those who use their services are safe and can live the lives they want to live, be this in their own home, in residential or nursing care, or a hospital. Being able to express sexuality is essential to this and promotes a culture of openness that supports that right, as well as helping to protect people from harm or abuse.