CQC chief urges social care staff to have 'open culture' when talking 'sex and sexuality'

The chief inspector of adult social care for the Care Quality Commission is ‘urging’ all sector managers and staff to develop a culture where all people feel empowered to talk about sexuality.

Speaking at the Future of Care conference earlier this week, Kate Terroni told delegates of her ‘anxiety and sleepless nights’ about publishing an independent review called ‘Promoting sexual safety through empowerment’.

The CQC initiated this review after hearing of many shocking experiences of sexual abuse from people and family members using the services in adult social care.

’We feel uncomfortable about having conversations about sex and sexuality’

Ms Terroni said: “If you are a provider in the room, I would really urge you to have a read of it. It was a report I personally had a huge host of anxiety and sleepless nights about publishing. We know social care is a sector that is not held in high regard and we know we have got a huge amount of challenges, so I knew how some of the information gave me a lot of cause for concern.

“What we found in our sexual safety was we feel uncomfortable about having conversations about sex, sexuality and relationships, people are also less confident about raising the red flag when things go wrong, we don’t have the skills. If you are an adult with learning disabilities, physical disabilities an older woman with dementia, the idea about having conversations about sex and sexuality is a really tough one to have.

“If I’m a 22-year-old care worker in a care home. What would it look like if I had to talk to a 50-year-old daughter that her mum has started a relationship with another man? I might be pretty terrified. We called for an open culture for a better dialogue around sex and sexuality and the ability for people to raise concerns when they need to.”

CQC worked independently with Skills for Care and the Department of Health and Social Care for practical guidance and support to all staff in social care about how to initiate conversations about sex and sexuality as well as how to spot signs of assault and abuse.

48 per cent of incidents reported to CQC were categorised as sexual assault

The report used information from the ‘notifications’ that CQC received from providers between the period March 2018 to May 2018. In that time, CQC identified and analysed 661 notifications that described 899 sexual incidents or incidents of alleged sexual abuse that took place in adult social care services.

A total of 48 per cent of incidents reported in this period were categorised as sexual assault, defined as sexually touching another person without their consent. Eleven per cent was exposure and nudity, and eight per cent was categorised as sexual harassment. Five per cent were allegations of rape. CQC has followed up the alleged rapes with providers to ensure they have addressed incidents appropriately, including involving relevant agencies such as the police, safeguarding teams and local authorities.

Of the 661 notifications, 46 per cent were from a residential care home, 28 per cent from a nursing home, and 12 per cent from domiciliary care service.

Ms Terroni said: “On the flip side there is a positive side to this.” The report tells the account of an older man who lived in a care home. He had a photo on his table, which had been taken when he was younger and in the armed forces. The photo showed another man. His care worker realised it might have some significance and asked him gently about the picture. Over time, the gentleman felt increasingly able to open up and talk about his relationship with the man in the photo. He had never told his family about it and had kept it a secret for his whole life. Only in the care home was he finally able to talk openly about his sexual orientation, thanks to the relationship and trust built with the care worker.

“That is the power of social care when we get it right,” said the CQC chief.

The report recommends

• A culture must be developed where people and staff feel empowered to talk about sexuality and raise concerns around safety.

• Updated skills for care guidance – a practical guide about how to protect people using adult social care from sexual abuse and how to support them to develop and maintain relationships and express their sexuality.

• CQC should strengthen the focus on sexuality and sexual safety through regulation of services.

’There is the very real human impact when that goes wrong’

During her speech, the delegates also heard about concerns regarding storing and administering medicines. An NHS report states 237 million medication errors occur in the NHS, of which 22,000 deaths are caused annually and in response to this is a lack of medicines optimisation giving poor outcomes for people and a significant cost to the health and care system.

Ms Terroni said: “The reason why this is such a hot topic is each year between five to 10 per cent of hospital admissions are from medication not being administered properly. There is the very real human impact when that goes wrong.

"There is a clear need to have a pharmacy attached to social care providers and any ongoing training so staff are confident about giving medicine. It's not just a tick in the box regarding medicines but how that person receiving medicine is feeling about it, involve them in the discussion."

Ms Terroni also spoke to delegates about the need for joined-up care and a need for innovation in social care: “So many people we serve are people with multiple needs and in order for them to get a good outcome, [it] needs to be joined up as is possible. Are you running your domiciliary practice joined up with your dentist, your acute hospital? How do you behave with other key partners in your system to ensure people who are receiving care are doing it in a joined-up way? If you’re a dentist, what is your outreach offer to people who can’t leave their home to get dentistry?"

In regards to innovation, Ms Terroni said: "For many years we have all been busily scrabbling trying keeping our heads above water and that has been our main focus but there has been a great amount of creativity of innovation within social care.

"We need to really strive to overcome the absence of the infrastructure that our health partners have around innovation. We have pockets of fabulous practice happening across the country but we don't currently have that infrastructure for sharing that best practice and making sure that everyone is able to learn from that. We are going to be doing some more thinking with the department about how we can encourage that to happen.”

To read Promoting sexual safety through empowerment click here

The Future of Care North with be taking place at Pavilions of Harrogate on 3rd November 2020.