Sex and Sexuality In Adult Social Care

By Abi Spence, Contributor on Registration and Inspection with Quality Compliance Systems (QCS) – www.qcs.co.uk

Personal relationships are an important part of people’s lives, and that includes sexual relationships. When we talk about meeting people’s needs holistically to deliver person-centred care, we need to understand their relationship and sexual needs too. Abi Spence, the leading provider of content, guidance and standards for the social care sector, looks at some of the challenges around this sensitive issue.

Traditionally, within adult social care services, sexuality as a topic has been difficult for some providers to implement. We talk about meeting the physical needs of the people we support, and their emotional needs too. But when it comes to sexual needs, they may be skirted around for a number of reasons.

But if we are to deliver complete person-centred care, then we must understand and address the sexual needs of those we support, whilst ensuring individuals are protected from sexual harm and abuse.

But how should managers and social care workers approach individuals when talking about sex and sexuality?
In a QCS podcast on the topic of Relationships and Sexuality I hosted recently, which is out in July, I commented that “we are having a general chat about relationships and sexuality in social care and even saying those words ‘sexuality and relationships’ I struggle’. My point is that discussing sex is something we are often embarrassed by in our own personal lives. So talking about these issues at work can be even more difficult.

The podcast discusses how these conversations, when conducted correctly, are important to enable people who draw on social care services, to lead their life the way they wish and uphold their human rights.

But when it comes to sexuality what do we mean?
The Care Quality Commission (CQC) in its 2019 guide, ‘Relationships and sexuality in adult social care services Guidance for CQC inspection staff and registered adult social care providers’ provides us with a definition: “Sexuality encompasses a person’s gender identity, body image and sexual desires and experiences. This means people can have needs relating to their sexuality, regardless of their age, mental capacity or personal history.”

it is useful to quote the guide here, especially as it says that it is important to recognise that sexuality can mean different things to different groups of people.

To recap, its guidance relates to:

· sex, masturbation, sensuality, physical intimacy, romance and physical attraction
· gender identity – the sense that we are male or female or not aligned with either gender
· sexual orientation, including heterosexual, homosexual and bisexual
· personal dress, body image, personal grooming and sexual expression.

So how should providers speak to the people they support within their services about this sensitive issue?
Providers need to look at ways to cultivate an open culture for both staff and people who draw on care. It’s only then they will create an environment where people feel comfortable to talk through relationships and sexuality.
The goal is to help individuals feel more connected and empowered, to promote healthy adult sexual relationships in care, and spot any potential risks of abuse.

When individuals are open to receiving information from the provider and specialist resources, this will support their decision making when it comes to living their life the way they want to.

Putting guidance in place

Skills for Care, a QCS partner, worked with the CQC, and released their “Supporting Personal Relationships” guide, which is downloadable from their website. Other learning resources on the subject were developed in collaboration with Supported Loving and the Department of Health and Social Care.

Kate Terroni, Chief Inspector of Adult Social Care CQC, quoted on the Skills for Care website, says:
“People must be empowered to speak about relationships and sexuality, in order for them to articulate their needs and feel valued. It is not good enough to put this issue in a ‘too difficult to discuss’ box. It is particularly because these topics are sensitive and complex that they should not be ignored.”

It’s agreed, then, that sex and sexuality isn’t an easy topic for most. But the provision of good clear guidance helps us know what best practice looks like. Managers, then, can help their staff by thinking about what they need to know and understand about sex and sexuality, and then put learning materials and best practice guides in place.

The Skills for Care content is designed to help employers understand what staff need to know about personal relationships, and how they can create a workforce development programme for their organisation.

It recommends that, “to minimise risk and increase positive experiences for people who draw on care and support services, social care organisations need to adopt a proactive approach to supporting relationships and this starts by having those relaxed, frank, and informative conversations. “

The guidance states that effective adult social care leaders should “develop a culture, an environment, care planning and processes that support people’s sexuality and relationship needs and keep them safe.”

It goes on to say that organisations that are led by a set of values of person-centred care, which are promoted in their recruitment and work practices, “have a strong basis for protecting people’s rights, as well as protecting them from harm.”

Although these conversations need to begin at assessment, we don’t want to just go in with a list of questions and run down it in a ‘tick box’ approach. We may be supporting individuals in their 80s, who are reserved, who maybe hid their sexual preferences throughout their life, and any suggestion of relationships and sexuality could cause them embarrassment.

During the talk with my guest, we agree that building relationships and trust is key. After all, the assessment process deals with a wide range of sensitive issues such as personal care, continence etc. Training is given to staff to ensure they handle these areas sensitively. And the same applies to the area of sex and sexuality — it is the basis of good outcomes.

Delivering a holistic approach to person-centred care, then, should encompass positive personal and sexual relationships, and beyond that, enable individuals to express themselves, their gender identity, preferences and wider sexuality. It is about allowing those we support to make their own choices, and supporting them to live out these choices safely. Resident managers should build a confident, knowledgeable, and supportive culture for people and staff to enable this to happen.

You can listen to the podcast where Abi and her guest, Dawn Wallace, spend time unpicking this sensitive issue further for free here: www.qcs.co.uk/thecarer-podcast
Skills for Care Supporting Personal Relationships resource can be found at https://tinyurl.com/5xkcmjza

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