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CQC Guidance on Relationships and Sexuality in Social Care Services

  1. understand the importance of enabling people to manage their sexuality need. This includes making sure people have access to education and information to help them develop and maintain relationships and express their sexuality;

  2. understand the risks associated with people’s sexuality needs;

  3. recognise and support these needs, so that they do not risk discriminating against people or breaching their human right.

Defining sexuality 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. The definition of sexuality within the guidance is deliberately broad as it is important to recognise that sexuality can mean different things to different groups of people. This guidance relates to:

  1. sex, masturbation, sensuality, physical intimacy, romance and physical attraction;

  2. gender identity – the sense that we are male or female or not aligned with either gender;

  3. sexual orientation, including heterosexual, homosexual and bisexual;

  4. personal dress, body image, personal grooming and sexual expression. The guidance goes on to define in greater detail sexual orientation, identity and terminology.

Assessment of sexuality needs CQC advise providers that a person receiving care and support in their own home or moving into a care home need not signal an end to romantic relationships or sexual activity. However, providers need to consider certain practical implications. These include maintaining privacy and understanding of what a person’s needs are. Sexual expression is a positive, natural human need. Ignoring it can have a negative impact on individuals’ physical and mental wellbeing. When providers assess people’s needs they should ask about their sexuality needs. In the first instance, this may include information about:

  1. previous and current relationships

  2. sexual orientation

  3. understanding of sexual health

  4. personal dress preferences

  5. gender identity.

Responding to incidents When people living in care experience unwanted sexual behaviour, providers must investigate and report it in a timely and appropriate way. Such incidents include sexual contact, sexual advances, assault or verbal or offensive gestures. When incidents occur between people who lack capacity, both parties should be treated as vulnerable adults. Staff should be sensitive and discreet and recognise the distress that can be caused to both parties and their families. People living in their own homes may be subject to grooming and sexual exploitation. This may be less obvious, however, than in a communal care setting. Training should be provided for staff to help them to identify if people are at risk of exploitation and abuse and how to report this.

Relationship and sexuality policy Inspectors may ask providers extra questions to ensure they are helping people to develop intimate personal relationships:

  1. Does the organisation have a relationship and sexuality policy, including an easy read version?

  2. Does the organisation recognise that people have different ways of experiencing and expressing sexuality?

  3. Are staff trained to support people with their personal relationship needs?

  4. Are there examples that demonstrate positive support for relationships?

  5. Are people using the service given information and support about relationships and sexual health?

  6. Can people be signposted to a local organisation that provides this service?

  7. Are staff aware of what action to take if they have concerns that someone is at risk of harm or abuse?

Summary In this guidance the CQC are promoting people’s equality and diversity rights that are embedded in the inspection planning tool, KLOEs and quality assurance checklist. This includes people’s rights relating to their sexuality. Providers will need to take cognisance of this guidance and ensure they have a relationship and sexuality policy in place that addresses people’s equality and diversity rights and the requirements of the KLOE. Albert Cook Albert Cook BA, MA & Fellow Charted Quality Institute Managing Director Bettal Quality Consultancy

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