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Sexual safety policy

Contents

  1. Introduction
  2. Purpose
  3. Scope
  4. Responsibilities, accountabilities and duties
  5. Definitions
  6. Responsibilities and safeguarding
  7. Principles
  8. Training implications
  9. Monitoring arrangements
  10. Equality impact assessment screening
  11. Links to any other associated documents
  12. References
  13. Appendices

1 Introduction

The sexual safety policy is to promote the sexual safety of individuals who utilise our services, as well as support RDaSH staff members where there are concerns regarding sexual behaviours that may have an impact upon patients, staff members and others. The drive for the sexual safety initiative has resulted from the CQC report sexual safety on mental health wards (2018).

The CQC “Sexual Safety on Mental Health Wards (2018)” report identified:

  • from April to June 2017, there were over 1100 sexual incidents reported on NHS Trust mental health wards. The types of incident identified that more than a third could be categorised as sexual assault or sexual harassment of patients or staff
  • other common incident types included nakedness, (including where this was clearly non-sexual) exposure, and sexual words that were used as ‘insults’.
    • ‘People with mental health conditions have just as much right as everyone else to have safe and fulfilling sexual relationships. However, people affected by mental ill health can at times act in disinhibited ways or lack the mental capacity to make sound decisions about relationships. They may have experienced abuse in the past, contributing to their mental ill health, which might leave them at risk of exploitation from others. These factors make it more likely that people affected by mental ill health may engage in sexual behaviour or make them vulnerable to sexual abuse’.

The aim of the policy is to support staff to ensure that ‘sexual safety’ is promoted across the RDaSH footprint.

Practitioners need to be aware that patients may not report their concerns to staff directly and need to remain vigilant to the signs of sexual behaviour and the impact of this. If practitioners have concerns regarding any of the issues that are discussed in the policy, they should consult with their ward manager or modern matron in the first instance or liaise with the Safeguarding team for advice or support.

2 Purpose

Sexual safety incidents can occur anywhere, to any of the patients with whom we work and engage with. This can be as a community patient in their own home, an out-patient setting, through to an in-patient on one of our wards.

RDaSH operate multiple services for physical, mental and sexual health and it is vital that all clinical staff and practitioners are aware of this policy and the additionally referenced policies and procedures that dovetail with this.

The sexual safety policy is applicable to all patients, including patients who have a different gender to the one assigned at birth; sexual orientation or identification; disability, physical health, employment, or marital status.

This policy will:

  • support practitioners to ensure that: sexual wellbeing is promoted and that all concerns relating to “sexual incidents” are listened to and actioned appropriately
  • consider the professional boundaries between staff and patients
  • enable practitioners to understand their responsibilities in relation to sexual activity between patients
  • to support all persons (including staff, patients and visitors) who may be subject of a “sexual incident”
  • ensure those who lack the mental capacity to make decisions are protected whilst in the care of the trust. Ensure that any allegations of sexual abuse are reported via the Safeguarding team, utilising appropriate reporting mechanisms. Reports should be logged
    using the trust Ulysees system (IR1 reporting system) and an incident report generated at the earliest opportunity. Appropriate safeguarding concerns should also be raised with the local authority.
  • where required, that allegations of sexual abuse are reported to the police
  • that all allegations of sexual assault are reporting to the Safeguarding team via the Safeguard Ulysses IR1 system

2.1 Sexual safety group

The Safeguarding team has established a sexual safety group within the trust. This group reports to the safeguarding assurance group and provides assurance that the trust are considering and implementing best practice surrounding incidents relating to sexual safety. The group aims to improve the culture of sexual safety within the organisation by drawing together patterns of sexual incidents through the use of the IR1 reporting system. It will utilise a joint approach with the Patient Safety team to analyse and determine any specific themes or clinical areas where sexual safety issues have, or are occurring.

3 Scope

This document applies to and is relevant across the following services, departments and care groups:

  • all community based services
  • all inpatient areas
  • all care groups

4 Responsibilities, accountabilities and duties

4.1 Executive Management team

The Executive Management team is responsible for approving the sexual safety policy and for its approval, dissemination, and implementation.

4.2 The director of nursing, quality and allied health professionals

The director of nursing, quality and allied health professionals will, on behalf of trust board, ensure that this policy is implemented and that documents are controlled in accordance with non-clinical records management requirements.

4.3 The deputy director of nursing

The director of nursing will, on behalf of trust board, ensure that this policy is implemented and that documents are controlled in accordance with non-clinical records management requirements.

The nurse consultant for safeguarding will have oversight of the policy and act as a point of escalation for matters requiring this and seek to achieve resolution.

4.4 Specialist staff

The lead professionals for safeguarding adults and the named professionals for safeguarding children have a frontline role in supporting the nurse consultant and associated directors in developing and implementing this policy. The Safeguarding team are responsible for giving advice to clinical teams regarding sexual safety incidents from a safeguarding perspective.

The Safeguarding team will liaise directly with members of staff throughout the trust regarding any matters requiring specialist support, advice and guidance.

4.5 All RDaSH staff

All clinical staff must be aware of the sexual safety policy and how it impacts on individual practice. Staff have an individual responsibility and accountability to ensure they are working within legal and ethical boundaries. It is each member of staff’s responsibility to seek out contemporary guidance and seek assistance in implementing this guidance where they experience difficulty.

Practitioners must ensure that all incidents relating to sexual safety are reported using the Ulysees IR1 reporting system to ensure the trust has a robust mechanism for monitoring incidents of a sexual nature.

5 Definitions

Term Definition
Sexual incidents Any behaviour of a sexual nature that is unwanted, or makes another person feel uncomfortable or afraid. It also extends to being spoken to using sexualised language or observing other people behaving in a sexually disinhibited manner, including nakedness and exposure. Sexual incidents may also include the unwanted exposure to pornography
Sexual safety Feeling safe from sexual harm means feeling free from being made to feel uncomfortable, frightened, or intimidated in a sexual way by patients or staff
Sexual wellbeing Defined as feeling and being sexually safe in and being free from unwanted sexual activity, sexual harassment, and sexual assault
Sexual abuse This includes rape and sexual assault or sexual acts to which the adult has not consented or was pressured into consenting (Department of Health, NHS England (North) (Date Not Known) safeguarding adults. Department of Health)
Sexual assault This definition is adapted from The Crown Prosecution
Service ‘is when a person is coerced or physically forced to engage in sexual activity against their will, or when a person (of any gender) touches another person sexually without their consent. Touching can be done with any part of the body or with an object’
Sexual assault Does not always involve physical violence, so physical injuries or visible marks may not be seen
Sexual consent Where an individual has the freedom and capacity to agree to sexual activity with other persons. It is important to note that individuals with mental health and or a learning disability conditions may appear to consent to activity, but may lack the capacity due to their mental health or learning disability condition
Sexual harassment Sexual harassment includes any behaviour that is characterised by inappropriate sexual remarks, gestures or physical advances which are unwanted and make a person feel uncomfortable, intimidated or degrade their dignity
Verbal and non-verbal sexual gestures or behaviours Are categorised as sexual harassment (including staring, leering, and suggestive comments or jokes). These unwanted behaviours may only happen once or be an ongoing series of events. Sexual harassment also includes exposure to body parts and, or self-stimulation and exposure to unwanted online sexual activity (use of the internet, text, audio, video), and this includes unwelcome sexual advances or unwelcome requests for sexual conduct. Sexual harassment may also include unwanted or non-consenting exposure to pornography
Grooming Grooming is a process offenders use to abuse and exploit children. It can happen online and in person. Learning more about grooming can help you spots signs and know what to do if you have concerns (National Crime Agency, Think u know (date not known) what is sexual grooming? (viewed 28 June 2021) (opens in new window). Vulnerable adults can also experience the process of grooming
Other This category is for sexual incidents where an individual may have witnessed or experienced something of a sexual nature that does not fit in to the categories of sexual harassment or assault, and which made the person feel uncomfortable or sexually unsafe

6 Responsibilities and safeguarding

6.1 Adults and children who experience a sexual safety incident

Immediate action should be taken to protect the adult at risk from further harm. This should be discussed with the RDaSH Safeguarding team for advice around the need to report to the police and the Local Authority Safeguarding team. If this occurs out of core office hours (09:00 to 17:00), practitioners should directly consider liaison with the police (taking into account the patients wishes and mental capacity) and the on-call manager and in the case of inpatients the patients responsible clinician or on-call consultant for further advice and support. A discussion should take place with the adult at risk in relation to the incident being reported to either the police or the local authority. Although it is best practice to gain consent, this should not prevent staff from reporting a sexual incident. If an alleged sexual safety incident has occurred, then it would be the expectation that a member of staff would report on behalf of the victim or adult at risk if there is any doubts surrounding the mental capacity of the individual. All actions must be clearly documented within the clinical records; an incident is to be reported via the Ulysees IR1 reporting system must be completed with the cause group of safeguarding adults, and the cause being ‘sexual’. If a patient requires medical treatment this must be prioritised. Evidence must be preserved for forensic purposes as requested or advised by the police, if reported to them. Clinical staff should also refer to the trust incident management procedure for significant incidents that occur and require oversight or management.

All sexual incidents that occur, should follow the usual procedures of reporting, documenting and seeking advice, support and guidance. Safeguarding procedures should be considered and applied accordingly, and there should be a low threshold for application of the ‘three stage test’ (see below).

6.1.1 Adult at risk of abuse or harm

Who is an adult at risk:

  • an adult (over the age of 18) who:
    • has needs for care and support whether or not the local authority is meeting any of those needs
    • is experiencing, or at risk of, abuse and neglect
    • as a result of those care and support needs is unable to protect themselves from either the risk of, or the experience of abuse or neglect

There are occasions when there are children (under 18 years of age) on RDaSH inpatient areas. Any sexual incidents would trigger safeguarding children procedures.

6.1.2 Interface with safeguarding adults manual

For any adult who meets the ‘three-stage’ test and a safeguarding concern is required to be submitted, access the safeguarding adults manual. This will provide further guidance for completion of forms dependent upon the locality of the incident.

6.2 If a child is the victim of a sexual safety incident

A child remains a child until their eighteenth birthday, as defined by the Children Act (1989). Immediate action should be taken to protect the child from further harm. Actions must be discussed with the RDaSH Safeguarding Children’s team and must be reported to the Local Authority Safeguarding team and the police. If this occurs out of hours, staff should directly contact the police and the Local Authority Safeguarding team. A discussion should take place with the child and their care giver in relation to the incident being reported

6.3 The safeguarding definition of safeguarding children and child protection

Working Together to Safeguard Children (2015) states that safeguarding and promoting the welfare of children means the process of:

  • protecting children from maltreatment
  • preventing impairment of children’s health or development
  • ensuring that children are growing up in circumstances consistent with the provision of safe and effective care
  • taking action to enable all children to have the best outcomes

The term child protection refers to the activity which is undertaken to protect specific children who are suffering, or at risk of suffering, significant harm. Child protection is part of safeguarding and promoting the welfare of all children.

6.3.1 Interface with safeguarding children’s manual

For further information and guidance relating to safeguarding children, access the safeguarding adults manual. This will provide further guidance for enacting specific processes and protocols.

7 Principles

The fundamental actions points of this policy and procedural guidance are:

  • that all practitioners are aware of their responsibilities in relation to possible sexual safety incidents that may impact on individuals within RDaSH
  • that any behaviour of a sexual nature that is unwanted, or makes another person feel uncomfortable or afraid is appropriately actioned, whether this behaviour is from another patient or a staff member or other person in a position of trust
  • that practitioners need to understand what may be possible criminal, safeguarding or disciplinary actions that may be required

8 Training implications

Training relating to this policy will be included within safeguarding training.

Support is available to assist implementation of this policy from the lead professionals for safeguarding adults or the named professionals for safeguarding children.

There are no specific training needs in relation to this policy, but the following staff will need to be familiar with its contents:

  • care group directors and associate nurse directors
  • service managers and modern matrons
  • inpatient care providing staff (registered practitioners and non-registered practitioners)
  • community-based staff (registered practitioners and non-registered practitioners)

Additional, bespoke training may be accessed to support the delivery of this policy however it is not mandatory.

As a trust policy, all staff need to be aware of the key points that the policy covers. Staff can be made aware through a variety of means such as:

  • all user emails for urgent messages
  • one to one meetings or supervision
  • continuous professional development sessions
  • posters
  • daily email (sent Monday to Friday)
  • practice development days
  • group supervision
  • special meetings
  • intranet
  • team meetings
  • local induction

9 Monitoring arrangements

9.1 Incidents of a sexual safety nature

  • How: Collation of IR1 forms.
  • Who by: Safeguarding team and Patient Safety team.
  • Reported to: Ulysses.
  • Frequency: Yearly.

9.2 Themes of discussions with practitioners and supervision

  • How: Analysis of themes of safeguarding contacts.
  • Who by: Safeguarding team.
  • Reported to: Safeguarding team.
  • Frequency: Yearly.

10 Equality impact assessment screening

To access the equality impact assessment for this policy, please email rdash.equalityanddiversity@nhs.net to request the document.

10.1 Privacy, dignity and respect

The NHS Constitution states that all patients should feel that their privacy and dignity are respected while they are in hospital. High Quality Care for All (2008), Lord Darzi’s review of the NHS, identifies the need to organise care around the individual, ‘not just clinically but in terms of dignity and respect’.

Consequently, the trust is required to articulate its intent to deliver care with privacy and dignity that treats all service users with respect. Therefore, all procedural documents will be considered, if relevant, to reflect the requirement to treat everyone with privacy, dignity, and respect, (when appropriate this should also include how same sex accommodation is provided).

10.1.1 Indicate how this will be met

No issues have been identified in relation to this policy.

10.2 Mental capacity act

Central to any aspect of care delivered to adults and young people aged 16 years or over will be the consideration of the individual’s capacity to participate in the decision-making process. Consequently, no intervention should be carried out without either the individual’s informed consent, or the powers included in a legal framework, or by order of the court.

Therefore, the trust is required to make sure that all colleagues working with individuals who use our service are familiar with the provisions within the Mental Capacity Act (2005). For this reason, all procedural documents will be considered, if relevant to reflect the provisions of the Mental Capacity Act (2005)to ensure that the rights of individual are protected, and they are supported to make their own decisions where possible and that any decisions made on their behalf when they lack capacity are made in their best interests and least restrictive of their rights and freedoms.

10.2.1 Indicate how this will be achieved

All individuals involved in the implementation of this policy should do so in accordance with the guiding principles of the Mental Capacity Act 2005 (section 1).

There are additional policies and procedures that interlink with this policy.

All trust staff (including volunteers) must adhere to and acknowledge their duties and responsibilities for both the safeguarding of children and vulnerable adults. Safeguarding is everyone’s business.

11.1 Safeguarding adults and safeguarding children’s manuals

Please click here to access the trust’ safeguarding adults manual or here to access the safeguarding children manual which will provide links to various topics of advice, support and guidance regarding local procedural arrangements relating to both the safeguarding of children and of vulnerable adults.

11.2 Mental Capacity Act (2005)

Mental capacity should be considered in all cases relating to safeguarding adults and clear rationale for decision making evidenced and documented. Please click here to access the MCA policy.

11.3 Person in position of trust (PiPoT)

If an adult makes an allegation against a member of staff, or other circumstances such as being the perpetrator of domestic harm or having caused harm to a child, (either an employed member of staff or volunteer within RDaSH) then this will trigger the use of the person in position of trust policy (PiPoT).

11.4 Local authority designated officer (LADO)

If allegations are made relating to a child as the victim, then a referral must be made to the local authority designated officer (LADO). In these cases, and in the first instance please seek advice and guidance from the Safeguarding team.

There may also be occasions whereby an individual, either in the community or as an in-patient, makes a disclosure regarding non-recent (or historical) sexual abuse. Whilst it is important to acknowledge and explore any current sexual safety elements, the procedure relating to disclosures must be utilised and the safeguarding team must be contacted for advice. This can be accessed here (opens in new window).

12 References

13 Appendices

13.1 Appendix A sexual safety incident identified

  1. Sexual safety incident identified.
  2. Ensure safety of victim, access medical services (emergency department and SARC), all practical steps to safeguard victim to be taken.
  3. Preservation of evidence and report to the police as soon as practicable, if this has happened on an inpatient ward then seal off rooms or restrict access, prevent showering if at all possible of victim or perpetrator.
  4. If this occurs in hours, liaise with unit or service managers or if this occurs out-of-hours, liaise with on call managers for further support and advise.
  5. Consider safeguarding:
    • safeguarding concern?
    • safeguarding protection plan (for both victim and alleged source of harm)
  6. In hours seek additional support, advice and guidance from the Safeguarding team, out-of-ours notify the Safeguarding team by email (this will be actioned the next working day).
  7. Complete contemporaneous documentation, incident report to be completed under the category of sexual safety.

Document control

  • Version: 1.
  • Unique reference number: 597.
  • Approved by: Clinical policy review and approval group (CPRAG).
  • Date approved: 6 July 2021.
  • Name of originator or author: Safeguarding adults lead professional.
  • Name of responsible individual: Safeguarding adults lead professional.
  • Date issued: 21 July 2021.
  • Review date: July 2024.
  • Target audience: All trust staff.
  • Description of change: New policy.

Page last reviewed: April 30, 2024
Next review due: April 30, 2025

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