Written by: Mary Howden
I started my career in Social Care when I was 17. I worked in a care home for older people and my first involvement in providing personal intimate care was assisting another care worker in the bathing of an 80-year-old man. I had never seen a man naked before and in many ways, it was a baptism by fire.
I quickly learned that carrying out the most intimate personal care tasks requires confidence to get on with the task in a sensitive manner, but also that the view of any individual in that situation must be heard and they must be treated with dignity and respect.
After all, when you’ve managed these tasks for yourself how do you adapt to the fact that you need assistance with having a bath or a wash? Your bottom wiped, your breasts lifted to dry underneath them, your incontinence pad changed cleaning faeces and urine away or sanitary protection changed. Having parts of your body touched that are very rarely seen let alone touched by others.
Maybe you can’t give consent due to learning difficulties or dementia, or you just don’t have capacity. You need others to understand what dignity and respect means for someone who cannot consent.
Later in my career I worked in learning and development. I assessed many staff across a range of organisations who provided a range of intimate personal care to older adults or children with physical and learning disabilities either in their own home or residential care.
When I had chemotherapy for breast cancer, I experienced first-hand the powerlessness you feel when you are dependent on others for your personal needs. And I have had to support a family member with bathing and toileting.
I understand what is needed to deliver personal intimate care from both a personal and professional basis.
What is intimate care?
Intimate Care is any care which involves washing, touching or carrying out an invasive procedure that children or vulnerable adults are unable to carry out for themselves due to physical disability, additional support needs associated with learning difficulties, medical needs or needs arising from a child’s or an adult’s stage of development.
Intimate Care may involve help with drinking, eating, dressing, toileting, continence management, bathing, showering, applying creams and lotions or dressing. Help may also be needed with changing colostomy bags and other such equipment. And it might require the administration of invasive medication and therapy programmes.
Of course, safeguards exist, and all organisations have policies and procedures. Personal care and intimate support are provided against a set of National Occupational Standards. Individuals must have disclosure checks to make sure they don’t have a criminal record that would bar them.
In parts of the UK staff must be registered with a regulatory body and undergo learning and continuous development. Organisations are inspected against a set of standards. The Equality Act 2010 provides an exemption to employ staff on the basis of sex.
However, despite all these safeguards we cannot ignore that abuse happens particularly with those who are so vulnerable they do not have a voice.
This is all set in the context of an understanding that sex matters, that those who need this kind of service will be explicitly asked if they consent to a male or a female carer if they are able to do so. That biology is immutable and that you cannot change sex.
However, here we are in 2022 with gender ideology sweeping our institutions and proclaiming that men can be women and women can be men. In Scotland we are progressing full steam ahead to a world where you can self-identify as a man or a woman.
Even our disclosure processes allow people who are transgender special dispensation. There is no requirement to give employers or regulatory bodies the information about their previous names and the information they need to ensure individuals are safe to work with vulnerable people.
Where are the safeguards? How do we protect vulnerable children and adults and especially those that cannot consent? How do we give individuals a choice to say whether they want a man or a woman to provide care if we are not allowed to say with certainty who can provide that care? And if we complain we are accused of being bigoted or transphobic.
Surely, if you need help with the most intimate tasks you can ever imagine, you should be allowed a choice in who does that for you.
Yet here we are. And we don’t.