Working with Sexual Vulnerability: The Experiences of NHS Clinicians Supporting People with Learning Disabilities

This thesis comprises of three papers, focused on staff experiences of supporting individuals with learning disabilities, particularly in relation to managing clinical risk and addressing issues of sexual vulnerability. The aim of the thesis is to contribute to this under-researched area of literature and clinical practice.
The first paper presents a systematic review of the current literature, appraising ten studies that explore how professionals manage clinical risk within community learning disability care settings. Three overarching themes were identified: (1) Balancing risk, (2) The importance of experience and appropriate professional input, and (3) The role of policy, support systems, and education. Articles reviewed were found to be of overall good quality, however limitations are discussed. Ideas for future research are also proposed.

The second paper presents an empirical study exploring NHS clinicians’ experiences of supporting people with learning disabilities around issues of sexual vulnerability. This qualitative research involved eleven participants from community learning disability teams who took part in semi-structured interviews. Data was analysed using Reflexive Thematic Analysis, resulting in five themes: (1) Ignorance is not bliss: Lack of education, (2) The internet: Fresh challenges in sexual vulnerability, (3) Protection or people’s rights: What is the bottom line?, (4) Risk-focused mindsets: Negative attitudes toward sexuality and relationships, and (5) Polarity of multiagency working. The findings highlight the need for systemic change to promote inclusive, rights-based approaches to sexual health for people with learning disabilities.

The final paper is an executive summary, offering a concise presentation of the research from the empirical study. It is designed for use by the study’s participants, who expressed an interest in a shorter summary highlighting key insights and recommendations.