2.2 Recognising and Reporting Abuse and Neglect

This section sets out the signs of abuse and neglect, the contexts in which this takes place, and details the process for raising safeguarding concerns.

Everyone is responsible for preventing abuse by raising any concerns they have – it really is ‘Everyone’s Business’.

No-one should have to live with abuse or neglect. It is always wrong, whatever the circumstances.  Don’t assume that someone else is doing something about the situation.

Abuse and neglect could be prevented if concerns are identified and raised as early as possible. It is important that everyone knows what to look for, and who they can go to for advice and support.

Changes in someone’s physical or emotional state, or injuries that cannot be explained, may be a sign of abuse.

Under the Care Act 2014, specific adult safeguarding duties apply to any adult (18 years or over) who:

• has care and support needs and,
• is experiencing, or is at risk of, abuse or neglect and,
• is unable to protect themselves because of their care and support needs.

Local authorities also have safeguarding responsibilities for carers and a general duty to promote the wellbeing of the wider population in the communities they serve.

Safeguarding duties apply regardless of whether a person’s care and support needs are being met, whether by the local authority or anyone else. They also apply to people who pay for their own care and support services.

An adult with care and support needs may be:

• a person with a physical disability, a learning difficulty or a sensory impairment,
• someone with mental health needs, including dementia or a personality disorder,
• a person with a long-term health condition,
• someone who misuses substances or alcohol to the extent that it affects their ability to manage day-to-day living.

This is not an exhaustive list. In its definition of who should receive a safeguarding response, the legislation could also include people who are victims of sexual exploitation, domestic abuse and modern slavery. These are all largely criminal matters, and safeguarding duties would not be an alternative to police involvement, and would only be applicable where an adult is not able to protect themselves due to their care and support needs.

Adult safeguarding duties apply in whatever setting people live, with the exception of prisons and approved premises such as bail hostels. They apply regardless of whether or not someone has the ability to make specific decisions for themselves at specific times. There may be times when an adult has care and support needs and is unable to protect themselves for a short, temporary period – for example, if they were significantly unwell due to an infection.

The wellbeing of people who live and sleep on the street may need to be considered under a safeguarding response. Homelessness may be a consequence of health problems and is very commonly a cause of worsening health. Many people who ‘sleep rough’ may have significant needs in relation to physical health, mental health and substance misuse.  Amongst the population of people who sleep rough there are significantly higher prevalence rates of organic and functional mental illness, substance use, acquired brain injury, autistic spectrum conditions and learning difficulties, and some communicable diseases.  Any of these conditions can contribute to behaviours which result in self-neglect.  The requirements set out in Section 2.8 Safeguarding and Self-Neglect may need to be considered for people who sleep rough.

People with care and support needs are not inherently vulnerable, but they may come to be at risk of abuse or neglect at any point due to:

• physical or mental ill-health,
• becoming disabled,
• frailty,
• not having support networks,
• inappropriate accommodation,
• financial circumstances or,
• being socially isolated.

Abuse can happen anywhere, for example:

• at home,
• in a care home, hospital or day service,
• at work or college, or,
• in a public place or in the community.

Abuse can be caused by anyone, for example:

• a partner, carer, relative, child, neighbour or friend,
• a health, social-care or other worker, whether they are paid or a volunteer,
• a stranger, or,
• an adult with care and support needs.

Family and friends as carers may be involved in situations which require a safeguarding response, for example:

• A carer may witness or speak up about abuse or neglect.
• A carer may experience intentional or unintentional harm from the adult they are trying to support, or from professionals and organisations they are in contact with.
• A carer may intentionally, or unintentionally, harm or neglect the adult they support on their own or with others.

Assessment of both the carer and the adult they care for must include consideration of the wellbeing of both of them. In these situations the aim of any safeguarding response will be to support the carer to provide support and help to make changes in order to decrease the risk of further harm to the person they are caring for.

Below is a list of types of abuse. This list is not exhaustive.

The Social Care Institute for Excellence provides further information on indicators, types and signs of abuse.

Controlling or coercive behaviour is a range of acts designed to make a person subordinate and / or dependent by isolating them from sources of support, exploiting their resources and capacities for personal gain, depriving them of the means needed for independence, resistance and escape and regulating their everyday behaviour. Section 76 of the Serious Crime Act 2015 has created an offence in relation to coercive control within domestic abuse, and sets out the importance of recognising the harm and cumulative impact on the victim caused by these patterns of behaviour.

Stalking and Harassment: Stalking refers to unwanted, persistent or obsessive attention by an individual or group towards another person causing fear, anxiety, emotional or psychological distress to the victim. Harassment can include repeated attempts to impose unwanted communications and contact upon a victim in a manner which causes fear or distress to the victim.  Stalking and harassment behaviours may include nuisance telephone calls, sending excessive emails, regularly sending gifts, following the person or spying on them and making death threats.  The Protection from Harassment Act 1997 makes stalking a specific offence. 

Hate Crime is defined as any crime that is perceived by the victim, or any other person, to be racist, homophobic, transphobic or due to a person’s religion, belief, gender identity or disability. It should be noted that this definition is based on the perception of the victim or anyone else and is not reliant on evidence.  Such incidents may constitute a criminal offence.

Cuckooing is a form of crime in which drug dealers take over the home of a vulnerable person in order to use it as a base for criminal activity. Organised criminal groups are increasingly targeting adults with care and support needs in this way, and the level of coercion and control involved with cuckooing often leaves the victims with little choice but to cooperate with the perpetrators.

County Lines is the police term for groups who are supplying drugs to suburban areas and market and coastal towns using dedicated mobile phone lines or “deal lines”. It can involve child criminal exploitation and using adults who are vulnerable to move drugs and money. Groups establish a base in the market location, typically by taking over the homes of local adults by force or coercion in a practice referred to as ‘cuckooing’. The Home Office County Lines guidance describes County Lines as a major, cross-cutting issue involving drugs, violence, safeguarding, criminal and sexual exploitation, modern slavery, and missing persons. The response to tackle this activity involves the police, the National Crime Agency, a wide range of government departments, local government agencies, voluntary and community organisations and groups. County Lines activity and the associated violence, drug dealing and exploitation have a devastating impact on young people, adults at risk of exploitation and local communities.

‘Honour’-based violence is a crime or incident which may have been committed to protect or defend the perceived ‘honour’ of the family and / or community. Women are predominantly (but not exclusively) the victims and the violence is often committed with a degree of collusion from family members and / or the community.  Many victims are so isolated and controlled that they are unable to contact the police or other organisations.

Forced marriage is a term used to describe a marriage in which one or both of the parties are married without their consent or against their will. A forced marriage differs from an arranged marriage, in which both parties consent to the assistance of their parents or a third party in identifying a spouse.  Forced marriage can be a particular risk for people with learning disabilities and people lacking capacity.

Female genital mutilation (FGM) involves procedures that include the partial or total removal of the external female genital organs for cultural or other non-therapeutic reasons. The practice is medically unnecessary, extremely painful and has serious health consequences, both at the time when the mutilation is carried out and in later life.  The age at which girls undergo FGM varies enormously according to the community.  The procedure may be carried out when the girl is first born, during childhood or adolescence, just before marriage or during the first pregnancy.  FGM constitutes a form of abuse and violence against women and girls.  In England and Wales the practice is illegal under the Female Genital Mutilation Act 2003.

Sexual Exploitation involves exploitative situations, contexts and relationships where adults at risk (or a third person or persons) receive 'something' (e.g. food, accommodation, drugs, alcohol, cigarettes, affection, gifts, money) as a result of them performing, and/or another or others performing on them, sexual activities. It affects men as well as women. People who are sexually exploited do not always perceive that they are being exploited. Those exploiting the adult have power over them such as by virtue of their age, gender, physical strength, and economic or other resources. There is a distinct inequality in the relationship.

Extremism by Radicalisation: Prevent is a key part of the government’s counter-terrorism strategy. Its aim is to stop people becoming terrorists, or supporting terrorism, including preventing the exploitation of susceptible people who are at risk of being drawn into violent extremism by radicalisation. 

Click here to access more information regarding the Prevent strategy.

Sexual and Violent Offenders: Multi-Agency Public Protection Arrangements (MAPPA) is a framework to reduce the risks posed by sexual and violent offenders in order to protect the public, including previous victims, from serious harm.

Click here to access more information regarding MAPPA.

Abuse by children: If a child or children is / are causing harm to an adult, this should be dealt with under the safeguarding adults’ policy and procedures, but will also need to involve the local authority Children’s Services.

Anybody can raise a safeguarding concern for themselves or for another person.

What is a safeguarding concern? 

A ‘safeguarding concern’ is when any person has a reasonable cause to believe that:

• an adult has needs for care and support and,
• may be experiencing, or is at risk of abuse or neglect and,
• is unable to protect themselves from that abuse or neglect because of their care and support needs.

If on the basis of the presenting information available, it appears that these stages are met then a safeguarding concern should always be raised with the local authority. In an emergency, the emergency services should be contacted.

Whenever there is information which indicates that an adult may be, or is, at risk of experiencing abuse, neglect or exploitation, this should be shared with the local authority even when it is also shared with other agencies that may need to be advised, such as the Care Quality Commission or the police. 

Where possible and safe to do so, the person contacting the local authority about a safeguarding concern would have had a conversation with the adult regarding their consent, views and wishes.

The exception to this could be if the person contacting the local authority was unable to have a conversation because of concerns that it would have increased the risk for the adult.

Remember!

• You may not be the only person who has noticed or experienced the abuse or neglect.
• There could be lots of people who have ‘low-level’ concerns about the same thing but if you do not pass the information on it cannot be addressed.
• Even if it has not affected you, or someone you know directly, it could be affecting someone else who may not be able, or in a position, to say something about it.
• Abuse and neglect does not just appear from nowhere.  Sharing information before something becomes abuse or neglect is really important – do not think you are making a fuss about nothing!

Diagram 2: Raising a Safeguarding Concern

Immediate actions to be considered by the person raising the concern

• Make an evaluation of any risks and take steps to ensure that the adult or others are not in immediate danger. Ensure that other people are also not in danger.
• If a crime is in progress, or life is at risk, dial emergency services on 999.
• Encourage and support the adult to report the matter to the police if a crime is suspected and not an emergency situation.
• Safeguard any potential evidence. Do not tamper with, clean up or move any potential evidence if a crime is suspected. Expert advice may be needed from the police.
• If you believe a crime has been committed, contact the police and then contact Adult Social Care.
• Contact Children’s Services if a child or young person is also at risk.
• If you are a member of staff, inform your manager, unless your manager is implicated, then talk to an appropriate independent manager.
• Record any information received and all actions taken. 

Good practice guidance to disclosure

Talk with the adult as soon as possible unless this would put them, others or you at risk. 

• Speak in a private and safe place.
• Accept what the adult is saying without judgement.
• Don’t ‘interview’ the adult - just gather information to establish the basic facts. This will help when you inform Adult Social Care or the police. Ask the adult what they would like to happen. 
• Never promise the adult that you’ll keep what they tell you confidential; explain who you will tell and why.
• If there are grounds to override an adult’s consent to share information, explain what these are.
• Explain to the adult how they will be involved and kept informed.
• Provide information and advice on keeping safe and the safeguarding process.
• Keep an accurate record of your conversations, and actions or decisions taken by you and others. 

Reporting an adult safeguarding concern to the local authority

Reporting a concern about a child to the local authority

A Making Safeguarding Personal approach is about ensuring adults have their right to make decisions about their own lives. As a general principle, no action should be taken for, or on behalf of, any adult without first obtaining their consent. 

If the adult is not the person raising the safeguarding concern, wherever possible every effort should be made to seek their views and agreement regarding this, unless doing so is likely to increase the risk to the adult or put others at risk. 

Adults who may be at risk of, or who are, experiencing abuse and neglect, may often feel disempowered by the abuse, and acting without involving them or seeking their consent will often disempower them further. 

Empowering adults in this situation involves a proactive approach to seeking consent and maximising the person's involvement in decisions about their care, safety and protection, and this includes decisions regarding whether to raise a safeguarding concern.

All interventions must take into account the mental capacity of the adult to make informed choices and specifically the adult’s ability:

• To understand the implications of their situation and to take action themselves (or with support) to prevent abuse.
• To participate to the fullest extent possible in decision-making about safeguarding interventions.

 Having a conversation with the adult 

Wherever possible there should be a conversation with the adult at the earliest opportunity to establish their views including:

• Whether they see the issue as a cause for concern or not.
• What they want to happen, if anything, including any actions they may or may not want to take themselves.

Things to consider:

• Always speak to the adult in a private place where they are likely to feel safe, and inform them about the concerns.
• Use open questions e.g. ‘tell, explain, describe’ to gain an understanding of the situation, the adult’s wishes, what actions may need to be taken, including raising a safeguarding concern. Do not ask leading questions or begin to make enquiries inappropriately.
• If something has happened, get the adult’s views on what has happened and what they want done about it.
• Give the adult information about advice, support and different options that may be available to them in an accessible format, and about the safeguarding adults’ procedures and how these could help to make them safer, and about responsibilities of people working with adults to share information where there may be concerns of abuse or neglect.
• Support the adult to ask questions about issues of confidentiality.
• Consider any advocacy support needs.
• Explain what will happen next, and how they will be kept informed and supported.

Balancing individual choice and risk 

An adult’s right to make choices about their own safety has to be balanced with the rights of others to be safe. Information must only be shared on a ‘need to know basis’ when it is in the interests of the adult. If it is not possible to have obtained informed consent and other adults are at risk of abuse or neglect, it may be necessary to override the requirement to share information.

The individual / practitioner will have to assess whether providing the information will be necessary and consider the risk of not sharing the information.

  In these situations the adult must always be:

• Advised about what information will be shared, with whom and the reasons for this.
• Advised that their views and wishes will be respected as far as possible by the local authority or other agencies in relation to any response they may have a duty to make.
• Provided with relevant information regarding what happens when a local authority is advised of a safeguarding concern.

It is not possible, nor arguably desirable, to eliminate risk.  Empowerment in safeguarding involves risk management that is based on understanding the autonomy of the adult and how they view the risks they face.  There may be risks the adult welcomes because they enhance their quality of life, risks the adult is prepared to tolerate and risks they want to eliminate. 

If the adult has capacity to make an informed decision that they do not want the information to be shared, and there is no indication that they may be experiencing undue influence, then the adult’s wishes would be respected. However there are circumstances in which an adult’s consent may be overridden, including:

• If the adult is at significant risk of serious harm.
• If there is a risk to others.
• If a criminal offence has taken place.
• Where action is needed in the public interest, such as where a member of staff is in a position of trust.

Adults who lack capacity to make relevant decisions

The Mental Capacity Act 2005 was designed to protect and restore power to those vulnerable people who lack capacity.

Where an adult is unable to make a specific decision for themselves, the Act sets out a clear process that must be followed before a decision can be made on the adult’s behalf.

Where an adult is found to lack capacity to make a specific decision any action taken must be taken in their best interests.

Professionals and other staff need to understand and always work in-line with the Mental Capacity Act 2005.

If the adult lacks capacity to make decisions about the incident and their ability to maintain their safety and they do not want a safeguarding concern to be raised, and / or other action to be taken, professionals have a duty to act in their best interests in accordance with the Mental Capacity Act 2005. 

Adults who are thought to lack capacity to make a specific decision need to be provided with all practicable support to enable them to make their own decision before it can be concluded that they lack capacity regarding the decision and a best interests process is entered into.  This may be achieved in a variety of ways such as the help of a family member or friend (as long as they are not the person thought to be the cause of risk), an advocate or Independent Mental Capacity Advocate, an interpreter or other communication assistance or aids.

Where a crime may have been committed 

If it is suspected that a crime may have been committed, there should always be a conversation with the adult regarding whether they wish the police to be involved. 

If the adult does not want the police to be involved, this does not override a practitioner’s responsibility to share information regarding a potential or actual offence with them. 

Such situations should always be approached sensitively.  The adult should be advised that the police will be contacted, and assured that the police will be informed that the adult does not wish to pursue this matter or speak to the police.  It is for the police to determine if they feel it is necessary for them to speak to the adult, or if there is further action they may need to take.

See Section 2.4 Safeguarding and Criminal Investigations for additional guidance. 

When the local authority receives a safeguarding concern they will check to see if they already have any other information that would help determine how best to support the adult and address any immediate risks.  This will also take account of the adult’s wishes and what they want to happen, as far as this is known. 

Under Section 42 of the Care Act, the safeguarding duties apply to an adult 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 or 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.

These are referred to as the ‘three key tests’. If these tests are met the local authority has a legal duty to make enquiries or cause others to do so.  

If the presenting information is unclear proportionate fact finding should be undertaken to support decision making and determine if the three key tests are met or not.

Enquiries will always be undertaken using the six principles outlined in the Care Act and using a Making Safeguarding Personal approach. 

In undertaking an enquiry the local authority will seek relevant information, including talking with the adult who might be at risk as well as to the person who raised the concern.  The local authority will always consult with the adult unless there is a significant reason not to do this, for example if talking to them at this point might put them at further risk. 

It is important to note that concerns that do not meet the threshold for the Section 42 duty to make enquiries may be resolved through other actions, for example an assessment of care and support needs, or passing information onto another service or agency.  

The person who raised the safeguarding concern should always be informed by the local authority that it has been received and where appropriate notified as to the outcome of how the concern is being progressed. Adult Social Care can be contacted directly for further information on specific safeguarding concerns, in accordance with information sharing protocols.