2.8 Raising a safeguarding concern
Raising a safeguarding concern
It’s everyone’s business …
Anybody can raise a safeguarding concern for themselves or another person.
Preventing abuse and neglect by raising issues or sharing information as early as possible
Often abuse and neglect can be prevented from occurring in the first place if issues are identified and raised as soon as they arise so that they can be addressed at the earliest point. This relies on the adult, those in their support networks and those working with them being aware of where to go and who they may be able to talk to for advice or support.
It is important that adults and those involved with them have access to clear information about the advice and support available to them, how to be aware of possible signs of abuse or neglect and how they can avoid and protect themselves from abuse or neglect as far as possible.
Even, and often especially, where an issue may not appear to be or has not reached a point that it would be described, or thought of, as ‘abuse’ or ‘neglect’, it is important that the adult or anyone concerned about this is able to seek advice and support. This information must be shared appropriately with relevant organisations and agencies that may need to be made aware of the concern and could help or need to take action.
It is important to remember that there may be concerns that have been identified or raised by others of which you may not be aware. Passing on your concerns can enable serious abuse or harm to be prevented from happening or from continuing.
Staff (paid or unpaid) working with adults have a particular responsibility to ensure they are aware of concerns, and are proactive in passing these on to relevant agencies that could prevent abuse or neglect from occurring, for example, in relation to issues about the quality of care and support services.
Why should safeguarding concerns or information that relates to the safety, abuse, neglect or exploitation of an adult always be shared with the local authority?
The local authority has a legal duty to make enquiries, or ask others to do so, if an adult with care and support needs may be or is experiencing abuse or neglect and is unable to protect themselves because of those needs.
In order to ensure relevant information is co-ordinated and responded to as effectively as possible, it has been agreed that the local authority will be the agency responsible for receiving information relating to actual or potential safeguarding concerns that relate to an adult.
Whenever there is information that may indicate 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.
- 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 don’t pass the information on it can’t 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 – don’t think you are making a fuss about nothing!
What this section covers
This section provides an overview of when and how to raise a safeguarding concern; issues relating to this, including the consent of the adult who is the subject of the concern; and the responsibilities of all those working with adults (paid and unpaid).
What is a safeguarding concern?
A safeguarding concern is where an adult who has needs for care and support (whether or not any of those needs are being met) may be experiencing, or is at risk of, abuse or neglect, and as a result of their care and support needs is unable to protect themselves from either the risk of, or the experience of, abuse or neglect.
Responsibilities of paid and unpaid staff
Those working with adults (paid or unpaid) have specific professional, and organisational and legal responsibilities to ensure where there is a safeguarding concern, that this information is shared with the local authority and other organisations appropriately.
Those working with adults should understand their responsibilities regarding:
- Recognising possible signs of abuse.
- Responding to safeguarding concerns appropriately.
- Raising adult safeguarding concerns where these are identified.
- Sharing information appropriately where this may prevent abuse.
Staff have a responsibility to take appropriate action in response to safeguarding concerns, wherever possible in line with the wishes of the adult to whom the concern relates, and to report their concerns whenever they become aware that abuse or neglect may be taking place or is at risk of occurring.
Information for adults and others regarding circumstances when information or safeguarding concerns will need to be shared with the local authority and others
All care, support and advice services should have clear information available to all adults and others using their services, regarding the professional and organisational responsibilities staff have for sharing information relating to safeguarding concerns where they become aware of these. This should include:
- The sort of issues and information that will need to be shared.
- When, how and what information might need to be passed on, and to whom and which organisations.
- How the consent of the adult and others involved or affected would be sought.
- The circumstances where information would need to be passed on without the consent of the adult and others involved or affected.
Responsibilities of organisations working with adults
Local authorities must co-operate with each of their partners, as described in the Care Act, and those partners must also co-operate with the local authority, in the exercise of their functions relevant to care and support including those to protect adults.
Employers must ensure that staff, including volunteers, are trained in recognising the signs and symptoms of abuse or neglect, how to respond and where to go for advice and assistance.
These responsibilities should be written down in policy documents that can be easily understood and used by all the key organisations.
Agencies should stress the need for preventing abuse and neglect wherever possible.
Observant professionals and other staff making early, positive interventions with individuals and families can make a huge difference to their lives, preventing the deterioration of a situation or breakdown of a support network. It is often when people become increasingly isolated and cut off from families and friends that they become extremely vulnerable to abuse and neglect.
Agencies should implement robust risk management processes in order to prevent concerns escalating to a crisis point and requiring intervention under safeguarding adults procedures.
Partners should ensure that they have the mechanisms in place that enable early identification and assessment of risk through timely information sharing and targeted multi-agency intervention.
Policies and strategies for safeguarding adults should include measures to minimise the circumstances, including isolation, which make adults vulnerable to abuse.
Employers also have responsibilities to support and protect whistle blowers.
High level information sharing protocols
There should be a clear understanding between partners at a local level when other agencies such as the local authority, Care Quality Commission or Clinical Commissioning Group(s) need to be notified or involved, and what role they have.
Effective information sharing between organisations is essential to prevent abuse, neglect and exploitation. This includes statutory and independent sector organisations involved in all aspects of safeguarding adults work.
Information will be shared within and between organisations in line with the principles set out below:
- Adults have a right to independence, choice and self-determination, including the right to have control over information about themselves and to determine what information is shared. Even in situations where there is no legal requirement to obtain written consent before sharing information, it is good practice to do so.
- The adult’s wishes should always be considered, however, information about an incident of suspected or actual abuse must be shared when this is appropriate.
- Information given to an individual member of staff belongs to the organisation and not to the individual employee. An individual employee cannot give a personal assurance of confidentiality to an adult.
- An organisation should obtain the adult’s written consent to share information and should routinely explain what information may be shared with other people or organisations.
- Difficulties in working within the principles of maintaining the confidentiality of an adult should not lead to a failure to take action to protect the adult from abuse or harm.
- Confidentiality must not be confused with secrecy, that is, the need to protect the management interests of an organisation should not override the need to protect the adult.
- Staff reporting concerns at work (Confidential Reporting Policy – ‘Whistleblowing’) are entitled to protection under the Public Interest Disclosure Act 1998.
Decisions about what information is shared and with whom will be taken on a case-by-case basis. Whether information is shared with or without the adult’s consent, the information shared should be:
- Necessary for the purpose for which it is being shared.
- Shared only with those who need it.
- Accurate and up-to-date.
- Shared in a timely fashion.
- Shared accurately.
- Shared securely.
All information must be treated in accordance with the Data Protection Act 1998.
Consent and involvement of the adult in raising a safeguarding concern
Adults have a legal right to make decisions about their own lives.
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 them or to 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.
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 might want taken or may want to take themselves or not take; if the adult agrees that a safeguarding concern should be raised, what they want to be achieved from this and if they do not agree, the reasons for this.
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 eg. ‘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, 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.
- Identify any communication needs and relevant decision making capacity issues the adult may have, including any need for support from an advocate.
- 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.
It is not possible, nor arguably desirable, to eliminate risk. Empowerment in safeguarding involves risk management that is based on understanding the person, understanding the autonomy of the person and how they view the risks they face. There may be risks the person welcomes because they enhance their quality of life, risks the person is prepared to tolerate and risks they want to eliminate.
Three main factors may affect an adult’s right to control the decision regarding whether information about a safeguarding concern (or other important information, for example, concerns about the quality of a care or support service) is shared with the local authority and other appropriate agencies, or not:
- If others are, or may be, at risk of abuse or neglect.
- Legal or professional responsibilities of staff who have become aware of the concern, for example, if this relates to a breach of regulation, professional code of conduct, or an offence appears to have been committed. This includes where there may be an overriding public interest.
- The adult to whom the concern relates has issues of impaired mental capacity and impaired decision making, and in this situation the Mental Capacity Act should be followed.
An adult’s legal right to make their own decisions
- The Mental Capacity Act 2005 sets out in law each person’s rights regarding making their own decisions, and protects their rights regarding this in law. Where a person 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 their behalf.
- People must be assumed to have capacity to make their own decisions and be given all practicable help before anyone treats them as not being able to make their own decisions.
- Where an adult is found to lack capacity to make a decision, any action taken, or any decision made for or on their behalf must be made in their best interests.
- Professionals and other staff need to understand and always work in-line with the Mental Capacity Act 2005 (MCA). They should use their professional judgement and balance many competing views.
- Employers should provide considerable guidance and support to ensure that professionals and other staff are able to help adults manage risk in ways and put the adults in control of decision making if possible.
- Regular face-to-face supervision from skilled managers is essential to enable staff to work confidently and competently in difficult and sensitive situations.
When an adult does not want information shared and there is a professional responsibility to do so
Where an adult with capacity to make an informed decision about their own safety does not want any action taken, this does not override a professional’s responsibility to raise a safeguarding concern and to share key information with relevant professionals in the circumstances outlined above.
If there appears to be significant risk to the adult, and no one else, consideration would need to be given to whether their wishes should be overridden. The adult’s wishes should not stop professionals from fulfilling their responsibilities in relation to duty of care regarding appropriate sharing of 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 information regarding what happens when a local authority is advised of a safeguarding concern.
- Assured by the professional passing this information to the local authority, that their lack of consent to the information being shared, and their views and wishes regarding actions they do or do not want taken in relation to the situation as far as it affects them directly will also be explained to the local authority.
Professionals should be alert to the risk of situational incapacity, where a person who would otherwise have capacity no longer has it due to their circumstances.
Where an offence may have been committed
If it is suspected that an offence 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 professional’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 they do 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 pursue.
Adults who lack capacity to make relevant decisions
If the adult lacks capacity to make informed 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 under the Mental Capacity Act 2005. This requires a Best Interest decision to be made regarding whether a safeguarding concern should be raised.
Adults who lack capacity need to be supported to be able to make informed choices if possible before a decision can be made and a best interest decision made on their behalf. 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, a language interpreter or other communication assistance or aid.
What are care and support needs?
Care and support should be given its natural meaning, ie. it is when a person needs assistance, or is unable to do something for themselves.
Is an adult able to protect him / herself from abuse?
Where an adult with care and support needs is experiencing, or is at risk of, abuse or neglect and is unable to protect him / herself from the abuse because of those needs, staff working with the adult have a responsibility to raise a safeguarding concern to share this information with the local authority.
Wherever possible, there should be a conversation with the adult at the earliest opportunity to discuss whether they are able to protect themselves from abuse. If it is not possible to have a conversation safely with the adult, there should not be any delay in raising a safeguarding concern if it appears the adult may be at risk of, or experiencing, abuse or neglect.
It is important to remember that many adults with care and support needs may be well able to protect themselves from abuse, neglect or exploitation by others, and that an adult is not inevitably unable to protect him / herself from abuse or neglect just because of their age, frailty or disability. For example, an adult with a disability who has mental capacity to make decisions about their own safety could be perfectly able to make informed choices and protect themselves from harm.
In some circumstances the ability of an adult to protect him / herself from abuse, neglect or exploitation will be affected by their needs for care and support. These needs may affect how far they are able to make and exercise their own informed choices free from pressure or duress. For example, if they are reliant on the support of an individual and concerned or fearful about the consequences of challenging them, or risking the withdrawal of support without which they would be unable to manage.
An adult’s ability to protect him / herself from abuse, neglect or exploitation may be affected or influenced by a range of factors including those associated with their personal experiences and characteristics, their situation, environment and social circumstances. Some of these factors are described in the table below.
Factors that may indicate an adult is more able or less able to protect him / herself from abuse, neglect or exploitation
Factors that can increase an adult’s ability to protect themselves may include:
Factors that could decrease an adult’s ability to protect themselves may include:
· Having mental capacity to make decisions about their own safety.
· Good physical and mental health.
· Having no communication difficulties or, if so, having the
· No physical reliance on others.
· If needing help, able to self-direct care.
· Positive former life experiences.
· Self-confidence and high self-esteem.
· Not having mental capacity to make decisions about their own safety, including fluctuating mental capacity associated with mental illness and other conditions.
· Communication difficulties.
· Being physically reliant on others for personal care and activities of daily life.
· Low self-esteem.
· Experience of abuse.
· Childhood experience of abuse.
Social or situational factors that could decrease the risk of abuse may include:
Social or situational factors that could increase the risk of abuse may include:
· Good family relationships.
· Active social life and a circle of friends.
· Able to participate in the wider community.
· Good knowledge of, and access to, a range of community facilities.
· Remaining independent and active.
· Access to sources of relevant information.
· Being supported or cared for in a setting that is, more or less, reliant on others.
· Not getting the right amount or the right kind of support or care that they need.
· Isolation and social exclusion.
· Stigma and discrimination.
· Lack of access to information and support.
· Being the focus of anti-social behaviour.
Responsibilities of paid or unpaid staff working with adults when a safeguarding concern is identified
When a safeguarding concern is identified, staff must:
- Ensure any immediate action regarding the safety of the adult is taken, including any emergency medical treatment.
- Talk to the adult, unless this would put them or others at risk, regarding their view of the concern, what they want to happen and agree actions that will be taken (see also: Consent and involving the adult).
- Refer to the police if the suspected abuse is a crime or offence.
- Ensure any staff or volunteer who may be thought to be the cause of risk is not in contact with the adult, or other adults.
- Raise a safeguarding concern with adult social care without delay. This should be no later than at the end of the working day in question. If unsure whether a safeguarding concern should be raised, seek advice from adult social care.
- Pass information to other relevant organisations where this is required, for example, the Care Quality Commission.
- Always share information relating to the quality of care and support services with the regulator (CQC) and agencies that commission this service.
Where someone working with an adult is thought to be the cause of risk
All organisations should have:
- Procedures in place that can be followed when a safeguarding concern relates to a member of its own staff. These procedures should complement the Sussex Safeguarding Adults Policy.
- A confidential reporting (whistle blowing) policy.
When it comes to raising safeguarding adults concerns, no distinction should be made between staff employed by an organisation and other individuals, and the Sussex Safeguarding Adults Policy should always be followed.
Where staff do not meet their responsibilities regarding raising a safeguarding concern, this is a serious matter and could indicate a safeguarding concern in itself.
Where there may be a number of different agencies and organisations needing to respond to the safeguarding concern, this will be co-ordinated through the Sussex Safeguarding Adults Policy and Procedures, to ensure that the adult and the outcomes they want to achieve remain at the centre of the enquiry. This includes where there may be the need for, for example, a police investigation or investigation into the conduct of the employee. Any disciplinary process is the responsibility of the employer.
Incident management processes in care and support services and when safeguarding concerns should also be raised
This section applies to the responses of paid and unpaid staff working with adults in care and support services.
It clarifies the circumstances in which information about a ‘low level’ or other incident that has involved an adult should be shared with adult social care, and where raising a safeguarding concern should be considered as well as following the internal incident, reporting and management systems in place in that organisation.
When an incident occurs, consideration should always be given as to whether the information should be shared with adult social care or another agency, for example, the Care Quality Commission, commissioning services, regardless of whether the incident might be considered as a safeguarding concern or not.
Incident reporting and management systems in care and support services
Care and support services have their own internal processes for reporting and responding to incidents and accidents. These processes include:
- Identifying and managing risks that may be related to the incident or accident.
- Identifying potential patterns of incidents or activity that might indicate potential or actual risks which require action to ensure they can be proactively addressed and future risks or incidents prevented.
Monitoring and accountability systems within organisations, for example, quality monitoring officers or serious incident processes, are essential to identify and prevent abuse and neglect. These systems must include clear guidance for staff regarding when relevant information should be passed to external agencies responsible for monitoring the quality of care and support services, such as the Care Quality Commission, and services responsible for commissioning these services.
Commissioners, contract teams and the Care Quality Commission must also have procedures in place in relation to their responsibilities regarding safeguarding adults. These procedures should include the circumstances in which information should be shared with other agencies and safeguarding concerns raised.
The role of routine information sharing in preventing abuse or neglect
Routine quality assurance and risk management systems and processes are part of a general responsibility of provider services and commissioners to ensure the safety of adults using care and support services.
Provider services and commissioners also have a routine responsibility to ensure that information is shared regularly, proactively and appropriately with other organisations and agencies where this is appropriate. This is essential in order to prevent abuse or neglect from taking place or situations where it may take place from developing, and for identifying action that may be needed to address abuse or neglect at the earliest point.
When a safeguarding concern should always be raised
Where the three key tests in the Care Act appear to be met, a safeguarding concern should always be raised, that is:
- An adult who has needs for care and support (whether or not any of those needs are being met).
- The adult may be experiencing, or is at risk of, abuse or neglect.
- As a result of their care and support needs, the adult is unable to protect themselves from either the risk of, or the experience of, abuse or neglect.
Where it is unclear if this is the case, consideration should be given to raising a safeguarding concern, and adult social care should be contacted for advice.
Whilst it is important to talk to the adult regarding their views and wishes, and the actions they may wish to take, this will not override the responsibility of staff working with the adult to raise a safeguarding concern.
Situations where sharing information with the local authority or other agencies should be routinely considered
Information should be shared with the local authority or relevant agencies in the following situations:
- Adult social care or another agency is supporting, working with, or funding an adult who is directly or indirectly affected by an issue or incident.
- The incident has caused harm or has the potential for the adult or other adults to be harmed or to be at risk of abuse or neglect.
- An individual is thought to be the cause of risk because of something they did or did not do – this could be intentional or unintentional. The individual could be family, staff, or another adult and their identity may or may not be known).
- The incident occurred due to a failure in care, a breach of policy and procedure or a breach of a professional code of practice.
- There has been adult has been, or appears to have been, a detrimental impact of an adult’s well-being or there is a potential risk of this to them or another adult, even where the three key tests may not be met.
In any of these circumstances, information about the incident should be shared with adult social care and / or other relevant agencies. Raising a safeguarding concern should also be considered.
Responsibilities of care and support services
Proprietors and managers of care and support services have overall responsibility for ensuring the care and support services they run meet the required standards of care, and for responding to these issues effectively as they arise.
When an employer is aware of abuse or neglect in their organisation, then they are under a duty to correct this and protect the adult from harm as soon as possible, and inform the local authority, CQC and CCG where the latter is the commissioner.
The role of incident management procedures in care and support services
Incident procedures cover a wide range of issues including minor incidents that may happen as a result of issues to do with practice or the quality of care provided. It is the provider manager’s responsibility to ensure these are addressed proactively and effectively through internal processes and to ensure the service they provide meets the required standards of care.
Managers and staff are responsible for taking appropriate action in line with their own policy and procedures for incident reporting. This should reflect the Care Quality Commission’s Compliance to Essential Standards of Quality and Safety.
Consideration should also be given, depending on the nature of the incident, as to whether it may be necessary to notify relevant parties such as relatives, or any external agencies or organisations due to contractual or regulatory requirements.
The views and wishes of the adult should always be sought, however, this does not override professionals’ responsibilities for passing information to relevant agencies.
Where an incident has resulted in harm, or the risk of significant harm, to an adult, information regarding this should always be shared with the local authority, and agencies responsible for the regulation and commissioning of the service. These situations may not necessarily require a safeguarding concern to be raised, unless it appears that the three key tests in the Care Act are met. Where the three key tests are met, a safeguarding concern should always be raised.
Records relating to incidents and the response to these should include:
- A clear account of the incident.
- The views and wishes of the adult – what action they wanted taken or not taken and the outcomes they wanted to achieve. If they were unable to express their views, what was done to support them, eg. whether they had a representative who was consulted, consideration of whether they needed an advocate, whether a best interests decision under the MCA should be taken.
- An assessment of risk, and actions taken.
- Updating the adult’s care plan.
- If another adult was involved, their view of the incident. If they were unable to express their views, what was done to support them, eg. whether they had a representative who was consulted, consideration of whether they needed an advocate, whether a best interests decision under the MCA should be taken. Their care plan and / or risk assessment should be updated.
- A review of the effectiveness of this intervention.
If the same or a similar incident occurs that relates to the same or another adult, it would suggest that the risk assessment or care plan, or other elements of prevention are not effective. Recurring incidents may not appear to have a visible impact on the person or others, however, raising a safeguarding concern should be considered.
Abuse and neglect can occur if risks are not identified or action taken to prevent further incidents occurring or the issue escalating. Incident logs should always be checked for patterns by those recording incidents and those responsible for monitoring the effective implementation of that organisation’s incident policy.
Managers and staff have a duty to have systems in place that enable them to identify patterns or cumulative incidents and to raise a safeguarding concern if there are a number of these, even if this is retrospective once a pattern is identified.
The following examples, though not exhaustive, provide guidance for what should be considered in certain situations:
- When an issue relating to the quality of a care or support service is addressed through the incident management processes in place within that service:
- There must be a conversation at the earliest opportunity with the adult or their representative or advocate to understand their views, what they want to happen, and to agree what actions will be taken in relation to the incident that has occurred. That is, the approach should be in line with the principles of Making Safeguarding Personal but this does not override the service’s responsibility for sharing the information with relevant agencies.
- Information regarding the quality of care and support services where this has had a direct or indirect impact on the adult must always be shared with services responsible for commissioning and / or regulating the care and support service.
- When issues relating to the quality of a care or support service could potentially indicate that an adult may be experiencing or could be at risk of abuse:
- In these circumstances information about these issues should be shared with adult social care, and consideration should be given to whether raising a safeguarding concern would be appropriate.
- If there is any doubt about whether a safeguarding concern should be raised, this should be discussed with adult social care.
- If this is a recurring incident or it affects more than one person a safeguarding concern should be raised:
- There must be a conversation at the earliest opportunity with the adult or their representative or advocate to understand their views, what they want to happen, and to agree what actions will be taken in relation to the incident that has occurred. That is, the approach should be in line with the principles of Making Safeguarding Personal but this does not override the service’s responsibility for sharing the information with relevant agencies.
- Information regarding the quality of care and support services where this has had a direct or indirect impact on the adult must also be shared with services responsible for commissioning and / or regulating the care and support service.
This is not an exhaustive list; it gives examples of different scenarios regarding the information / concern and the type of response that may be required.
‘Harm’ means a negative or detrimental impact on a person’s emotional, physical or mental well-being. It is important to remember that the impact and experience of this may be different for each person.
Care and support service would respond using their own incident management processes
Information should be shared with agencies responsible for commissioning and regulating the service (refer to local processes).
Where issues relating to the quality of a care or support service could indicate an adult may be experiencing, or is at risk of, abuse or neglect
Information should be shared with adult social care and consideration should be given to raising a safeguarding concern.
The service remains responsible for addressing the issue.
Significant assessed needs of one person not documented in care plan, eg. management of behaviour, liquid diet due to swallowing difficulties, bed rails to prevent falls. Provider identifies this and addresses it. No harm occurs.
Failure to specify in care plan how a significant need must be met and inappropriate action or inaction results in harm or injury eg. the person experiences pain, choking, or falls out of bed.
Care plan not followed. Provider identifies this and addresses it. No harm occurs.
Failure to follow care plan results in the person experiencing harm.
A person does not receive necessary help to eat or drink on one occasion. No harm occurs.
Recurring event, or is happening to more than one person. Harm suffered, eg. hunger, dehydration, constipation.
Incontinence needs of one person not met on one occasion. No significant distress or harm caused.
Recurring event, or is happening to more than one person. Harm suffered, eg. loss of dignity and self-confidence, pressure ulcer development.
A person does not receive their medication on one occasion. No harm occurs. The person’s doctor or pharmacist was contacted for advice regarding the impact of the missed medication.
Medication error on one (or more occasions) that caused harm or could have caused significant harm given the nature of the medication eg. insulin for a diabetic. Recurring event, or happening to more than one person. Harm experienced eg. pain, health deterioration, side effects.
A person is discharged from hospital without adequate planning, but no harm occurs.
Discharge planning procedures not followed and harm occurs, or recurring event. Eg. increased risks, no care provision, information not communicated to care provider, medication not administered.
Domiciliary care call missed on one occasion for one person, but no harm occurs.
The person does not receive a visit, and no other contact is made to check their well-being and safety resulting in them experiencing harm, and / or numerous calls missed, or more than one person affected.
A staff member is reported to have talked to a colleague about an adult using the service in an unprofessional way.
A staff member is reported to have shouted at or sworn at an adult.
On one occasion, one adult taps or pushes another adult but no mark or bruise is visible, and the person pushed is not distressed or intimidated in any way.
Note Minor, accidental or non-threatening physical contact between adults that has caused no harm or injury does not require reporting to the police.
Predictable and preventable incident between two adults at risk, causing visible injury or emotional distress. One adult hits out at more than one other adult or ‘targets’ more vulnerable individuals.
If an injury is caused, regardless of intent, a safeguarding concern should be raised and consideration should be given to contacting the police as this could have occurred due to neglect.
Identified one-to-one support not provided to one person on one occasion, but no harm occurs.
Recurring event, resulting in harm to the person and putting other people at risk, and / or unnecessary restraint used.
Staff not managing aggressive behaviour of one person, on one occasion. No harm occurs, to the adult or others.
Recurring event, adult at risk of harming self and others due to inaction. Inappropriate use of restraint.
One person susceptible to pressure ulcers is not formally assessed on one occasion, but no harm occurs and no skin damage is present.
One person is not formally assessed, wounds visible and harm suffered eg. pain. Advice is not sought and a referral is not made to the Tissue Viability Nurse, and pressure damage occurs.
Urinalysis sticks not in stock or order not placed. Staff undertake alternative tests eg. blood glucose to ensure the person’s diabetes is monitored until stock arrives. No harm occurs.
Urinalysis sticks not in stock and no more ordered. The person’s diabetes is not monitored in accordance with care plan. Harm caused eg. the person becomes hypoglycaemic.
If there is any doubt regarding whether a safeguarding concern should be raised this should be discussed with adult social care.
General considerations when raising a safeguarding concern
If something happens to you, or someone you know or are working with, or you see or hear about something which could be adult abuse do the following:
- If there is immediate danger or someone needs urgent medical attention, call the police or an ambulance and then contact adult social care.
- If no-one is in immediate danger, ensure you or the adult are as safe as possible.
- Talk to the adult as soon as possible unless this would put them, others or you at risk, about what they want to happen, what action they do or do not want taken, or want to take themselves. Do not use leading questions, instead ask open questions eg. can you tell me / explain / describe what happened, when did it happen, where did it happen etc. Gather information so that you are in a better position to inform adult social care or the police – be careful not to start looking into the incident yourself.
- If you are a member of staff, explain your responsibility to share information or raise a safeguarding concern; remember to also complete your organisation’s own processes.
- Keep an accurate record of your conversations, and actions or decisions taken by you and others.
- Contact adult social care directly, without delay. Or, if you are a member of staff, tell your manager about your concern (unless your manager is implicated, then talk to an appropriate independent manager).
- Contact Children’s Services if a child may also be affected or is at risk.
- Make a note of what happened or your concerns in as much detail and as soon as possible.
- Remain calm, and try to be reassuring.
- Don’t be judgemental.
- Don’t attempt to look into the matter yourself.
- Do not confront anyone who is thought to be responsible for what has happened, and do not tell them that concerns have been raised about them.
- If there is a possibility that an offence has been committed, do not tamper with or move any potential evidence. Do not clean up.
- If you think an offence has been committed, tell the police and then contact Adult Social Care (or if employed in a service – tell your manger).
- Be mindful that information relating to safeguarding adults issues can be particularly sensitive.
- Promise the adult you can keep this secret.
- Start to look into the situation by asking leading questions.
- Confront the person you think may be responsible.
- Destroy any evidence.
What will be required of you?
When a concern is reported to adult social care, the following information will be needed where it is available:
- If you think there is any immediate or future risk.
- What the adult’s views of the incident are, what they want to happen, and if they have given their consent for you to contact adult social care. If you do not know the adult’s views, the reason you were not able to talk to them (this should usually only be if there was a concern that this might put them, others or you at risk).
- When the incident happened.
- Where the incident happened.
- Who was involved (names and relationships).
What happens next?
When adult social care 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.
If the three key tests in the Care Act appear to be met, the local authority has a duty to make enquiries or cause an enquiry to be made.
If the local authority does not have enough information to determine whether the three key tests have been met, but still has a concern that the adult may be or is experiencing abuse or neglect they will make informal enquiries. This will include talking to the adult at the earliest point or asking another organisation to do so if this would be more appropriate. For example, someone who knows the adult and is not involved in the concern raised.
If this resolves the concern or it becomes clear there are no grounds for concern or further action, the local authority’s duty to make enquiries ends here. This will always take account of the adult’s wishes, any risks to other adults, and other actions that may be required.
If informal enquiries do not resolve the safeguarding concern, the local authority’s duty to make enquiries continues until it is satisfied that the adult is protected and any other actions that may be required have been completed.
Enquiries will always be approached using the six principles outlined in the Care Act and using a Making Safeguarding Personal approach. As part of this process adult social care will gather as much relevant information as they can including talking to the person who might be at risk as well as to the person who raised the concern. We 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.
The response will take account of: the wishes of the person regarding any further action they may or may not want to be taken, the seriousness of the concern, and whether anyone else is affected or at risk in relation to the allegation or concern raised.