1. Introduction

The term ‘inherent jurisdiction’ refers to the High Court’s ability to make declarations, orders and grant injunctions in situations where there is no statutory power to intervene to protect an adult. It has been described by courts as a ‘safety net’ as it allows them to intervene where there is no other legal avenue available. It can be used in situations not covered by existing legislation, such as the Mental Capacity Act 2005 (MCA), Mental Health Act 1983 or legislation in relation to domestic abuse, coercive and controlling behaviour or forced marriage. However, it cannot be used in a way that would directly contradict any legislation.

It can be used to fill a gap where there is no existing applicable legislation, but not as a way of getting around or circumventing existing legislation.

In all cases, it is necessary to first consider what, if any, other legislative mechanisms exist. It is only after considering whether any existing legislation covers the position. that it can be clear whether there is a gap to be filled, and whether recourse to the inherent jurisdiction is necessary.

Any legal professions or organisation with legal standing can bring an application to the High Court. This includes local authorities, NHS trusts and Integrated Care Boards.

2. Scope of the Inherent Jurisdiction

The inherent jurisdiction can be used to fill a legal ‘gap’ and so can cover a variety of scenarios.  By its very nature, there is no legislation setting out the precise remit of the inherent jurisdiction, and it is instead developed on an ongoing basis by way of case law.  For this reason, legal advice must be obtained as soon as possible in circumstances where it is thought that an application to the High Court may be required.

One of the main areas where the inherent jurisdiction has been used in recent cases is in situations where an adult is not able to freely make their own decisions, but this is not as a result of mental incapacity. In these situations, the courts have used the term ‘capacitous but vulnerable’ which means the person has mental capacity but is vulnerable in some other way.

For example, an adult may be subject to external influences, such as coercion or undue influence from another person, which limits their ability to make their own decisions freely. The adult’s decision-making is therefore impaired, and they are unable to make their own choice freely, but this is because of coercion or undue influence, rather than because of a disturbance or impairment in the functioning of their mind or brain, as required by the MCA (see Mental Capacity and Code of Practice chapter).

Case law has established that a person may have physical or cognitive impairments but those will not necessarily, on their own, mean that they are ‘at risk’ so as to make use of the inherent jurisdiction necessary.  On the other hand, a person may have no physical or cognitive impairment but is still ‘at risk’ as a direct result of the coercion or abuse from another person, and so may come within the remit of the inherent jurisdiction.  A family member may use influence over another family member, but for the situation to come within the inherent jurisdiction, the influence must be ‘undue’ or ‘coercive’ so the adult is incapable of making their own decisions.

The inherent jurisdiction may also be used in situations where action is required to safeguard an adult from risks from themselves, such as self-neglect or hoarding, where the adult has mental capacity and so action under legislation is not an option, but the risks they cause to themselves are so great that court intervention is necessary.

It may also be used where an adult lacks capacity but the situation is not covered by the Mental Capacity Act, for example where the adult falls into a legislative ‘gap’ between the Mental Health Act 1983 and the Mental Capacity Act 2005 (see Interface between Mental Capacity Act 2005 and Mental Health Act 1983 chapter).

3. Types of Order

Before making any order, the court must be satisfied that it is necessary and proportionate to do so.  The order must be reasonable and proportionate to the circumstances and not go beyond the minimum necessary to safeguard the adult.

Orders may or may not be time-limited.

Orders may require someone to take specified actions (such as to allow access to an adult) or may set out what someone must not do (such as to threaten or assault an adult).

Types of orders which may be made under the inherent jurisdiction include (but are not limited to) orders:

• allowing social care professionals to gain access to adults where there are safeguarding concerns but where, for example, another person is denying or restricting access to the person about whom there are concerns and there are no grounds for an order under existing legislation;
• freezing assets to prevent the adult’s money or property being wrongly transferred or spent;
• recovering money and / or property belonging to the adult which has already been disposed of;
• overturning a decision about the transfer of money belonging to the adult which has already been made.

Orders made under the inherent jurisdiction can be directed either at the adult or at the person who is coercing them.

For example, orders have been made against the person coercing the adult preventing them from:

• refusing access to the adult by health and social care professionals;
• not allowing the adult to have contact with family and / or friends;
• behaving in an aggressive and / or confrontational manner to health and social care staff;
• interfering in the provision of care and support to the adult;
• assaulting or threatening the adult;
• seeking to persuade or coerce the adult into transferring ownership of property (such as money or their home);
• trying to persuade or coerce the adult into moving into a care home or nursing home;
• behaving in a way towards the adult which is degrading or coercive, such as having unreasonable restrictions on which rooms in the house the adult is allowed in, or punishing the adult, particularly if those punishments are degrading or otherwise humiliating.

Case law has established that, in general, it is better for orders to be made in relation to the person coercing the adult, rather than directed at the adult themself. This is because such an order is likely to be less of a restriction for the adult, and so more proportionate and more likely to promote their independence and empowerment.

Where an order is requested which is directed at the adult, the High Court* has stated that, in order to satisfy the requirements for the order to be both necessary and proportionate, the applicant should be able to demonstrate (with supporting evidence) that they have considered:

• whether the adult will be informed about the order;
• whether the adult is likely to understand the purpose of the order;
• whether the adult will appreciate the impact if the order is breached or broken.

*Redcar  & Cleveland Borough Council v PR [2019] EWHC 2305 (para. 46)

See Appendix 1: Case Law regarding mental health and inherent jurisdiction and deprivation of liberty safeguards and inherent jurisdiction

4. Legal Summary of the Inherent Jurisdiction

The inherent jurisdiction is the High Court’s jurisdiction or power to protect ‘incompetent’ and also ‘vulnerable’ adults. Usually this is where a person has mental capacity, and therefore the MCA cannot be used. It is a jurisdiction that can only be used by the High Court, not the Court of Protection (CoP).

The legal standard is set out by Munby J, Re SA (Vulnerable Adult with Capacity: Marriage) [2005] EWHC 2942 (Fam), at 76-83

McFarlane LJ in A Local Authority v DL & Ors [2012] EWCA Civ 253 at paras 54, 62 described it as:

The High Court has jurisdiction over those who, if not incapacitated, are reasonably believed to be i) under constraint, or ii) subject to coercion or undue influence, or iii) other disabling circumstance: “some other reason deprived of capacity to make relevant decision, disabled from making a free choice, or incapacitated or disabled from giving or expressing a real and genuine consent.

4.1 Basic principles

To be able to use the inherent jurisdiction, the proposed intervention must be necessary and proportionate.

The Court will first attempt to use inherent jurisdiction to assist creative decision-making, rather than taking a decision for the adult: LBL v RYJ and VJ [2010] EWHC 2665 (COP) “facilitative, rather than dictatorial, approach of the court”;

A Local Authority v DL & Ors [2012] EWCA Civ 253 at para 68 per McFarlane LJ noted that inherent jurisdiction is not limited solely to affording a vulnerable adult a temporary safe space’ within which to make a decision free from any alleged source of undue influence. The Court may, in appropriate cases, impose long-term injunctive relief to protect the vulnerable adult.

5. Practice Guidance for using the Inherent Jurisdiction

5.1 Documents required

The relevant legal team will make the application to the High Court using a Part 8 claim form and will include:

• draft order;
• witness statement;
• source documents.

5.2 Grounds / what to show

• Explanation of how the court has jurisdiction; for example coercion; undue influence; other disabling influences.
• That the proposed intervention is necessary.
• That the proposed intervention is proportionate; this should include the alternative options which have been considered.

5.3 Legal process

• The application is filed in the Family Division of the High Court.

Points to consider / discuss include:

• Does the application need to be lodged without notice being given to those who are alleged to be controlling the person?
• Is it urgent?
• If it is not urgent, should the application be started with a request for directions (which is when the court gives instructions to the parties on how they are to prepare the case) ?
• Are there any interim measures required?
• Does there need to be any fact-finding hearing?

5.4 Where a person has borderline mental capacity

If mental capacity is uncertain at the start of the proceedings, there are two options:

1. Commence in High Court and explain why;
2. Commence in the CoP and transfer to the High Court if required.

If urgent action is required, it is best to start proceedings in the High Court.

6. Further Reading

6.1 Relevant chapters

Mental Capacity and Code of Practice

6.2 Relevant information

Guidance Note: Using the Inherent Jurisdiction in Relation to Adults (39 Essex Chambers)

Gaining access to an adult suspected to be at risk of neglect or abuse (SCIE)

Appendix 1: Case Law

Redcar & Cleveland Borough Council v PR [2019] EWHC 2305 (para. 46)

The facts centred around a capacitous (person with mental capacity) but vulnerable 32-year-old woman who was living with her parents. Her mental health deteriorated, and she was admitted to hospital. While she was in hospital, she made allegations about her father. The woman’s mental health improved, and when she was well enough to be discharged from hospital, the local authority became concerned that she was planning to return home to live with her parents. The authority issued an application under the inherent jurisdiction for protective orders.

In its judgment at paragraph 46, Cobb J observed that “before a local authority made an application under the court’s inherent jurisdiction, which was designed to regulate the conduct of a subject by way of injunction, particularly where mental illness or vulnerability was an issue, it should be able to demonstrate (and support with evidence) that it had appropriately considered:

• whether the person was likely to understand the purpose of the injunction;
• (ii) would receive knowledge of the injunction; and
• (iii) would appreciate the effect of breach of that injunction. If the answer to any of these questions was in the negative, the injunction was likely to be ineffectual and should not be applied for or granted since no consequences could flow from the breach”.

There is not yet clear case-law as to the extent to which orders may be made under the inherent jurisdiction which would have the effect of depriving the adult of their liberty.

Appendix 2: Deprivation of Liberty Safeguards and Inherent Jurisdiction

The use of the inherent jurisdiction to authorise a deprivation of liberty must comply with article 5 of the European Convention on Human Rights and is illustrated in the case of NHS Trust v Dr A [2013] COPLR 605.

The facts involved an Iranian doctor, Dr A, who went on hunger strike to recover his passport that had been confiscated by the UK Borders Agency following his failed claims for asylum. He suffered from a delusional disorder which impaired the functioning of his brain by affecting his ability to use or weigh up information relevant to his decision whether to accept nourishment. It was in his best interests for the court to make an order permitting the forcible administration of artificial nutrition and hydration. This treatment would involve deprivation of liberty, but Dr A was ineligible to be deprived of his liberty under the MCA because he was already detained under the MHA. A legislative gap had occurred; as he could not be given the treatment under the MHA because it was not for a mental disorder, but a physical disorder.

2.1 Issues and judgement

The legal question was whether the High Court had power to make order under inherent jurisdiction to authorise forcible feeding of an  incapacitated adult where a deprivation of liberty could not be authorised under MCA 2005 section16(A)(1): “If a person is in ineligible to be deprived of liberty by this Act, the court may not include in a welfare order provision which authorises the person to be deprived of his liberty”. It was not disputed that subjecting Dr A to forcible feeding amounted to a deprivation of liberty, but the difficulty was identifying how that deprivation was to be authorised in law.

The solution to the problem was to authorise treatment under the High Court’s inherent jurisdiction as being in Dr A’s best interests (paragraphs 94 & 96) In NHS Trust v Dr A, the Courts firmly established that the inherent jurisdiction was available to provide a remedy particularly, when none was available under the comprehensive MCA 2005 legislation that would meet the care of such a mentally incapacitated adult.

“[96] In all the circumstances, I hold that this court has the power under its inherent jurisdiction to make a declaration and order authorising the treatment of an incapacitated adult that includes the provision for the deprivation of his liberty provided that the order complies with Art 5. Unless and until this court or another court clarifies the interpretation of s 16A of the MCA, it will therefore be necessary, in any case in which a hospital wishes to give treatment to a patient who is ineligible under s 16A, for the hospital to apply for an order under the inherent jurisdiction where the treatment (a) is outside the meaning of medical treatment of the MHA and (b) involves the deprivation of a patient’s liberty.”

This decision illustrates how the inherent jurisdiction is a flexible legal tool to plug legislative gaps. It can not only protect adults who fall outside the scope of the MCA but can also be raised for those persons who need to be deprived of liberty and fall between the provisions of the MHA and MCA.

Being professionally curious is essential to help identify abuse and neglect which isn’t always obvious. Asking questions, looking, listening, and reflecting on information received is vital to keep adults safe from abuse and neglect.

Professional curiosity is a reoccurring theme in Safeguarding Adult Reviews (SARs).  The purpose of reviews is to learn lessons and influence best practice. Lack of professional curiosity is highlighted locally and nationally as an area to develop.

KSAB’s 7-Minute Professional Curiosity Briefing has been updated to give practitioners practical tips, to help be professionally curious within your role.

Other useful links:

• Rochdale Safeguarding Partnership (YouTube video)
• How to be professionally curious in virtual settings (Leeds Council)
• Professional Curiosity Guidance (Norfolk SAB)

Please get in touch with KSAB@knowsley.gov.uk if you have any further questions.

1. Introduction

The key principle of Making Safeguarding Personal (MSP) is a person-centred and outcome focused approach to safeguarding adults. It emphasises that they adult concerned must always be at the centre of adult safeguarding, and that their wishes and views should be sought at the earliest opportunity.  MSP requires professionals to see adults as experts in their own lives and to work with them in order to identify strengths-based and outcomes focused solutions. Professionals must work in a way that enhances individual involvement, choice and control as part of improving quality of life, wellbeing and safety.

MSP seeks to achieve:

• a personalised approach that enables safeguarding to be done with, not to, people;
• practice that focuses on achieving meaningful improvement to people’s circumstances (outcomes) rather than just the process of ‘investigation’ and reaching a ‘conclusion’;
• an approach that utilises social work skills rather than just ‘putting people through a process, with the ultimate aim of improving outcomes for people at risk of harm.

MSP is led by the Local Government Association (LGA) and by Association of Directors of Adult Social Services (ADASS).

The Care and Support Statutory Guidance also states:

‘…it is also important that all safeguarding partners take a broad community approach to establishing safeguarding arrangements. It is vital that all organisations recognise that adult safeguarding arrangements are there to protect individuals. We all have different preferences, histories, circumstances and life-styles, so it is unhelpful to prescribe a process that must be followed whenever a concern is raised …. Making safeguarding personal means it should be person-led and outcome-focused. It engages the person in a conversation about how best to respond to their safeguarding situation in a way that enhances involvement, choice and control as well as improving quality of life, wellbeing and safety. Nevertheless, there are key issues that local authorities and their partners should consider. (para 14.14-14.15)

2. Key Areas for Effective Practice

MSP can be divided into a number of key areas:

• person led and person centred: being safe and well means different things to different people, this means the safeguarding process should be person-led and recognise people as the experts in their own lives. It should engage the person in a conversation about how best to respond to their safeguarding situation in a way that enhances involvement, choice and control as well as improving quality of life, wellbeing and safety. Professionals should be interested, and look for the full picture of a person’s experience.
• focused on outcomes, not process: safeguarding is not about undertaking a process but is a commitment to improve outcomes by working alongside people experiencing abuse or neglect. The key focus is on developing a real understanding of what people wish to achieve, agreeing, negotiating and recording their desired outcomes, working out with them (and their representatives or advocates if they lack capacity) how best those outcomes might be realised and then seeing, at the end, the extent to which desired outcomes have been realised. This approach involves adults being encouraged to define their own meaningful improvements to change their circumstances and then to be involved throughout the safeguarding investigation, support planning and response.

3. Safeguarding Outcomes

A high quality service keeps people safe from harm. The Adult Social Care Outcomes Framework (ASCOF), reflects this priority, and emphasises the need for services to safeguard adults whose circumstances make them vulnerable and protect them from avoidable harm. Findings from this work have highlighted the clear benefits of asking adults about their experiences of support services.

4. Further Reading

4.1 Relevant chapter

Promoting Wellbeing

4.2 Relevant information

Resources to support Making Safeguarding Personal (LGA) – tools to support safeguarding practice

Making Safeguarding Personal Toolkit (LGA)

Making Safeguarding Personal Toolkit –  Case Studies (LGA and ADASS)

Revisiting Safeguarding Practice (DHSC) 

ePractice

1. The Local Authority’s Role in carrying out Enquiries

Local authorities must make enquiries, or cause others to do so, if they reasonably suspect an adult is at risk of, being abused or neglected (see Adult Safeguarding).

An enquiry is the action taken or instigated by the local authority in response to a concern that abuse or neglect may be taking place.

An enquiry could range from a conversation with the adult, or if they lack capacity, or have substantial difficulty in understanding the enquiry, their representative or advocate, prior to initiating a formal enquiry under section 42, right through to a much more formal multi-agency plan or course of action.

Whatever the course of subsequent action, the professional concerned should record:

• the concern;
• the adult’s views, wishes;
• any immediate action taken; and
• the reasons for those actions.

The purpose of the enquiry is to decide whether or not the local authority or another organisation, or person, should do something to help and protect the adult. If the local authority decides that another organisation should make the enquiry, for example a care provider, the local authority should be clear about:

• timescales;
• the outcomes of the enquiry;
• what action will follow if this is not done.

What happens as a result of an enquiry should reflect the adult‘s wishes wherever possible. If they lack capacity it should be in their best interests if they are not able to make the decision, and be proportionate to the level of concern.

The adult should always be involved from the beginning of the enquiry unless there are exceptional circumstances that would increase the risk of abuse. If the adult has substantial difficulty in being involved, and where there is no one appropriate to support them, then the local authority must arrange for an independent advocate to represent them for the purpose of facilitating their involvement (see Independent Advocacy).

Professionals and other staff need to handle enquiries in a sensitive and skilled way to ensure distress to the adult is minimised. It is likely that many enquiries will require the input and supervision of a social worker, particularly the more complex situations and to support the adult to realise the outcomes they want and to reach a resolution or recovery. For example, where abuse or neglect is suspected within a family or informal relationship it is likely that a social worker will be the most appropriate lead. Personal and family relationships within community settings can prove both difficult and complex to assess and intervene in. The dynamics of personal relationships can be extremely difficult to judge and re-balance. For example, an adult may make a choice to be in a relationship that causes them emotional distress which outweighs, for them, the unhappiness of not maintaining the relationship.

Whilst work with the adult may frequently require the input of a social worker, other aspects of enquiries may be best undertaken by others with appropriate skills and knowledge. For example, health professionals should undertake enquiries and treatment plans relating to medicines management or pressure sores.

2. Criminal Offences and Adult Safeguarding

Everyone is entitled to the protection of the law and access to justice. Although the local authority has the lead role in making enquiries, where criminal activity is suspected, the early involvement of the police is likely to have benefits in many cases.

Behaviour which amounts to abuse and neglect also often constitutes specific criminal offences, for example:

• physical or sexual assault or rape;
• psychological abuse or hate crime;
• wilful neglect;
• unlawful imprisonment;
• theft and fraud;
• certain forms of discrimination of legislation.

For the purpose of court proceedings, a witness is competent if they can understand the questions and respond in a way that the court can understand. Police have a duty under legislation to assist those witnesses who are vulnerable and intimidated.

A range of special measures are available to facilitate the gathering and giving of evidence by vulnerable and intimidated witnesses. Consideration of specials measures should occur from the onset of a police investigation. In particular:

• immediate referral or consultation with the police will enable the police to establish whether a criminal act has been committed and this will give an opportunity of determining if, and at what stage, the police need to become involved further and undertake a criminal investigation;
• the police have powers to take specific protective actions, such as Domestic Violence Protection Orders (DVPO);
• a higher standard of proof is required in criminal proceedings (‘beyond reasonable doubt’) than in disciplinary or regulatory proceedings (where the test is the balance of probabilities) and so early contact with police may assist in obtaining and securing evidence and witness statements;
• early involvement of the police will help ensure that forensic evidence is not lost or contaminated;
• police officers need to have considerable skill in investigating and interviewing adults with a range of disabilities and communication needs if early involvement is to prevent the adult being interviewed unnecessarily on subsequent occasions. Research has found that sometimes evidence from victims and witnesses with learning disabilities is discounted. This may also be true of others such as people with dementia. It is crucial that reasonable adjustments are made and appropriate support given, so people can get equal access to justice;
• police investigations should be coordinated with health and social care enquiries but they may take priority, however the local authority’s duty to ensure the wellbeing and safety of the person continues;
• guidance should include reference to support relating to criminal justice matters which is available locally from such organisations as Victim Support and court preparation schemes;
• some witnesses will need protection;
• the police may be able to get victim support in place.

Special Measures were introduced through legislation in the Youth Justice and Criminal Evidence Act 1999 and include a range of measures to support witnesses to give their best evidence and to help reduce some of the anxiety when attending court. Measures in place include the use of screens around the witness box, the use of live link or recorded evidence in chief and the use of an intermediary to help witnesses understand the questions they are being asked and to give their answers accurately.

Vulnerable adult witnesses have one of the following:

• mental disorder;
• learning disability;
• physical disability.

These witnesses are only eligible for special measures if the quality of evidence that is given by them is likely to be diminished by reason of the disorder or disability.

Intimidated witnesses are defined as those whose quality of evidence is likely to be diminished by reason of fear or distress. In determining whether a witness falls into this category the court takes account of:

• the nature and alleged circumstances of the offence;
• the age of the witness;
• the social and cultural background and ethnic origins of the witness;
• the domestic and employment circumstances of the witness;
• any religious beliefs or political opinions of the witness;
• any behaviour towards the witness by the accused or third party.

Also falling into this category are:

• complainants in cases of sexual assault;
• witnesses to specified gun and knife offences;
• victims of and witnesses to domestic abuse, racially motivated crime, crime motivated by reasons relating to religion, homophobic crime, gang related violence and repeat victimisation;
• those who are older and frail;
• the families of homicide victims.

Registered Intermediaries (RIs) facilitate communication with vulnerable witnesses in the criminal justice system.

A criminal investigation by the police takes priority over all other enquiries. Although a multi-agency approach should be agreed to ensure that the interests and personal wishes of the adult will be considered throughout, even if they do not wish to provide any evidence or support a prosecution. The welfare of the adult and others, including children, is paramount and requires continued risk assessment to ensure the outcome is in their interests and enhances their wellbeing.

If the adult has the mental capacity to make informed decisions about their safety and they do not want any action to be taken, this does not preclude the sharing of information with relevant professional colleagues. This enables professionals to assess the risk of harm and be confident that the adult is not being unduly influenced, coerced or intimidated and is aware of all the options. This will also enable professionals to check the safety and validity of decisions made. It is good practice to inform the adult that this action is being taken unless doing so would increase the risk of harm.

3. The Mental Capacity Act 2005

See also Mental Capacity.

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 then 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 to balance competing views. They will need considerable guidance and support from their employers if they are to help adults manage risk in ways and put them 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.

Mental capacity is frequently raised in relation to adult safeguarding. The requirement to apply the MCA in adult safeguarding enquiries (see Mental Capacity Act 2005 Code of Practice, Office of the Public Guardian) challenges many professionals and requires utmost care, particularly where it appears an adult has capacity for making specific decisions that nevertheless places them at risk of being abused or neglected.

3.1 Ill treatment and wilful neglect

See also Ill Treatment and Wilful (Deliberate) Neglect chapter 

The MCA created the criminal offences of ill treatment and wilful neglect in respect of people who lack the ability to make decisions. The offences can be committed by anyone responsible for that adult’s care and support – paid staff, but also family carers as well as people who have the legal authority to act on that adult’s behalf (that is persons with power of attorney or Court appointed deputies).

These offences are punishable by fines and / or imprisonment.

Ill treatment covers both deliberate acts of ill treatment and also those acts which are reckless which results in ill treatment.

Wilful neglect requires a serious departure from the required standards of treatment and usually means that a person has deliberately failed to carry out an act that they knew they were under a duty to perform.

3.2 Attorneys and deputies

If someone has concerns about the actions of an attorney acting under a registered enduring power of attorney (EPA) or lasting power of attorney (LPA), or a deputy appointed by the Court of Protection, they should contact the Office of the Public Guardian (OPG). The OPG can investigate the actions of a deputy or attorney and can also refer concerns to other relevant agencies.

When it makes a referral, the OPG will make sure that the relevant agency keeps it informed of the action it takes. The OPG can also make an application to the Court of Protection if it needs to take possible action against the attorney or deputy.

Whilst the OPG primarily investigates financial abuse, it is important to note that that it also has a duty to investigate concerns about the actions of an attorney acting under a health and welfare lasting power of attorney or a personal welfare deputy. The OPG can investigate concerns about an attorney acting under a registered enduring power of attorney or lasting power of attorney, regardless of the adult’s capacity to make decisions. Read about the role and powers of the OPG and its policy in relation to adult safeguarding.

4. Information Gathering

If the issue cannot be resolved through these means or the adult remains at risk of abuse or neglect (real or suspected) then the local authority’s enquiry duty under section 42 continues until it decides what action is necessary to protect the adult and by whom and ensures itself that this action has been taken.

Principles for local decision making process:

• empowerment: presumption of person led decisions and informed consent;
• prevention: it is better to take action before harm occurs;
• proportionate and least intrusive response appropriate to the risk presented;
• protection: support and representation for those in greatest need;
• partnership: local solutions through services working with their communities;
• communities: have a part to play in preventing, detecting and reporting neglect and abuse;
• accountability and transparency in delivering safeguarding;
• feeding back whenever possible.

Decision making diagrams

5. When should an Enquiry take place?

Local authorities must make enquiries, or cause another agency to do so, whenever abuse or neglect are suspected in relation to an adult and the local authority thinks it necessary to enable it to decide what (if any) action is needed to help and protect the adult.

The scope of that enquiry, who leads it and its nature, and how long it takes, will depend on the particular circumstances.

It will usually start with asking the adult their view and wishes which will often determine what next steps to take.

Everyone involved in an enquiry must focus on improving the adult’s wellbeing and work together to that shared aim.

At this stage, the local authority also has a duty to consider whether the adult requires an independent advocate to represent and support the adult in the enquiry.

See Decision Making diagrams above, which highlight appropriate pauses for reflection, consideration and professional judgement and reflect the different routes and actions that might be taken.

6. Objectives of an Enquiry

The objectives of an enquiry into abuse or neglect are to:

• establish facts;
• ascertain the adult’s views and wishes;
• assess the needs of the adult for protection, support and redress and how they might be met;
• protect from the abuse and neglect, in accordance with the wishes of the adult;
• make decisions as to what follow up action should be taken with regard to the person or organisation responsible for the abuse or neglect;
• enable the adult to achieve resolution and recovery.

The first priority should always be to ensure the safety and wellbeing of the adult.

The adult should experience the safeguarding process as empowering and supportive. Practitioners should wherever practicable seek the consent of the adult before taking action. However, there may be circumstances when consent cannot be obtained because the adult lacks the capacity to give it, but it is in their best interests to undertake an enquiry.

Whether or not the adult has capacity to give consent, action may need to be taken if others are or will be put at risk if nothing is done or where it is in the public interest to take action because a criminal offence has occurred.

It is the responsibility of all staff and members of the public to act on any suspicion or evidence of abuse or neglect and to pass on their concerns to a responsible person or agency.

7. What should an Enquiry take into Account?

The wishes of the adult are very important, particularly where they have capacity to make decisions about their safeguarding. The wishes of those that lack capacity are of equal importance. Wishes need to be balanced alongside wider considerations such as the level of risk or risk to others including any children affected. All adults at risk, regardless of whether they have capacity or not may want highly intrusive help, such as the barring of a person from their home, or a person to be brought to justice or they may wish to be helped in less intrusive ways, such as through the provision of advice as to the various options available to them and the risks and advantages of these various options.

Where an adult lacks capacity to make decisions about their safeguarding plans, then a range of options should be identified, which help the adult stay as much in control of their life as possible (see Mental Capacity). Wherever possible, the adult should be supported to recognise risks and to manage them. Safeguarding plans should empower the adult as far as possible to make choices and to develop their own capability to respond to them.

Any intervention in family or personal relationships needs to be carefully considered. While abusive relationships never contribute to the wellbeing of an adult, interventions which remove all contact with family members may also be experienced as abusive interventions and risk breaching the adult’s right to family life if not justified or proportionate. Safeguarding needs to recognise that the right to safety needs to be balanced with other rights, such as rights to liberty and autonomy, and rights to family life. Action might be primarily supportive or therapeutic, or it might involve the application of civil orders, sanctions, suspension, regulatory activity or criminal prosecution, disciplinary action or deregistration from a professional body.

It is important, when considering the management of any intervention or enquiry, to approach reports of incidents or allegations with an open mind. In considering how to respond the following factors need to be considered:

• the adult’s needs for care and support;
• the adult’s risk of abuse or neglect;
• the adult’s ability to protect themselves or the ability of their networks to increase the support they offer;
• the impact on the adult, their wishes;
• the possible impact on important relationships;
• potential of action and increasing risk to the adult;
• the risk of repeated or increasingly serious acts involving children, or another adult at risk of abuse or neglect;
• the responsibility of the person or organisation that has caused the abuse or neglect;
• research evidence to support any intervention.

8. Who can carry out an Enquiry?

Although the local authority is the lead agency for making enquiries, it may require others to undertake them. The specific circumstances will often determine who the right person is to begin an enquiry. In many cases a professional who already knows the adult will be the best person. They may be a social worker, a housing support worker, a GP or other health worker such as a community nurse. The local authority retains the responsibility for ensuring that the enquiry is referred to the right place and is acted upon.

The local authority, in its lead and coordinating role, should assure itself that the enquiry satisfies its duty under section 42 to decide:

• what action (if any) is necessary to help and protect the adult;
• by whom;
• to ensure that such action is taken when necessary.

The local authority is able to challenge the body making the enquiry if it considers that the process and / or outcome is unsatisfactory.

8.1 Police

Where a crime is suspected and referred to the police, the police must lead the criminal investigations, with the local authority’s support where appropriate, for example by providing information and assistance. The local authority has an ongoing duty to promote the wellbeing of the adult in these circumstances by assessing, offering or organising care and support to ensure the wellbeing of the person by meeting their needs and ensuring their safety.

8.2 Employers

Employers must ensure that staff, including volunteers, are trained in recognising the signs or symptoms of abuse or neglect, how to respond and where to go for advice and assistance. These are best written down in shared policy documents that can be easily understood and used by all the key organisations.

Employers must also ensure all staff keep accurate records, stating what the facts are and what are the known opinions of professionals and others and differentiating between fact and opinion. It is vital that the views of the adult are sought and recorded. These should include the outcomes that the adult wants, such as feeling safe at home, access to community facilities, restricted or no contact with certain individuals or pursuing the matter through the criminal justice system.

9. What happens after an Enquiry?

Once the wishes of the adult have been ascertained and an initial enquiry undertaken, discussions should be undertaken with them as to whether further enquiry is needed and what further action could be taken.

That action could take a number of courses including:

• disciplinary action;
• complaints;
• criminal investigations; or
• work by contracts managers and CQC to improve care standards.

Those discussions should enable the adult to understand what their options might be and how their wishes might best be realised. Social workers must be able to set out both the civil and criminal justice approaches that are open and other approaches that might help to promote their wellbeing, such as therapeutic or family work, mediation and conflict resolution, peer or circles of support. In complex domestic circumstances, it may take the adult some time to gain the confidence and self-esteem to protect themselves and take action and their wishes may change. The police, health service and others may need to be involved to help ensure these wishes are realised.

10. Safeguarding Plans

Once the facts have been established, a further discussion of the needs and wishes of the adult is likely to take place. This could be focused safeguarding planning to enable the adult to achieve resolution or recovery, or fuller assessments by health and social care agencies (for example a needs assessment under the Care Act). This will entail joint discussion, decision taking and planning with the adult for their future safety and wellbeing. This applies if it is concluded that the allegation is true or otherwise, as many enquiries may be inconclusive.

The local authority must determine what further action is necessary. Where the local authority determines that it should itself take further action (for example, a protection plan), then the authority would be under a duty to do so.

The MCA is clear that local authorities must presume that an adult has the capacity to make a decision until there is a reason to suspect that capacity is in some way compromised; the adult is best placed to make choices about their wellbeing which may involve taking certain risks. Where the adult may lack capacity to make decisions about arrangements for enquiries or managing any abusive situation, their capacity must be assessed and any decision made in their best interests.

If the adult has the capacity to make decisions in this area of their life and declines assistance, this may limit the safeguarding intervention that organisations can make. The focus should then be on harm reduction. It should not however limit the action that may be required by the local authority to protect others who are at risk of harm. The potential for ‘undue influence’ will need to be considered if relevant. If the adult is thought to be refusing intervention on the grounds of duress then action must be taken.

In order to make sound decisions, the adult’s emotional, physical, intellectual and mental capacity in relation to self-determination and consent and any intimidation, misuse of authority or undue influence will have to be assessed. Read the guidance on the Mental Capacity Act: Making Decisions (Office of the Public Guardian, 2014) for information.

11. Taking Action

Once enquiries are completed, the outcome should be notified to the local authority which should then determine with the adult what, if any, further action is necessary and acceptable. It is for the local authority to determine the appropriateness of the outcome of the enquiry. One outcome of the enquiry may be the formulation of agreed action for the adult which should be recorded on their care plan. This will be the responsibility of the relevant agencies to implement.

In relation to the adult, this should set out:

• what steps are to be taken to assure their safety in future in relation to identified risks;
• the provision of any support, treatment or therapy including ongoing advocacy;
• any modifications needed in the way services are provided (for example same gender care or placement; appointment of an Office of the Public Guardian deputy);
• how best to support the adult through any action they take to seek justice or redress;
• any ongoing risk management strategy as appropriate;
• any action to be taken in relation to the person or organisation that has caused the concern.

12. Person Alleged to be Responsible for Abuse or Neglect

When a complaint or allegation has been made against a member of staff, including people employed by the adult, they should be made aware of their rights under employment legislation and any internal disciplinary procedures.

If a person who is alleged to have carried out the abuse themselves has care and support needs and is unable to understand the significance of questions put to them or their replies, they should be assured of their right to the support of an ‘appropriate’ adult if they are questioned in relation to a suspected crime by the police under the Police and Criminal Evidence Act 1984 (PACE). Victims of crime and witnesses may also require the support of an ‘appropriate’ adult.

Under the MCA, people who lack capacity and are alleged to be responsible for abuse, are entitled to the help of an Independent Mental Capacity Advocate, to support and represent them in the enquiries that are taking place (see Independent Mental Capacity Advocate Service). This is separate from the decision whether or not to provide the victim of abuse with an independent advocate under the Care Act.

The Police and Crown Prosecution Service (CPS) should agree procedures with the local authority, care providers, housing providers, and the NHS / Integrated Care Board (ICB) to cover the following situations:

• action pending the outcome of the police and the employer’s investigations;
• action following a decision to prosecute an individual;
• action following a decision not to prosecute;
• action pending trial;
• responses to both acquittal and conviction.

Employers who are also providers or commissioners of care and support have a duty to the adult  and a responsibility to take action in relation to the employee when allegations of abuse are made against them. Employers should ensure that their disciplinary procedures are compatible with the responsibility to protect adults at risk of abuse or neglect.

With regard to abuse, neglect and misconduct within a professional relationship, codes of professional conduct and /or employment contracts should be followed and should determine the action that can be taken. Robust employment practices, with checkable references and recent disclosure and barring checks are important (see Disclosure and Barring Service). Reports of abuse, neglect and misconduct should be investigated and evidence collected.

Where appropriate, employers should report workers to the statutory and other bodies responsible for professional regulation such as the General Medical Council and the Nursing and Midwifery Council. If someone is removed from their role providing regulated activity following a safeguarding incident the regulated activity provider (or if the person has been provided by an agency or personnel supplier, the legal duty sits with them) has a legal duty to refer to the Disclosure and Barring Service (DBS). The legal duty to refer to the DBS also applies where a person leaves their role to avoid a disciplinary hearing following a safeguarding incident and the employer / volunteer organisation feels they would have dismissed the person based on the information they hold.

The standard of proof for prosecution is ‘beyond reasonable doubt’. The standard of proof for internal disciplinary procedures and for discretionary barring consideration by the DBS and the Vetting and Barring Board is usually the civil standard of ‘on the balance of probabilities’. This means that when criminal procedures are concluded without action being taken this does not automatically mean that regulatory or disciplinary procedures should cease or not be considered. In any event there is a legal duty to make a safeguarding referral to DBS if a person is dismissed or removed from their role due to harm to a child or a vulnerable adult.

13. Allegations against People in Positions of Trust

See also North West Policy for Managing Concerns around People in Positions of Trust with Adults who have Care and Support Needs

The local authority’s relevant partners and those providing universal care and support services, should have clear policies in line with those from the Safeguarding Adults Board for dealing with allegations against people who work, in either a paid or unpaid capacity, with adults with care and support needs. Such policies should make a clear distinction between an allegation, a concern about the quality of care or practice or a complaint.

Safeguarding adults boards need to establish and agree a framework and process for how allegations against people working with adults with care and support needs (that is those in positions of trust) should be notified and responded to. Whilst the focus of safeguarding adults work is to safeguard one or more identified adults with care and support needs, there are occasions when incidents are reported that do not involve an adult at risk, but indicate, nevertheless, that a risk may be posed to adults at risk by a person in a position of trust.

Where such concerns are raised about someone who works with adults with care and support needs, it will be necessary for the employer (or student body or voluntary organisation) to assess any potential risk to adults with care and support needs who use their services, and, if necessary, to take action to safeguard those adults.

Examples of such concerns could include allegations that relate to a person who works with adults with care and support needs who has:

• behaved in a way that has harmed, or may have harmed an adult or child;
• possibly committed a criminal offence against, or related to, an adult or child;
• behaved towards an adult or child in a way that indicates they may pose a risk of harm to adults with care and support needs.

When a person’s conduct towards an adult may impact on their suitability to work with or continue to work with children, this must be referred to the local authority’s designated officer.

If a local authority is given information about such concerns they should give careful consideration to what information should be shared with employers (or student body or voluntary organisation) to enable risk assessment.

Employers, student bodies and voluntary organisations should have clear procedures in place setting out the process, including timescales, for investigation and what support and advice will be available to individuals against whom allegations have been made. Any allegation against people who work with adults should be reported immediately to a senior manager within the organisation. Employers, student bodies and voluntary organisations should have their own sources of advice (including legal advice) in place for dealing with such concerns.

If an organisation removes an individual (paid worker or unpaid volunteer) from work with an adult with care and support needs (or would have, had the person not left first) because the person poses a risk of harm to adults, the organisation must make a referral to the DBS. It is an offence to fail to make a referral without good reason.

Allegations against people who work with adults at risk must not be dealt with in isolation. Any corresponding action necessary to address the welfare of adults with care and support needs should be taken without delay and in a coordinated manner, to prevent the need for further safeguarding in future.

Local authorities should ensure that their safeguarding information and advice services are clear about the responsibilities of employers, student bodies and voluntary organisations, in such cases, and signpost them to their own procedures and legal advice appropriately. Information and advice services should also be equipped to advise on appropriate information sharing and the duty to cooperate (see Information and Advice chapter).

Local authorities should ensure that there are appropriate arrangements in place to effectively liaise with the police and other agencies to monitor the progress of cases and ensure that they are dealt with as quickly as possible, consistent with a thorough and fair process.

Decisions on sharing information must be justifiable and proportionate, based on the potential or actual harm to adults or children at risk and the rationale for decision making should always be recorded.

When sharing information about adults, children and young people at risk between agencies it should only be shared:

• where relevant and necessary, not simply all the information held;
• with the relevant people who need all or some of the information;
• when there is a specific need for the information to be shared at that time.

14. Further Reading

14.1 Relevant chapters

Adult Safeguarding

Information Sharing and Confidentiality

14.2 Relevant information

Chapter 14, Safeguarding, Care and Support Statutory Guidance (Department of Health and Social Care)

Making Decisions on the Duty to carry out Safeguarding Adults Enquiries: Resources (LGA)

Gaining Access to an Adult Suspected to be at Risk of Neglect or Abuse (SCIE)

1. Introduction

Each local authority must set up a Safeguarding Adults Board (SAB). The SAB’s overarching purpose is to help and safeguard adults with care and support needs by assuring itself that local safeguarding arrangements are in place, and partners are working well together to help prevent abuse and where possible providing a timely and proportionate response where abuse has occurred.

The SAB has a strategic role and oversees and leads adult safeguarding locally. It has an interest in a range of matters that contribute to the prevention of abuse and neglect, including:

• oversees and leads adult safeguarding across the locality and will be interested in a range of matters that contribute to the prevention of abuse and neglect;
• the safety of patients in its local health services;
• the quality of local care and support services;
• the effectiveness of prisons and approved premises in safeguarding offenders;
• the awareness and responsiveness of further education services.

The SAB will need intelligence on safeguarding from all providers of health and social care in its locality (not just those with whom its members commission or contract). It is important that SAB partners feel able to challenge each other and other organisations where it believes that their actions or inactions are increasing the risk of abuse or neglect. This will include commissioners, as well as providers of services.

The SAB can be an important source of advice and assistance, for example in helping others improve their safeguarding mechanisms and practice. It is important that the SAB has effective links with other key partnerships in the locality and share relevant information and work plans. The SAB should consciously cooperate to reduce any duplication and maximise any efficiency, particularly as objectives and membership is likely to overlap.

2. Core Duties of the Safeguarding Adults Board

A SAB has three core duties:

• it must publish a strategic plan for each financial year that sets how it will meet its main objective and what the members will do to achieve this. The plan must be developed with local community involvement, and the SAB must consult the local Healthwatch organisation. The plan should be evidence based and make use of all available evidence and intelligence from partners to form and develop its plan;
• it must publish an annual report detailing what the SAB has done during the year to achieve its main objective and implement its strategic plan, and what each member has done to implement the strategy as well as detailing the findings of any safeguarding adults reviews and subsequent action;
• it must conduct any safeguarding adults review (see Section 5, Safeguarding Adults Reviews).

Safeguarding requires collaboration between partners in order to create a framework of inter-agency arrangements. Local authorities and their relevant partners must collaborate and work together as set out in the cooperation duties in the Care Act 2014 and, in doing so, must, where appropriate, also consider the wishes and feelings of the adult on whose behalf they are working.

Local authorities may cooperate with any other body they consider appropriate where it is relevant to their care and support functions. The lead agency with responsibility for coordinating adult safeguarding arrangements is the local authority, but all the members of the SAB should each designate a lead officer. Other agencies should also consider the benefits of having a lead for adult safeguarding.

Each SAB should:

• identify the role, responsibility, authority and accountability with regard to the action each agency and professional group should take to ensure the protection of adults;
• establish ways of analysing and interrogating data on safeguarding notifications that increase the SAB’s understanding of prevalence of abuse and neglect locally that builds up a picture over time;
• establish how it will hold partners to account and gain assurance of the effectiveness of its arrangements;
• determine its arrangements for peer review and self-audit;
• establish mechanisms for developing policies and strategies for protecting adults which should be formulated, not only in collaboration and consultation with all relevant agencies but also take account of the views of adults who have needs for care and support, their families, advocates and carer representatives;
• develop preventative strategies that aim to reduce instances of abuse and neglect in its area;
• identify types of circumstances giving grounds for concern and when they should be considered as a referral to the local authority as an enquiry;
• formulate guidance about the arrangements for managing adult safeguarding, and dealing with complaints, grievances and professional and administrative malpractice in relation to safeguarding adults;
• develop strategies to deal with the impact of issues of race, ethnicity, religion, gender and gender orientation, sexual orientation, age, disadvantage and disability on abuse and neglect;
• balance the requirements of confidentiality with the consideration that, to protect adults, it may be necessary to share information on a ‘need to know basis’ (see Case Recording Standards and Information Sharing chapter);
• identify mechanisms for monitoring and reviewing the implementation and impact of policy and training;
• carry out safeguarding adult reviews and determine any publication arrangements;
• produce a strategic plan and an annual report;
• evidence how SAB members have challenged one another and held other boards to account
• promote multi-agency training and consider any specialist training that may be required. Consider any scope to jointly commission some training with other partnerships, such as the Community Safety Partnership.

See Care and Support Statutory Guidance paragraphs 14.133-14.161 for further information about Safeguarding Adults Boards.

3. Provision of Local Adult Safeguarding Procedures

See also Knowsley Safeguarding Adults Procedures

In order to respond appropriately where abuse or neglect may be taking place, anyone in contact with the adult, whether as a volunteer or in a paid role, must understand their own role and responsibility and have access to practical and legal guidance, advice and support. This will include understanding local inter-agency policies and procedures.

In any organisation, there should be adult safeguarding policies and procedures. These should reflect the Care and Support statutory guidance and the Decision Making Tree diagram 1B (see Section 4, Information Gathering, Safeguarding Procedures for Responding in Individual Cases) and are for use locally to support the reduction or removal of safeguarding risks, as well as to secure any support to protect the adult and, where necessary, to help the adult recover and develop resilience. Such policies and procedures should assist those working with adults know how to develop swift and personalised safeguarding responses and how to involve adults in this decision making. This, in turn, should encourage proportionate responses and improve outcomes for the people concerned. Procedures may include:

• a statement of purpose relating to promoting wellbeing, preventing harm and responding effectively if concerns are raised;
• a statement of roles and responsibility, authority and accountability sufficiently specific to ensure that all staff and volunteers understand their role and limitations
• a statement of the procedures for dealing with allegations of abuse, including those for dealing with emergencies by ensuring immediate safety, the processes for initially assessing abuse and neglect and deciding when intervention is appropriate, and the arrangements for reporting to the police, urgently when necessary;
• a full list of points of referral indicating how to access support and advice at all times, whether in normal working hours or outside them, with a comprehensive list of contact addresses and telephone numbers, including relevant national and local voluntary bodies;
• an indication of how to record allegations of abuse and neglect, any enquiry and all subsequent action;
• a list of sources of expert advice;
• a full description of channels of inter-agency communication and procedures for information sharing and for decision making;
• a list of all services which might offer access to support or redress;
• how professional disagreements are resolved especially with regard to whether decisions should be made, enquiries undertaken for example.

The SAB should keep policies and procedures under review and report on these in the annual report as necessary. Procedures should be updated to incorporate learning from published research, peer reviews, case law and lessons from recent cases and Safeguarding Adults Reviews. The procedures should also include the provisions of the law – criminal, civil and statutory – relevant to adult safeguarding. This should include local or agency specific information about obtaining legal advice and access to appropriate remedies.

The Care Act requires that each local authority must arrange for an independent advocate to represent and support an adult who is the subject of a safeguarding enquiry or Safeguarding Adult Review where the adult has ‘substantial difficulty’ in being involved in the process and where there is no other suitable person to represent and support them (see Independent Advocacy chapter).

4. Responding to Abuse and Neglect in a Regulated Care Setting

It is important that all partners are clear where responsibility lies when abuse or neglect is carried out by employees or in a regulated setting, such as a care home, hospital, or college. The first responsibility to act must be with the employing organisation as provider of the service. However, social workers or counsellors may need to be involved in order to support the adult to recover.

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 Integrated Care Board (ICB) where the latter is the commissioner.

Where a local authority has reasonable cause to suspect that an adult may be experiencing or at risk of abuse or neglect, then it is still has a duty to make (or cause to be made) whatever enquiries it thinks necessary to decide what if any action needs to be taken and by whom. The local authority may be reassured by the employer’s response so that no further action is required. However, a local authority would have to satisfy itself that an employer’s response has been sufficient to deal with the safeguarding issue and, if not, to undertake any enquiry of its own and any appropriate follow up action (for example referral to CQC, professional regulators).

The employer should investigate any concern (and provide any additional support that the adult may need) unless there is compelling reason why it is inappropriate or unsafe to do this. For example, this could be a serious conflict of interest on the part of the employer, concerns having been raised about non-effective past enquiries or serious, multiple concerns, or a matter that requires investigation by the police.

An example of a conflict of interest where it is better for an external person to be appointed to investigate may be the case of a family run business where institutional abuse is alleged, or where the manager or owner of the service is implicated. The circumstances where an external person would be required should be agreed locally. All those carrying out such enquiries should have received appropriate training.

There should be a clear understanding between partners at a local level when other agencies such as the local authority, CQC or ICB need to be notified or involved and what role they have. The Association of Directors of Adult Social Services (ADASS), Care Quality Commission, Local Government Association, National Police Chiefs Council and NHS England have jointly produced a high level guide on these roles and responsibilities: Safeguarding Adults Roles. The focus should be on promoting the wellbeing of those adults at risk.

Commissioners of care or other professionals should only use safeguarding procedures in a way that reflects the principles above not as a means of intimidating providers or families. Transparency, open mindedness and timeliness are important features of fair and effective safeguarding enquiries. CQC and commissioners have alternative means of raising standards of service, including support for staff training, contract compliance and, in the case of CQC; enforcement powers may be used.

Commissioners should encourage an open culture around safeguarding, working in partnership with providers to ensure the best outcome for the adult. A disciplinary investigation, and potentially a hearing, may result in the employer taking informal or formal measures which may include dismissal and possibly referral to the Disclosure and Barring Service (see Disclosure and Barring chapter).

If someone is removed by being either dismissed or redeployed to a non-regulated activity, from their role providing regulated activity following a safeguarding incident, or a person leaves their role (resignation, retirement) to avoid a disciplinary hearing following a safeguarding incident and the employer/volunteer organisation feels they would have dismissed the person based on the information they hold, the regulated activity provider has a legal duty to refer to the Disclosure and Barring Service. If an agency or personnel supplier has provided the person, the legal duty sits with that agency. In circumstances where these actions are not undertaken then the local authority can make such a referral.

5. Safeguarding Adults Reviews

There are different types of Safeguarding Adults Review:

• SABs must arrange a Safeguarding Adults Review (SAR) when an adult in its area dies as a result of abuse or neglect, whether known or suspected, and there is concern that partner agencies could have worked more effectively to protect the adult;
• SABs must also arrange a SAR if an adult in its area has not died, but the SAB knows or suspects that the adult has experienced serious abuse or neglect. In the context of SARs, something can be considered serious abuse or neglect where:
  • the individual would have been likely to have died but for an intervention;
  • has suffered permanent harm;
  • has reduced capacity or quality of life (whether because of physical or psychological effects) as a result of the abuse or neglect;
• SABs are free to arrange for a SAR in any other situations involving an adult in its area with needs for care and support.

The SAB should be primarily concerned with weighing up what type of ‘review’ process will promote effective learning and improvement action to prevent future deaths or serious harm occurring again. This may be where a case can provide useful insights into the way organisations are working together to prevent and reduce abuse and neglect of adults.

Early discussions need to take place with the adult, family and friends to agree how they wish to be involved. The adult who is the subject of any SAR need not have been in receipt of care and support services for the SAB to arrange a review in relation to them.

See Care and Support Statutory Guidance paragraphs 14.162-179 and local Safeguarding Adults Boards procedures for further information.

6. Providing and Disseminating Information

6.1 People with care and support needs and their carers

Information should be produced in a range of different ways and in user friendly formats for people with care and support needs and their carers. Information should explain clearly:

• what abuse is;
• how to share any concerns;
• how to make a complaint;
• that their concerns or complaints will be taken seriously;
• that concerns will be dealt with independently;
• that they will be kept involved in the process to the degree that they wish to be;
• that they will receive help and support in taking action on their own behalf;
• that they can nominate an advocate or representative to speak and act on their behalf if they wish.

If an adult has no appropriate person to support them and has substantial difficulty in being involved in the local authority processes, they must be informed of their right to an independent advocate (see Independent Advocacy chapter). Where appropriate local authorities should provide information on access to appropriate services such as, for example, how to obtain independent legal advice or counselling services. The involvement of adults at risk in developing such communication is sensible.

6.2 Commissioners, providers and other staff

All commissioners or providers of services in the public, voluntary or private sectors should disseminate information about the multi-agency safeguarding adults policies and procedures.

Staff should be made aware through internal guidelines of what to do when they suspect or encounter abuse of adults in vulnerable situations.

This should be incorporated in staff manuals or handbooks detailing terms and conditions of appointment and other employment procedures so that individual staff members will be aware of their responsibilities in relation to safeguarding adults.

This information should emphasise that all those who express concern will be treated seriously and will receive a positive response from managers.

6.3 Local roles and responsibilities

Roles and responsibilities should be clear and collaboration should take place at all the following levels:

• operational;
• supervisory line management;
• practice leadership;
• strategic leadership within the senior management team;
• corporate / cross authority;
• chief officers / chief executives;
• local authority members and local police and crime commissioners;
• commissioners;
• providers of services;
• voluntary organisations;
• regulated professionals.

6.3.1 Front line staff

Operational front line staff are responsible for identifying and responding to allegations of abuse and poor practice. Staff at operational level need to share a common view of what types of behaviour may be abuse or neglect and what to do as an initial response to a suspicion or allegation that it is or has occurred. This includes GPs. It is employers’ and commissioners’ duty to set these out clearly and reinforce regularly.

It is not for front line staff to second guess the outcome of an enquiry in deciding whether or not to share their concerns. There should be effective and well publicised ways of escalating concerns if immediate line managers do not take action in response to the concern being raised.

Concerns about abuse or neglect must be reported, regardless of the alleged source. It is imperative that poor or neglectful care is brought to the immediate attention of managers and responded to swiftly, including ensuring immediate safety and wellbeing of the adult. Where the source of abuse or neglect is a member of staff it is for the employer to take immediate action and record what they have done and why (similarly for volunteers and or students).

There should be clear arrangements in place covering what each agency should contribute at this level. These will cover approaches to enquiries and subsequent courses of action. The local authority is responsible for ensuring effective coordination at this level.

6.3.2  Supervision

Skilful and knowledgeable supervision focused on outcomes for adults is critically important in safeguarding work. Managers have a central role in ensuring high standards of practice and that practitioners are properly equipped and supported. It is important to recognise that dealing with situations involving abuse and neglect can be stressful and distressing for staff and workplace support should be available.

Managers need to develop effective working relationships with their counterparts in other agencies to improve cooperation locally and swiftly address any differences or difficulties that arise between front line staff or managers.

They should have access to legal advice when proposed interventions, such as the proposed stopping of contact between family members, or if it is unclear whether proposed serious and/or invasive medical treatment is likely to be in the best interests of the adult who lacks capacity to consent, require applications to the Court of Protection.

7. Senior Strategic Response

7.1 Practice leadership

All social workers undertaking work with adults should have access to a source of additional advice and guidance particularly in complex and contentious situations. Principal social workers are often well placed to perform this role or to ensure that appropriate practice supervision is available.

Principal social workers in the local authority are responsible for providing professional leadership for social work practice in their organisation and organisations undertaking statutory responsibilities on behalf of the local authority. Practice leaders / principal social workers should ensure that practice is in line with the Care and Support Statutory Guidance.

All providers of healthcare should have in place named professionals, who are a source of additional advice and support in complex and contentious cases within their organisation. There should be a designated professional lead in the Integrated Care Board (ICB), who is a source of advice and support to the governing body in relation to the safeguarding of individuals and is able to act as the lead in the management of complex cases.

All commissioners and providers of healthcare should ensure that staff have the necessary competences and that training in place to ensure that their staff are able to deliver the service in relation to the safeguarding of individuals. This is strengthened by the development of the Safeguarding Adults: Roles and Competences for Health Care Staff – Intercollegiate Document (RCN), which details the levels of training and competencies required for the different groups of staff in the organisations.

Many of the police investigators involved in safeguarding investigations have received specialist training in designated units. Each of those units has a set of arrangements to help provide advice and guidance to ensure that a thorough investigation takes place in order to achieve successful outcomes for the individual.

The police service itself has identified ways that enable non specialist officers to seek advice from supervisors at every stage of the safeguarding process, even when specialist departments are unavailable.

7.2 Strategic leadership within the senior management team

Each SAB member agency – local authority, ICB and police – should identify a senior manager to take a lead role in the organisational and in inter-agency arrangements, including the SAB. In order for the Board to be an effective decision making body providing leadership and accountability, members need to be sufficiently senior within their organisation and have the authority to commit the required resources and able to make strategic decisions. To achieve effective working relationships, based on trust and transparency, the members will need to understand the contexts and restraints within which their counterparts work.

All police forces in England and Wales have a head of public protection that has strategic management responsibility for all aspects of protecting people in vulnerable situations, including adults at risk. The role of the head of public protection is to build an effective working team and develop a multi-agency approach into alleged offences involving people in vulnerable circumstances. They will also have responsibility for managing and developing policy that ensures standardised processes of investigation and working practice throughout each force. The police and ICBs are now represented at a strategic level on every local safeguarding adults board and contact details for the individuals concerned will be available to the Board and all Board members.

7.3 Corporate / cross authority roles

To ensure effective partnership working, each organisation must recognise and accept its role and functions in relation to adult safeguarding. These should be set out in the SAB’s strategic plan as well as its own communication channels. They should also have protocols for mediation and family group conferences and for various forms of dispute resolution.

7.4 Chief Officers and Chief Executives

As chief officer for the leading adult safeguarding agency, the Director of Adult Social Services (DASS) has a particularly important leadership and challenge role to play in adult safeguarding.

Responsible for promoting prevention, early intervention and partnership working is a key part of a DASS’s role and also critical in the development of effective safeguarding. Taking a personalised approach to adult safeguarding requires a DASS promoting a culture that is person centred, supports choice and control and aims to tackle inequalities.

However, all officers, including the chief executive of the local authority, NHS executives and police chief officers should lead and promote the development of initiatives to improve the prevention, identification and response to abuse and neglect. They need to be aware of and able to respond to national developments and ask searching questions within their own organisations to assure themselves that their systems and practices are effective in recognising and preventing abuse and neglect. The chief officers must sign off their organisation’s contributions to the strategic plan.

7.5 Local authority elected members

Local authority elected members need to have a good understanding of the range of abuse and neglect issues that can affect adults and of the importance of balancing safeguarding with empowerment. Local authority members need to understand prevention, proportionate interventions, and the dangers of risk adverse practice and the importance of upholding human rights. Some SABs include elected members and this is one way of increasing awareness of members and ownership at a political level. Others take the view that members are more able to hold their officers to account if they have not been party to Board decision making, though they should always be aware of the work of the SAB. Managers must ensure that members are aware of any critical local issues, whether of an individual nature, matters affecting a service or a particular part of the community.

In addition, Local Authority Health Scrutiny Functions, such as the Council’s Health Overview and Scrutiny Committee, Health and Wellbeing Boards (HWBs) and Community Safety Partnerships can play a valuable role in assuring local safeguarding measures, and ensuring that SABs are accountable to local communities. Similarly, local Health and Wellbeing Boards provide leadership to the local health and wellbeing system; ensure strong partnership working between local government and the local NHS; and ensure that the needs and views of local communities are represented. HWBs can therefore play a key role in assurance and accountability of SABs and local safeguarding measures. Equally SABs may on occasion challenge the decisions of HWBs from that perspective.

7.7 Commissioners

Commissioners from the local authority, NHS and ICBs are all vital to promoting adult safeguarding. Commissioners have a responsibility to assure themselves of the quality and safety of the organisations they place contracts with and ensure that those contracts have explicit clauses that holds the providers to account for preventing and dealing promptly and appropriately with any example of abuse and neglect.

7.8 Providers of services

All service providers, including housing and housing support providers, should have clear operational policies and procedures that reflect the framework set by the SABs in consultation with them. This should include what circumstances would lead to the need to report outside their own chain of line management, including outside their organisation to the local authority. They need to share information with relevant partners such as the local authority even where they are taking action themselves. Providers should be informed of any allegation against them or their staff and treated with courtesy and openness at all times. It is of critical importance that allegations are handled sensitively and in a timely way both to stop any abuse and neglect but also to ensure a fair and transparent process. It is in no one’s interests to unnecessarily prolong enquiries. However some complex issues may take time to resolve.

7.9 Voluntary organisations

Voluntary organisations need to work with commissioners and the SAB to agree how their role fits alongside the statutory agencies and how they should work together. This will be of particular importance where they are offering information and advice, independent advocacy, and support or counselling services in safeguarding situations. This will include telephone or online services. Additionally, many voluntary organisations also provide care and support services, including personal care. All voluntary organisations that work with adults need to have safeguarding procedures and lead officers.

Regulated professionals

Staff governed by professional regulation (for example, social workers, doctors, allied health professionals and nurses) should understand how their professional standards and requirements underpin their organisational roles to prevent, recognise and respond to abuse and neglect.

8. Further Reading

8.1 Related chapters

Adult Safeguarding

Safeguarding Procedures in Individual Cases

Information Sharing and Confidentiality

8.2 Related information

Chapter 14, Safeguarding, Care and Support Statutory Guidance (Department of Health and Social Care)

Audio & Quick Read Summary

1. Introduction

The Care Act 2014 provides the statutory framework for safeguarding adults, and contains the powers and duties that local authorities, Safeguarding Adults Boards and partner agencies have. It also provides guidance on how local authorities should work to prevent and tackle abuse, keep people safe and promote wellbeing. Chapter 14, Care and Support Statutory Guidance is the accompanying statutory guidance.

Social workers are the lead professionals in undertaking the statutory safeguarding duties, but it is vital they work with partners in other agencies to prevent, investigate and resolve safeguarding concerns.

2. The Safeguarding Duty

Under section 42 of the Care Act 2014, local authorities have legal adult safeguarding duties which are to:

• make enquiries, or cause others to do so, when a concern has been raised about an adult in its area (whether or not they are ordinarily resident in it) to establish whether an action should be taken to prevent or stop abuse or neglect.

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.

The adult experiencing, or at risk of abuse or neglect will be referred to as ‘the adult’ throughout this chapter.

Safeguarding duties also apply to other organisations, not just the local authority, for example the NHS and the police.

Where someone is 18 or over but is still receiving children’s services and a safeguarding issue is raised, the matter should be dealt with through adult safeguarding arrangements. For example, this could occur when a young person with substantial and complex needs continues to be supported in a residential educational setting until the age of 25 (see Transition to Adult Care and Support chapter). Where appropriate, adult safeguarding services should involve the local authority children’s safeguarding colleagues as well as any relevant partners (for example the police or NHS) or other people relevant to the case. The level of needs is not relevant, and the young adult does not need to have eligible needs for care and support under the Care Act, or be receiving any particular service from the local authority, in order for the safeguarding duties to apply – so long as the conditions set out above are met.

Local authority statutory adult safeguarding duties apply equally to those adults with care and support needs:

• regardless of whether those needs are being met;
• regardless of whether the adult lacks mental capacity or not;
• regardless of setting, other than prisons and approved premises where prison governors and HM Prison and Probation Service respectively have responsibility.

3. What is Adult Safeguarding?

Safeguarding means protecting an adult’s right to live in safety, free from abuse and neglect. It requires people and organisations to work together to prevent and stop both the risks and experience of abuse or neglect, while at the same time making sure that the adult’s wellbeing is promoted including, where appropriate, having regard to their views, wishes, feelings and beliefs in deciding on any action (see Making Safeguarding Personal chapter). This must recognise that adults are the experts in their own lives and that they sometimes have complex interpersonal relationships and may be ambivalent, unclear or unrealistic about their personal circumstances.

Organisations should always promote the adult’s wellbeing in their safeguarding arrangements. People have complex lives and being safe and well may mean different things to different people, as well as being just one aspect of what they want to achieve. Professionals should work with the adult to establish what being safe means to them and how that can be best achieved. Professionals and other staff should not be advocating ‘safety’ measures that do not take account of individual wellbeing (see Promoting Wellbeing chapter).

Safeguarding is not a substitute for:

• providers’ responsibilities to provide safe and high quality care and support;
• commissioners regularly assuring themselves of the safety and effectiveness of commissioned services;
• the Care Quality Commission (CQC) ensuring that regulated providers comply with the fundamental standards of care or by taking enforcement action;
• the core duties of the police to prevent and detect crime and protect life and property.

The Care Act requires that each local authority must:

• set up a Safeguarding Adults Board (SAB) (see Safeguarding Adults Boards);
• make enquiries, or cause others to do so, if it believes an adult is experiencing, or is at risk of, abuse or neglect (see Safeguarding Procedures in Individual Cases). An enquiry should establish whether any action needs to be taken to prevent or stop abuse or neglect and if so, by who;
• arrange, where appropriate, for an independent advocate to represent and support an adult who is the subject of a safeguarding enquiry or Safeguarding Adult Review (SAR) where the adult has ‘substantial difficulty’ in being involved in the process and where there is no other suitable person to represent and support them (see Independent Advocacy);
• cooperate with each of its relevant partners (see Integration, Cooperation and Partnerships) in order to protect the adult. In their turn each relevant partner must also cooperate with the local authority.

The aims of adult safeguarding are to:

• prevent harm and reduce the risk of abuse or neglect to adults with care and support needs;
• stop abuse or neglect wherever possible;
• safeguard adults in a way that enhances individual choice and control as part of improving their quality of life, safety and wellbeing;
• work alongside the adult to identify strengths based and outcomes focused solutions;
• raise public awareness so that communities as a whole, alongside professionals, play their part in preventing, identifying and responding to abuse and neglect;
• provide information and support in accessible ways to help people understand the different types of abuse, how to stay safe and what to do to raise a concern about the safety or wellbeing of an adult;
• address what has caused the abuse or neglect.

In order to achieve these aims, it is necessary to:

• ensure that everyone, both individuals and organisations, are clear about their roles and responsibilities;
• create strong multi-agency partnerships that provide timely and effective prevention of and responses to abuse or neglect;
• support the development of a positive learning environment across these partnerships and at all levels within them to help break down cultures that are risk averse and seek to scapegoat or blame practitioners;
• enable access to mainstream community resources such as accessible leisure facilities, safe town centres and community groups that can reduce the social and physical isolation which in itself may increase the risk of abuse or neglect;
• clarify how safeguarding concerns arising from poor quality and inadequacy of service provision, including patient safety in the health sector, should be responded to.

4. Key Principles underpinning all Adult Safeguarding Work

The following six principles apply to all sectors and settings including care and support services, further education colleges, commissioning, regulation and provision of health and care services, social work, healthcare, welfare benefits, housing, wider local authority functions and the criminal justice system. The principles should underpin all work with adults. The principles can also help SABs, and organisations more widely, by using them to examine and improve their local arrangements. They also have ‘I’ statements as examples.

4.1 The six principles

Empowerment

• People are supported and encouraged to make their own decisions and give informed consent. People must always be treated with dignity and respect, and staff should work alongside them to ensure they receive quality, person centred care which ensures they are safe on their own terms.
• ‘I am asked what I want as the outcomes from the safeguarding process and these directly inform what happens.’

Prevention

• Prevention and early support are key to effective safeguarding.  The principle of prevention recognises the importance of taking action before harm occurs and seeks to put mechanisms in places so that they don’t reoccur.
• ‘I receive clear and simple information about what abuse is, how to recognise the signs and what I can do to seek help.’

Proportionality

• The means deciding the least intrusive response appropriate to the risk presented.
• ‘I am sure that the professionals will work in my interest, as I see them and they will only get involved as much as needed.’

Protection

• This involves organising and delivering support and representation for those in greatest need who may not be able to do it themselves.
• ‘I get help and support to report abuse and neglect. I get help so that I am able to take part in the safeguarding process to the extent to which I want.’

Partnership

• Effective safeguarding cannot be delivered in isolation, and should involve other partners and systems that interact with or impact on a person. Local solutions are best achieved through services working with their communities, professionals and services as a whole.
• ‘I know that staff treat any personal and sensitive information in confidence, only sharing what is helpful and necessary. I am confident that professionals will work together and with me to get the best result for me.’

Accountability

• This recognises the importance of being open, clear and honest in the delivery of safeguarding, and ensuring there are systems in place to hold practitioners and services to account.
• ‘I understand the role of everyone involved in my life and so do they.’

See also Making Safeguarding Personal chapter

5. Types of Abuse and Neglect

This section considers the different types and patterns of abuse and neglect and the different circumstances in which they may take place. This is not intended to be an exhaustive list but an illustrative guide as to the sort of behaviour which could give rise to a safeguarding concern. See also Safeguarding Case Studies.

Local authorities should not limit their view of what constitutes abuse or neglect, as it can take many forms and the circumstances of the individual case should always be considered; although the criteria in Section 2, The Safeguarding Duty will need to be met before the issue is considered as a safeguarding concern.

5.1 Physical abuse

This includes:

• assault;
• hitting;
• slapping;
• pushing;
• misuse of medication;
• inappropriate use of restraint;
• inappropriate use of physical sanctions.

5.2 Domestic abuse

Domestic abuse can take many different forms including psychological, physical, sexual, financial or emotional abuse. The Domestic Abuse Act 2021 defines domestic abuse as occurring between two people (aged 16 or over) who are ‘personally connected to each other’ and the behaviour is deemed ‘abusive’. Behaviour is ‘abusive’ when any of the following is identified:

• physical or sexual abuse;
• violent or threatening behaviour;
• controlling or coercive behaviour;
• economic abuse;
• psychological, emotional or other abuse.

Domestic Abuse chapter

5.3 Sexual abuse

This includes:

• rape;
• indecent exposure;
• sexual harassment;
• inappropriate looking or touching;
• sexual teasing or innuendo;
• sexual photography;
• subjection to pornography or witnessing sexual acts;
• indecent exposure;
• sexual assault;
• sexual acts to which the adult has not consented or was pressured into consenting.

Sexual abuse may also take the form of sexual exploitation which can involve coercion and an exchange for basic necessities or something that the perpetrator seeks to gain from the victim.

5.4 Psychological abuse

This includes:

• emotional abuse;
• threats of harm or abandonment;
• deprivation of contact;
• humiliation;
• blaming;
• controlling;
• intimidation;
• coercion;
• harassment;
• verbal abuse;
• cyber bullying;
• isolation;
• unreasonable and unjustified withdrawal of services or supportive networks.

5.5 Financial abuse

This includes:

• theft;
• fraud;
• scams, including internet scamming;
• coercion in relation to an adult’s financial affairs or arrangements, including in connection with wills, property, inheritance or financial transactions;
• the misuse or misappropriation of property, possessions or benefits.

Potential indicators of a person being financially abused include:

• change in living conditions;
• lack of heating, clothing or food;
• inability to pay bills / unexplained shortage of money;
• unexplained withdrawals from an account;
• unexplained loss / misplacement of financial documents;
• the recent addition of authorised signers on a client or donor’s signature card;
• sudden or unexpected changes in a will or other financial documents;
• unexpected change of behaviour or loss of trust in professionals.

5.6 Modern slavery

See Modern Slavery chapter

This includes:

• slavery;
• human trafficking;
• forced labour and domestic servitude.

Perpetrators of modern slavery coerce, deceive and force individuals into a cycle of abuse, servitude or inhumane treatment.

5.7 Discriminatory abuse

This includes forms of:

• harassment;
• slurs or similar treatment:
  • because of race;
  • gender and gender identity;
  • age;
  • disability;
  • sexual orientation;
  • religion.

See Equality, Diversity and Human Rights chapter and Discrimination: your rights (gov.uk) for further information.

5.8 Organisational abuse

Organisational abuse can take the form of suspected or reported neglect and poor practice within an institution or care setting, including the care provided in a person’s own home. This could be a one off incident or make take the form of ongoing, long term or recurring poor treatment of a person. Staff should consider where the abuse in the organisation is being perpetrated and whether it is being enabled by the structure, policies or processes in place.

See Ill Treatment and Wilful / Deliberate Neglect and Emerging Concerns Protocol chapters.

5.9 Neglect and acts of omission

Self-neglect is used to describe a range of behaviours which relate to neglect to care for one’s own personal hygiene, health or surroundings, The person themselves may not recognise the impact of their behaviour or may not use the same terminology to describe their situation. Ultimately, self-neglect becomes a cause for concern where there are serious risks identified to a person’s health, well-being or lifestyle. Self-neglect may take the form of neglect of nutrition or hydration, or behaviours such as hoarding.

Self-neglect will not always prompt a section 42 (safeguarding) enquiry.

An assessment should be made on a case by case basis, and practitioners should remain curious as to whether incidents are one off or multiple, affect the people around the adult and whether there are any patterns of harm that may be an indication of other types of abuse or poor mental health. A decision on whether a response is required under safeguarding or a decision to offer a care and support assessment of need / risk assessment will depend on the adult’s ability to protect themselves by controlling their own behaviour. There may come a point when they are no longer able to do this, without external support.

5.10 Self-neglect

See also Self-Neglect.

This covers a wide range of behaviour neglecting to care for one’s personal hygiene, health or surroundings and includes behaviour such as hoarding. Self-neglect may not prompt a section 42 enquiry.

An assessment should be made on a case by case basis. A decision on whether a response is required under safeguarding or a decision to offer a care and support assessment of need / risk assessment will depend on the adult’s ability to protect themselves by controlling their own behaviour. There may come a point when they are no longer able to do this, without external support.

6. Patterns of Abuse

See also Emerging Concerns Protocol chapter

Incidents of abuse may be one off or multiple, and affect one person or more. Professionals and others should look beyond single incidents or individuals to identify patterns of harm, just as the CQC, as the regulator of service quality, does when it looks at the quality of care in health and care services. Repeated instances of poor care may be an indication of more serious problems and of what we now describe as organisational abuse. In order to see these patterns it is important that information is recorded and appropriately shared.

Patterns of abuse vary and include:

• serial abuse, in which the perpetrator seeks out and ‘grooms’ individuals. Sexual abuse sometimes falls into this pattern as do some forms of financial abuse;
• long term abuse, in the context of an ongoing family relationship such as domestic violence between spouses or generations or persistent psychological abuse;
• opportunistic abuse, such as theft occurring because money or jewellery has been left lying around

6.1 Appointees and deputies

Where the abuse is perpetrated by someone who has the authority to manage an adult’s money, the relevant body should be informed – for example, the Office of the Public Guardian for deputies or attorneys and Department for Work and Pensions (DWP) in relation to appointees.

If anyone has concerns that a DWP appointee is acting incorrectly, they should contact the DWP immediately. Note that the DWP can get things done more quickly if it also has a National Insurance number in addition to a name and address. However, people should not delay acting because they do not know an adult’s National Insurance number. The important thing is to alert DWP to concerns. If DWP knows that the person is also known to the local authority, then it should also inform the relevant authority.

7. Who Abuses and Neglects Adults?

Anyone can perpetrate abuse or neglect, including:

• spouses / partners;
• other family members;
• carers;
• neighbours;
• friends;
• acquaintances;
• local residents;
• people who deliberately exploit adults they perceive as vulnerable to abuse;
• paid staff or professionals and volunteers;
• strangers.

While a lot of attention is paid, for example, to targeted fraud or internet scams perpetrated by complete strangers, it is far more likely that the person responsible for abuse is known to the adult and is in a position of trust and power.

Abuse can happen anywhere: for example, in someone’s own home, in a public place, in hospital, in a care home or in college. It can take place when an adult lives alone or with others.

8. Signs of Abuse and Neglect

Workers across the local authority should be vigilant for adult safeguarding concerns.

Findings from safeguarding adult reviews have found that if professionals or other staff had been professionally curious and / or acted upon their concerns or sought more information, then death or serious harm might have been prevented.

Anyone can witness or become aware of information suggesting that abuse and neglect is occurring. The matter may, for example, be raised by a worried neighbour, a concerned bank cashier, a GP, a welfare benefits officer, a housing support worker or a nurse on a ward. Primary care staff may be particularly well placed to spot abuse and neglect, as in many cases they may be the only professionals with whom the adult has contact. The adult may say or do things that hint that all is not well. It may come in the form of a complaint, a call for a police response, an expression of concern, or come to light during a needs assessment.

Regardless of how the safeguarding concern is identified, everyone should know what to do, and where to go locally to get help and advice. It is vital that professionals, other staff and members of the public are vigilant on behalf of those unable to protect themselves. This will include:

• knowing about different types of abuse and neglect and their signs;
• supporting adults to keep safe;
• knowing who to tell about suspected abuse or neglect;
• supporting adults to think and weigh up the risks and benefits of different options when exercising choice and control.

Awareness campaigns for the general public and multi-agency training for all staff will contribute to achieving these objectives.

9. Reporting and Responding to Abuse and Neglect

See also Safeguarding Procedures for Responding in Individual Cases.

It is important to understand the circumstances of abuse, including:

• the wider context such as whether others may be at risk of abuse;
• whether there is any emerging pattern of abuse;
• whether others have witnessed abuse;
• the role of family members, carers and other staff.

The circumstances surrounding any actual or suspected case of abuse or neglect will inform the response. For example, abuse or neglect may be unintentional and may arise because a carer is struggling to care for another person. This makes the need to take action no less important, but in such circumstances, an appropriate response could be a support package for the carer and monitoring. However, the primary focus must still be how to safeguard the adult.

In other circumstances where the safeguarding concerns arise from abuse or neglect, it is necessary to immediately consider:

• what steps are needed to protect the adult;
• whether to refer the matter to the police to consider whether a criminal investigation would be required or is appropriate.

It should be remembered that abuse may consist of a single or repeated act. It may be physical, verbal or psychological, an act of neglect or an omission. Defining abuse can be complex but it can involve an intentional, reckless, deliberate or dishonest act by the perpetrator.

In any case where you encounter abuse and you are uncertain about your next steps, you should contact your manager, the safeguarding adults team or police for advice. See Knowsley Safeguarding Adults Board procedures.

The nature and timing of the intervention and who is best placed to lead will be, in part, determined by the circumstances. For example, where there is poor, neglectful care or practice, resulting in pressure sores, then an employer led enquiry may be more appropriate; along with clinical intervention to improve the care given immediately and a clinical audit of practice.

Commissioning or regulatory enforcement action may also be appropriate.

Early sharing of information is the key to providing an effective response where there are emerging concerns regarding information sharing and confidentiality (see Case Recording Standards and Information Sharing chapter). To ensure effective safeguarding arrangements:

1. All organisations must have arrangements in place which set out clearly the processes and the principles for sharing information, with other professionals and the SAB; this could be via an Information Sharing Agreement to formalise the arrangements;
2. No professional should assume that someone else will pass on information which they think may be critical to the safety and wellbeing of the adult. If a professional has concerns about the adult’s welfare and believes they are suffering or likely to suffer abuse or neglect, then they should share the information with the local authority and, or, the police if they believe or suspect that a crime has been committed.

Local authorities may choose to undertake safeguarding enquiries for people even when there is no section 42 enquiry duty, if the local authority believes it is proportionate to do so, and will enable the local authority to promote the person’s wellbeing and support a preventative agenda.

10. Carers and Safeguarding

Circumstances in which a carer (for example, a family member or friend) could be involved in a situation that may require a safeguarding response include:

• 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 unintentionally or intentionally 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 people (see Promoting Wellbeing chapter). As such, a needs or carer’s assessment is an important opportunity to explore the individuals’ circumstances and consider whether it would be possible to provide information, or support that prevents abuse or neglect from occurring, for example, by providing training to the carer about the condition that the adult they care for has or to support them to care more safely. Where that is necessary the local authority should make arrangements for providing it.

If a carer speaks up about abuse or neglect, it is essential that they are listened to and that where appropriate a safeguarding enquiry is undertaken and other agencies are involved as appropriate.

If a carer experiences intentional or unintentional harm from the adult they are supporting, or if a carer unintentionally or intentionally harms or neglects the adult they support, consideration should be given to:

• whether, as part of the assessment and support planning process for the carer and, or, the adult they care for, support can be provided that removes or mitigates the risk of abuse. For example, the provision of training or information or other support that minimises the stress experienced by the carer. In some circumstances the carer may need to have independent representation or advocacy; in others, a carer may benefit from having such support if they are under great stress or similar;
• whether other agencies should be involved; in some circumstances where a criminal offence is suspected this will include alerting the police, or in others the primary healthcare services may need to be involved in monitoring.

Other key considerations in relation to carers should include:

• involving carers in safeguarding enquiries relating to the adult they care for, as appropriate;
• whether or not joint assessment is appropriate in each individual circumstance;
• the risk factors that may increase the likelihood of abuse or neglect occurring;
• whether a change in circumstance changes the risk of abuse or neglect occurring.

A change in circumstance should also trigger the review of the care and support plan and, or, support plan.

11. Further Reading

11.1 Relevant chapters

Safeguarding Procedures in Individual Cases

Information Sharing and Confidentiality

Safeguarding Adults Boards

Making Safeguarding Personal

11.2 Relevant information

Chapter 14, Safeguarding, Care and Support Statutory Guidance (Department of Health and Social Care)

Revisiting Safeguarding Practice (Department of Health and Social Care)  

Making Decisions on the Duty to carry out Safeguarding Adults Enquiries: Resources (Local Government Association)

Using the Inherent Jurisdiction in relation to Adults (39 Essex Chambers)

What Constitutes a Safeguarding Concern and how to Carry out an Enquiry (LGA)

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