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Section 2: Adult Safeguarding Policy

Adult Safeguarding Policy

2.1 What is Safeguarding?

Safeguarding is defined as ‘protecting an adult’s right to live in safety, free from abuse and neglect.’ (Care and Support statutory guidance, chapter 14).  Adult safeguarding is about preventing and responding to concerns of abuse, harm or neglect of adults. Staff should work together in partnership with adults so that they are:

  • Safe and able to protect themselves from abuse and neglect;
  • Treated fairly and with dignity and respect;
  • Protected when they need to be;
  • Able easily to get the support, protection and services that they need.

2.2 The Aims of Adult Safeguarding are to:

  • Stop abuse or neglect wherever possible;
  • Prevent harm and reduce the risk of abuse or harm to adults with care and support needs;
  • Safeguard adults in a way that supports them in making choices and having control about how they want to live;
  • Promote an approach that concentrates on improving life for the adults concerned;
  • 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 adults 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 who has needs for care and support, how people can keep safe and how to support people to keep safe;
  • Address what has caused the abuse.

2.3 Prevention in Adult Social Care

Section 2 of the Care Act requires local authorities to ensure the provision of preventative services (i.e. services which help prevent or delay the development of care and support needs, or reduce care and support needs). Organisations should take a broad community approach to establishing safeguarding arrangements, working together on prevention strategies.

Partners should embrace strategies that support action before harm can occur. Where abuse or neglect has occurred, steps should be taken to prevent it from reoccurring wherever possible, doing so within relevant parameters but sharing intelligence to support a holistic partnership approach to prevention.

Organisations should implement robust risk management processes that identify adults at risk of abuse or neglect and take timely appropriate action. Safeguarding functions should be integrated into quality management and assurance structures.

Prevention should be discussed at every stage of safeguarding, and is especially important at the closure stage (which can happen at any time) when working with adults on resilience and recovery. Discussions between staff and adults, their personal network and the wider community (if appropriate) help build up resilience as part of the recovery process. Where support is needed to prevent abuse, this needs to be identified and put into safeguarding planning.

2.4 Preventing Abuse and Neglect

The provisions of the Care Act (2014) are intended to promote and secure wellbeing. Under the definition of wellbeing (see Chapter 1, Para 1.5), it is made clear that protection from abuse and neglect is a fundamental part of that.

The identification and management of risk is an essential part of any assessment process; the risk to an adult of abuse or neglect should be considered during all assessments. (14.64 Care and Support Statutory Guidance 2021).

The most effective way to safeguard adults from abuse is to enable them to safeguard themselves. For some people this may involve their own support networks, or support or care services, depending on their individual circumstances.  In order to safeguard themselves, adults and people who support them should consider the following:

  • What kind of harm or exploitation they may be at risk of;
  • Where the risk might arise;
  • Who might potentially exploit or harm them.

There are many ways in which people can reduce the risks they may face, including:

  • Considering how they can reduce the risks of being harmed or exploited;
  • Identifying what strengths, skills, supports and networks they could use to avoid potentially abusive situations;
  • Being aware of what to do if an abusive situation arises e.g. How to get help, how to report concerns.

2.5 Workers (including paid carers), Volunteers and Managers

Preventing abuse by paid and unpaid staff working with adults at risk begins with robust recruitment and retention processes.

All processes and checks for those who work with adults must include measures to avoid abuse occurring, including:

  • Staff recruitment and vetting;
  • Policies and procedures staff work to, including confidential reporting (whistle-blowing) and complaints procedures;
  • Staff induction and training, including safeguarding adults policy and procedures and awareness of abuse and how to raise a safeguarding concern(s).
  • Staff supervision and support;
  • Professional codes of conduct or practice and relevant service standards e.g. compliance with Essential Standards as detailed by the Care Quality Commission.

Employers should ensure they:

  • Meet their responsibilities for obtaining Disclosure & Barring Service (DBS) checks and referring to the DBS;
  • Meet their professional responsibilities under employment and other legislation;
  • Have robust management systems in place for training and support.

Agencies and organisations must have a local policy and procedure in place detailing how these processes will be implemented to safeguard adults.  If managers are not upholding their responsibilities this could leave adults at risk of abuse, and this should be reported as a safeguarding concern.

For more information, please visit http://www.legislation.gov.uk/ukdsi/2014/9780111117613/contents

2.6 Informal or Unpaid Carers (e.g. family, friends and neighbours)

A response within this policy and procedures may be required in the following circumstances:

  • An unpaid 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;
  • An unpaid carer may intentionally or unintentionally harm or neglect the adult they support on their own or with others.

When a safeguarding concern is raised regarding a relative or unpaid carer, consideration should be given to the specific circumstances, the nature of the issues and the appropriate proportionate response.

The decision should consider an outcome which supports or offers the opportunity to develop, or maintain, a private life which includes those people with whom the adult wishes to establish, develop or continue a relationship. Responses should ordinarily seek to support the continuation of family and caring relationships where this is consistent with the wishes and desired outcomes of those concerned.

Informal carers are often the mainstay of ensuring that people are protected from abuse and as such they should be supported and aided in this task. Carers could be at risk of abuse themselves due to their caring role. Carers are entitled to an assessment of their needs in their own right.

In many cases no deliberate harm is intended, however, the impact on the cared-for person could be significant.

It is important to ensure that informal carers are aware of how to get advice and help when needed, to support them and avoid potential risk of abuse to them or the adult.  All informal carers should have access to information regarding safeguarding adults, so they can recognise and prevent abuse, raise concerns, seek advice or support where needed.

Work developed by the Association of Directors of Adult Social Services (ADASS), carers groups, commissioners and organisations working with carers, identified six distinct areas related to carers and safeguarding which can be viewed by clicking on the links below:

2.7 The Public and Community

The public has a vital role in safeguarding adults through the recognition and prevention of abuse. It is the responsibility of all agencies and organisations to ensure that there is a good level of public awareness of adult abuse and how concerns should be reported.

2.8 Resilience

Safeguarding support and interventions which lead to building or rebuilding a person’s confidence, assertiveness and sense of self-worth will help empower them to take control of situations which can lead to abuse or neglect.

The consequences and impact of abuse and neglect will vary from person to person, depending on their circumstances and their level of resilience.  This will depend on a number of factors including personal attributes, their history and what support is available to them.

Taking a strengths-based approach to assessment within safeguarding can help practitioners to recognise a person’s skills. This can help to support individuals in developing the coping skills necessary to manage problematic situations.  Such an approach can help people to protect themselves from abuse and neglect in the future.

2.9 Who do Safeguarding Adults Duties Apply to?

Where a local authority has reasonable cause to suspect that an adult in its area:

  • Has needs for care and support (whether or not the local authority is meeting any of those care and support needs); and
  • Is experiencing, or is at risk of, abuse or neglect; and
  • As a result of those care and support needs is unable to protect themselves from either the risk of, or the experience of abuse and neglect.

The local authority must make (or cause to be made) whatever enquiries it thinks necessary to enable it to decide whether any action should be taken in the adult’s case. This is referred to as a Statutory Section 42 Enquiry.

2.10 Non Statutory Safeguarding Enquiries

Local authorities are not required by law to carry out safeguarding enquiries on behalf of adults who do not fit the criteria outlined in Section 42 of the Care Act 2014; they do so at their own discretion. These enquiries would relate to an adult who:

  • Is believed to be experiencing, or is at risk of, abuse or neglect; and
  • Does not have care and support needs (but might have just support needs).

These might be in relation to a carer (see Section 2.6 of this document) for example, and follows the principles of Wellbeing (see Section 1.1 of this document).

NB. If at any point during the non-statutory Safeguarding Enquiry the criteria under which s42 duty applies, the enquiry would then become a s42 Enquiry and this will need to be recorded as such.

Outside of scope of this policy and procedures:

  • Adults in custodial settings i.e. prisons and approved premises. Prison  governors and National Offender Management Services have responsibility  for these arrangements. The Safeguarding Adults Board does however have a duty to assist prison governors on adult safeguarding matters. Local authorities are required to assess for care and support needs of prisoners which take account of their wellbeing. Equally NHS England has a responsibility to commission health services delivered through offender health teams which contribute towards safeguarding offenders.
    • Prisons and approved premises will still be responsible for the safety of their detainees. This means that Safeguarding Adults Boards do not have a duty to carry out enquiries or reviews where a prisoner with care and support needs may be, or has been, at risk of abuse and neglect. Safeguarding Adults Boards can provide advice and assistance on safeguarding to prison governors and other officials and can invite prison staff to be members. (Care Act Factsheet 12: Prisoners and people in resident in approved premises)

2.11 Children and Young People

The Children Act 1989 provides the legislative framework for agencies to take decisions on behalf of children and to take action to protect them from abuse and neglect. Young people who receive leaving or after care support from children and family services, are included in the scope of adult safeguarding, but close liaison with children and family service providers is key to establishing who is the best person to lead or support young people through adult safeguarding processes.

Section 11 of the Children Act 2004 places duties on a range of organisations and individuals to ensure their functions, and any services that they contract out to others, are discharged having regard to the need to safeguard and promote the welfare of children.

In all adult safeguarding work, staff working with the person at risk should establish whether there are children in the family and whether checks should be made on children and young people who are part of the same household, irrespective of whether they are dependent on care either from the adult at risk, or the person alleged to have caused harm.

Children and young people may be at greater risk of harm or be in need of additional help in families where adults have mental health problems, misuse substances or alcohol, are in a violent relationship, have complex needs or have learning difficulties. For further information see Working Together to Safeguard Children.

Abuse within families reflects a diverse range of relationships and power dynamics, which may affect the causes and impact of abuse. These can challenge professionals to work across multi-disciplinary boundaries in order to protect all those at risk. In particular staff may be assisted by using domestic abuse risk management tools as well as safeguarding risk management tools. Staff providing services to adults, children and families should have appropriate training whereby they are able to identify risks of abuse and neglect to children and adults at risk.

2.12 Transition

Together the Children and Families Act 2014 and the Care Act 2014, create a new comprehensive legislative framework for transition when a young person turns 18 (Mental Capacity Act 2005  applies, once a young person turns 16). The duties in both Acts, are on the local authority, but this does not exclude the need for all organisations to work together to ensure that the safeguarding adults policy and procedures work in conjunction, with those for children and young people.

There should be robust joint working arrangements between children’s and adults’ services for young people who meet the criteria set out in Section 2.4.2 of this document. The care needs of the young person should be at the forefront of any support planning and requires a coordinated multi-agency approach. Assessments of care needs should include issues of safeguarding and risk. Care planning needs to ensure that the young adult’s safety is not put at risk through delays in providing the services they need to maintain their independence, wellbeing and choice.

Where there are on-going safeguarding issues for a young person and it is anticipated that on reaching 18 years of age they are likely to require adult safeguarding. Safeguarding arrangements should be discussed as part of transition support planning and protection. Conference Chairs and Independent Reviewing Officers, if involved, should seek assurance that there has been appropriate consultation with the young person by adult social care and invite them to any relevant conference or review. Clarification should be sought on:

  • What information and advice the young person has received about adult safeguarding;
  • The need for advocacy and support;
  • Whether a Mental Capacity Assessment is needed and who will undertake it;
  • If a best interest decision(s) needs to be made;
  • Whether any application needs to be made to the Court of Protection.

If the young person is not subject to a plan, it may be prudent to hold a professionals’ meeting.

2.13 Children and Young People who Abuse

If a child or children is/are causing harm to any adult covered by the adult safeguarding procedures, action should be taken under these procedures, and a referral and close liaison with children’s services should take place.

Physical and sexual  abuse towards parents and other relatives (for example, grandparents, aunts, uncles) some of whom, may be adults at risk, can be carried out by adults and by young people and children, some of which can cause serious harm or death.

2.14 Young Carers

In respect of young carers, Section 1 of the Care Act 2014, alongside Section 96 and Section 97 of the Children and Families Act 2014, provides a legal framework to identify young carers and parent carers and their support needs. Both Acts have a strong emphasis on outcomes and wellbeing.

2.15 Types and Indicators of Abuse and Neglect

There are 10 categories of abuse described within the Care and Support Statutory Guidance. These categories are expansive and cover a range of abusive situations or behaviours. It is important to recognise that exploitation is a common theme in nearly all types of abuse and neglect. The Statutory Guidance (para 14.17) states that:

Local authorities should not limit their view of what constitutes abuse or neglect, as they can take many forms and the circumstances of the individual case should always be considered; although the 3 stage criteria will need to be met before the issue is considered as a safeguarding concern”.

Some of these issues overlap with areas of responsibility for other safeguarding partnerships for example;  Safeguarding Children Partnerships or Community Safety Partnerships. The approach or response could be a joint one, therefore please note the section marked Linked Agendas on pages 27-35.

TYPE OF ABUSE  DESCRIPTION FROM STATUTORY GUIDANCE AND / OR OTHER SUPPORTING GUIDANCE
Discriminatory AbuseDiscrimination on the grounds of race, faith or religion, age, disability, gender, sexual orientation and political views, along with racist, sexist, homophobic or ageist comments or jokes, or comments and jokes based on a person’s disability or any other form of harassment, slur or similar treatment. Excluding a person from activities on the basis they are ‘not liked’ is also discriminatory abuse.  
Domestic AbuseExamples of domestic abuse include Psychological; Physical; Sexual; Financial; Emotional abuse; as well as so called ‘honour’ based violence, forced marriage and female genital mutilation. The  Home  Office  (March  2013)  defines  domestic  abuse  as: “any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence, or abuse between people aged 16 years or over who are, or have been, intimate partners or are family members regardless of gender or sexuality. It includes psychological, physical, sexual, emotional, and financial abuse, forced marriage, and ‘honour’-based violence.”
Financial or Material AbuseTheft, fraud, internet scamming, postal and doorstep scams, coercion in relation to an adult’s financial affairs or arrangements, including in connection with wills, property, inheritance or financial transactions, or the misuse or misappropriation of property, possessions or benefits are all forms of financial abuse and are more often than not targeted at adults at risk. The adult at risk can be persuaded to part with large sums of money and in some cases their life savings. These instances should  be reported to the local police service and local authority Trading Standards Services for investigation. Financial abuse can have serious effects including loss of income and independence and harm to health, including mental health. Where the abuse is perpetrated by someone who has the authority to manage an adult’s money, the relevant body should be informed, e.g. the Office of the Public Guardian for deputies and attorneys and DWP for appointees.  
Modern SlaverySlavery, servitude and forced or compulsory labour. A person commits an offence if:   The person holds another person in slavery or servitude and the circumstances are such that the person knows or ought to know that the other person is held in slavery or servitude; or The person requires another person to perform forced or compulsory labour and the circumstances are such that the person knows or ought to know that the other person is being required to perform forced or compulsory labour.   There are many different characteristics that distinguish modern day slavery from other human rights violations, however only one needs to be present for slavery to exist. Someone is in slavery if they are:   Forced to work – through mental or physical threat; Owned or controlled by an ’employer’, usually through mental or physical abuse or the threat of abuse; Dehumanised, treated as a commodity or bought and sold as ‘property’; Physically constrained or has restrictions placed on his/her freedom of movement; Humans who are trafficked, recruited and transported for example using threats, to coerce or force a person into sexual exploitation, forced labour or domestic servitude.   Modern day slavery takes various forms and affects people of any age, gender and race. Adults who are enslaved are not always subject to human trafficking. Recent court cases have found homeless adults promised paid work opportunities enslaved and forced to work and live in dehumanised conditions, and adults with a learning difficulty restricted in their movements and threatened to hand over their finances and work for no gains. Specified public authorities have a duty to notify the Secretary of State of any individual identified in England and Wales, as a suspected victim of slavery or human trafficking, under Section 52 of the Modern Slavery Act 2015.  
Neglect and Acts of OmissionIgnoring medical, emotional or physical care needs, failure to provide access to appropriate health, social care or educational services, and the withholding of the necessities of life such as medication, adequate nutrition and heating. Neglect also includes a failure to intervene in situations that are dangerous to the person concerned or to others, particularly when the person lacks the mental capacity to assess risk for themselves.  
Organisational AbuseIs the mistreatment, abuse or neglect of an adult by a regime or individuals in a setting or service where the adult lives or that they use. Such abuse violates the person’s dignity and represents a lack of respect for their human rights.  
Physical AbuseAssault, hitting, slapping, pushing, misuse of medication, restraint or inappropriate physical sanctions.   Restraint Unlawful or inappropriate use of restraint or physical interventions. In extreme circumstances unlawful or inappropriate use of restraint may constitute a criminal offence. Someone is using restraint if they use force, or threaten to use force, to make someone do something they are resisting, or where an adult’s freedom of movement is restricted, whether they are resisting or not.   Restraint covers a wide range of actions. It includes the use of active or passive means to ensure that the person concerned does something, or does not do something they want to do, for example, the use of key pads to prevent people from going where they want from a closed environment.  
Psychological Abuse  Emotional abuse, threats of harm or abandonment, deprivation of contact, humiliation, blaming, controlling, intimidation, coercion, harassment, verbal abuse, cyber bullying, isolation or unreasonable and unjustified withdrawal of services or supportive networks.  
Sexual AbuseExamples of sexual  abuse include rape, indecent exposure, sexual harassment, inappropriate looking or touching, sexual teasing or innuendo, sexual photography, subjection to pornography or witnessing sexual acts, indecent exposure and sexual assault or sexual acts to which the adult has not consented or was pressured into consenting.   Sexual abuse is not confined to issues of consent the following factors should also be considered: Any sexual relationship or inappropriate sexualised behaviour between a member of staff and service user should lead to disciplinary proceedings;A sexual act between a care worker and service user with a mental disorder is also a criminal offence under section 38-42 of the Sexual Offences Act.  

2.16 Patterns of Abuse

Abuse can take place in any context. It may occur when an adult at risk lives alone or with a relative; it may also occur within nursing, residential or day care settings, within hospitals or other places previously assumed safe, or in public places.

Patterns of abuse may reflect very different dynamics, such as:

  • Serial abuse in which someone seeks out and ‘grooms’ individuals. Sexual abuse sometimes falls into this pattern as do some forms of financial abuse;
  • Long term abuse – may occur in the context of an ongoing relationship such as domestic violence between partners or generations or persistent psychological abuse;
  • Opportunistic abuse – such as theft occurring because money or jewellery has been left lying around;
  • Self-neglect – where a person declines support and assistance with their care and support needs, impacting on their individual wellbeing.

Abuse may consist of:

  • A single or repeated acts;
  • An act of commission or omission;
  • Multiple acts, for example, an adult at risk may be neglected and also being financially abused.

Abuse may be intentional or unintentional.  A number of abusive acts are crimes and informing the police must be a key consideration.

2.17 Who Might Abuse

This policy is relevant for all safeguarding concerns, to all incidents of abuse, regardless of who has committed them. Anyone might be responsible for abuse, including:

  • A member of staff, a proprietor or service manager;
  • A member of a recognised professional group;
  • Another adult at risk;
  • A volunteer;
  • A member of a community group such as place of worship or social club;
  • A spouse, relative, member of the person’s social network or an unpaid carer;
  • A child, including the person’s own son or daughter;
  • A neighbour, member of the public or stranger; or
  • A person who deliberately targets adults at risk in order to exploit them.

2.18 Managing Concerns involving a ‘Person in a Position of Trust’ (PIPOT)

2.19 Concerns within Employment

Employers, student bodies and voluntary organisations should have clear procedures in place setting out the process, including timescales for investigation and what sources of support and advice will be available to individuals against whom allegations have been made, in accordance with Employment Law.

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.

Such employer investigations may form a Section 42 enquiry. Local authorities’ relevant partners, as set out in section 6(7) of the Care Act, 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 paid or voluntary 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.

If an organisation permanently 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 Disclosure and Barring Service (DBS) and the relevant regulatory body (where applicable). 

2.20 Action in Relation to the Person(s) Alleged to have Caused Harm and Criminal Enquiries

It may be necessary to take action against the person alleged to have caused harm (PATCH) / Organisation to ensure the safety and wellbeing of other people.

Other processes including Police investigations can continue alongside the safeguarding enquiry. It is important to liaise with the police to confirm for example when they have interviewed key witnesses and that it is appropriate to proceed with the safeguarding enquiry. Cooperation between organisations to achieve the person’s outcomes is essential and agreed actions need to be considered to ensure the safety of the person. Information sharing should be timely and comply with all legislative requirements, where this may involve a criminal enquiry the Police will consider disclosure under current legislation.

2.21 Concerns Arising Outside of Employment

Sometimes concerns arise for persons who work with adults at risk where an enquiry begins outside of their employment. This may require an assessment of the risk they pose in their work.

The Care Act statutory guidance states that 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 risks to adults with care and support needs who use their services, and if necessary, to take action to safeguard those adults. It will be necessary to notify the Police if a crime has been committed.

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 indicated they may pose a risk of harm to adults with care and support needs.

Please refer to your local Safeguarding Adults Board framework on allegations against People in Positions of Trust.

Disclosure to third parties requires an assessment of the person’s Article 8 Human Rights balanced against the potential risk to the adults in the person’s care.

If the concern arises out of a Police investigation, the Police, as holders of all the necessary information should refer the matter to their own Disclosure Unit to determine the relevant statutory provision under which disclosure to other parties can be made.

If the local authority holds the information, for example, if the person concerned is involved in a child protection enquiry, the person concerned should be asked to inform their employers themselves. This will also require an agreed date as to when this will be checked with the employer and the action to be taken by the employer to manage any perceived risk the person presents in their employment.

If the person concerned refuses to inform their employer, then the Local Authority will need to gather all the available information and make a decision on disclosure to the employer against the wishes of the person concerned. This will require liaison with the local authority legal services to ensure any disclosure is legal, proportionate and necessary and is properly defensible, should the person mount a legal challenge against the decision to disclose.

Please refer to your local Policy regarding for Managing Allegations People in Positions of Trust.  

2.22 Referral to Local Authority Designated Officer (LADO)

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 Designated Officer (LADO) within one day. Refer to your local authority website for information on how to make a referral.

2.23 Information Sharing

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

Each local authority should seek advice from their legal team about sharing information.

2.24 Referrals to Disclosure and Barring Service (DBS)

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) they have a legal duty to refer them to the DBS. The legal duty to refer to the DBS also applies where a person leaves their role before a disciplinary hearing has taken place following a safeguarding incident and the employer/volunteer organisation feels they would or might have dismissed the person based upon the information they hold.

Where appropriate, employers should also report workers to the statutory and other bodies responsible for professional regulation such as the General Medical Council the Nursing and Midwifery Council and the Health & Care Professions Council.

It is an offence to fail to make a referral without good reason. (See section 5.12 Provider duties to the Person alleged to have caused harm and 5.13 Disciplinary Investigations and Referrals to the Disclosure and Barring Service (DBS).

The employer organisation should also consider a referral to the relevant professional body if necessary. This may include the Nursing and Midwifery Council, The General Medical Council, the Health Care Professions Council and Social Work England, are a few examples.

In circumstances where the employer is a regulated service provider (Schedule 1 of the Health and Social Care Act 2008, Regulated Activities Regulations 2014), they should also notify the Care Quality Commission (CQC).

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 any delay and in a coordinated manner, to prevent the need for further safeguarding in the future.

The employer will need to follow their own procedures regarding managing allegations, managing risk and seek legal advice appropriately.

It will be necessary to refer to local information sharing protocols and have due regard to the duty to cooperate under Section 6 of the Care Act. See also Section 2.23 of this policy.

Local arrangements should be 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, reasonable and proportionate, based on the potential or actual harm to adults or children, and the rationale for decision making should always be recorded.

The importance of employers complying with their duties to notify the Disclosure Barring Service (DBS) be noted. In particular, the legal duty to refer to the DBS applies where a person leaves their role before a disciplinary hearing has taken place following a safeguarding incident and the employer/volunteer organisation feels they would or might have dismissed the person based on the information they hold.

2.25 Abuse by another Adult at Risk

It is the nature of the incident and its impact, rather than the nature of the relationship between those concerned that are the important factors in determining the need for the safeguarding adult’s procedure to be followed.  Where such an incident occurs within a service, for example where both people are living in a care setting, the risk of harm may be compounded by the emotional distress of living with an abusive person.

The safety of the adult will be of primary importance. However, where the person alleged to have caused harm is also an adult with care and support needs, there may also be ongoing responsibilities for their welfare. Consideration may be required as to how their care and support needs are being provided for, and whether the incident reveals unmet needs. Such an assessment should be undertaken separately from the person experiencing abuse.

It will be necessary for such an assessment to consider:

  • Whether the person causing the harm is able to understand his/her actions;
  • Whether actions reflect the unmet needs of the person causing the harm;
  • The risk that the person causing the harm will further abuse the adult or others;
  • The support/care needs of that individual.

2.26 Self-Neglect

There is no single operational definition of self-neglect. The Department of Health (2016), defines it as, ‘… a wide range of behaviour neglecting to care for one’s personal hygiene, health or surroundings and includes behaviour such as hoarding’.

The Department of Health commissioned the universities of Sussex and Bedford to undertake research into interventions with those that self-neglect with recommendations on how staff can assist individuals to achieve positive outcomes.

Skills for Care provided a framework for research into self-neglect identifying three distinct areas that are characteristic of self-neglect:

  • Lack of self-care – this includes neglect of one’s personal hygiene, nutrition and hydration, or health, to an extent that may endanger safety or wellbeing;
  • Lack of care of one’s environment – this includes situations that may lead to domestic squalor or elevated levels of risk in the domestic environment (e.g. health or fire risks caused by hoarding or potential loss of home through breach of tenancy or mortgage);
  • Refusal of assistance that might alleviate these issues. This might include, for example, refusal of care services in either their home or a care environment or of health assessments or interventions, even if previously agreed, which could potentially improve self-care or care of one’s environment.

Self-neglect is a behavioural condition in which an individual neglects to attend to their basic needs such as personal hygiene, or tending appropriately to any medical conditions, or keeping their environment safe to carry out what is seen as usual activities of daily living. It can occur as a result of mental health issues, personality disorders, substance abuse, dementia, advancing age, social isolation, and cognitive impairment or through personal choice. It can be triggered by trauma and significant life events. Self-neglect is an issue that affects people from all backgrounds. However, if self-neglect results from free and informed personal choice, refer to local safeguarding procedures.

2.27 Hoarding

Hoarding may be an aspect of self-neglect. Most people associate hoarding with the acquisition of items with an associated inability to discard things that have little or no value (in the opinions of others) to the point where it interferes with use of living space or activities of daily living.

Compulsive hoarding (more accurately described as ‘hoarding disorder’) is a pattern of behaviour characterised by the excessive acquisition of and inability or unwillingness to discard large quantities of objects that cover the living areas of the home and cause significant distress. Compulsive hoarders may be conscious of their irrational behaviour but the emotional attachment to the hoarded objects far exceeds the motivation to discard the items. Hoarding can include new items that are purchased e.g. food items, refuse, animals. Many hoarders may be well‐presented to the outside world, appearing to cope with other aspects of their life quite well, giving no indication of what is going on behind closed doors.

Most fire authorities have prevention strategies that consistently identify the level of hoarding and use the International OCD Foundations clutter image rating. This can be invaluable in assessing risk, so including local Fire Services in any multi-agency response is vital in hoarding situations.

2.28 Response to Self-Neglect and Hoarding

Given the complex and diverse nature of self-neglect and hoarding, responses by a range of organisations are likely to be more effective than a single agency response with particular reference to housing providers. It is important to recognise that assessments of self-neglect and hoarding are grounded in and influenced by personal, social and cultural values and staff working with the adult should always reflect on how their own values might affect their judgement. Finding the right balance between respecting the adult’s autonomy and meeting the duty to protect their wellbeing may involve building up a rapport with the adult to come to a better understanding about whether self-neglect or hoarding are matters for adult safeguarding or any other kind of intervention.

Crucial to all decision making is a robust risk assessment, preferably multi-agency that includes the views of the adult and their personal network. The risk assessment might cover:

  • Capacity and consent;
  • Indications of mental health issues;
  • The level of risk to the adult’s physical health;
  • The level of risk to their overall wellbeing;
  • Effects on other people’s health and wellbeing;
  • Serious risk of fire;
  • Serious environmental risk e.g. destruction or partial destruction of accommodation.

A significant element of self-neglect and hoarding is the risk that these behaviours pose to others. This might include members of the public, family members or professionals. Partnerships may wish to invest in agreeing local self-neglect procedures.

The revised Statutory Guidance (March 2016) contains additional advice concerning self-neglect – suggesting that it:

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 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.”

In such cases in order to balance an individual’s autonomy and dignity, where harm is resulting from the self-neglect, it will be likely that action will be required whether or not the adult has care and support needs.

All steps should be taken to support an individual to understand any risks to them or others, and the safeguarding process, regardless of support needs. Using different communication methods or changing the environment may support the individual to make an informed decision.

2.29 Serious Incidents and Never Events

NHS England has produced a Serious Incident (SI) Framework and never events policy and framework; never events are recorded and investigated under the serious incident policy. A SI is required to be reported by all organisations providing NHS funded care to the Strategic Executive Information System (STEIS). Organisations should continue to comply with their own local significant event or other reporting systems including reporting to the National Reporting and Learning System (NRLS) and other statutory bodies and regulators such as the CQC, MHRA, and HSE.

Neither of these frameworks are a substitute for safeguarding nor are all SI’s a safeguarding issue but  where safeguarding concerns are indicated a safeguarding concern  must be made, however a Root Cause Analysis under the Serious Incident Framework may be considered an appropriate response to a safeguarding enquiry or may from part of a joint investigation.

All Safeguarding Adult Board SAR’s where NHS services are involved are reported as a SI on STEIS by the CCG designated professional and monitored by NHSE.

For further information or guidance click on the links below or contact your local CCG designated professional.

NHS never events framework https://improvement.nhs.uk/uploads/documents/never-evnts-pol-framwrk.pdf

NHS serious incidents framework – supporting learning to prevent reoccurrence https://www.england.nhs.uk/wp-content/uploads/2015/04/serious-incidnt-framwrk-upd.pdf  

NHS serious incident frequently asked questions https://improvement.nhs.uk/uploads/documents/serious-incdnt-framwrk-faqs-mar16.pdf

2.30 Pressure Ulcers

All Health providers and local Clinical Commissioning Groups have their own procedures for reviewing how a pressure ulcer may have developed. Such cases will only become a safeguarding concern if there is a clear element of neglect and act of omission which resulted in the pressure ulcer developing.

Please refer to Safeguarding Adults Protocol: Pressure Ulcers and the Interface with a Safeguarding Enquiry, DOH&SC January 2018.

Refer to your local SAB’s guidance.

2.31 Linked Agendas

2.32 Domestic Violence and Abuse

The issues below can be areas of responsibility for other safeguarding partnerships, for example Safeguarding Children Partnerships or Community Safety Partnerships. There are also types and indicators of abuse and neglect for Safeguarding Adults Boards, so the approach or response could be a joint one, or be responded to by those partnerships. Therefore please note the issues set out in the table starting on page 16.

Domestic violence and abuse is defined as:

Any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 or over who are or have been intimate partners or family members regardless of gender or sexuality. This can encompass, but is not limited to, the following types of abuse:

  • Emotional
  • Female genital mutilation
  • Financial
  • Forced marriage
  • ‘Honour based violence’
  • Physical
  • Psychological
  • Sexual
  • Stalking

The safeguarding adults procedures relate to people aged 18 years and over. If the person at risk is under 18 years of age, then local procedures for  Safeguarding Children  should be followed.

Domestic abuse is a defined type of abuse within the safeguarding adults procedures and practitioners should be aware of the principles of ‘Safe Enquires’.  The LGA/ADASS (2015) Adults Safeguarding and Domestic Abuse: A guide to support practitioners and managers, which provide useful guidance on responses to domestic abuse within the safeguarding adult procedures.

Responses should include specialist support from domestic abuse services as required. Specialist domestic violence and abuse services provide support in relation to personal safety planning, housing options, legal options, and counselling. 

In relation to high risk domestic abuse cases a Multi-Agency Risk Assessment Conference (MARAC) meeting may be held. MARAC meetings include representatives of local Police, probation, health, children and safeguarding adults, housing practitioners, substance misuse services, Independent Domestic Violence Advisers (IDVAs) and other specialist organisations from the statutory and voluntary sectors.

The aims of a MARAC are as follows:

  • To safeguard adult victims who are at high risk of future domestic violence and abuse;
  • To make links with other public protection arrangements in relation to children, the perpetrator and people at risk;
  • To safeguard agency staff; and
  • To work towards addressing and managing the behaviour of the perpetrator.

Safeguarding adults’ services and domestic abuse services need to work together to ensure the safety, protection, needs and wishes of the adult are met.

Domestic abuse can be reported to the Police. If the person has needs for care and support, and is unable to protect themselves as a result, a safeguarding concern should be raised. The Police and safeguarding adults services will both work with domestic abuse services for that area. See the following link to the SafeLives website for www.safelives.org.uk

The Serious Crime Act (2015) creates an offence of controlling or coercive behaviour in intimate or familial relationships (Section 76). The new offence closes a gap in the law around patterns of controlling or coercive behaviour in an ongoing relationship between intimate partners or family members. The offence carries a maximum sentence of 5 years imprisonment, a fine or both. See Statutory Guidance Framework Controlling or Coercive Behaviour in an Intimate or Family Relationship (Home Office 2015).

2.33 Forced Marriage

Forced marriage is against the law and occurs when one or both spouses do not consent to a marriage and some element of duress is involved.  Duress might include physical and/or emotional /psychological pressure.  Forced marriage is recognised as an abuse against human rights and will also constitute abuse within the context of this policy and procedures if the person is also an adult at risk.

The Forced Marriage Unit is a joint initiative between the Home Office and the Foreign and Commonwealth Office providing specialist advice and guidance.  The Forced Marriage Unit provides comprehensive resources and information, including the following guidance:

The guidance recommends forced marriage of an adult, should be dealt with within the Safeguarding Adults procedures. The “One Chance Rule” is that sometimes there will only be one chance to help a person facing forced marriage, hence reference should be made with urgency to the Multi-Agency Practice Guidelines listed above.

The Police should always be contacted for advice in relation to suspicions or concerns about forced marriage.

In addition, the Forced Marriage Unit provides a confidential advice and assistance for:

  • Those who have been forced into marriage;
  • Those at risk of being forced into marriage;
  • People worried about friends or relatives;
  • Professionals working with actual or potential victims of forced marriage.

If the person has needs for care and support, and is unable to protect themselves as a result, a safeguarding concern should also be raised to ensure an opportunity for additional support to ensure care needs are met as part of the safeguarding plan.

The Forced Marriage Unit website provides a wealth of information and guidance www.fco.gov.uk/forcedmarriage  together with a helpline: 020 7008 0151

2.34    Honour-Based Violence

So-called ‘honour-based violence’ is a crime or incident, which has or may have been, committed to protect or defend the perceived honour of the family and/or community.

Honour-based violence can take many forms; it is used to control behaviour within families to protect perceived cultural and religious beliefs and/or honour. Examples may include murder, fear of or actual forced marriage, domestic abuse, sexual abuse, false imprisonment, threats to kill, assault, harassment and forced abortion. This list is not exhaustive.

Women are predominantly (but not exclusively) the victims and the violence is often committed with a degree of collusion from family members and/or the community. 

Honour-based violence is a crime and should be reported to the Police. If the person has needs for care and support, and is unable to protect themselves as a result, a safeguarding concern should be raised.

2.35 Modern Slavery

Modern slavery can take many forms including the trafficking of people, forced labour, servitude and slavery. Any consent victims have given to their treatment will be irrelevant where they have been coerced, deceived or provided with payment or benefit to achieve that consent.

The term ‘modern slavery’ captures a whole range of types of exploitation, many of which occur together. These include but are not limited to:

  • Sexual exploitation:  This includes but is not limited to sexual exploitation and abuse, forced prostitution and the abuse of children for the production of child abuse images/videos. Whilst women and children make up the majority of victims, men can also be affected. Adults are coerced often under the threat of force, or other penalty.
  • Domestic servitude: This involves a victim being forced to work, usually in private households, performing domestic chores and childcare duties. Their freedom may be restricted and they may work long hours often for little pay or no pay, often sleeping where they work.
  • Forced labour: Victims may be forced to work long hours for little or no pay in poor conditions under verbal or physical threats of violence to them or their families. It can happen in various industries, including construction, manufacturing, laying driveways, hospitality, food packaging, agriculture, maritime and beauty (nail bars).
  • Criminal exploitation: This is the exploitation of a person to commit a crime, such as pick pocketing, shop-lifting, cannabis cultivation, drug trafficking and other similar activities.
  • Other forms of exploitation may include organ removal, forced begging, forced benefit fraud, forced marriage and illegal adoption.
  • Human Trafficking: for a person to have been a victim of human trafficking there must have been: action (e.g. recruitment, transportation); means (threat or use of force, coercion, abduction, fraud N.B there does not need to be a means for children as they are not able to give informed consent); purpose of exploitation (e.g. sexual exploitation, forced labour or domestic servitude, slavery, financial exploitation, illegal adoption, removal of organs).

For information and advice, refer to the Modern Slavery Helpline: 08000 121 700 www.modernslavery.co.uk

Modern slavery must be reported to the Police. If the person has needs for care and support, and is unable to protect themselves as a result, a safeguarding concern must also be raised. For information on the National Referral Mechanism go to: www.gov.uk/government/publications/duty-to-notify-the-home-office-of-potential-victims-of-modern-slavery

2.36 Prevent Agenda: Exploitation by Radicalisers who Promote Violence

Prevent is part of the Government’s counter-terrorism strategy CONTEST and aims to safeguard and provide support to divert vulnerable individuals at risk from being radicalised or groomed into supporting terrorist activity, before any crimes are committed. Radicalisation is comparable to other forms of exploitation, such as grooming and Child Sexual Exploitation. It is the process by which a person comes to support terrorism and extremist ideologies associated with terrorist groups. Radicalisation is process rather than an event, and there is no single profile or pathway by which someone can be drawn into terrorism.

There are instead a range of contributing factors including, peer pressure, bullying, family tensions, race/hate crime, lack of self-esteem or identity and personal or political grievances which can make people more vulnerable. Vulnerable individuals are often targeted and influenced by radicalisers either directly or increasingly in online chat rooms or through social media. The Counter-Terrorism and Security Act (2015) places a specific legal duty on specified authorities, including local authorities and health providers in the exercise of their functions, to have due regard to the need to prevent people being drawn into terrorism.

Channel is a confidential, voluntary, multi-agency safeguarding process designed to support vulnerable children and adults who may be at risk of being radicalised and drawn into terrorist activity.

It is an early intervention service which has been mandated in every local authority in England and Wales. Channel addresses all types of radicalisation including the extreme far right as well as the Al Quieda inspired ideologies.

A Channel Panel is chaired by the local authority and has multi agency involvement including from police, social services and health.

The panel works collaboratively to assess the nature and extent of the risk and, if necessary, provide an appropriate support package tailored to the vulnerable individual’s needs. This is monitored closely and regularly reviewed. The care plan will vary according to the risk that has been identified, and may include targeted interventions (including faith guidance, counselling or diversionary activities) or access to specific services, such as health or education.

Local safeguarding structures have a role to play for those eligible for adult safeguarding. Referrals to Channel can be made through the local authority Prevent Lead or the local police Prevent Officer.

The Channel Vulnerability Assessment is used by safeguarding professionals in the Channel Panel to identify specific factors which make some vulnerable to extremist messages and provide appropriate support as required. It should be read alongside the Channel Duty Guidance (2015).

2.37    Hate Crime

Hate crime is taken to mean any crime where the perpetrator’s prejudice against any identifiable group of people is a factor in determining who is victimised.  Hate crime is a form of discriminatory abuse.

Hate crimes happen because of hostility, prejudice or hatred of people due to:

  • Disability
  • Gender identity
  • Race, ethnicity or nationality
  • Religion or belief
  • Sexual orientation

It should be noted that this definition is based on the perception of the victim or anyone else and is not reliant on evidence. Apart from individually charged offences under the Crime and Disorder Act 1998, local crime reduction partnerships can prioritise action where there is persistent anti-social behaviour that amounts to hate crime where appropriate. 

The Police and other organisations work together to ensure a robust, coordinated and timely response to situations where adults at risk become a target for hate crime. Coordinated action will aim to ensure that victims are offered support and protection and action is taken to identify and prosecute those responsible.

Hate crime should be reported to the local community safety initiative. If the adult has needs for care and support, and is unable to protect themselves as a result, a safeguarding concern should also be raised. In the event that a person is at immediate risk, contact the Police.

More information can be found about the different forms of hate crime including Disability Hate Crime and Hate Incidents, on the Citizens Advice website

2.38    Mate Crime

Mate Crime is a term used where people within communities, particularly people with learning disabilities, mental health issues or substance abuse issues, and older people are befriended with the intention of then being exploited financially, physically or sexually as well as other types of abuse. And it can be extreme; as it was for Steven Hoskin, a man with learning disabilities who in 2006 was murdered in Cornwall by a group of people he thought were his friends.

Mate Crime is a form of Disability Hate Crime. The CPS makes it clear that “mate crime – people with learning disabilities or mental health issues are often befriended by people who then exploit them. The term ‘mate crime’ is used by some disability organisations within the disabled community to raise awareness of the issue. It is not CPS policy to use this phrase as it may introduce further confusion regarding terminology and is potentially confusing to people with learning disabilities”.

As with Hate Crime it is advised that a Mate Crime should be reported to the local community safety initiative as a Disability Hate Crime. If the person has needs for care and support, and is unable to protect themselves as a result, a safeguarding concern should also be raised. In the event that a person is at immediate risk, contact the Police.

Further information and resources can be found on http://arcuk.org.uk/safetynet/

2.39    Anti-Social Behaviour

Anti-social behaviour is any aggressive, intimidating or destructive activity that damages or destroys another person’s quality of life. This might, for example, include:

  • Persistent verbal abuse or threats;
  • Assault or physical harassment;
  • Racial or homophobic harassment;
  • Graffiti, vandalism or damage to property.

Anti-social behaviour teams bring together experienced staff from the local authority, Police, housing and other organisations to prevent and resolve anti-social behaviour.  Anti-social behaviour teams will manage incidents referred, working with the private or social housing agency concerned in addressing incidents of anti-social behaviour.

Persistent anti-social behaviour can cause significant alarm, harassment and stress.

The anti-social behaviour team may assist by a range of actions, including:

  • Setting up mediation sessions;
  • Referring those committing anti-social behaviour to diversionary activities and support;
  • Using acceptable behaviour contracts to deter the person or group from persisting with their action;
  • Securing injunctions against individuals;
  • Use of housing legislation to address persistent incidents within a local neighbourhood;
  • Use of anti-social behaviour orders to prevent the person or group from persisting with their activities.

Anti-social behaviour should be reported to the local community safety initiative. If the person has needs for care and support, and is unable to protect themselves as a result, consideration should be given to raising a safeguarding concern. In the event that a person is at immediate risk, contact the Police.

2.40    Multi-Agency Public Protection Arrangements (MAPPA)

The purpose of MAPPA is to help reduce the re-offending behaviour of sexual and violent offenders in order to protect the public, including previous victims, from serious harm.  It aims to do this by ensuring that all relevant agencies work together effectively to:

  • Identify all relevant offenders;
  • Complete comprehensive risk assessments that take advantage of coordinated information sharing across the agencies;
  • Devise, implement and review robust risk management plans; and
  • Focus the available resources to best protect the public from serious harm.

MAPPA brings together the Police, Probation and Prison Service into what is known as the MAPPA Responsible Authority. The Responsible Authority has a statutory duty to ensure that MAPPA is established in its geographic areas and to undertake the risk assessment and management of all identified MAPPA offenders.

A number of other agencies are under a ‘Duty to Co-operate’ with the Responsible Authority. These include Social Services, Health Services, Youth Offending Teams, Jobcentre Plus and Local Housing and Education Authorities.

Where an offender is managed through the Multi-Agency Public Protection Arrangements, and they present a risk to an adult with care and support needs, consideration should be given to raising a safeguarding concern with the local authority and involving the local authority in the multi-agency risk management plan.

See the following link for MAPPA statutory guidance. https://www.gov.uk/government/publications/multi-agency-public-protection-arrangements-mappa–2

2.41    Herbert Protocol

The Herbert Protocol is a national scheme supported by local Police and other agencies which encourages carers to compile useful information which could be used in the event of a person going missing.

Carers, family members and friends can complete in advance, a form recording all vital details, such as medication required, mobile numbers, places previously located, a photograph etc.  In the event of your family member or friend going missing, the form can be easily sent or handed to the police to reduce the time taken in gathering this information. Refer to your local police website for information on the Herbert Protocol.

2.42    People Who Live Street Based Lives

There are a range of risks experienced by people living street based lives; both rough sleepers and those with insecure accommodation that expose them to a higher level of vulnerability to abuse and neglect . These risks include assault, domestic violence, physical and mental ill health, learning difficulties, cognitive impairment and drug and alcohol misuse. This group often face significant challenges to accessing services. Among homeless people, the mean age at death was 45.9 years for males and 43.4 years for females in 2019; in the general population of England and Wales, the mean age at death was 76.1 years for men and 80.9 years for women Deaths of Homeless people in England and Wales: 2019 registrations

The risks for this group are often great and complex and will require time and perseverance in order to build trusting relationships. A safeguarding response will often be required and when this is not deemed appropriate / possible, all other options must be explored to reduce harm and promote wellbeing. 

Homelessness: Duty to Refer

Public Authorities in England have a duty to tell local housing authorities about:

  • people they think may be homeless;
  • or at risk of becoming homeless within 56 days.

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