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5.1 Adult Safeguarding

CARE ACT 2014

The Act sets out the local authority’s responsibility for adult safeguarding; the responsibility to ensure enquiries into cases of abuse and neglect.
The accompanying Care and Support Statutory Guidance (Department of Health, 2016) also sets out the key principles of safeguarding and what constitutes abuse and neglect. It is also explicit about the emphasis on making safeguarding personal, which means it should be person led and outcome focused with the person involved from beginning to end.

RELEVANT CHAPTERS

Safeguarding Procedures in Individual Cases

Information Sharing and Confidentiality

Safeguarding Adults Boards

MANCHESTER SPECIFIC INFORMATION

Manchester City Council’s Guidance  on Safeguarding Adults

Manchester Safeguarding Adults Board website

Reporting Abuse and Neglect (Manchester City Council’s website)

Manchester City Council’s Prevent Channel Policy

RELEVANT INFORMATION

Chapter 14, Safeguarding, Care and Support Statutory Guidance (Department of Health, 2016)

1. Introduction

The Care Act 2014 introduces new duties and requirements of local authorities in a number of areas, including safeguarding adults. It provides, for the first time, a legislative framework for those working in adult safeguarding. The Act does not allow certain functions to be delegated and safeguarding is one of those functions. Since the local authority must be one of the members of the Safeguarding Adult Board (SAB), and it must take the lead role in adult safeguarding, it may not delegate these statutory functions to another party.

Chapter 14, Safeguarding of the Care and Support Statutory Guidance 2014 either introduced or amended a number of powers and responsibilities for local authorities, Safeguarding Adults Boards and partner agencies. It replaced the previous multi-agency statutory guidance: No Secrets, 2000. It was revised in March 2016: Care and Support Statutory Guidance (2016).

2. The Safeguarding Duty

See Manchester Safeguarding Adults Board website.

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 hereafter be referred to as ‘the adult’ throughout this chapter.

The safeguarding duties have a legal effect in relation to organisations other than the local authority on 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). Where appropriate, adult safeguarding services should involve the local authority’s children’s safeguarding colleagues as well as any relevant partners (for example the police or NHS) or other persons 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 National Offender Management Service (NOMS) respectively have responsibility.

However, senior representatives of those services may sit on the Safeguarding Adults Board and play an important role in the strategic development of adult safeguarding locally. Additionally, they may ask for advice from the local authority when faced with a safeguarding issue that they are finding particularly challenging.

3. What is Adult Safeguarding?

See also Manchester City Council’s Guidance  on Safeguarding Adults

Safeguarding means protecting an adult’s right to live in safety, free from abuse and neglect. It is about people and organisations working 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. This must recognise that adults 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 is only one of the things they want for themselves. Professionals should work with the adult to establish what being safe means to the adult concerned 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).

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:

  • 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;
  • set up a Safeguarding Adults Board (SAB) (see Safeguarding Adults Boards);
  • 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 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 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 responses to safeguarding concerns deriving from the 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.

4.1 The six principles

Empowerment

  • People being supported and encouraged to make their own decisions and informed consent.
  • I am asked what I want as the outcomes from the safeguarding process and these directly inform what happens.

Prevention

  • It is better to take action before harm occurs.
  • 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 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

  • Support and representation for those in greatest need.
  • 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

  • Local solutions through services working with their communities. Communities have a part to play in preventing, detecting and reporting neglect and abuse.
  • 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

  • Accountability and transparency in delivering safeguarding.
  • I understand the role of everyone involved in my life and so do they.

4.2 Making safeguarding personal

In addition to these principles, 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 (see also Safeguarding Case Studies).

Making safeguarding personal means it should be person led and outcome focused. It is a conversation with the adult 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.

There are key issues that local authorities and their partners should consider – see Safeguarding Procedures in Individual Cases.

5. What Constitutes 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 they 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. Exploitation, in particular, is a common theme in the following list of the types of abuse and neglect.

5.1 Physical abuse

This includes:

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

5.2 Domestic violence and abuse

This includes:

  • psychological;
  • physical;
  • sexual;
  • financial;
  • emotional abuse;
  • coercion and control and threatening behaviour;
  • so called ‘honour’ based violence.

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.

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 or material abuse

This includes:

  • theft;
  • fraud;
  • 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.

5.6 Modern slavery

This includes:

  • slavery;
  • human trafficking;
  • forced labour and domestic servitude;
  • traffickers and slave masters using whatever means they have at their disposal to coerce, deceive and force individuals into a life of abuse, servitude and 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.

Read Discrimination: your rights for further information.

5.8 Organisational abuse

This includes neglect and poor care practice within an institution or specific care setting such as a hospital or care home,  or care provided in one’s own home. This may range from one off incidents to ongoing ill treatment. It can be through neglect or poor professional practice as a result of the structure, policies, processes and practices within an organisation.

5.9 Neglect and acts of omission

This includes:

  • ignoring medical;
  • emotional or physical care needs;
  • failure to provide access to appropriate health, care and support or educational services;
  • the withholding of the necessities of life, such as medication, adequate nutrition and heating.

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.

5.11 Preventing Radicalisation

See also Manchester City Council’s Prevent Channel Policy.

Circumstances where there are concerns that an adult with care and support needs and / or someone they are in contact with, has been radicalised or is at risk of being radicalised.

6. Patterns of Abuse

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 clinical commissioning group (CCG), 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 Domestic violence and abuse

See also Manchester City Council’s Domestic Abuse and Prevention Strategy.

The definition of domestic abuse is any incident or pattern of incidents of controlling, coercive, 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. The abuse can encompass, but is not limited to:

  • psychological;
  • physical;
  • sexual;
  • financial;
  • emotional.

An offence of coercive and controlling behaviour in intimate and familial relationships was introduced into the Serious Crime Act 2015.

6.2 Financial abuse

Financial abuse is the main form of abuse investigated by the Office of the Public Guardian both amongst adults and children at risk. Financial abuse can occur in isolation, but as research has shown, where there are other forms of abuse financial abuse is likely to occur. Although this is not always the case, everyone should also be aware of this possibility.

Potential indicators of financial abuse 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.

This is not an exhaustive list, nor do these examples prove that there is actual abuse occurring. However, they do indicate that a closer look and possible investigation may be needed. See also The Financial Abuse of Older People (Help the Aged, 2008).

Local authorities should not underestimate the potential impact of financial abuse.

It could significantly threaten an adult’s health and wellbeing. Financial abuse can amount to theft or fraud and would be a matter for the police to investigate. It may require attention and collaboration from a wider group of organisations, including shops and financial institutions such as banks.

Internet scams, postal scams and doorstep crime are more often than not, targeted at adults and all are forms of financial abuse. These scams are becoming ever more sophisticated and elaborate. For example:

  • internet scammers can build very convincing websites;
  • people can be referred to a website to check the caller’s legitimacy but this may be a copy of a legitimate website;
  • postal scams are massed produced letters which are made to look like personal letters or important documents;
  • doorstep criminals call unannounced at the adult’s home under the guise of legitimate business and offering to fix an often non-existent problem with their property; sometimes they pose as police officers or someone in a position of authority.

The adult can be persuaded to part with large sums of money and in some cases their life savings. These instances should always be reported to the local police service and local authority Trading Standards Services for investigation. The SAB will need to consider how to involve local Trading Standards in its work.

These scams and crimes can seriously affect the health, including mental health, of an adult at risk. Agencies working together can better protect adults at risk. Failure to do so can result in an increased cost to the state, especially if the adult at risk loses their income and independence.

6.2.1 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;
  • 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 a wide range of organisations need to be vigilant about adult safeguarding concerns in all walks of life including, amongst others in health and social care, welfare, policing, banking, fire and rescue services and trading standards; leisure services, faith groups, and housing.

GPs, in particular, are often well placed to notice changes in an adult that may indicate they are being abused or neglected.

Findings from serious case reviews have sometimes stated that if professionals or other staff had 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 understand 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 and Reporting Abuse and Neglect (Manchester City Council’s website).

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 and paid staff or professionals.

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 the police for advice.

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 disciplinary response 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 Information Sharing and Confidentiality). 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 where there is not a 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). 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. See also Carers and Safeguarding (ADASS).


ePractice

  • Now complete the 5 minute ePractice Quiz to test your understanding and provide evidence for CPD.

  • (tick as many as you feel apply)
  • 4. Abuse and neglect can occur in many different ways and local authorities should not restrict their views of what may constitute abuse. Which of the following constitute abuse?

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