5.1 Adult Safeguarding

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1. Introduction

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

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

In Manchester the Safeguarding Adults Board is called the Manchester Safeguarding Partnership. It is made up of organisations that work together to safeguard and promote the welfare of adults, children, young people and their families in Manchester.

2. The Safeguarding Duty

See Manchester Safeguarding Partnership website.

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

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

The safeguarding duties apply to an adult who:

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

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

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 chapter). Where appropriate, adult safeguarding services should involve local authority’s children’s safeguarding colleagues as well as any relevant partners (for example the police or NHS) or other people relevant to the case. The level of needs is not relevant, and the young adult does not need to have eligible needs for care and support under the Care Act, or be receiving any particular service from the local authority, in order for the safeguarding duties to apply – so long as the conditions set out above are met.

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

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

3. What is Adult Safeguarding?

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

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

Safeguarding is not a substitute for:

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

The Care Act requires that each local authority must:

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

The aims of adult safeguarding are to:

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

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

• ensure that everyone, both individuals and organisations, are clear about their roles and responsibilities;
• create strong multi-agency partnerships that provide timely and effective prevention of and responses to abuse or neglect;
• support the development of a positive learning environment across these partnerships and at all levels within them to help break down cultures that are risk averse and seek to scapegoat or blame practitioners;
• enable access to mainstream community resources such as accessible leisure facilities, safe town centres and community groups that can reduce the social and physical isolation which in itself may increase the risk of abuse or neglect;
• clarify how responses to safeguarding concerns arising 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. They also have ‘I’ statements as examples.

4.1 The six principles

Empowerment

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

Prevention

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

Proportionality

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

Protection

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

Partnership

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

Accountability

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

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 chapter.

5. Types of Abuse and Neglect

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

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

5.1 Physical abuse

This includes:

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

5.2 Domestic violence and abuse

See also Domestic Abuse chapter

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

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

5.3 Sexual abuse

This includes:

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

Sexual abuse may also take the form of sexual exploitation which can involve coercion and an exchange for basic necessities or something that the perpetrator seeks to gain from the victim (see Working with Adults Affected by Child Sexual Exploitation and Organised Sexual Abuse chapter).

5.4 Psychological abuse

This includes:

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

5.5 Financial abuse

This includes:

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

Potential indicators of a person being financially abused include:

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

5.6 Modern slavery

See Modern Slavery chapter

This includes:

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

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

For more information see Modern Slavery chapter.

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

See also Ill Treatment and Wilful (Deliberate) Neglect chapter.

5.8 Organisational abuse

See Self-Neglect chapter

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

Self-neglect will not always prompt a section 42 (safeguarding) enquiry. An assessment should be made on a case by case basis, and practitioners should remain curious as to whether incidents are one off or multiple, affect the people around the adult and whether there are any patterns of harm that may be an indication of other types of abuse or poor mental health.. A decision on whether a response is required under safeguarding or a decision to offer a care and support assessment of need / risk assessment will depend on the adult’s ability to protect themselves by controlling their own behaviour. There may come a point when they are no longer able to do this, without external support.

5.9 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

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 Care Quality Commission (CQC) as the regulator of service quality, does when it looks at the quality of care in health and care services. Repeated instances of poor care may be an indication of more serious problems and of what we now describe as organisational abuse. In order to see these patterns it is important that information is recorded and appropriately shared.

Patterns of abuse vary and include:

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

6.1 Appointees and deputies

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

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

7. Who Abuses and Neglects Adults?

Anyone can perpetrate abuse or neglect, including:

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

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

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

8. Signs of Abuse and Neglect

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

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

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

Regardless of how the safeguarding concern is identified, everyone should know what to do, and where to go locally to get help and advice. It is vital that 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 chapter 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, carers and other staff.

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

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

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

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

In any case where staff encounter abuse and they are uncertain about their next steps, they should contact the safeguarding adults team or 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 chapter). To ensure effective safeguarding arrangements:

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

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

10. Carers and Safeguarding

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

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

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

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

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

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

Other key considerations in relation to carers should include:

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

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

11. Further Reading

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

Revisiting Safeguarding Practice (Department of Health and Social Care)

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

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