5.2 Safeguarding Procedures for Responding in Individual Cases

1. The Local Authority Role in carrying out Enquiries

Local authorities must make enquiries, or cause others to do so, if they reasonably suspect than 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.

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

Depending on the nature of the concern(s), an enquiry could range from a conversation with the adult (or if they lack mental capacity or have substantial difficulty in understanding the enquiry, a conversation with their representative or advocate), before beginning a formal safeguarding enquiry under section 42, Care Act 2014, right through to a  formal multi-agency plan or course of action.

Whatever action is taken, the practitioner concerned should record details of:

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

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

• the timescales for completing the enquiry;
• the outcome / conclusion of the enquiry and what action is recommended as a result; and
• what will happen if this is not done.

What happens as a result of an enquiry should reflect the adult‘s wishes wherever possible. If they lack capacity, any actions agreed should be in their best interests  and be proportionate to the level of concern.

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

Practitioners and other staff need to handle enquiries in a sensitive and skilled way to ensure distress to the adult is minimised. It is likely that many enquiries will require the input and supervision of a social worker, particularly when dealing with more complex situations and to support the adult to realise the outcomes they want and to reach a resolution or recovery. Where abuse or neglect is suspected within a family or informal relationship it is likely that a social worker will be the most appropriate lead. Personal and family relationships within community settings can be difficult and complex to assess and intervene in.  For example, an adult may make a choice to maintain a relationship that causes them emotional distress because this outweighs, for them, the unhappiness of ending the relationship.

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

2. The Mental Capacity Act 2005

See also Mental Capacity chapter

It must always be assumed that a person has mental capacity to make their own decisions unless they have been assessed as lacking mental capacity. They should not be treated as unable to make a decision unless all practicable steps to help them do so have been taken without success.

Where an adult is assessed as lacking capacity to make a decision then any action taken, or any decision made for, or on their behalf, must be made in their best interests.

Practitioners should always work in line with the Mental Capacity Act 2005 (MCA), and use their professional judgement to balance competing views.

Issues around mental capacity are frequently raised in relation to adult safeguarding, particularly where it appears an adult has mental capacity to make specific decisions that nevertheless place them at risk of being abused or neglected. See also Working with Adults with Impaired Executive Function chapter.

3. Information Gathering

Discussion with the adult, or their representative, should be at the heart of the information gathering process. The discussion should explore the nature of the concern which has been raised, agree the outcomes the adult wants to achieve and what action should be taken.

As well as this discussion, other possible sources of information include:

• the police;
• the local authority or voluntary organisations;
• GP and other health practitioners;
• the organisation commissioning or providing care and support to the adult, for example NHS, care home, housing provider etc;
• the Office of the Public Guardian or Department of Work and Pensions (in relation to deputies and attorneys);
• the CQC.

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

4. Local Decision-Making Processes

4.1 Principles for making decisions

The following principles should guide decision making when responding to safeguarding adults concerns:

• empowerment: presumption of person-led decisions and informed consent;
• prevention: it is better to take action before harm occurs;
• proportionate and least intrusive response appropriate to the risk presented;
• protection: support and representation for those in greatest need;
• partnership: local solutions through services working with their communities;
• communities: have a part to play in preventing, detecting and reporting neglect and abuse;
• accountability and transparency in delivering safeguarding;
• feeding back whenever possible.5.2 Decision making steps

The Care and Support Statutory Guidance (Department of Health and Social Care) sets out the following steps in relation to the local decision-making process:

1. enquiries must be made to decide if any action is required to safeguard the adult;
2. if no further safeguarding action is identified, consideration should be given to what other advice/action or information is needed to promote the adult’s wellbeing;
3. where criminal activity is suspected, this must be reported to the police;
4. where further actions are identified, it should be agreed who will take what action, next steps planned, timescales agreed, desired outcomes established and feedback provided to relevant people. The local authority retains accountability and oversight of the safeguarding enquiry and outcomes;
5. if the outcomes are achieved, the local authority’s duty to make safeguarding enquiries under section 42 Care Act ends. Other relevant actions should be agreed, such as giving of advice and information; assessment and support; review of care and support plans;
6. if the adult is considered to be at continuing risk of harm, the local authority’s duty to make safeguarding enquiries under section 42 Care Act continues;
7. work should continue with the adult and strategies developed to reduce / manage the risk;
8. if the outcome of the evaluation process is that a safeguarding plan is needed, the safeguarding plan should agree who will be the lead practitioner to monitor and review the plan, and timescales for review and monitoring of the safeguarding plan should be agreed;
9. the safeguarding plan should be reviewed to evaluate whether the outcomes have been achieved and whether further action is required.

5. When should an Enquiry take place?

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

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

The enquiry should usually start with asking the adult their views and wishes which will often determine what next steps to take.

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

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

6. Objectives of an Enquiry

The first priority should always be to ensure the safety and wellbeing of the adult, as well as:

• establishing the facts;
• ascertaining the adult’s views and wishes;
• assessing the adult’s need for protection, support and redress and how these might be met;
• addressing what has caused the abuse or neglect;
• protecting the adult from abuse and neglect, in accordance with their wishes;
• making decisions as to what follow up action should be taken in relation to the person or organisation responsible for the abuse or neglect;
• enabling the adult to achieve resolution and recovery;
• safeguarding adults in a way that supports them in making choices and having control about how they want to live.

The safeguarding process should be empowering and supportive and reflect the making safeguarding personal (MSP) approach. MSP helps to ensure that the enquiry process is person-centred and outcome-focused; with the adult concerned at the centre of discussions and decision making. See Making Safeguarding Personal chapter.

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

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

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

From BMA Adult Safeguarding Toolkit:

…where a competent adult explicitly refuses any supporting intervention, this should normally be respected. Exceptions to this may be where a criminal offence may have taken place or where there may be a significant risk of harm to a third party. If, for example, there may be an abusive adult in a position of authority in relation to other adults, it may be appropriate to breach confidentiality and disclose information to a relevant authority. Where a criminal offence is suspected it may also be necessary to take legal advice. Ongoing support should also be offered. An adult should not be lost to or abandoned by relevant services because they initially refused the offer of assistance. The situation should be monitored and the individual informed that they can take up the offer of assistance at any time.

7. What should an Enquiry take into Account?

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

The Care and Support Statutory Guidance sets out that, in line with principles of making safeguarding personal (MSP), the enquiry process and safeguarding partners should take account of all the circumstances of the case and the adult’s preferences, histories, circumstances and lifestyle, rather than adopting a rigid process to be followed in each case. The local decision-making process should include appropriate pauses for reflection, consideration and professional judgement about the different routes and actions that might be taken.

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

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

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

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

8. Who can carry out an Enquiry?

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

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

8.1 Police

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

8.2 Employers

Employers must ensure that staff, including volunteers, are trained in recognising the signs or symptoms of abuse or neglect, know how to respond and where to go for advice and assistance.

Employers must also ensure all staff keep accurate records, which make clear what is being reported as a fact and what is opinion. It is vital that the views of the adult are sought and recorded. These should include the outcomes that the adult wants, such as feeling safe at home, access to community facilities, restricted or no contact with certain individuals or pursuing the matter through the criminal justice system.

9. What happens after an Enquiry?

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

That action could take a number of courses including:

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

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

10. Safeguarding Plans

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

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

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

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

In order to make sound decisions, the adult’s emotional, physical, intellectual and mental capacity in relation to self-determination and consent and any intimidation, misuse of authority or undue influence will have to be assessed.

11. Taking Action

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

In relation to the adult, this should set out:

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

12. Person Alleged to be Responsible for Abuse or Neglect

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

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

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

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

With regard to abuse, neglect and misconduct within a professional relationship, codes of professional conduct and / or employment contracts should be followed and should determine the action that can be taken.

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

13. Supporting Adults Through Criminal Justice Processes

Everyone is entitled to the protection of the law and access to justice. Although the local authority has the lead role in making safeguarding enquiries under the Care Act, where criminal activity is also suspected, the police should be informed at an early stage.

Types of abusive or neglectful behaviour which are also criminal offences include:

• physical abuse;
• sexual abuse including rape, sexual assault, sexual harassment and sexual exploitation;
• so-called honour-based abuse, including forced marriage and female genital mutilation;
• modern slavery;

• psychological abuse ;
• wilful / deliberate neglect;
• unlawful imprisonment;
• theft and fraud;
• certain forms of discrimination (such as hate crime).

For the purpose of court proceedings, a witness is considered to be competent if they can understand the questions being asked and can respond to them in a way that the court can understand. Police have a duty under legislation to assist any witnesses who are identified as vulnerable and / or intimidated.

13.1 Involving the police

Early referrals to the police to discuss whether a criminal offence may have been committed helps to ensure that any possible forensic evidence is not lost or contaminated. It also provides an opportunity to consider whether the police can take any specific actions to protect victims, such as applying for Domestic Violence Protection Orders (DVPO) / Domestic Abuse Protection Orders, a Forced Marriage Protection Order or a Stalking Protection Order for example.

When a crime is reported, the police will complete a victim needs assessment, to identify any support which a victim may need, including any special measures. If a victim is identified as vulnerable or intimidated, the police will outline what special measures are available and how they work.

13.2 Vulnerable and intimidated witnesses

The Youth Justice and Criminal Evidence Act 1999 provides a definition for vulnerable and intimidated witnesses who can ask for special measures when giving evidence in court.

A range of special measures are available, including the use of screens around the witness box, the use of live link or recorded evidence and the use of an intermediary to help witnesses understand the questions they are being asked and to give their answers accurately

Vulnerable witnesses are adults who have:

• a mental health disorder;
• a learning disability; and / or
• a physical disability.

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

Intimidated witnesses are those whose quality of evidence is likely to be diminished because of fear or distress. In deciding whether a witness comes into this category the court takes account of:

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

Also coming under this category are:

• victims or witnesses to sexual assault;
• victims or witnesses to offences under the Modern Slavery Act 2015;
• witnesses to certain gun and knife offences, and other serious crimes including murder and terrorist offences;
• victims of and witnesses to domestic abuse, racially motivated crime, crime motivated by reasons relating to religion, homophobic crime, gang related violence and repeat victimisation;
• those who are older and frail.

Some victims or witnesses may require additional support during police interviews and investigations, and police officers involved will need to have specific skills in investigating and interviewing adults with disabilities and communication needs. It is crucial that any reasonable adjustments which are required are also made.

Although police investigation may take priority over all other enquiries, a multi-agency approach should be agreed to ensure that the interests and personal wishes of the adult are considered throughout, even if they do not wish to provide any evidence or support a prosecution. The local authority’s duty to ensure the wellbeing and safety of the person continues throughout any criminal investigation.

Adults who have mental capacity to make informed decisions about their safety may decide that they do not want any police action to be taken. Possible reasons for this could include that they are frightened of reprisals, are being coerced or intimidated or they fear their relationship with the abuser will be damaged; it is important therefore that practitioners support adults and explore the reasons for their decisions.

14. Ill Treatment and Wilful Neglect

See Ill Treatment and Wilful (Deliberate) Neglect chapter

Ill-treatment and wilful neglect are offences under the Criminal Justice and Courts Act 2015. The offences can apply to organisations which provide care and to individual care workers.

‘Wilful’ means that a care worker has acted deliberately or carelessly in relation to the adult they are paid to care for.

‘Ill-treatment’ is also deliberate and is when a care worker knew that they were ill-treating an adult or were being reckless in the care or support they were providing.

Ill-treatment does not have to result in physical harm. It can involve behaviour that causes, or could cause, emotional and psychological distress to an adult and their family.

It can also include a care worker failing to protect the privacy and dignity of an adult they are providing care and support to.

15. Allegations against People in Positions of Trust

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

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

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

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

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

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

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

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

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

15.1 Attorneys and deputies

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

16. Further Reading

16.1 Relevant chapters

Adult Safeguarding

Information Sharing and Confidentiality

16.2 Relevant information

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

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

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

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