This chapter provides information for multi-agency practitioners about what action they should take if they have concerns that an adult is experiencing, or at risk of, abuse or neglect.

RELEVANT CHAPTERS AND INFORMATION

Categories of Abuse and Neglect

Responding to Concerns of Abuse or Neglect is Everybody’s Business

Stage 2: Screening and Initial Decision Making

Body Map (see Local Forms, Leaflets, Letters)

See also Safeguarding Case Studies

1. What is a Concern?

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

Workers (both paid and unpaid) across a wide range of agencies need to be vigilant about adult safeguarding concerns and act appropriately when dealing with such concerns.

A safeguarding adult concern is about an adult who:

  • has needs for care and support (whether or not the local authority is meeting any of those needs); and
  • is experiencing, or 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 or neglect.

A concern may be raised by anyone and can be:

  • an active disclosure of abuse by the adult, where the adult tells a member of staff that they are experiencing abuse and/or neglect;
  • a passive disclosure of abuse where someone has noticed signs of abuse or neglect, for example clinical staff who notice unexplained injuries;
  • an allegation of abuse by a third party, for example a family / friend or neighbour who has observed abuse or neglect or has been told of it by the adult;
  • a complaint or concern raised by an adult or third party who does not perceive that it is abuse or neglect. Complaint officers should consider whether there are safeguarding matters;
  • a concern raised by staff or volunteers, others using the service, a carer or a member of the public;
  • an observation of the behaviour of the adult;
  • an observation of the behaviour of another.

Where the safeguarding concerns arise from abuse or neglect, it will not only be necessary to immediately consider what steps are needed to protect the adult but also whether a possible crime has occurred. Early engagement with the police is vital to support the criminal investigation.

It should never be assumed that someone else will pass on information which may be critical to the safety and wellbeing of the adult. All staff have a duty of care to pass on their concerns and therefore would be failing in this duty if they did not do so.

2. Taking Immediate Action

 Anyone with concerns of abuse or neglect should ensure the safety and wellbeing of the adult or others.  The following should be considered:

  • making an immediate evaluation of the risk and taking steps to ensure that the adult is in no immediate danger;
  • where appropriate, dial 999 for an ambulance if there is need for emergency medical assistance or arrange for any other medical treatment (note that offences of a sexual nature will require expert advice from the police);
  • contacting the police if a crime has been or may have been committed;
  • if a crime is in progress or life is at risk, dial the emergency services – 999 – or dial 101 for a non-emergency;
  • not disturbing or moving articles that could be used in evidence, and taking steps to secure the scene, for example by locking the door to a room;
  • preserve evidence through recording (see also Body Map in Local Forms, Leaflets, Letters);
  • where possible, encourage and support the adult to report the matter to the police if a crime is suspected and not an emergency situation;
  • contact the Multi-Agency Risk Assessment Team (MARAT) if there are concerns that a child is also at risk (see Local Contacts);
  • if possible, making sure that other adults and other individuals are not at risk;
  • implement human resources process if required;
  • record the information received, risk evaluation and all actions clearly and accurately.

A concern must be raised to the Community Screening Team, Trafford Council (see Stage 2 for further details).

All employees should be authorised to call emergency services, without referral to a manager, to ensure that there is no delay.

Although staff should do what they can to ensure the immediate safety of an adult, they must not put themselves in risky or dangerous situations.

2.1 Informing managers and safeguarding leads

See also Section 6, Responsibilities of the Manager and Safeguarding Lead

Staff must inform their line manager or safeguarding lead of the safeguarding concern without delay, as appropriate.

Where there are concerns that the line manager / safeguarding lead has abused or is involved in the abuse, the member of staff must inform a senior manager in their organisation or refer to the appropriate agency.

If abuse or harm has been reported to the management and appropriate action has not been taken, staff should refer to their organisation’s whistle blowing policy or contact the Community Screening Team, Trafford Council (see Local Contacts).

If staff are concerned that an adult may have abused another adult (with care and support needs), they should inform their line manager or safeguarding lead.

3. Preserving Evidence 

The police will always be responsible for the gathering and preservation of evidence to pursue criminal allegations against people causing harm, and should be contacted immediately if there is reasonable belief a crime has been committed.

The first concern is always to ensure the safety and wellbeing of the alleged victim. However, in situations where there has been or may have been a crime and the police have been called it is important that forensic and other evidence is collected and preserved. The police will attend the scene, and agencies and individuals can ensure evidence is not contaminated by:

  • disturbing a ‘scene’ as little as possible, sealing off areas if possible;
  • discouraging washing / bathing / eating / drinking / smoking and use of the toilet in cases of sexual assault;
  • not cleaning or allowing further use by others of a toilet used by the victim since the alleged incident in cases of sexual assault;
  • not handling items which may hold DNA evidence;
  • putting any bedding, clothing which has been removed, or any significant items given to you (weapons etc) in a safe, dry place in bags (for example bin liners) if practical
  • preserve all containers / documents.

Remember, evidence may be present even if it cannot be phsically seen. If in any doubt contact the police and ask for advice.

Staff can contribute to evidence by making a note of their observations in relation to the condition and attitude of the people involved and any actions taken.

4. Responding to Disclosures

Disclosures by the adult themselves should be listened to and recorded carefully as soon as possible, using their own words where possible. Staff should also:

  • speak in a private and safe place;
  • give assurances that they are taking the concerns seriously;
  • listen carefully to what they are saying, staying calm, getting as clear a picture as possible, and avoid asking leading questions;
  • do not interview the person; but establish the basic facts avoiding asking the same questions more than once;
  • ask the adult what they would like to happen (that is, what they want their outcomes to be) and what they would like you to do;
  • record conversations in the person’s own words where possible;
  • not give promises of complete confidentiality – explain who you will have to tell and why;
  • if there are grounds to override a person’s consent to share information, explain what these are;
  • explain how the adult will be involved and kept informed;
  • provide information and advice on keeping safe, and the safeguarding process as appropriate at the time;
  • make a best interests decision about the risks and protection needed if the person is unable to provide informed consent. Record and date this decision;
  • if the person has specific communication needs, provide support and information in a way that is most appropriate and accessible to them, and that will help them to understand what is happening for example interpreter, speech and language therapist. The use of an interpreter service for the individual’s first language or sign language, could be vital at this stage as family members or friends may not be appropriate;
  • not be judgemental or jump to conclusions.

The adult should not be questioned in detail at this stage, to avoid creating unnecessary stress through repeatedly describing events or creating a perception that they are not believed. Such questioning can also risk the contamination of evidence. This should not detract from the initial seeking of information to establish basic facts.

5. Contact with the Person Alleged to Have Caused Harm

The person alleged to have caused harm should not be contacted, unless this is part of an emergency action to safeguard the adult or others (for example, suspending a member of staff following allegations of abuse or neglect).

Consider whether it is appropriate to discuss the concern with the person alleged to have caused harm. This decision must be made in consultation with a line manager, safeguarding lead or local authority representative and where relevant the police.

Where relevant (that is they have care and support needs), the person alleged to have caused harm is protected by completion of an appropriate risk assessment and protection plans.

6. Responsibilities of the Manager and Safeguarding Lead

Once informed of concerns, the manager and / or safeguarding lead should review any actions taken and:

  • clarify that the adult is safe, that their views have been clearly sought and recorded and that they are aware what action will be taken;
  • address any gaps;
  • check that issues of consent and mental capacity have been addressed
  • in the event that a person’s wishes are being overridden, check that this is appropriate and that the adult understands why;
  • contact MARAT if a child or young person is also at risk (see Local Contacts);
  • if the person allegedly causing the harm is also an adult at risk or or experiencing abuse or neglect, arrange appropriate care and support;
  • make sure action is taken to safeguard other people;
  • where appropriate, consider taking action in accordance with organisational disciplinary procedures; including whether it is appropriate to suspend staff or move them to alternative duties;
  • if the service is registered with the Care Quality Commission, and the incident constitutes a notifiable event, complete and send a notification to CQC (see Local Contacts);
  • if a criminal offence has occurred or may occur, contact the police if they have not already been contacted;
  • make a referral under Prevent if appropriate (see Radicalisation and Violent Extremism)
  • consider if the case should be put forward for a Safeguarding Adults Review (see Safeguarding Adults Reviews);
  • record the information received and all actions and decisions.

6.1 Decision making: factors to consider when considering making a referral

The manager or safeguarding lead will usually lead on decision making. Where such support is unavailable, consultation with other senior staff should take place. In the event that these are unavailable, seek advice from the Community Screening Team, Trafford Council (see Local Contacts).

Staff should also raise a concern without the immediate authority of a line manager:

  • if discussion with the manager would involve delay in an apparently high risk situation;
  • if the person has raised concerns with their manager and they have not taken appropriate action (whistleblowing).

Decisions need to take into account all relevant information that is available, including the views of the adult in all circumstances where it is possible and safe to do so. If the adult has mental capacity and does not want to pursue matters through safeguarding action, staff should be sure that the adult is fully aware of the consequences of their decisions, and that all options have been explored and that not proceeding further is consistent with legal duties.

There may be some occasions when the adult does not want to pursue a referral to the local authority. Where it is a personal matter and may cause family disharmony for example, if possible the adult’s wishes should be respected and other ways of ensuring the adult’s safety explored. Where there is a potentially high risk situation, staff should be vigilant of possible coercion and the emotional or psychological impact that the abuse may have had on the adult.

Decision makers also need to take account of whether or not there is a public or vital interest to refer the concern to the local authority. Where there is a risk to other adults, children or young people or there is a public interest to take action because a criminal offence had occurred and the view is that it is a safeguarding matter, the wishes of the individual may be overridden. Where the sharing of information to prevent harm is necessary, lack of consent to information sharing can also be overridden.

In the event that people lack the capacity to provide consent, action should be taken in line with the Mental Capacity Act 2005 (see Mental Capacity).

Where a possible crime has been committed people should always be encouraged to report the matter to the police.

Having taken into account all the factors above, a referral must be made to Trafford Council where an adult:

  • has needs for care and support (whether or not the local authority is meeting any of those needs); and
  • is experiencing, or at risk of, abuse or neglect; and
  • ss 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 (as specified in Section 1, What is a Concern?).

6. Responding to Abuse or Neglect in a Regulated Setting

See also Allegations against People in Positions of Trust.

It is important that all partners are clear where responsibility lies where abuse or neglect is carried out by employees or in a regulated setting, such as a care home, hospital, or college.

The first responsibility to act must be with the employing organisation as provider of the service. However, social workers or counsellors may need to be involved in order to support the adult to recover.

When an employer is aware of abuse or neglect in their organisation, they are under a duty to address this and protect the adult from harm as soon as possible.

Where a local authority has reasonable cause to suspect that an adult may be experiencing or at risk of abuse or neglect, it is under a duty to make (or cause to be made) whatever enquiries it thinks necessary to decide what if any action needs to be taken and by whom (see Stage 1: Initial Safeguarding Actions).

The local authority may well be reassured by the employer’s response so that no further action is required. However, a local authority would have to satisfy itself that an employer’s response has been sufficient to deal with the safeguarding issue and, if not, to undertake any enquiry of its own and any appropriate follow up action (for example referral to the Care Quality Commission and / or professional regulators).

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

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

There should be a clear understanding between partners at a local level when other agencies such as the local authority, CQC or the clinical commissioning group (CCG) need to be notified or involved and what role they have. The focus should be on promoting the wellbeing of those adults at risk (see Promoting Wellbeing). It may be that additional training or supervision will be the appropriate response, but the impact of this needs to be assessed.

Commissioners of care or other professionals should use safeguarding procedures in a way that reflects the principles above not as a means of intimidating providers or families.

Transparency, open mindedness and timeliness are important features of fair and effective safeguarding enquiries.

CQC and commissioners have alternative means of raising standards of service, including support for staff training, contract compliance and, in the case of CQC, enforcement powers.

7. Recording Concerns

See also Record Keeping.

It is vital that a written record of any incident or allegation is made as soon as possible after the information is obtained.

Written records must reflect as accurately as possible what was said and done by the people initially involved in the incident either as a victim, suspect or potential witness. The notes must be kept safe as it may be necessary to make records available as evidence and to disclose them to a court.

The record should include:

  • date and time of the incident;
  • exactly what the adult said, using their own words (their account), where possible, about 
the abuse and how it occurred or exactly what has been reported to you;
  • appearance and behaviour of the adult including any changes noticed;
  • any injuries observed;
  • any actions taken (for example contacting police or other emergency services);
  • name and signature of the person making the record.

If the member of staff witnessed the incident, they should write down exactly what they saw.

The record should be factual. However, if the record does contain opinion or an assessment, it should be clearly stated as such and be backed up by factual evidence. Information from another person should be clearly attributed to them.

See Stage 2: Safeguarding Screening and Initial Decision Making