1. Introduction

Workers in all organisations need to be vigilant about adult safeguarding concerns. This includes people working in health and social care, policing, banking, fire and rescue services, trading standards, leisure services, faith groups, and housing.

GPs and other primary care staff may be particularly well placed to spot abuse or neglect, as in many cases they may be the only professionals with whom the adult has contact.

People in the community, such as neighbours, also have a role to play in identifying when an adult is experiencing or at risk of abuse or neglect, for example, someone who notices the elderly lady next door who lives alone has not collected the milk from her doorstep for two days.

Findings from safeguarding adult reviews have sometimes stated that if professionals or other staff had acted upon their concerns or sought more information, death or serious harm might have been prevented.

2. Raising Concerns

Anyone can witness or become aware of information suggesting that abuse or neglect is occurring. It is vital that professionals, other staff and members of the public are vigilant on behalf of those unable to protect themselves.

The adult may say or do things that raise concerns. This may come in the form of a complaint, a call for a police response, an expression of concern, or information which is revealed during a needs assessment.

Regardless of how the safeguarding concern is identified, everyone should know what to do, and where to go to get help and advice. 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; and
  • 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.

2.1 Professionals Reporting Concerns

Each organisation should have internal reporting processes that should be followed as part of the safeguarding process.

In most cases, frontline staff should report any concerns to their immediate line manager. There should be protocols in place for staff to follow when their line manager is not available (for example on leave, sick leave).

If the concerns involve another member of staff or a service user, staff should inform their line manager (see the Person / People in Positions of Trust (PIPOT) – Multi-Agency Practice Guidance).

If it is believed that the manager may be implicated in the abuse, or the worker does not feel able to discuss it with them, they should inform a Senior Manager or someone else designated in their agency’s reporting protocol. Staff can also refer to their agency guidance on whistleblowing (see also Whistleblowing chapter).

Where there is any suspicion of abuse or neglect which relates to an adult who may be at risk living in a private, voluntary or local authority care (nursing or residential) home or adult placement, or is supported by a domiciliary or nursing care agency, the Care Quality Commission must also be informed.

3. Reporting and Responding to Abuse and Neglect

It is important that there is a professional understanding of:

  • the circumstances of abuse;
  • 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 and the role of family members and paid staff or professionals.

A local authority may decide to undertake a safeguarding enquiry for an adult where there is no enquiry duty (under Section 42 Care Act), if it believes it is proportionate to do so and will enable it to promote the person’s wellbeing and support a preventative agenda.

The response will depend on the circumstances surrounding any actual or suspected case of abuse or neglect. For example, it is important to recognise that 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 (see also Carers chapter).

However, the primary focus must always be how to safeguard the adult. In other circumstances where the safeguarding concerns arise from abuse or neglect deliberately intended to cause harm, it would be necessary to immediately take steps to protect the adult and consider also whether to refer the matter to the police to consider whether a criminal investigation would be required or appropriate.

Defining abuse can be complex but it can involve an intentional, reckless, deliberate or dishonest act by the perpetrator. It may be physical, verbal or psychological, an act of neglect or an omission to act. In any case where anyone encounters abuse and they are uncertain about their next steps, they should contact the police or adult social care 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, an employer led disciplinary response may be appropriate, but this situation will also need steps 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 (see South Tyneside Multi Agency Information Sharing Agreement and Case Recording chapter). To ensure effective safeguarding arrangements:

  • all organisations must have arrangements in place which set out clearly the processes and the principles for sharing information between each other, with other professionals and the South Tyneside Safeguarding Adults Board; this could be via an information-sharing agreement to formalise the arrangements; and,
  • 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, they should share the information with the local authority, and the police if they believe or suspect that a crime has been committed.
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1. Introduction

The Care Act 2014 identifies types of abuse, but also emphasises that organisation should not limit their view of what constitutes abuse or neglect.

The specific circumstances of an individual case should always be considered (see What is Safeguarding and Why does it Matter?). All three factors need to be satisfied for a safeguarding enquiry to be addressed in accordance with Section 42 of the Care Act 2014. The table below identifies what forms of abuse are considered in the guidance documents.

2. Types of Abuse

Type of Abuse Description or Supporting Guidance
Disability Hate Crime The criminal justice system defines a disability hate crime as any criminal offence, which is perceived, by the victim or any other person, to be motivated by hostility or prejudice based on a person’s disability or perceived disability. The police monitor five strands of hate crime: disability; race; religion; sexual orientation; transgender.
Discriminatory abuse Discrimination on the grounds of race, faith or religion, age, disability, gender, sexual orientation and political views, along with racist, sexist, homophobic or ageist comments or jokes, or comments and jokes based on a person’s disability or any other form of harassment, slur or similar treatment. Excluding a person from activities on the basis they are ‘not liked’ is also discriminatory abuse
Domestic abuse The Domestic Abuse Act (2021) defines domestic abuse as: Abusive behaviour that is: physical or sexual abuse; violent or threatening behaviour; controlling or coercive behaviour; economic abuse; psychological, emotional or other abuse. Applies to people aged 16+, who are personally connected to each other.
Female genital mutilation (FGM)   Involves procedures that intentionally alter or injure female genital organs for non-medical reasons. The procedure has no health benefits for girls and women. The Female Genital Mutilation Act (2003) makes it illegal to practise FGM in the UK or to take girls who are British nationals or permanent residents of the UK abroad for FGM whether or not it is lawful in another country. See also Female Genital Mutilation.
Financial or material abuse 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, or the misuse or misappropriation of property, possessions or benefits. See also Financial or Material Abuse.
Forced marriage Is a term used to describe a marriage in which one or both of the parties are married without their consent or against their will. A forced marriage differs from an arranged marriage, in which both parties consent to the assistance of a third party in identifying a spouse. In a situation where there is concern that an adult is being forced into a marriage they do not or cannot consent to, there will be an overlap between action taken under the forced marriage provisions and the adult safeguarding process.

See also Forced Marriage.

Hate crime The police define Hate Crime as ‘any incident that is perceived by the victim, or any other person, to be racist, homophobic, transphobic or due to a person’s religion, belief, gender identity or disability’. It should be noted that this definition is based on the perception of the victim or anyone else and is not reliant on evidence. In addition it includes incidents that do not constitute a criminal offence.
Honour based abuse So called honour based abuse is a term used to describe abuse committed within the context of the extended family which are usually motivated by a perceived need to restore standing within the community, which is presumed to have been lost through the behaviour of the victim. Women are predominantly (but not exclusively) the victims and the violence and abuse is often committed with a degree of collusion from family members and / or the community. Some of these victims will contact the police or other organisations. However, many others are so isolated and controlled that they are unable to seek help. See Honour Based Abuse
Human trafficking Is actively being used by organised crime groups to make considerable amounts of money. This problem has a global reach covering a wide number of countries. It is run like a business with the supply of people and services to a customer, all for the purpose of making a profit. Traffickers exploit the social, cultural or financial vulnerability of the victim and place huge financial and ethical obligations on them. They control almost every aspect of the victim’s life, with little regard for the victim’s welfare and health. The organised crime groups will continue to be involved in the trafficking of people, whilst there is still a supply of victims, a demand for the services they provide and a lack of information and intelligence on the groups and their activities.
Mate Crime   A ‘mate crime’ as defined by the Safety Net Project is ‘when vulnerable people are befriended by members of the community who go on to exploit and take advantage of them. It may not be an illegal act but still has a negative effect on the individual.’ Mate crime is often difficult for police to investigate, due to its sometimes ambiguous nature, but should be reported to the police who will make a decision about whether or not a criminal offence has been committed. Mate Crime is carried out by someone the adult knows and often happens in private. In recent years there have been a number of Safeguarding Adult Reviews relating to people with a learning disability who were murdered or seriously harmed by people who purported to be their friend. See Gemma Hayter and Steven Hoskin reviews. See also Safe Places (mate crime resources)
Modern slavery Slavery, servitude and forced or compulsory labour. A person commits an offence if:

  • the person holds another person in slavery or servitude and the circumstances are such that the person knows or ought to know that the other person is held in slavery or servitude; or
  • the person requires another person to perform forced or compulsory labour and the circumstances are such that the person knows or ought to know that the other person is being required to perform forced or compulsory labour.

See also Modern Slavery chapter.

Neglect and acts of omission Ignoring medical, emotional or physical care needs, failure to provide access to appropriate health, social care or educational services, and the withholding of the necessities of life such as medication, adequate nutrition and heating. Neglect also includes a failure to intervene in situations that are dangerous to the person concerned or to others, particularly when the person lacks the mental capacity to assess risk for themselves.  See also Pressure Ulcers, below.
Organisational abuse The mistreatment, abuse or neglect of an adult by a regime or individuals in a setting or service where the adult lives or that they use. Such abuse violates the person’s dignity and represents a lack of respect for their human rights (see also Provider Concerns Process and Person / People in Positions of Trust (PIPOT) – Multi-Agency Practice Guidance).
Physical abuse Assault, hitting, slapping, pushing, misuse of medication, restraint or inappropriate physical sanctions.
Psychological/emotional abuse Emotional abuse, threats of harm or abandonment, deprivation of contact, humiliation, blaming, controlling, intimidation, coercion, harassment, verbal abuse, cyber bullying, isolation or unreasonable and unjustified withdrawal of services or supportive networks.
Restraint Unlawful or inappropriate use of restraint or physical interventions. In extreme circumstances unlawful or inappropriate use of restraint may constitute a criminal offence. Someone is using restraint if they use force, or threaten to use force, to make someone do something they are resisting, or where an adult’s freedom of movement is restricted, whether they are resisting or not (see also Provider Concerns Process).

Restraint covers a wide range of actions. It includes the use of active or passive means to ensure that the person concerned does something, or does not do something they want to do, for example, the use of key pads to prevent people from going where they want from a closed environment.

Sexual abuse Rape, indecent exposure, sexual harassment, inappropriate looking or touching, sexual teasing or innuendo, sexual photography, subjection to pornography or witnessing sexual acts, indecent exposure and sexual assault or sexual acts to which the adult has not consented or was pressured into consenting.
Sexual exploitation Involves exploitative situations, contexts and relationships where adults (or a third person or persons) receive ‘something’ (e.g. food, accommodation, drugs, alcohol, cigarettes, affection, gifts, money) as a result of them performing, and/or another or others performing on them, sexual activities. It affects men as well as women. People who are sexually exploited do not always perceive that they are being exploited.

See also Working with Adults Affected by Child Sexual Exploitation or Organised Sexual Abuse.

NB: Pressure Ulcers

Pressure ulcers may occur as a result of neglect. Where concerns are raised regarding skin damage as a result of pressure, there is a need to raise it as a safeguarding concern within the organisation. In a minority of cases it may warrant a safeguarding concern with the local authority. Please see Pressure Areas and Safeguarding.

3. 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, 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 is now described as organisational abuse. In order to see these patterns it is important that information is recorded and appropriately shared (see also South Tyneside Multi Agency Information Sharing Agreement and Case Recording chapter).

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 abuse between spouses or generations or persistent psychological abuse; or
  • opportunistic abuse such as theft occurring because money or jewellery has been left lying around.
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