Amendment – In May 2023, this chapter was reviewed and updated throughout.
- 1. Introduction
- 2. The Safeguarding Duty
- 3. Who Abuses and Neglects Adults?
- 4. Principles of Adult Safeguarding
- 5. Aims of Adult Safeguarding
- 6. Making Safeguarding Personal
- 7. Personal Budgets and Personal Health Budgets
- 8. Raising Awareness
- 9. NHS England -Serious Incidents
Safeguarding requires people and organisations to work together to prevent both the risk of and the experience of abuse or neglect. At the same time, the adult’s wellbeing must be promoted including, where appropriate, having regard to their views, wishes, feelings and beliefs when deciding on any action. 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 means 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).
2. The Safeguarding Duty
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.
- This duty applies to 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.
Regardless of whether the local authority is providing any services to the adult, it must follow up any concerns about either actual or suspected abuse or neglect.
The adult experiencing, or at risk of abuse or neglect will be referred to as the ‘adult’ throughout this APPP, replacing previous terms of adult at risk or vulnerable adult.
Local authority statutory adult safeguarding duties apply equally to adults with care and support needs:
- regardless of whether those needs are being met;
- regardless of whether the adult lacks mental capacity or not (see Mental Capacity chapter);
- regardless of setting, except prisons and approved premises.
Within the scope of this definition are:
- all adults who meet the above criteria regardless of their mental capacity to make decisions about their own safety or other decisions relating to safeguarding processes and activities;
- adults who manage their own care and support through personal or health budgets;
- adults whose needs for care and support have not been assessed as eligible or which have been assessed as below the level of eligibility for support;
- adults who fund their own care and support;
- children and young people in specific circumstances as detailed below.
Outside of scope of this policy and procedure:
- adults in custodial settings (prisons and approved premises). Prison governors and HM Prison and Probation Service (HMPPS) have responsibility for these arrangements (see Adult Social Care, HMPSS and Ministry of Justice). The Safeguarding Adults Board does however have a duty to assist prison governors on adult safeguarding matters;
- local authorities are required to assess for care and support needs of prisoners which take account of their wellbeing (see Factsheet 12: Prisoners and people in resident in approved premises, Department of Health and Social Care). Equally NHS England has a responsibility to commission health services delivered through offender health teams which contributes towards safeguarding offenders.
2.1 Children and young people
The Children Act 1989 provides the legislative framework for agencies to take decisions on behalf of children and to take action to protect them from abuse and neglect. Young people who receive leaving or after care support from children and family services, are included in the scope of adult safeguarding, but close liaison with children and family service providers is key to establishing who is the best person to lead or support young people through adult safeguarding processes.
The Children Act 2004 places duties on a range of organisations and individuals to ensure their functions, and any services that they contract out to others, are discharged having regard to the need to safeguard and promote the welfare of children. In all adult safeguarding work, staff working with the adult should establish whether there are children in the family and whether checks should be made on children and young people who are part of the same household, irrespective of whether they are dependent on care either from the adult, or the person alleged to have caused harm. See Whole Family Approach chapter.
Children and young people may be at greater risk of harm or be in need of additional help in families where adults have mental health problems, misuse substances or alcohol, are in a violent relationship, have complex needs or have learning difficulties.’ For further information see Working Together to Safeguard Children (Department for Education).
Abuse within families reflects a diverse range of relationships and power dynamics, which may affect the causes and impact of abuse. These can challenge professionals to work across multi-disciplinary boundaries in order to protect all those at risk. In particular staff may be assisted by using domestic abuse risk management tools as well as safeguarding risk management tools. Staff providing services to adults, children and families should have appropriate training whereby they are able to identify risks and abuse to children and vulnerable adults.
In respect of young carers, the Care Act 2014, alongside the Children and Families Act 2014, offers a joined up legal framework to identify young carers and parent carers and their support needs. Both Acts have a strong emphasis on outcomes and wellbeing.
The Care Act 2014 places a duty on local authorities to conduct transition assessments for children, children carers and young carers where there is a likely need for care and support after the child in question turns 18 and a transition assessment would be of significant benefit. See also Transition to Adult Care and Support chapter.
Where there are ongoing safeguarding issues for a young person and it is anticipated that on reaching 18 years of age they are likely to require adult safeguarding, safeguarding arrangements should be discussed as part of transition support planning and protection. Conference chairs and Independent Reviewing Officers, if involved, should seek assurance that there has been appropriate consultation with the young person by adult social care and invite them to any relevant conference or review. Clarification should be sought on:
- what information and advice the young person has received about adult safeguarding;
- the need for advocacy and support;
- whether a mental capacity assessment is needed and who will undertake it.
- if best Interest decisions need to be made
- whether any application needs to be made to the Court of Protection.
- If the young person is not subject to a plan, it may be prudent to hold a professionals meeting.
2.1.2 Children and young people who abuse
If a child or young person is causing harm to an adult covered by the adult safeguarding procedures, action should be taken under these procedures, and a referral and close liaison with children’s services should take place.
Violence towards parents and other relatives (for example, grandparents, aunts, uncles) some of whom, may be adults experiencing or at risk of abuse or neglect, can be carried out by adults and by young people and children, some of which can cause serious harm or death.
2.2 Carers and safeguarding
Circumstances in which a carer could be involved in a situation that may require a safeguarding response includes when:
- 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; or,
- a carer may unintentionally or intentionally harm or neglect the adult they support on their own or with others.
Where there is intentional abuse, adult safeguarding under the Care Act should always be considered. See Carers chapter.
3. Who Abuses and Neglects Adults?
Anyone can carry out abuse or neglect, including:
- spouses / partners;
- other family members;
- neighbours or friends;
- a paid or volunteer carer;
- local residents;
- people who deliberately exploit adults they perceive as vulnerable to abuse;
- paid staff or professionals;
- volunteers and strangers.
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 where an adult lives alone, or with others.
4. Principles of Adult Safeguarding
There are six principles which 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 inform the ways in which professionals and other staff work with adults. The principles can also help the Safeguarding Adults Board and partner organisations more widely, by using them to examine and improve their local arrangements.
Empowerment: People are supported and encouraged to make their own decisions and give informed consent. People should 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 place so they don’t 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 delivering support and representation for those in greatest need who may not be able to do it for 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. 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.”
5. Aims of Adult Safeguarding
The aims of adult safeguarding are to:
- prevent harm and reduce risk of abuse and neglect for those 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, ;
- 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 to help people understand abuse, how to stay safe and how to raise concerns;
- address the causes of abuse.
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 regulated providers comply with the fundamental standards of care or by taking enforcement action; and
- the core duties of the police to prevent and detect crime and protect life and property.
6. Making Safeguarding Personal
See also Making Safeguarding Personal chapter.
Making Safeguarding Personal is a person-centred approach that promotes a commitment to improving outcomes for adults experiencing, or at risk of, abuse or neglect. The key focus is recognising that people are experts in their own lives and that developing a real understanding of what people wish to achieve will give the person greater control over their lives.
It involves working with the adult (and their representatives) to determine how best their outcomes might be realised and regularly evaluating the extent of which desired outcomes have been met. This approach involves adults being encouraged to define their own meaningful improvements to change their circumstances and then to be involved throughout the safeguarding process, support planning and response.
Adults need to be encouraged to make their own decisions as far as practicably possible and are provided with support and information to empower them to do so. This approach recognises that adults have a general right to independence, choice and self-determination including control over information about themselves.
Making safeguarding personal It engages the adult in a conversation 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.
Staff should work to deliver effective safeguarding n line with the six principles of safeguarding (see Section 2, Principles). They should ensure that the adult has accessible information so that they can make informed choices about safeguarding: what it means, risks and benefits and possible consequences.
7. Personal Budgets and Personal Health Budgets
Regardless of the adult’s preferred method of managing a personal budget, the local authority retains its duty of care with regard to the adult and their protection from abuse. The Integrated Care Board (ICB) also has responsibilities around the provision of personal health budgets.
Personalised care planning can enhance good safeguarding practice, bringing in people’s own resources and intelligence. Through empowering adults, organisations can help raise awareness of what is acceptable and use information from adults and their families to identify potential problems with providers.
The kind of support available to adults managing their own care and support includes advice on:
- managing money;
- safer recruitment;
- safeguarding and dignity;
- what to expect from services and individuals;
- using approved or accredited providers of employment services;
- contractual issues;
- who to contact if things go wrong;
- guidance on mental capacity issues;
- guidance on deputyship and Lasting Power of Attorney.
8. Raising Awareness
Partners should plan regular public awareness campaigns as these can make a significant contribution to the prevention of abuse. Such campaigns are more effective when supported by information and advice about where to get help, and when there is effective training for staff and services to respond. See also Safeguarding Leaflets and Safeguarding Posters.
9. NHS England -Serious Incidents
The NHS England Serious Incident Framework should be read in conjunction with the Never Events Policy and Framework. The Serious Incident Framework is not a substitute for safeguarding. Where safeguarding is indicated a safeguarding referral must be made, however a root cause analysis under the Serious Incident Framework may be considered an appropriate response to a safeguarding enquiry.
Broadly speaking there are three scenarios:
- NHS identifies a safeguarding concern, for example through staff at Accident and Emergency seeing signs of physical abuse. This may warrant a safeguarding referral to the Local Authority but would not be routinely recorded as an SI.
- If there are allegations against healthcare staff within the provider of a service to adults, then a safeguarding referral and SI would need to be declared. Equally if there is patient against patient abuse.
- Lastly, there are incidents that are reported on STEIS that are not safeguarding issues, for example a pressure ulcer that was unavoidable (see the chapter on Pressure Areas and Safeguarding). Investigations will still be undertaken but without referral for a safeguarding. This is obviously dependent on the situation.