5.2 Stage 1: Concerns

1. What is an Adult Safeguarding Concern?

An adult safeguarding concern is any worry about an adult who has or appears to have care and support needs that they may be subject to, or may be at risk of, abuse and neglect and may be unable to protect themselves against this.

It is the responsibility of all staff (practitioners 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 across a wide range of agencies need to be vigilant about adult safeguarding concerns and act appropriately when dealing with such concerns.

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 would be failing in this duty if they failed to do so.

A concern may be raised by anyone, and can be:

• an active disclosure of abuse by the adult, where the adult tells another person that they are experiencing abuse and / or neglect or believes they are at risk of 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 member, friend or neighbour who have observed abuse or neglect or has been told by the adult;
• a complaint or concern raised by an adult or a 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;
• patterns of concerns or risks that emerge through reviews, audits and complaints or regulatory inspections or monitoring visits (Care Quality Commission, NHS England etc).

Concerns can be raised in person by contacting the South Tyneside Let’s Talk Team (see Local Contacts). Professionals, however, should submit referrals using the Multi Agency Safeguarding Adults Referral Form (see Forms, Leaflets and Posters).

Concerns may also be raised through other locally agreed specific organisation processes. For example, Adult Concern Notifications (ACN) are reports completed by operational police officers and sent to the local authority where there are concerns about people who may be adults at risk, whether they are a victim, witness, suspect or member of the public. The police will make a decision about whether to refer to the local authority using their own operational toolkit. Some concerns may not sit under adult safeguarding processes, but remain concerns that may require other action. All concerns should be responded to, and SABs should be satisfied that concerns are being addressed appropriately through their oversight of safeguarding practice.

2. Involving the Police

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.

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

Staff contact with the police will fall mainly into four main areas:

1. reporting a crime – if an individual witnesses a crime, they have a duty to report it to the police;
2. third party reporting of a crime – if an individual is made aware of a crime, they should support the adult to report to the police, or make a best interest decision to do so. In domestic abuse situations practitioners should be aware of the principles of ‘safe enquiries’;
3. consultation with the police – seeking advice;
4. sharing intelligence and managing risk.

Where the safeguarding concerns arise from abuse or neglect deliberately intended to cause harm, then it will not only be necessary to immediately consider what steps are needed to protect the adult but also how best to report as a possible crime. Early engagement with the police is vital to support the criminal investigation.

3. Action by other Professionals

4. Decision Making: Pre-Referral to the Local Authority

The safeguarding lead in the service / organisation will usually lead on decision making. Where such support is unavailable, consultation with other more senior staff should take place. In the event that this is not possible, advice should be sought from South Tyneside Let’s Talk Team (see Local Contacts).

Staff should take action 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 seek their views. If the adult does not want to pursue matters through formal safeguarding action overseen by the local authority, 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, 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 to others is necessary, lack of consent to information sharing can also be overridden (see the chapter on Consent in relation to Safeguarding).

In the event that people lack the capacity to provide consent, action should be taken in line with the Mental Capacity Act 2005. Where a possible crime has been committed the adult should always be encouraged to report the matter to the police. Professionals, however, also have a duty to report the matter to the police.

5. Referral to the Local Authority

South Tyneside Safeguarding Adults Procedures, Summary of Stages

South Tyneside Safeguarding Adults Process Flowchart

If, on the basis of the information available, it appears that the following three steps are met a referral must be made to the local authority.

Referrals from professionals should be made using the Multi Agency Safeguarding Adults Referral Form (see Forms, Leaflets and Posters).

5.1 Information the referral should contain

• Organisations that refer to the local authority should include the following information:
• demographic and contact details for the adult, the person who raised the concern and for any other relevant individual, specifically carers and family / advocate;
• basic facts, focussing on whether or not the person has care and support needs including communication and ongoing health needs;
• factual details of what the concern is about – what, when, who, where;
• immediate risks and action taken to address risk;
• preferred method of communication;
• if reported as a crime – details of which police station / officer, crime reference number etc;
• whether the adult has  care and support needs which may impede their ability to protect themselves;
• any information on the person alleged to have caused harm;
• wishes and views of the adult with desired outcomes;
• capacity to consent to the referral;
• consent to the referral;
• advocacy involvement (includes family / friends);
• information from other relevant organisations for example, CQC;
• any recent history (if known) about previous concerns of a similar nature or concerns raised about the same person, or someone within the same household.