STAGE 1: CONCERNS

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.

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 have observed abuse or neglect or have been told of it by the adult; 
  • A complaint or concern raised by an adult or a third party who doesn't 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 at risk;
  • 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 (CQC, Monitor etc.).

Concerns can be raised in a variety of ways.

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.

 Police Engagement

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

A. Reporting a crime – if an individual witnesses a crime, they have a duty to report it to the police;

B. Third party reporting of a crime – if an individual is made aware of a crime, they should support the adult at risk to report to the police, or make a best interest decision to do so (refer to Mental Capacity Act section 3.1). In domestic abuse situations practitioners should be aware of the principles of ‘Safe Enquires’ (see adult safeguarding and domestic abuse);

C. Consultation with the police – seeking advice;

D. Sharing intelligence and managing risk – where there is an integrated MASH, this will be the channel for information sharing, in addition to agreed information sharing protocols.

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.

PRIOR TO RAISING A CONCERN WITH THE LOCAL AUTHORITY:

IMMEDIATE ACTION BY THE PERSON RAISING THE CONCERN

The person who raises the concern has a responsibility to first and foremost safeguard the adult at risk:

  1. Make an evaluation of the risk and take steps to ensure that the adult is in no immediate danger;
  2. Arrange any medical treatment. (Note that offences of a sexual nature will require expert advice from the police);
  3. If a crime is in progress or life is at risk, dial emergency services – 999;
  4. Encourage and support the adult to report the matter to the police if a crime is suspected and not an emergency situation - 101;
  5. Take steps to preserve any physical evidence if a crime may have been committed, and preserve evidence through recording;
  6. Ensure that other people are not in danger;
  7. If you are a paid employee, inform your manager. Report the matter internally through your internal agency reporting procedures (e.g. NHS colleagues may still need to report under clinical governance or serious incident processes.) Report to HR department if an employee is the source of risk;
  8. Record the information received, risk evaluation and all actions.
THE SAFEGUARDING MANAGER/LEAD SHOULD REVIEW ACTION TAKEN, AND:
  1. Clarify that the adult at risk is safe, that their views have been clearly sought and recorded and that they are aware what action will be taken;
  2. Address any gaps;
  3. Check that issues of consent and mental capacity have been addressed;
  4. In the event that a person’s wishes are being overridden, check that this is appropriate and that the adult understands why;
  5. Contact the children and families department if a child or young person is also at risk;
  6. If the person allegedly causing the harm is also an adult at risk arrange appropriate care and support;
  7. Make sure action is taken to safeguard other people;
  8. Take any action in line with disciplinary procedures, including whether it is appropriate to suspend staff or move them to alternative duties;
  9. If your service is registered with the Care Quality Commission, and the incident constitutes a notifiable event, complete and send a notification to CQC;
  10. In addition, if a criminal offence has occurred or may occur, contact the police force where the crime has / may occur;
  11. Preserve forensic evidence and consider a referral to specialist services;
  12. Make a referral under Prevent if appropriate;
  13. Consider if the case should be put forward for a SAR;
  14. Record the information received and all actions and decisions.

Considerations prior to raising a concern with the Local Authority

The organisation’s safeguarding representative or lead will usually lead on decision making. Where such support is unavailable, consultation with other more senior staff should take place. In the event that these are unavailable, seeking the advice of the Local Authority should be considered.

Staff should also 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 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 at risk does not want to pursue a referral to the Local Authority. It is best practice to gain the adult’s consent but when this cannot be gained, the concern can still be raised where necessary. Be specific about the adult’s views. 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 adult may be overridden. Where the sharing of information to prevent harm is necessary, lack of consent to information sharing can also be overridden. For further information, refer to Berkshire’s Information Sharing Protocol and Appendix 2 Information Governance.

In the event that people lack the capacity to provide consent, action should be taken in line with the Mental Capacity Act 2005. (See Section 3.1). Where a possible crime has been committed people should always be encouraged to report the matter to the police.

Some local areas may have a Threshold Guidance Document for practitioners to refer to.

GOOD PRACTICE GUIDANCE – DISCLOSURE
  • Speak in a private and safe place
  • Accept what the person is saying.
  • Don’t ‘interview’ the adult or person disclosing the concern.
  • Ask them what they would like to happen and what they would like you to do.
  • Don’t promise the adult or person that you’ll keep what they tell you confidential; explain who you will tell and why.
  • If there are grounds to override a adult's or 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.
  • Make a best interest decision about the risks and protection needed if the person is unable to provide informed consent, in line with the Mental Capacity Act.

Establish 

  • The risks and what immediate steps to take.
  • Communication needs, whether an interpreter or other support is needed.
  • Whether it is likely that advocacy may be required. 
  • Personal care and support arrangements.
  • Mental capacity to make decisions about whether the adult is able to protect themselves and understand the safeguarding process.
CONCERNS CHECKLIST
  • Safety of adult and others made
  • Initial conversation held with the adult
  • Emergency services contacted and recorded
  • Medical treatment sought
  • Consent sought
  • Mental Capacity considered
  • Best Interest Decisions made and recorded
  • Public and vital interest considered and recorded
  • Police report made
  • Evidence preserved
  • Referrals to specialist agencies
  • Referral to children services if there are children and young people safeguarding matters
  • Referral to adult services if another adult with care and support needs are impacted
  • Action taken to remove/reduce risk where possible and recorded
  • Recorded clear rationales for decision making
  • Referral to Local Authority included relevant information.

Referral to the Local Authority

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.

 

Information the referral might contain

Organisations that refer to the Local Authority should include the following information:

  • Demographic and contact details for the adult at risk, the person who raised the concern and for any other relevant individual, specifically carers and next of kin; 
  • Basic facts, focussing on whether or not the person has care and support needs including communication and on-going 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 at risk has any cognitive impairment which may impede their ability to protect themselves; 
  • Any information on the person alleged to have caused harm; 
  • Wishes and views of the adult at risk, in particular consent;
  • Advocacy involvement (includes family/friends);
  • Information from other relevant organisations for example, the Care Quality Commission; 
  • 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.