3.3 Responding to Signs of Abuse and Neglect

1. Introduction

Workers across a wide range of 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 adults 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 or agency 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 manger (see Managing Allegations against People in Positions of Trust).

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).

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. Alerting Managers

See also Stage 1: Alert

The alerting manager could be any manager, including a designated manager or lead, matron or care home manager.  The role and responsibility of the alerting manager is:

• to ensure the alleged victim is made safe and to preserve any evidence relating to the abuse;
• to ensure that any member of staff or volunteer who may have caused harm is not in contact with the alleged victim, other service users or others who may be at risk, or where relevant contact is appropriately monitored in order to manage risk (for example, whistle blowing);
• to ensure that safeguarding referrals are raised as appropriate;
• to ensure that appropriate information is provided in accordance with local policy guidance and time frames.

The primary responsibility for coordinating information in response to a safeguarding adult concerns lies with the lead agency i.e. the local authority. However the local authority can delegate parts of the enquiry to other organisations whilst retaining overall responsibility for leading this (see also Thresholds).

All managers should ensure that they:

• make staff aware of their duty to report any allegations or suspicions of abuse to their line manager, or if the line manager is implicated, to another responsible person or to the local authority, and the procedure for doing so;
• meet their legal responsibilities and the Care Quality Commission Fundamental Standards, DBS and ensure compliance with registration, outcomes and guidance on compliance, quality, safeguarding and safety standards;
• operate safe recruitment practices and routinely take up and check references;
• adhere to and operate within their own organisation’s ‘whistleblowing’ policy and support staff who raise concerns;
• ensure all staff receive training in safeguarding adults consistent with their job roles and responsibilities.

Managers have a responsibility for making checks on and referring staff and volunteers who have been found to have harmed an adult or put an adult at risk of harm.

Managers in health settings should report concerns as a ‘serious incident requiring investigation’ (SIRI), in line with clinical governance procedures, and a decision must be made whether the circumstances meet the criteria for referral to the safeguarding adults process in line with these multi-agency safeguarding policy and procedures.

Alerts relating to abuse / neglect in respect of other NHS staff / settings should be raised with the lead agency in the normal way (see Stage 1: Alert).

Managing officers should also be aware of their responsibility to consider a case for referring up to the appropriate Safeguarding Adults Board Safeguarding Adult Review Group if an adult has:

• died (including suicide) and abuse or neglect is known or suspected to be a factor;
• sustained a serious or life threatening injury or permanent impairment and abuse or neglect is known or suspected to be a factor;
• there is in addition cause for concern about the way in which organisations and professionals involved in the case have worked together to safeguard and promote the welfare of the adult.

See:

• Leicester Safeguarding Adults Board;
• Leicestershire and Rutland Safeguarding Adults Board.

4. 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 (see Section 1: Alert).

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 and Adult Safeguarding).

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 Information Sharing and Record Keeping). 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 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.