April 2017: Section 5, Exploitation by Radicalisers who Promote Violence has been updated to include information about Prevent, and local contact details for reporting concerns and a new Section 17, Ill Treatment and Wilful Neglect has been added.
‘Honour’ based violence is a crime, and referring to the police must always be considered. It has or may have been committed when families feel that dishonour has been brought to them. Women are predominantly (but not exclusively) the victims and the violence is often committed with a degree of collusion from family members and/or the community.
Many 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.
Referrals that may indicate honour-based violence include domestic abuse and violence, concerns about forced marriage, enforced house arrest and missing person’s reports. If a concern is raised through a safeguarding adults referral, and there is a suspicion that the adult is the victim of honour based violence, referring to the police must always be considered as they have the necessary expertise to manage the risk.
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 (FGMA) was introduced in 2003 and came into effect in March 2004. The Act 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. It also makes it illegal to aid, abet, counsel or procure the carrying out of FGM abroad.
In relation to adults NHS England states: ‘There is no requirement for automatic referral of adult women with FGM to adult social services or the police. Healthcare professionals should be aware that a disclosure may be the first time that a woman has discussed her FGM with anyone. Referral to the police must not be introduced as an automatic response when identifying adult women with FGM, and each case must continue to be individually assessed. The healthcare professional should seek to support women by offering referral to community groups for support, clinical intervention or other services as appropriate, for example through an NHS FGM clinic. The wishes of the woman must be respected at all times. If she is pregnant, the welfare of her unborn child or others in her extended family must also be considered at this point as they are potentially at risk and action must be taken accordingly.’
The NHS link above also includes information about the mandatory reporting programme for all cases of FGM. It is now mandatory to record FGM in a patient’s healthcare record and submit anonymised monthly data to the Department of Health.
Forced marriage is a term used to describe a marriage in which one or both of the parties is 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 their parents or 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 safeguarding adults process. In this case action will be coordinated with the police and other relevant organisations.
The police must always be contacted in such cases as urgent action may need to be taken.
Human trafficking involves an act of recruiting, transporting, transferring, harbouring or receiving a person through a use of force, coercion or other means, for the purpose of exploiting them.
If an identified victim of human trafficking is also an adult who is experiencing or at risk of abuse or neglect, the response will be coordinated under the safeguarding adults process. The police are the lead agency in managing responses to adults who are the victims of human trafficking.
There is a national framework to assist in the formal identification and help to coordinate the referral of victims to appropriate services, known as the National Referral Mechanism.
Staff with concerns should contact Leicestershire Police via 101.
See also Prevent Strategy, HM Government (2011).
Individuals may be susceptible to recruitment into violent extremism by radicalisers. Violent extremists often use a persuasive rationale and charismatic individuals to attract people to their cause. The aim is to attract people to their reasoning, inspire new recruits, embed their extreme views and persuade vulnerable individuals of the legitimacy of their cause. The Home Office leads on the anti-terrorism strategy.
Prevent is about safeguarding people and communities from the threat of terrorism. At the heart of Prevent is safeguarding children and adults and providing early intervention to protect and divert people away from being drawn into terrorist activity.
If you have any concerns please call 101 and ask for Prevent Team. This will take the caller through to the Police’s Prevent team who can make an initial assessment of the details.
Where the person causing the harm is also an adult who is experiencing or at risk of abuse or neglect, the safety of the person who may have been abused is paramount. Organisations may also have responsibilities towards the person causing the harm, and certainly will have if they are both in a care setting or have contact because they attend the same place (for example, a day centre). In this situation it is important that the needs of the adult who is the alleged victim are addressed separately from the needs of the person allegedly causing harm.
It may be necessary to reassess the adult allegedly causing the harm. This will involve a meeting where the following could be addressed:
The principles and responsibilities of reporting a crime apply regardless of whether the person causing harm is deemed to be an adult.
Increasingly people are deciding to use less traditional ways of having their eligible social care and health care needs met. Many are taking the opportunity to exercise greater choice and control over what kinds of services they receive, who provides them and the way in which they are delivered. This revolution brings with it opportunities and challenges from the perspective of risk enablement and safeguarding.
Regardless of the person’s preferred method of managing a personal budget (for example, council managed account, direct payment, individual service account or a combination of these), the local authority still retains its duty of care with regard to the person and their protection from abuse. However, the balance of power and consequently how risk is managed can be significantly different from previous, traditional, models of social care management. This model is more about the co-production of risk enablement, with the person having a greater say and therefore greater control over how risk is managed. This is therefore an inherently less risk averse arrangement than before.
Throughout the process, from self-assessment (supported or otherwise) through to personal budget setting, arranging direct payments or other personal budget management arrangements, to final sign off of a care and support plan, appropriate risk assessment should be taking place with the individual and their supporters.
At the various key stages in the process, risk and safety should be considered.
In this arrangement people using personal budgets, to a greater or lesser degree, are the commissioners of their own services, particularly where they are using direct payments to manage them.
Different arrangements exist to support people through the process of setting up a care and support package. In some areas this may be the responsibility of local authority adult social care staff, independent brokerage services or user led organisations (ULOs). The kinds of support available may include:
It should be remembered that, where someone has capacity to make their own decisions in these matters, they may choose not to seek or use such advice or support services. This does not necessarily have a detrimental impact on the legality or safety of the support plan.
People with personal budgets and care and support plans which utilise direct payments are subject to the same reviewing arrangements as those in receipt other services (that is a minimum of once per year).
People who fund their own care arrangements (also known as self-funders) are legally entitled to receive support if subject to abuse or neglect in exactly the same way as those supported or funded by the local authority.
A hate crime is any criminal offence that is motivated by hostility or prejudice based upon the victim’s:
Hate crime can take many forms including:
See also local information about reporting hated crime:
The purpose of the Multi-Agency Public Protection Arrangements (MAPPA) framework is to reduce the risks posed by sexual and violent offenders in order to protect the public, including previous victims, from serious harm. The responsible authorities in respect of MAPPA are the police, prison and probation services who have a duty to ensure that MAPPA is established in each of their geographic areas and to undertake the risk assessment and management of all identified MAPPA offenders (primarily violent offenders on licence or mental health orders and all registered sex offenders).
The police, prison and probation services have a clear statutory duty to share information for MAPPA purposes (see also Information Sharing).
Other organisations have a duty to cooperate with the responsible authority, including the sharing of information. These include:
Local authority statutory adult safeguarding duties apply equally to those adults with care and support needs regardless of whether those needs are being met, regardless of whether the adult lacks mental capacity or not, and regardless of setting, other than prisons and approved premises where prison governors and National Offender Management Service (NOMS) respectively have responsibility. Senior representatives of those services may sit on the Safeguarding Adult Board.
There is a clear difference between unintentional harm caused inadvertently and a deliberate act of either harm or omission. However contact must be made with the police if a crime has been or may be committed
In cases where unintentional harm has occurred this may be due to lack of knowledge or due to the fact that the carer’s own physical or mental needs make them unable to care adequately for the adult. The carer may also be an adult experiencing or at risk of abuse or neglect. In this situation the aim of safeguarding adults work will be to help the carer to provide support and make changes in their behaviour in order to decrease the risk of further harm to the person they are caring for.
A carer’s assessment should follow the legal requirements of the Care Act 2014 and also take into account the following factors:
When a complaint or allegation has been made against a member of staff, including people employed by the adult, they should be made aware of their rights under employment legislation and any internal disciplinary procedures.
When the person who is alleged to have carried out the abuse themselves has care and support needs and is unable to understand the significance of questions put to them or their replies, they should be assured of their right to the support of an ‘appropriate’ adult if they are questioned in relation to a suspected crime by the police under the Police and Criminal Evidence Act 1984 (PACE). Victims of crime and witnesses may also require the support of an ‘appropriate adult’.
Under the Mental Capacity Act 2005, people who lack capacity and are alleged to be responsible for abuse, are entitled to the help of an Independent Mental Capacity Advocate, to support and represent them in the enquiries that are taking place, This is separate from the decision whether or not to provide the victim of abuse with an Independent Advocate under the Care Act.
The police and Crown Prosecution Service should agree procedures with the local authority, care providers, housing providers, and the NHS / clinical commissioning group to cover the following situations:
Employers who are also providers or commissioners of care and support not only have a duty to the adult, but also a responsibility to take action in relation to the employee when allegations of abuse are made against them. Employers should ensure that their disciplinary procedures are compatible with the responsibility to protect adults who are experiencing or at risk of abuse or neglect.
With regard to abuse, neglect and misconduct within a professional relationship, codes of professional conduct and / or employment contracts should be followed and should determine the action that can be taken. Robust employment practices, with checkable references and recent Disclosure and Barring Service (DBS) checks. Reports of abuse, neglect and misconduct should be investigated and evidence collected.
Where appropriate, employers should report workers to the statutory and other bodies responsible for professional regulation such as the General Medical Council and the Nursing and Midwifery Council. If someone is removed from their role providing regulated activity following a safeguarding incident the provider has a legal duty to refer to the DBS. The DBS must also be informed if the person leaves their role to avoid a disciplinary hearing following a safeguarding incident and the employer feels they would have dismissed the person based on the information provided. It is a legal duty to make a safeguarding referral to DBS if a person is dismissed or removed from their role due to harm to a child or a vulnerable adult.
If a child/ren is causing harm to an adult, this should be dealt with under the safeguarding adults policy and procedures, but will also need to involve the local authority children’s services. Click on the links below to view contact details for child protection referrals to each local authority:
The Children Act (CA) 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.
Everyone must be aware that in situations where there is a concern that an adult is experiencing or at risk of abuse or neglect and there are children in the same household, they too could be at risk. Reference should be made to the local child protection procedures, the Leicester, Leicestershire and Rutland Safeguarding Children Board Procedures and internal protocols dealing with cross boundary working if there are concerns about abuse or neglect of children and young people under the age of 18. Referral must be made to the relevant children and families department.
Robust joint working arrangements between children’s and adults’ services should be in place to ensure that the medical, psychosocial and vocational needs of children leaving care are assessed as they move into adulthood and begin to require support from adult services.
The care needs of the young person should be at the forefront of any support planning and require a coordinated multiagency approach. Assessments of care needs at this stage should include issues of safeguarding and risk. Care planning needs to ensure that the young adult’s safety is not put at risk through delays in providing the services they need to maintain their independence, wellbeing and choice.
The MCA 2005 applies to young people aged 16 years and over apart from the following aspects:
See also Does my child have the right to refuse treatment? This provides information on decisions to refuse treatment made in advance by young people under the age of 18 by NHS Choices.
Under Section 20 of the Criminal Justice and Courts Act 2015 it is a criminal offence for an individual to ill treat or wilfully neglect another individual of whom s/he has the care by virtue of being a care worker. A “care worker” is defined as anyone who, as paid work, provides social care for adults or health care for children or adults. The ‘wilful’ element of the neglect offence suggests that the perpetrator has acted deliberately or recklessly. Similarly, ‘ill-treatment’ is a deliberate act, where the individual recognised that s/he was inexcusably ill treating a person, or else was being reckless as to whether s/he was doing so. Genuine errors or accidents by an individual would therefore not be caught within the scope of this offence.
Under this legislation a ‘care worker’ means an individual, who, as paid work, provides health care, social care, or a director or similar officer of an organisation that provides such care.
Paid work is when a person receives or is entitled to receive payment for carrying out care. This does not include:
Health care provision includes all forms of health care provided for individuals relating to physical health or mental health. This also relates to health care provided for or in connection with the protection or improvement of public health, and procedures that are similar to forms of medical or surgical care but are not provided in connection with medical conditions which are classed as “excluded health care” as described in Schedule 4 of the Criminal Justice and Courts Act.
Social care provision includes all forms of personal care, physical support and other practical assistance provided for individuals who are in need of such care or assistance by reason of age, illness, disability, pregnancy, childbirth, dependence on alcohol or drugs or any other similar circumstances. This would not include a person whose provision of such care is merely incidental to the carrying out of other activities by the person.
An individual found guilty of an offence under this section is liable— on conviction on indictment, to imprisonment for a term not exceeding 5 years or a fine (or both); or on a summary conviction, to imprisonment for a term not exceeding 12 months or a fine (or both).
The term ‘care provider’ means:
A care provider commits an offence if:
Relevant duty of care means a duty owed under the law of negligence, or a duty that would be owed under the law of negligence but for a provision contained in an Act, or an instrument made under an Act, under which liability is imposed in place of liability under the law of negligence, but only to the extent that the duty is owed in connection with providing, or arranging for the provision of, health care or social care.
A person arranging for the provisions of such care do not include a person who makes arrangements under which the provision of such care is merely incidental to the carrying out of other activities.
A breach of a duty of care by a care provider is a ‘gross’ breach if the conduct alleged to amount to the breach falls far below what can reasonably be expected of the care provider in the circumstances.
References made to providing or arranging for the provision of health care or social care do not include making payments under:
(a) regulations under section 57 of the Health and Social Care Act 2001 (direct payments for community services and carers);
(b) section 12A of the National Health Act 2006 (direct payments for health care);
(c) section 31 or 32 of the Care Act 2014 (direct payments for care and support).
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