3.1 Raising Concerns

1. Introduction

It is the responsibility of all staff to act on any concerns or evidence of abuse and neglect and to pass this to either the Safeguarding Adults Lead in their organisation or to the local authority Safeguarding Adults Team.

Staff working in a range of different organisations need to be vigilant for adult safeguarding concerns. This includes people working in health and social care, policing, banking, fire and rescue services, trading standards, leisure services, faith groups, the voluntary sector / charities and housing.

GPs and other primary care staff are 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 their neighbour has not collected the milk from their doorstep for two days.

Findings from Safeguarding Adult Reviews have repeatedly found that if practitioners or other staff had been more professionally curious, had acted on their concerns or sought more information, then death or serious harm might have been prevented.

2. Sharing Concerns

Anyone can witness or become aware of information which suggests that abuse or neglect is taking place. 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 shared during a needs assessment.  Signs of abuse or neglect can include:

• an adult who looks dirty or who is not dressed properly;
• an adult who seems frightened or withdrawn around certain people;
• an adult with injuries such as bruises, fractures or other wounds;
• an adult who finds money has gone missing.

Regardless of how the safeguarding concern is identified, it is important that all staff 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 themselves safe;
• knowing who to tell about concerns of abuse or neglect; and
• supporting adults to think about and weigh up the risks and benefits of different options when exercising choice and control.

3. Deciding Whether to Raise a Concern

Concerns should be raised whenever there is a reasonable belief that first 2 criteria of the safeguarding duty apply:

1. The adult has need for Care and Support (regardless of whether these have been assessed or are being met by the local authority); and
2. They are experiencing, or at risk of experiencing abuse or neglect.

This is in accordance with guidance included in Understanding what constitutes a safeguarding concern and how to support effective outcomes (Local Government Association).

Before reporting the concern, consider the following checklist (not all will be possible / appropriate):

• Have you taken steps to keep the adult safe?
• Have you discussed your concerns with the adult?
• Have you sought consent from the adult to report a safeguarding concern?
• Have you discussed possible outcomes with the adult? Have you asked them what they would like to happen?
• Does the adult have mental capacity to understand that a safeguarding concern will be raised – and what this process means?
• Have you thought about who you need to share the concern with immediately?

3.1 Professionals Reporting Concerns

Each organisation will their own processes that should staff should follow if they have a safeguarding adults concern. This may involve staff sharing concerns with a line manager or safeguarding adults lead, or contacting the local authority safeguarding adults team directly.

Where there are concerns about the behaviour of a member of staff the Framework for the Management of Allegations against People in Positions of Trust (PiPoT) should be followed.

Where the concerns relate to an adult 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.

4. Local Authority Response

After receiving information about possible abuse or neglect of an adult, the local authority may decide to undertake a safeguarding enquiry.

The response required will depend on the circumstances. 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, resulting in the the risk of harm (from pressure ulcers, falls or medical errors etc).  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, not a formal safeguarding enquiry (see also Carers and Adult Safeguarding). Agencies may also initiate internal enquiries, as steps will be needed to improve the care being provided, this could include a clinical audit of practice and a review of care needs.

However, the main focus must always be how to best safeguard the adult. Where the safeguarding concerns arise from abuse or neglect deliberately intended to cause harm, immediate steps should be taken to protect the adult. The matter may also need to be referred 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 can be physical, verbal or psychological, and involve an act of neglect or an omission to act. If a staff member has concerns but is uncertain about the next steps, they should speak to their manager or the safeguarding adults team for advice.

The nature and timing of the intervention and who is best placed to lead will be, in part, determined by the circumstances.

Early sharing of information is the key to providing an effective response where there are emerging concerns (see Information Sharing and Confidentiality). To ensure effective adults are safeguarded:

• all organisations must have arrangements in place which set out clearly the processes and the principles for sharing information where there are concerns of abuse or neglect;
• 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.