April 2020: Coronavirus Act 2020

See also Coronavirus Act 2020 chapter

Safeguarding adults remains the duty of the local authority, to keep the most vulnerable safe from abuse or neglect. The Coronavirus Act 2020 does not affect that duty. It is vital that the local authority continues to offer the same level of safeguarding oversight and application of Section 42 of the Care Act. It is likely that the number of safeguarding concerns may increase over this period and so it is also important that safeguarding teams are proportionate in their responses and aware of the pressure social care providers are likely to be under. See Annex D, Safeguarding Guidance, Care Act easements: guidance for local authorities (Department of Health and Social Care).

1. What is Adult Safeguarding?

Safeguarding means protecting an adult’s right to live in safety, free from abuse and neglect. It is about people and organisations working together to prevent and stop both the risks and experience of abuse or neglect, while at the same time making sure that the adult’s wellbeing is promoted including, where appropriate, having regard to their views, wishes, feelings and beliefs in deciding on any action. This must recognise that adults sometimes have complex interpersonal relationships and may be ambivalent, unclear or unrealistic about their personal circumstances.

Organisations should always promote the adult’s wellbeing in their safeguarding arrangements. Professionals should work with the adult to establish what being safe means to the adult concerned and how that can be best achieved. Professionals and other staff should not be advocating ‘safety’ measures that do not take account of individual wellbeing (see Promoting Wellbeing).

The aims of adult safeguarding are to:

  • prevent harm and reduce the risk of abuse or neglect to adults with care and support needs;
  • stop abuse or neglect wherever possible;
  • safeguard adults in a way that supports them in making choices and having control about how they want to live;
  • promote an approach that concentrates on improving life for the adults concerned;
  • raise public awareness so that communities as a whole, alongside professionals, play their part in preventing, identifying and responding to abuse and neglect;
  • provide information and support in accessible ways to help people understand the different types of abuse, how to stay safe and what to do to raise a concern about the safety or wellbeing of an adult;
  • address what has caused the abuse or neglect.

In order to achieve these aims, it is necessary to:

  • ensure that everyone, both individuals and organisations, are clear about their roles and responsibilities;
  • create strong multi-agency partnerships that provide timely and effective prevention of and responses to abuse or neglect;
  • support the development of a positive learning environment across these partnerships and at all levels within them to help break down cultures that are risk averse and seek to scapegoat or blame practitioners;
  • enable access to mainstream community resources such as accessible leisure facilities, safe town centres and community groups that can reduce the social and physical isolation which in itself may increase the risk of abuse or neglect;
  • clarify how responses to safeguarding concerns deriving from the poor quality and inadequacy of service provision, including patient safety in the health sector, should be responded to.

2. The Safeguarding Duty

Safeguarding duties apply to an adult who:

  • has needs for care and support (whether or not the local authority is meeting any of those needs);
  • is experiencing, or at risk of, abuse or neglect;
  • as a result of those care and support needs is unable to protect themselves from either the risk of, or the experience of abuse or neglect.

The adult experiencing, or at risk of abuse or neglect will be referred to as ‘the adult’ throughout this chapter.

The local authority and other organisations such as the NHS and the police, have legal responsibilities in relation to adult safeguarding. All practitioners and agencies have a duty, however, to safeguard adults with care and support needs and report any concerns they may have (see Taking Initial Action where there are Safeguarding Concerns).

2.1 Safeguarding responsibilities of the service

According to the statutory regulations, by which the service must operate as a provider, the safeguarding responsibilities are clear:

  1. To put in place and operate effectively systems and process to help ensure children and adults who use services are safeguarded from the risk of or actual abuse and neglect
  2. To provide levels and a quality of service that meet all the requirements of the relevant safeguarding regulatory framework for the service they provide
  3. To remedy any shortcomings found in safeguarding practice in their service to help reduce risks to people who use the service
  4. To learn and apply learning from any safeguarding incident to help strengthen safeguarding in the future
  5. To notify local authorities of safeguarding issues that arise in their service
  6. To notify CQC of safeguarding incidents in accordance with regulations e.g. on notifications
  7. To co-operate with safeguarding enquiries (CQC, 2016: p8)

3. Key Principles underpinning all Adult Safeguarding Work

The following six principles apply to all sectors and settings including care and support services. The principles should underpin all work with adults.

3.1 The six principles

Empowerment

  • People being supported and encouraged to make their own decisions and informed consent.
  • I am asked what I want as the outcomes from the safeguarding process and these directly inform what happens.

Prevention

  • It is better to take action before harm occurs.
  • I receive clear and simple information about what abuse is, how to recognise the signs and what I can do to seek help.

Proportionality

  • The least intrusive response appropriate to the risk presented.
  • I am sure that the professionals will work in my interest, as I see them and they will only get involved as much as needed.

Protection

  • Support and representation for those in greatest need.
  • I get help and support to report abuse and neglect. I get help so that I am able to take part in the safeguarding process to the extent to which I want.

Partnership

  • Local solutions through services working with their communities. Communities have a part to play in preventing, detecting and reporting neglect and abuse.
  • I know that staff treat any personal and sensitive information in confidence, only sharing what is helpful and necessary. I am confident that professionals will work together and with me to get the best result for me.

Accountability

  • Accountability and transparency in delivering safeguarding.
  • I understand the role of everyone involved in my life and so do they.

See also Making Safeguarding Personal

4. What is Abuse and Neglect?

This section outlines the different types and patterns of abuse and neglect and the different circumstances in which they may take place. This is not a complete list but is a guide to the sort of behaviour which could be a safeguarding concern. See also Safeguarding Case Studies.

4.1 Physical abuse

This includes:

  • assault;
  • hitting;
  • slapping;
  • pushing;
  • misuse of medication;
  • restraint;
  • inappropriate physical sanctions.

4.2 Domestic violence and abuse

This includes:

  • psychological;
  • physical;
  • sexual;
  • financial;
  • emotional abuse;
  • controlling, coercive or threatening behaviour;
  • so called ‘honour’ based violence.

4.3 Sexual abuse

This includes:

  • rape;
  • indecent exposure;
  • sexual harassment;
  • inappropriate looking or touching;
  • sexual teasing or innuendo;
  • sexual photography;
  • subjection to pornography or witnessing sexual acts;
  • indecent exposure;
  • sexual assault;
  • sexual acts to which the adult has not consented or was pressured into consenting.

4.4 Psychological abuse

This includes:

  • emotional abuse;
  • threats of harm or abandonment;
  • deprivation of contact;
  • humiliation;
  • blaming;
  • controlling;
  • intimidation;
  • coercion;
  • harassment;
  • verbal abuse;
  • cyber bullying;
  • isolation;
  • unreasonable and unjustified withdrawal of services or supportive networks.

4.5 Financial or material abuse

This includes:

  • theft;
  • fraud;
  • internet scamming;
  • coercion in relation to an adult’s financial affairs or arrangements, including in connection with wills, property, inheritance or financial transactions;
  • the misuse or misappropriation of property, possessions or benefits.

See also Friends Against Scams website (National Trading Standards).

4.6 Modern slavery

This includes:

  • slavery;
  • human trafficking;
  • forced labour and domestic servitude;
  • traffickers and slave masters using whatever means they have at their disposal to coerce, deceive and force individuals into a life of abuse, servitude and inhumane treatment.

4.7 Discriminatory abuse

This includes forms of:

  • harassment;
  • slurs or similar treatment:
    • because of race;
    • gender and gender identity;
    • age;
    • disability;
    • sexual orientation;
    • religion.

Also see Discrimination: Your Rights for further information.

4.8 Organisational abuse

This includes neglect and poor care practice within an institution or specific care setting such as a hospital or care home,  or care provided in one’s own home. This may range from one off incidents to ongoing ill treatment. It can be through neglect or poor professional practice as a result of the structure, policies, processes and practices within an organisation.

4.9 Neglect and acts of omission

This includes:

  • ignoring medical, emotional or physical care needs;
  • failure to provide access to appropriate health, care and support or educational services;
  • the withholding of the necessities of life, such as medication, adequate nutrition and heating.

4.10 Self-neglect

See also Self-Neglect.

This covers a wide range of behaviour neglecting to care for one’s personal hygiene, health or surroundings and includes behaviour such as hoarding. Self-neglect may not prompt a section 42 enquiry.

5. Patterns of Abuse

Incidents of abuse may be one off or multiple, and affect one person or more. Staff should look beyond single incidents or individuals to identify patterns of harm. Repeated instances of poor care may be an indication of more serious problems and of what is described as organisational abuse. In order to see these patterns it is important that information is recorded and appropriately shared.

Patterns of abuse vary and include:

  • serial abuse, in which the perpetrator seeks out and ‘grooms’ individuals. Sexual abuse sometimes falls into this pattern as do some forms of financial abuse;
  • long term abuse, in the context of an ongoing family relationship such as domestic violence between spouses or generations or persistent psychological abuse;
  • opportunistic abuse, such as theft occurring because money or jewellery has been left lying around.

5.1 Domestic violence and abuse

The definition of domestic abuse is any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence or abuse between those aged 16 or over who are, or have been, intimate partners or family members regardless of gender or sexuality. The abuse can encompass, but is not limited to:

  • psychological;
  • physical;
  • sexual;
  • financial;
  • emotional.

An offence of coercive and controlling behaviour in intimate and familial relationships was introduced into the Serious Crime Act 2015.

5.2 Financial abuse

Financial abuse is the main form of abuse investigated by the Office of the Public Guardian both amongst adults and children at risk. Financial abuse can occur in isolation, but as research has shown, where there are other forms of abuse financial abuse is likely to occur. Although this is not always the case, everyone should also be aware of this possibility.

Potential indicators of financial abuse include:

  • change in living conditions;
  • lack of heating, clothing or food;
  • inability to pay bills/unexplained shortage of money;
  • unexplained withdrawals from an account;
  • unexplained loss/misplacement of financial documents;
  • the recent addition of authorised signers on a client or donor’s signature card;
  • sudden or unexpected changes in a will or other financial documents.

This is not a complete list, nor do these examples prove that there is actual abuse occurring. However, they do indicate that a closer look and possible investigation may be needed.

Staff should not underestimate the potential impact of financial abuse. It could significantly threaten an adult’s health and wellbeing. Financial abuse can amount to theft or fraud and would be a matter for the police to investigate. It may require attention and collaboration from a wider group of organisations, including shops and financial institutions such as banks.

Internet scams, postal scams and doorstep crime are more often than not, targeted at adults and all are forms of financial abuse. These scams are becoming ever more sophisticated and elaborate. For example:

  • internet scammers can build very convincing websites;
  • people can be referred to a website to check the caller’s legitimacy but this may be a copy of a legitimate website;
  • postal scams are massed produced letters which are made to look like personal letters or important documents;
  • doorstep criminals call unannounced at the adult’s home under the guise of legitimate business and offering to fix an often non-existent problem with their property; sometimes they pose as police officers or someone in a position of authority.

The adult can be persuaded to part with large sums of money and in some cases their life savings. These instances should always be reported to the local police service and local authority Trading Standards services for investigation (see Friends against Scams, National Trading Standards).

These scams and crimes can seriously affect the health, including mental health, of an adult at risk of abuse or neglect. Agencies working together can better protect such adults. Failure to do so can result in an increased cost to the state, especially if the adult loses their income and independence.

5.2.1 Appointees and deputies

Where the abuse is perpetrated by someone who has the authority to manage an adult’s money, the relevant body should be informed – for example, the Office of the Public Guardian for deputies or attorneys and Department for Work and Pensions (DWP) in relation to appointees.

If anyone has concerns that a DWP appointee is acting incorrectly, they should contact the DWP immediately. Note that the DWP can get things done more quickly if it also has a National Insurance number in addition to a name and address. However, people should not delay acting because they do not know an adult’s National Insurance number. The important thing is to alert DWP to concerns.

6. Who Abuses and Neglects Adults?

Anyone can perpetrate abuse or neglect, including:

  • spouses / partners;
  • other family members;
  • neighbours;
  • friends;
  • acquaintances;
  • local residents;
  • people who deliberately exploit adults they perceive as vulnerable to abuse;
  • paid staff or professionals and volunteers;
  • strangers.

While a lot of attention is paid, for example, to targeted fraud or internet scams perpetrated by complete strangers, it is far more likely that the person responsible for abuse is known to the adult and is in a position of trust and power.

Abuse can happen anywhere: for example, in someone’s own home, in a public place, in hospital, in a care home or in college. It can take place when an adult lives alone or with others.