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Lewisham Safeguarding Adults Board

Concerns Stage 1: Advice for Submitting an Adult Safeguarding Concern 

1. You need to recognise if what you are seeing or hearing is potential abuse or neglect

There are many forms and ways that adult abuse and neglect can occur, so we should not be constrained by definitions and terminologies. Adult abuse is also often complex involving more than one type of abuse occurring at any one time.

However, the most common forms of abuse are:    

Physical Abuse

– including assault, hitting, slapping, pushing, misuse of medication, restraint or inappropriate physical sanctions.

Domestic Abuse

– including psychological, physical, sexual, financial, emotional abuse; so called ‘honour’ based violence (see the full definition for Domestic Abuse in the Domestic Abuse Act 2021 - Statutory Guidance).

Domestic Abuse Act 2021 - Statutory Guidance July 2022

Domestic Abuse and Older People – Information from Safe Lives

Free online training for Female Genital Mutilation and Forced Marriage: Virtual College

Read the Lewisham: Domestic Abuse and Violence Against Women and Girls Strategy 2021-26

Raise awareness of the signs of Coercive Control by sharing and displaying - Lewisham's - Can you see the signs of coercive control? - Poster

Watch these two short clips for brilliant examples of "Gaslighting" a common form of abuse seen in Domestic Abuse.>

Gaslight - You Think I'm Insane: After becoming hysterical at a friend's house Paula (Ingrid Bergman), Gregory (Charles Boyer) shares his frustrations with her.

Gaslight (1944) - You Think I'm Insane Scene (5/8) | Movieclips – Youtube

Gaslight - You're Being Driven Insane: With Brian's (Joseph Cotten) help, Paula (Ingrid Bergman) discovers the horrifying truth about her husband.

Gaslight (1944) - You're Being Driven Insane Scene (6/8) | Movieclips - Youtube

Sexual Abuse

– including rape, indecent exposure, sexual harassment, inappropriate looking or touching, sexual teasing or innuendo, sexual photography.

Psychological Abuse

– including emotional abuse, threats of harm or abandonment, deprivation of contact, humiliation or blaming.

Financial or Material Abuse

– including theft, fraud, internet scamming, coercion in relation to an adult’s financial affairs or arrangements.

Modern Slavery

– encompasses slavery, human trafficking, forced labour and domestic servitude. 

Lewisham Modern Slavery and Human Trafficking Network - Partnership Strategy Oct 2022

Lewisham Modern Slavery Victim Care Pathway

Discriminatory Abuse

Including forms of harassment, slurs or similar treatment because of race, gender and gender identity, age, disability, sexual orientation or religion. 

For more information, please refer to:

Discriminatory Abuse Webinar

Discriminatory Abuse Self- Assessment (September 2023)

https://lewisham.gov.uk/inmyarea/publicsafety/hate-crime

www.stophateuk.org

https://www.met.police.uk/hatecrime

Metro Charity

Lewisham Speaking Up

Organisational Abuse

– including neglect and poor care practice within and institution or specific care setting such as a hospital or care home, for example, or in relation to care provided in one’s own home.

NICE Guidelines: Safeguarding in Care Homes

Guidance for reporting Falls Events as Adult Safeguarding Concerns - Oct 2022

If there any concerns about the behaviour and conduct of a professional working with an adult at risk of abuse and neglect, then this should be reported as a Safeguarding Concern under the 'Public Interest Duty', and if this work is a regulated activity, then a referral to the Disclosure and Barring Service (DBS) should also be considered: DBS Briefing

Neglect and Acts of Omission

– including 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.

Pressure Ulcers: Safeguarding Adults Protocol

Stop the Pressure: NHS Improvement

Pressure Ulcer Panel Process - University Hospital Lewisham Dec 2020

Pressure Ulcer Panel Process - In the Community Sep 2022

Guidance for reporting Falls Events as Adult Safeguarding Concerns - Oct 2022

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.

LSAB Self-Neglect and Hoarding Multi-Agency Policy, Practice Guidance and Hoarding Toolkit April 2021

Please see the London Fire Brigade: Help for Hoarders - Fire Safety Tips

Guidance for reporting Falls Events as Adult Safeguarding Concerns - Oct 2022

Read our Homelessness and Safeguarding Information page for guidance, tools and advice

More detailed information on this subject can be found here: Forms and Signs of Abuse

2. Talk to the adult (unless it is not safe to do so)

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Safeguarding Principle - Protection

What does this means for the professionals: Adults are offered ways to protect themselves, and there is a co-ordinated response to adult safeguarding.

What does this means for the adult: "I am provided with help and support to report abuse. I am supported to take part in the safeguarding process to the extent to which I want and which I am able".

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2.1 If the adult does not wish to report the abuse: Are they in immediate danger or risk of serious harm?

Has a crime been committed? If so, and the adult is in immediate danger or risk of serious harm, then this should be reported to the Police immediately. Help to keep the adult safe until the Police respond. The adult does not need to give their consent under these circumstances due to ‘vital interest’ considerations (immediate danger or risk of serious harm).

Is the adult experiencing a mental health crisis? If so then see this webpage for further advice on how to respond and Get Help with Mental Health  

How to Report Your Concerns About an Adult

Are others, including children in immediate danger or risk of serious harm? If so, then this should be reported to Police immediately, and consideration also give to reporting this to Children’s Services. Help to keep the child safe until the Police respond. The adult(s) does not need to give their consent under these circumstances due to ‘public interest’ considerations (others, including children are in immediate danger or risk of serious harm). 

How to Report Your Concerns About a Child

Safeguarding and promoting the welfare of children and adults most at risk of abuse and neglect is a shared responsibility. The ‘Think Family’ approach should be used by all practitioners who should consider the needs of the whole family, including young carers, taking into account family circumstances and responsibilities. Existing professional relationships should be viewed as a chance to identify risk, refer to colleagues in other services, and to use targeted support to help prevent problems from escalating and therefore potentially limiting harm. Refer to the: Lewisham Think Family Protocol and the Think Family Practice Guidance. If you are working with Father's and Male Carer's read our toolkit, use the checklist and resources

2.2 Consider if this matter meets the Section 42 (1) criteria within the Care Act 2014 as a Safeguarding Concern: 

a. do I have reasonable cause to suspect that the adult has needs for care and support; and

b.do I have reasonable cause to suspect that the adult is at risk, or, experiencing abuse or neglect. 

It must be noted that the third criteria (c) under the legal duty for a Section 42 Enquiry (1) is not relevant at the Concern stage: 

c. as a result of those needs is unable to protect himself or herself against the abuse or neglect or the risk of it. 

SCIE: Assessment and Eligibility Outcomes (Care & Support Needs)

LGA/ADASS Guidance on What Constitutes a Safeguarding Concern - Sept 2020

Local Government Association - What Constitutes a Safeguarding Concern: FAQ's

If this is not a crime and these criteria appear to have been met, then speak to the adult to get their views on the Safeguarding Concern or the incident. It is always best to support the adult in reporting abuse themselves. Find out what they want to happen next. 

If a decision is made not to refer to the Local Authority the individual agency must make a record of the concern and any action taken. Concerns should be recorded in such a way that repeated, low level harm incidents are easily identified and subsequently referred. 

Not referring under safeguarding adults’ procedures does not negate the need to report internally or to regulators/commissioners as required, and if care providers are using this guidance, it is important to note that all Safeguarding Concerns must be notified to the Local Authority. 

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Safeguarding Principle - Empowerment

What does this mean for the professionals: Adults are encouraged to make their own decisions and are provided with information and support.

What does this mean for the adult: "I am consulted about the outcomes I want from the safeguarding process and these directly inform what happens".…………………………………………………………………………………………………………………………...............................

If this criteria does not appear to have been met, but you are unsure, then you must seek further advice including from the Local Authority. How to Report Your Concerns About an Adult

If you are certain that this criteria has not been met, then consider what other pathways, options or services could be used to help support this adult, including providing relevant information? Record your decision-making in relation to this subject in an appropriate manner.

3. Seek the adult’s consent to submit a Safeguarding Concern to the Local Authority

Seek the adult’s consent to submit the Safeguarding Concern and explain this may mean that several agencies may gain access to their personal details:     

4. Gather as much information as possible

Having spoken to the adult (as above) and determined their views, wishes and desired outcomes. Also gather as much information as possible from other relevant sources and documentation:

  • Does anyone else need to be informed or involved, including the nominated safeguarding lead in your agency, before progressing to submitting a Safeguarding Concern?
  • Are there any other internal policy or procedural requirements within your agency?
  • If you unhappy about how your organisation is dealing with a Safeguarding Concern do you know how to escalate this, which could include the use of a Whistleblowing Policy?

Help to keep the adult safe until the Local Authority respond.

Professionals should read the London Multi-Agency Safeguarding Policy and Procedures (pages 61-66) for further information on this subject, using the checklists and good practice guidance that is provided.

5. Submit the Adult Safeguarding Concern

  • Ensure all of the relevant fields in the Safeguarding Concern Form are fully completed with as much detail as possible, and submitted correctly using the contact details outlined in the link below. The Safeguarding Concern Form is also included on the weblink below.
  • You should receive receipt of this and be kept informed of progress.
  • If you do not receive any feedback on progress you should follow this up with the Local Authority involving your organisational lead if required, and in exceptional circumstances this can also be escalated to the Lewisham Safeguarding Adults Board to consider.

How to Report Your Concerns About an Adult

6. Allegations against People in Positions of Trust (PiPOT)

The Local Authority’s 'relevant partners' (outlined in the Care Act), and those providing universal care and support services, should have clear policies for dealing with allegations against people who work, in either a paid or unpaid capacity, with adults with care and support needs. 

Where such concerns are raised about someone who works with adults with care and support needs, it will be necessary for the employer (or student body or voluntary organisation) to assess any potential risk to adults with care and support needs who use their services, and, if necessary, to take action to safeguard those adults.

If the allegation and the circumstances of it matches the criteria outlined above, then the guidance for submitting a Safeguarding Concern to the Local Authority should be followed. The guidance for the Local Authority in conducting Safeguarding Enquiries (on the following pathway pages) outline the possible outcomes that may be relevant in such cases. 

Whilst the focus of safeguarding adults work is to safeguard one or more identified adults with care and support needs (adult at risk), there are occasions when incidents are reported that do not involve an adult at risk, but indicate, nevertheless, that a risk may be posed to adults at risk by a person in a position of trust.

Examples of such concerns could include allegations that relate to a person who works with adults with care and support needs who has:

      • Behaved in a way that has harmed, or may have harmed an adult or child (this could include their own family members).
      • Possibly committed a criminal offence against, or related to, an adult or child.
      • Behaved towards an adult or child in a way that indicates they may pose a risk of harm to adults with care and support needs.

When a person’s conduct towards an adult may impact on their suitability to work with or continue to work with children, this must be referred to the Local Authority’s Designated Officer (LADO). 

Employers, student bodies and voluntary organisations should have clear procedures in place setting out the process, including timescales, for investigation and what support and advice will be available to individuals against whom allegations have been made. Any allegation against people who work with adults should be reported immediately to a senior manager within the organisation. Employers, student bodies and voluntary organisations should have their own sources of advice (including legal advice) in place for dealing with such concerns.

If an organisation removes an individual (paid worker or unpaid volunteer) from work with an adult with care and support needs (or would have, had the person not left first) because the person poses a risk of harm to adults, the organisation must make a referral to the Disclosure and Barring Service. It is an offence to fail to make a referral without good reason.

Disclosure and Barring Service (DBS) Briefing

In some instances a relevant agency may come across information about a person in a position of trust who does not work or volunteer for them, and feel it is appropriate to notify the local authority outside of the formal adult safeguarding procedures. 

Decisions on sharing information must be justifiable and proportionate, based on the potential or actual harm to adults or children at risk and the rationale for decision-making should always be recorded.

Care Act 2014 - Care and Support Statutory Guidance: 14.120 to 14.132

Principals to Inform PiPOT - National Safeguarding Adults Network

ADASS - Top Tips for Dealing with Allegations for PiPOT


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