Stage 2: Responding to a Concern/Information Gathering

If the adult at risk (or others) is in immediate danger steps should be taken to remove the source of harm, or to remove them from the source of harm.

For example, where an adult is at risk of harm in a care home they may be able to visit family, or it may be necessary to move them (or the person alleged to have caused harm) to another service.

The emergency services should be contacted immediately if the adult at risk (or others) is in immediate danger and cannot be removed from the source of harm. The person handling the concern should contact the emergency services on 999.

When an adult at risk appears to be in need of urgent medical attention they should be advised (and assisted if appropriate) to go to the nearest A & E department.

If necessary, A & E staff should consult with, and involve, relevant clinical specialists about diagnosis, treatment and investigation to establish the cause of symptoms.

If the adult at risk is not in immediate danger then consideration should still be made as to priority of response.

If this is the case the Police should be notified as a priority, if they have not already been contacted by the person reporting the concern.

This can be done without the adult at risk's consent if there is a reasonable belief that notifying the police would be in the public interest.

The duty to safeguard an adult applies when all of the following criteria is met:

1. The adult has needs for care and support (whether these have been assessed or are being met by the local authority or not);
2. They are experiencing, or at risk of experiencing abuse or neglect; and
3. 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.

If there is reasonable cause to suspect that all of the above criteria is met the duty to safeguard applies.

1. The adult has needs for care and support

The safeguarding duty applies regardless of whether an adult’s care and support needs have been formally assessed or not (by the local authority or anyone else). It also does not matter who is providing or commissioning any care and support services to meet the adult at risk’s needs.

For example, services could be:

1. Commissioned by adult care and support;
2. Commissioned by children's services (e.g. a 0-25 team or education services);
3. Commissioned by the NHS (e.g. in a hospital or through NHS Continuing Healthcare);
4. Informal support from a carer; and
5. Services arranged and funded by the adult or their family.

An adult with care and support needs may be:

• An older adult;
• Someone with mental health needs, including dementia or a personality disorder;
• An adult with a long-term health condition;
• An adult with a learning disability or Autism;
• Someone who misuses substances or alcohol to the extent that it affects their ability to manage day-to-day living.

The above is not an exhaustive list and it must be considered alongside the impact of needs on the adult's individual wellbeing.

Consideration of this need for care and support must be person-centred (for example, not all older adults will be in need of care and support but those who are 'frail due to ill health, physical disability or cognitive impairment' may be).

There are 10 areas of potential need (outcomes) set out in the Care Act:

• Manage and maintain nutrition;
• Maintain personal hygiene;
• Manage toilet needs;
• Being appropriately clothed;
• Be able to make use of their home safely;
• Maintain a habitable home environment;
• Develop/maintain family and other personal relationships;
• Access/engage in work, training, education or volunteering;
• Make use of community services;
• Carry out caring responsibilities for a child.

Based on the information provided, if there is any chance at all that the adult may have needs for care and support in any of these areas, this condition should be deemed as met.

Note: Decisions about whether an adult at risk has a need for care and support can be made on the basis of available information and do not require the adult to have had an assessment or their eligibility determined under the Care Act 2014.

2. The adult is experiencing, or at risk of experiencing abuse or neglect

Local authority practitioners should not limit their view of what constitutes abuse or neglect, as it can take many forms.

Responses and decisions should be based on the specific circumstances and take into consideration the actual or potential impact on the adult's individual wellbeing together with their views about the impact that the abuse or neglect has had upon them.

The Care Act 2014 sets out 10 specific categories of abuse and neglect.

For information about these categories, and examples of how the accompanying abuse or neglect may be experienced, see: The Care Act 2014, Categories of Abuse and Neglect.

3. As a result of care and support needs, the adult is unable to protect themselves against the abuse or neglect

Potential barriers to an adult's ability to protect themselves might include:

• They do not have the skills, means or opportunity to self-protect;
• They may have a disability which impairs their capacity to make decisions about protecting themselves or may need support to enact decisions;
• They live in a group setting where they lack control over the way they are treated or the environment;
• There is a power imbalance;
• They may not understand an intention to harm them;
• They may be trapped in a domestic situation which they are unable to leave, or where coercion and control means they cannot make a decision about doing so;
• Their resilience and resourcefulness to protect themselves from harm is eroded by, for example, coercive control and / or a high risk environment.

Unpaid carers will sometimes have care and support needs of their own. However, sometimes unpaid carers will only have support needs. In these circumstances this policy and procedures may still be used as a proportionate response to the concerns where appropriate, using its duty to promote wellbeing. This may be appropriate, for example, if an unpaid carer experiences intentional or unintentional harm from the adult they are trying to support.

If any of the safeguarding criteria is not met, the adult is not an 'adult at risk' as defined in the Care Act and the duty to undertake safeguarding enquiries under S42 does not apply.

However, the Care Act permits other actions to be taken to provide support to the adult (including carrying out a non-statutory ‘other’ enquiry), where it believes doing so is the most appropriate and proportionate response to the circumstances.

The local authority Safeguarding Coordinator should decide what, if any, other action is appropriate and proportionate to the presenting circumstances. Where further action is required the Safeguarding Coordinator must ensure that this is taken. For example, a referral to a specialist support service or intervention by a social work team.

Where a decision is made to carry out a non-statutory enquiry this should be undertaken in the same way as a statutory section 42 enquiry.

For further information and guidance see: Making decisions on the duty to carry out Safeguarding Adults enquiries (Local Government Association).

Anyone reporting a concern should always seek consent of the adult at risk before doing so, unless:

1. Seeking consent will increase the level of risk posed to them (or a child or other adult at risk); or
2. When consent cannot practically be sought (for example, the referrer is being denied access to the adult at risk or the adult at risk cannot be located in a timely way);
3. The adult lacks capacity to consent, and a decision has been made that reporting a concern is in their best interests.

If it is not clear from the concern reported whether or not consent has been sought the practitioner responding to the concern should contact the person that reported the concern to establish this.

If they are not contactable (for example if the concern was reported anonymously) the practitioner responding to the concern should work on the basis that consent was not sought.

If consent was not sought

The reasons that the person reporting the concern did not seek consent should be clearly recorded in line with local recording requirements.

If none of the above conditions apply then the adult at risk must be contacted, advised that a concern has been reported and asked about their wishes in regards to next steps. This can be done by the person that reported the concern or the local authority, whichever is deemed most appropriate and proportionate to the presenting circumstances.

It is only appropriate to make enquiries without consent if:

1. It is in the public interest e.g., there is also a risk to others, a member of staff or volunteer is involved, or the abuse has occurred on property owned or managed by an organisation with a responsibility to provide care;
2. The adult at risk lacks mental capacity to consent and it is in their best interests;
3. The adult at risk is subject to coercion or undue influence, to the extent that they are unable to give consent;
4. It is in the adult’s vital interests (to prevent serious harm or distress or life threatening situations).

In cases where the adult at risk has capacity to withhold consent the local authority should ensure that any safeguarding response is limited to that which is necessary to reduce the risk of harm.

If an adult is subject to coercion and control or undue influence by another person this may impair their judgement and could impact on their ability to make decisions about their safety. If this is the case, Mental Capacity Policy and Procedures may not cover the particular situation. Professionals from a range of disciplines will need to work with the person, to explore options that may be available to keep them safe. Supporting people who are subject to coercion is often complex and challenging work. If the situation cannot be resolved in other ways, you may need to seek legal advice regarding whether to apply to the High Court for inherent jurisdiction.

In line with the overarching aims, duties and principles of adult safeguarding, the local authority must have regard for the views and wishes of the adult at risk when deciding the outcome of a safeguarding concern. In particular, whether the adult at risk has expressed any outcomes that, as a consequence of the safeguarding they:

1. Want to achieve;
2. Want to change; or
3. Want to stay the same.

The views and wishes of the adult at risk should be clearly recorded in line with local recording requirements.

Note: If the adult at risk has expressed a clear view or wish about what the outcome should be any decisions made by the Safeguarding Coordinator should reflect this as closely as possible.

It is important as part of the decision making process that the impact on the adult at risk  is understood. This will ensure that the response is appropriate and proportionate to their specific circumstances.

Impact includes;

1. Nature of the risk of harm (physical, emotional or otherwise);
2. Likelihood (and frequency) of the harm occurring;
3. Severity of harm should it occur;
4. Effectiveness of any current risk reduction measures; and
5. Impact on individual Wellbeing domains.

Note: When assessing the likelihood of harm occurring this should be an evidence based judgement.

If circumstances are having a significant impact on the adult the local authority intervention required is likely to be more urgent and intensive.

It is important to ascertain whether or not there have been previous safeguarding concerns raised in respect of the adult at risk.

Although the existence of previous concerns must not dictate the outcome of the current concern, they can provide a great deal of intelligence and information. In particular, they can help determine whether the adult at risk is experiencing sustained abuse and which approaches to support them may be most/least effective.

Some key questions:

1. Is the nature of the abuse or neglect the same?
2. Is the person alleged to be causing harm the same?
3. What was the local authority's previous response to the concerns?
4. What was effective/ineffective about the previous response/s?
5. What do previous concerns indicate about the adult at risk's ability to engage with the safeguarding process?

Note: All concerns should be considered on their own merit and recorded individually.

Safeguarding is not a substitute for: 

• Providers responsibilities to provide safe and high quality care and support;
• Commissioners regularly assuring themselves of the safety and effectiveness of commissioned services;
• The Care Quality Commission (CQC) ensuring that regulated providers comply with the fundamental standards of care or by taking enforcement action.

Where a commissioner or the Care Quality Commission are taking their own action in relation to a concern, the local authority must consider if these actions already form an appropriate and proportionate response to the concerns raised. If the local authority identifies possible abuse, including organisational abuse it will lead on those aspects of the concerns, but performance and quality issues will continue to be addressed by Commissioners and/or the Care Quality Commission. 

Distinguishing between poor practice and neglect/abuse will often require a professional judgement. 

It is important to consider the impact of the incident on the adult at risk, whether others may be at risk of harm, and what the proportionate response to the concern should be. 

Where the practice is resulting in harm for the individual concerned, abuse is likely to be indicated. It is important to consider the nature, seriousness and individual circumstances of the incident and the impact on the adult at risk, before reaching a decision.

The Care Act 2014 sought to clearly differentiate between quality of service issues and abuse, with mistakes and errors to be treated as such and actual abuse triggering an enquiry. The Care Act however, also required a response to quality of service issues as an important preventative measure to ensure mistakes did not develop into abusive situations.

All the local authorities have their own processes for working with service providers and are required to have contingency plans for market failure. 

Some have a Multi-agency Quality of Service Forum which considers intelligence on the quality of providers’ services, with the aim to intervene early to prevent quality issues escalating and becoming more serious. 

The Care Quality Commission (CQC) plays a very important part in this as they have the statutory duty to ensure Regulated Services meet their quality standards.

All the local authorities have a service provider improvement process, which may include quality improvement planning meetings or less formal arrangements designed to support providers, to correct any identified quality failures.

Whatever system is followed, they are all aimed at working with service providers to ensure they provide a quality service for the benefit of the adults whose needs they serve. Refer to your own Local Authority Quality and Service Continuity Team or equivalent.

It is not always necessary or proportionate to contact the adult at risk at the Information Gathering stage.

When the Enquiry Officer is undertaking Information Gathering to inform the response, they may decide, depending on the nature of the concern and risk, to contact the adult at risk or their representative including the Commissioners of any care. If there is a concern about a care provider, the Commissioner should be informed.

Where the issue(s) has been resolved and the risk(s) has been mitigated as part of Information Gathering, the concern may be resolved quickly and proportionately by telephone enquiries. The Enquiry Officer may not contact the adult at risk as they have identified that there is no need to proceed with the enquiry, which is a proportionate response to the concern.

The Enquiry Officer may have established from the information on the concern and through conversations with other relevant parties what outcome the adult at risk wants to achieve. It may be identified that the issue(s) has been resolved, therefore the enquiry can be closed without any further action(s).

If it is not possible to speak to the adult at risk or it is identified that by doing so may place the adult at risk or others at risk, it would be appropriate to progress the enquiry to establish what urgent action(s) is required. Not being able to contact the adult at risk is not a reason to not progress an enquiry.

Abuse and neglect can occur in many ways and the same type of abuse can have a different effect on one adult at risk when compared to another. Hence it is not appropriate to have set responses based on the type of abuse that has occurred and the response should be based on the effect on the adult at risk.

Depending on the information gathered, and whether or not the duty to make enquiries is met, any number of responses could be deemed appropriate. This could be a single response or a combination of responses.

For example:

1. The provision of information and advice (relating to the risk of abuse and how the adult at risk may protect themselves, the presenting issues of the situation e.g. financial advice or any other care and support matter);
2. A referral to police where a criminal act appears to have taken place (for example theft or assault);
3. A referral to a service, for example an NHS service (for example community nursing) or a specialist support organisation;
4. A referral to another adult care and support service (for example a prevention service or a service that is able to carry out a needs assessment or a carers assessment);
5. A statutory Enquiry under Section 42 of the Care Act (where the duty to make enquiries is met);
6. A non-statutory enquiry (where the nature of the concern requires a formal or multi-agency approach).

The local authority Safeguarding Coordinator is responsible for making the decision about whether or not the safeguarding duty applies, and what the most appropriate and proportionate safeguarding response should be.

Enquiry Officers involved in Information Gathering are responsible for making a professional recommendation to the Safeguarding Coordinator and ensuring that they have access to all relevant information upon which to base their decision.

The Care Act 2014 is clear that all safeguarding decisions and actions must be made in a timely and proportionate way, based on the presenting circumstances.

The following are the timeframes in which the Safeguarding Coordinator should make decisions:

• Risks should be assessed, and steps taken to ensure the safety of the adult at risk within 24 hours of the concern being reported;
• Decisions about the most appropriate and proportionate response should be made within 5 days of the concern being reported.

The decision should be clearly recorded in line with local recording requirements.

The record should be clear about the rationale behind decision made and how the views and wishes of the adult at risk have been regarded.

Adult at risk previously aware

In all cases, if the adult at risk knew a concern was being raised, they must also be informed of the decision that has been made.

This can be done by the person that reported the concern or the local authority, whichever is deemed most appropriate and proportionate to the presenting circumstances.

The person informing the adult at risk should also:

1. Speak to them about likely next steps;
2. Ascertain how they wish to be an active part of the safeguarding response;
3. Establish whether they will have 'substantial difficulty' engaging with any aspect of the safeguarding response, and whether the duty to provide independent advocacy applies.

If the adult at risk does not wish to participate in any subsequent safeguarding response, their views and wishes in relation to desired outcomes should be sought.

For further information about independent advocacy, see Placing the Adult at Risk at the Centre of Safeguarding.

Adult at risk not aware - Decisions to make enquiries or instigate another safeguarding response

If the adult at risk was not aware of the safeguarding concern (because one or more of the conditions set out in section 6. above was met), they must now be told of the concern and the decision made to move to enquiry.

This is important because, without doing so, the overarching aims and principles of safeguarding adults cannot be applied.

The method of informing the adult at risk should be carefully considered, to take into account potential risk factors and distress. For example;

1. When to speak with them (best time of day, location);
2. Who should speak with them (person that raised the concern, practitioner, health professional, existing advocate);
3. How to speak with them to ensure maximum understanding (in person, face to face, use of easy read material);
4. Any support they may need during or after the conversation;
5. Any additional strategies that may need to be implemented to reduce risk afterwards.

Only in exceptional circumstances, where speaking with the adult at risk would increase the risk of abuse can the Safeguarding Coordinator decide not to inform them at this stage of the process and instead, move to appoint an independent advocate on the basis that they would find it substantially difficult to engage.

For further information about independent advocacy, see Placing the Adult at Risk at the Centre of Safeguarding.

Adult at risk not aware - Decisions to exit safeguarding 

If the adult at risk was not aware of the safeguarding concern (because one or more of the conditions set out in Section 6. above was met) then it is not necessary to inform them that the decision has been made to exit safeguarding, unless there is a need to discuss any other action with them. For example, the provision of information and advice or whether they would consent to a referral to another social care or health team.

For guidance on exiting safeguarding, see: Stage 4: Outcome and Closure (including Plan and Review).

All adult safeguarding concerns referred to the local authority should be assessed to decide if the criteria for adult safeguarding are met. Keeping the person who reported the concern informed is an essential requirement under this policy and procedures.

Feedback provides assurance that action has been taken whether under adult safeguarding or not. Organisations raising a concern may want to challenge or discuss the decision(s) and need to be updated on what action has been taken. It is more likely that the public will continue to report concerns, where there is an acknowledgement that their concern has reached the right agency and is being taken seriously.

Feedback to the wider community needs to take account of confidentiality and requirements of Data Protection legislation.

The principles of natural justice must be applied, consistently with the overriding aim of safety and the requirements of the Data Protection legislation. Providing information on the nature and outcomes of concerns to people alleged to have caused harm also needs to be seen in the wider context of prevention; for example, information can be used to support people to change or modify their behaviour. The person/organisation that is alleged to be responsible for abuse and/or neglect should be provided with sufficient information to enable them to understand what it is that they are alleged to have done or threatened to do that is wrong and to allow their view to be heard and considered. Whilst the safety of the adult remains paramount the right of reply should be offered where it is safe to do so. Decision making should take into consideration:

• The possibility that the referral may be malicious;
• The right to challenge and natural justice;
• Whether there are underlying issues for example employment disputes;
• Family conflict;
• Relationship dynamics;
• Whether it is safe to disclose particularly where there is domestic abuse;
• Compliance with the Mental Capacity Act 2005.

Sharing information should be provided in a way that will not exacerbate the situation, and acknowledges that the Data Protection legislation applies to people alleged to have caused harm as well as the adult at risk. The person alleged to have caused harm has a right to know what personal information relating to them is held.

If the matter is subject to Police involvement, the Police should always be consulted so any criminal investigation is not compromised.

The Local Government Ombudsman and the Parliamentary and Health Ombudsman are both useful sources to explore case examples. The Information Commissioner provides advice on sharing information.

Any external supporting documents (for example Disclosure Reports) must be stored in line with Data Protection legislation and local recording policy. They should also be stored in a logical manner so they can be easily accessed should the information be requested by legal services or the police.

The police should be notified as a matter of priority if:

1. The death of the adult is suspected to have been potentially attributed to abuse or neglect; and/or
2. There is reason to suspect that a crime is likely to be committed i.e., other people are at risk.

If the circumstances of the death mean that there are reasons to be concerned about risks to other adults, enquiries may need to be made to decide whether action needs to be taken to protect them. For example, this will often be necessary following a death in an organisational setting where other adults are continuing to receive a service.

If this is the case, follow the guidance in Stage 1: Reporting a Concern.

If the criteria for a Section 44 Safeguarding Adults Review is met, a Safeguarding Adults Referral must be made. A referral should also be made where the Section 44 criteria is not met, but carrying out a SAR would still be beneficial.

See: Safeguarding Adults Reviews (SARS).

If there are concerns about how a provider has cared for the adult prior to their death a notification should be made to CQC via the CQC website.

The CQC has powers to bring a criminal prosecution against health and social care providers for failing to provide care and treatment in a safe way.

If there are concerns about the quality of care delivered by the provider, the relevant Commissioning Team (Local Authority and / or Integrated Care Board) should be notified. This should be done in line with local processes and requirements.

Following a death, it is usually a doctor, or the police, who will decide whether a referral to the Coroner is required. When a death has been referred to the Coroner, the Coroner will make decisions regarding whether a police investigation should take place and whether a post-mortem is required.