5.1 Adult Safeguarding – Central Bedfordshire APPP Hub

CQC Quality Statements

Theme 3 – How the local authority ensures safety in the system: Safeguarding

We statement

We work with people to understand what being safe means to them as well as our partners on the best way to achieve this. We concentrate on improving people’s lives while protecting their right to live in safety, free from bullying harassment, abuse, discrimination, avoidable harm and neglect. We make sure we share concerns quickly and appropriately.

What people expect

I feel safe and supported to understand and manage any risks.

CENTRAL BEDFORDSHIRE SPECIFIC INFORMATION

Employee Information

This chapter is a summary of statutory guidance in this area. If you are employed by/work for Central Bedfordshire Council, you will also need to follow the Council’s code /associated policies and procedures: Central Bedfordshire Safeguarding and Mental Capacity.

1. Introduction

The Care Act 2014 provides the statutory framework for safeguarding adults, and contains the powers and duties for local authorities, Safeguarding Adults Boards and partner agencies. It also provides guidance on how local authorities should work to prevent and tackle abuse, keep people safe and promote wellbeing (see Care and Support Statutory Guidance).

Social workers are the lead professionals in undertaking the statutory safeguarding duties, but it is vital they work with partners in other agencies to prevent, investigate and resolve safeguarding concerns.

2. The Safeguarding Duty

Under section 42 of the Care Act 2014, local authorities have legal adult safeguarding duties to:

make enquiries, or cause others to do so, when a concern has been raised about an adult in its area (whether or not they are ordinarily resident there) to establish whether an action should be taken to prevent or stop abuse or neglect.

The 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 is referred to as ‘the adult’ throughout this chapter.

As well as the local authority, other organisations also have legal duties in relation to adult safeguarding for example the NHS and the police.

Where someone is 18 or over but is still receiving children’s services and a safeguarding issue is raised, the matter should be dealt with through adult safeguarding arrangements. For example, this could occur when a young person with substantial and complex needs continues to be supported in a residential educational setting until the age of 25 (see Transition to Adult Care and Support chapter). Where appropriate, adult safeguarding services should involve the local authority children’s safeguarding colleagues as well as any relevant partners (for example the police or NHS) or other people relevant to the case. The young person does not need to have eligible needs for care and support under the Care Act, or be receiving any particular service from the local authority, in order for the safeguarding duties to apply – so long as the conditions set out in Section 2 are met.

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;
regardless of setting, other than prisons and approved premises where prison governors and HM Prison and Probation Service respectively have responsibility.

However, senior representatives of those services may sit on the Safeguarding Adults Board and play an important role in the strategic development of adult safeguarding locally. Additionally, they may ask for advice from the local authority when faced with a safeguarding issue that they are finding particularly challenging.

3. What is Adult Safeguarding?

Safeguarding means protecting an adult’s right to live in safety, free from abuse and neglect. It requires people and organisations to work 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 when deciding on any action (see Making Safeguarding Personal chapter). This must recognise that adults are the experts in their own lives and that sometimes they 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. People have complex lives and being safe and well may mean different things to different people, as well as being just one aspect of what they want to achieve. Professionals should work with the adult to establish what being safe means to them and how that can be best achieved. Practitioners should work with the adult to establish what being safe means to them and how that can be best achieved. ’Safety’ measures which do not take account of individual wellbeing and the adult’s wishes and views are not appropriate (see Promoting Wellbeing chapter).

Safeguarding is not a substitute for:

providers’ responsibilities to provide safe and high quality care and support;
commissioners 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;
the core duties of the police to prevent and detect crime and protect life and property.

The Care Act requires that each local authority must:

set up a Safeguarding Adults Board (SAB) (see Safeguarding Adults Boards chapter);
make enquiries, or cause others to do so, if it believes an adult is experiencing, or is at risk of, abuse or neglect (see the chapter on Safeguarding Procedures in Individual Cases). An enquiry should establish whether any action needs to be taken to prevent or stop abuse or neglect and if so, by who;
arrange, where appropriate, for an independent advocate to represent and support an adult who is the subject of a safeguarding enquiry or Safeguarding Adult Review (SAR) where the adult has ‘substantial difficulty’ in being involved in the process and where there is no other suitable person to represent and support them (see Independent Advocacy chapter);
cooperate with each of its relevant partners (see Integration, Cooperation and Partnerships chapter) in order to protect the adult. In turn, each relevant partner must also cooperate with the local authority.

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 enhances individual choice and control as part of improving their quality of life, safety and wellbeing;
work alongside the adult to identify strengths based and outcomes focused solutions;
raise public awareness so that communities as a whole, alongside practitioners in all agencies, play their part in preventing, identifying and responding to abuse and neglect;
provide information and support in accessible ways to help people understand abuse, how to stay safe and how to raise concerns;
address the causes of abuse or neglect.

4. Principles of Adult Safeguarding

The six principles of adult safeguarding underpin all adult safeguarding work and apply to all sectors and settings including care and support services, further education colleges, commissioning, regulation and provision of health and care services, social work, healthcare, welfare benefits, housing, wider local authority functions and the criminal justice system.

4.1 The six principles

Empowerment

People are supported and encouraged to make their own decisions and give informed consent. People must always be treated with dignity and respect, and staff should work alongside them to ensure they receive quality, person centred care which ensures they are safe on their own terms.
“I am asked what I want as the outcomes from the safeguarding process and these directly inform what happens.”

Prevention

Prevention and early support are key to effective safeguarding. The principle of prevention recognises the importance of taking action before harm occurs and seeks to put mechanisms in places so that they do not reoccur.
“I receive clear and simple information about what abuse is, how to recognise the signs and what I can do to seek help.”

Proportionality

This means deciding 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

This involves organising and delivering support and representation for those in greatest need who may not be able to do it themselves.
“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

Effective safeguarding cannot be delivered in isolation, and should involve other partners and systems that interact with or impact on a person. Local solutions are best achieved through services working with their communities, professionals and services as a whole.
“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

This recognises the importance of being open, clear and honest in the delivery of safeguarding, and ensuring there are systems in place to hold practitioners and services to account.
“I understand the role of everyone involved in my life and so do they.”

5. Types of Abuse and Neglect

This section provides an overview of the different types of abuse and neglect outlined in the Care and Support Statutory Guidance. However, practitioners should keep an open mind about what abuse or neglect are, as they can take many forms.

The circumstances, and views of, the individual adult should always be considered when deciding the most appropriate response to any concerns.

5.1 Physical abuse

This includes:

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

5.2 Domestic abuse

Domestic abuse can take many different forms including psychological, physical, sexual, financial or emotional abuse. The Domestic Abuse Act 2021 defines domestic abuse as occurring between two people (aged 16 or over) who are ‘personally connected to each other’ and the behaviour is considered to be ‘abusive’. Behaviour is ‘abusive’ when any of the following is identified:

physical or sexual abuse;
violent or threatening behaviour;
controlling or coercive behaviour;
economic abuse;
psychological, emotional or other abuse.

See Domestic Abuse chapter

5.3 Sexual abuse

This includes:

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

Sexual abuse may also take the form of sexual exploitation which can involve coercion and an exchange for basic necessities or something that the perpetrator wants to gain from the victim (see Working with Adults Affected by Child Sexual Exploitation and Organised Sexual Abuse chapter).

5.4 Psychological abuse

This includes:

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

5.5 Financial abuse

This includes:

theft;
fraud;
scams including through the internet;
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.

5.6 Modern slavery

Modern slavery is a serious and often hidden crime where people are exploited by criminals, usually for profit. It includes: slavery;

human trafficking;
forced labour and domestic servitude.

Adult victims are usually coerced or forced into modern slavery using threats, force, deception or by someone abusing their position of power over the victim. However, vulnerable adults (and children) cannot consent to be in such a position and therefore exploitation – even without any type of coercion – could still be modern slavery.

For more information see Modern Slavery chapter.

5.7 Discriminatory abuse

Discriminatory abuse focuses on a difference or perceived difference such as race, gender, disability, or any of the protected characteristics of the Equality Act. It includes harassment, slurs or similar treatment because of a person’s:

race;
gender or gender identity;
age;
disability;
sexual orientation; or
religion.

See Equality, Diversity and Human Rights chapter and Discrimination: your rights for further information.

5.8 Organisational abuse

Organisational abuse (also called institutional abuse) includes neglect and physical and / or psychological abuse or poor care practices within a residential or other specific care setting; including care provided to an adult in their own home. This could be a one-off incident or involve ongoing, long term or recurring poor treatment of an adult.

Organisational abuse can include neglect or poor professional practices linked to the structure, policies, processes and practices in place in an organisation. In some organisations, poor practices can result in a ‘closed culture’ where not many people visit the care setting (if the care setting is located away from towns and cities and not easily accessible by transport for example) and adults are at risk of harm, including human rights breaches and abuse. See also Closed Cultures (CQC).

Where there are concerns about the quality of a service provided by a home or a service provided to an adult in their own home and possible poor practice, these should usually be raised with the service provider in the first instance, then escalated to the local authority, Integrated Care Board or Care Quality Commission (CQC) using local reporting systems.

Under the Care Act, local authorities have a duty to carry out safeguarding enquiries where there are concerns about the abuse and neglect of an adult in its area, even if another local authority is responsible for arranging the adult’s care and support.

See Ill Treatment and Wilful / Deliberate Neglect, Whistleblowing and Kindness, Respect and Compassion chapters.

5.9 Neglect and acts of omission

Neglect or an act of omission is when someone who is responsible for caring for an adult who has care and support needs fails to provide them with the care they need. This can be intentional or unintentional.

It includes:

ignoring the adult’s medical emotional or physical care needs;
failing to provide the adult with access to appropriate health, care and support or educational services;
the withholding the necessities of life from the adult, such as medication, adequate nutrition and heating.

5.10 Self-neglect

Self-neglect is a lack of self-care to an extent that it threatens an adult’s health, safety and well-being. It can include neglect of hygiene, health and surroundings (including hoarding), an inability or unwillingness to manage personal / financial affairs and a failure to seek help or access services. The adult themselves may not recognise the impact that their behaviour can have on others, including family and neighbours, or may not describe their situation in the same way as practitioners. A safeguarding adults referral may be needed when the adult, or others, are at risk of harm due to self-neglect.

However, it should be noted that self-neglect will not always prompt a section 42 (safeguarding) enquiry.

An assessment should be made on a case by case basis, and practitioners should be professionally curious as to whether incidents are one off or multiple, affect the people around the adult and whether there are any patterns of harm that may be an indication of other types of abuse or poor mental health (see Professional Curiosity chapter). A decision on whether a response is required under safeguarding or a decision to offer a care and support assessment of need / risk assessment will depend on the adult’s ability to protect themselves. . There may come a point when they are no longer able to do this, without external support.

6. Patterns of Abuse

Incidents of abuse may be one off or multiple, and affect one person or a number of different people.

It is important to look beyond any single incidents or concerns which have been raised to identify patterns of harm. Repeated instances of poor care may be an indication of more serious problems or organisational abuse. To identify patterns of abuse and neglect it is important that information is recorded and appropriately shared.

Patterns of abuse vary and include:

serial abuse, which is when a single perpetrator seeks out and ‘grooms’ individual adults. Sexual abuse sometimes falls into this pattern as do some forms of financial abuse;
long term abuse, in ongoing family relationships such as domestic abuse or persistent psychological abuse;
opportunistic abuse, such as theft because money or jewellery around, for example, are easily accessible.

6.1 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. If DWP knows that the person is also known to the local authority, then it should also inform the relevant authority.

7. Who Abuses and Neglects Adults?

Anyone can perpetrate abuse or neglect, including:

spouses / partners;
other family members;
carers;
neighbours;
friends or acquaintances;
local residents / members of the community;
people who deliberately exploit adults they perceive as vulnerable to abuse;
paid staff or volunteers;
strangers, including online.

While targeted fraud or internet scams committed by complete strangers receive a lot of publicity, it is more likely that the person responsible for any abuse will be known to the adult or is in a position of trust and power to them.

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

8. Signs of Abuse and Neglect

Workers across the local authority should be vigilant about adult safeguarding concerns.

Findings from safeguarding adult reviews have found that if practitioners or other staff had been professionally curious and / or had acted upon their concerns or sought more information, then death or serious harm might have been prevented.

Anyone can witness or become aware of information suggesting that abuse and neglect is occurring. The adult may say or do things that hint that all is not well. It may come in the form of a complaint, a call for a police response, an expression of concern, or come to light during a needs assessment.

Regardless of how the safeguarding concern is identified, everyone should know what to do, and where to go locally to get help and advice. It is vital that practitioners, other staff and members of the public are vigilant on behalf of those unable to protect themselves. This will include:

knowing about different types of abuse and neglect and their signs;
supporting adults to keep safe;
knowing who to tell about suspected abuse or neglect;
supporting adults to think and weigh up the risks and benefits of different options when exercising choice and control.