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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 (the definition for Domestic Abuse will change once the Domestic Abuse Act 2021 is implemented). Domestic Abuse and Older People – Information from Safe Lives

Also see this free online training for Female Genital Mutilation and Forced Marriage: Virtual College

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. (A new Lewisham Modern Slavery Protocol will be published in the early summer of 2021).

Discriminatory Abuse – including forms of harassment, slurs or similar treatment because of race, gender and gender identity, age, disability, sexual orientation or religion.

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.

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.

Refer to:

Pressure Ulcers: Safeguarding Adults Protocol

Stop the Pressure: NHS Improvement

SEL CCG Guidance on Pressure Ulcer Management

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. See: LSAB Self-Neglect and Hoarding Multi-Agency Policy, Practice Guidance and Hoarding Toolkit (April 2021)

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).

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

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

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:     

  • Read the The Eight Caldicott Principles (updated from seven in December 2020).
  • Does the adult have the mental capacity to consent to the Safeguarding Concern being submitted now?
  • Is there any possibility that the adult has/ is suffering from any type of coercion, control, threat, duress or pressure from another person(s) which may mean they refuse consent?
  • Does mental capacity (including executive capacity) need to be assessed or reviewed? For more information read: Decision Making and Mental Capacity (NICE Guidelines)
  • Give due regard to the adult’s views and wishes, including their desired outcomes, even if Best Interest Decisions have been made linked to the Mental Capacity Act. For more information read: Local Government Association - Making Safeguarding Personal Toolkit including on the six Safeguarding Principles.
  • If the adult does have the mental capacity to consent to the Safeguarding Concern being submitted, but refuses, professionals must be careful that they consider how to keep the adult safe if they continue to submit the concern. This may be particularly relevant in domestic abuse cases. The adult must be informed that a Safeguarding Concern has been submitted, unless it is unsafe or impractical to do so.
  • A Safeguarding Concern can still be submitted without the adult’s consent if ‘vital’ or ‘public’ interest considerations apply (see 2.1 above). For more information read: LGA/ADASS Guidance on What Constitutes a Safeguarding Concern - Sept 2020

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

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