What is Safeguarding
Safeguarding Adults
Every adult has the right to be treated with dignity, respect and live a life free of fear.
We call this process safeguarding adults.
Every adult has a right to make their own decisions and take risks, however, some adults are at greater risk of being abused because they rely on another person to manage day to day living.
We use the term "adult at risk" to describe people that need this support. Not all adults who need care and support are considered at risk, we assess each person according to their own abilities. Many adults with care and support needs manage their lives very well.
If you suspect that you or an adult you care about may be at risk of abuse or neglect please complete the Adult Safeguarding Concern form and return to the Lewisham Adult Gateway as instructed in the form. Alternatively if you have concerns about the immediate safety of an adult at risk then please contact the Police on 999.
Social Care and Health have produced a video on Safeguarding Adults in British Sign Language.
Forms and Signs of Abuse
Forms and Signs of Abuse
People with care and support needs, such as older people or people living with a disability, are more likely to be abused or neglected. They may be seen as an easy target and may be less likely to identify abuse themselves or to report it. People with communication difficulties can be particularly at risk because they may not be able to alert others. Sometimes people may not even be aware that they are being abused, and this is especially likely if they have a cognitive impairment. Abusers may try to prevent access to the person they abuse.
Whilst these particular adults are the specific focus of ‘Safeguarding Adults’ policy and procedures, this does not negate the public duty of those carrying out this work to protect the human rights of all citizens, including those who are the subject of concern but are not covered by these procedures, or those who are not the subject of the initial concern.
Such work is the responsibility of all agencies and cannot exist in isolation. It must be effectively linked to other initiatives, as part of a network of measures aimed at enabling all citizens to live lives that are free from violence, harassment, humiliation and degradation.
Signs of abuse
Signs of abuse can often be difficult to detect. The information below aims to help people who come into contact with people with care and support needs to identify abuse and recognise possible indicators. Many types of abuse are also criminal offences and should be treated as such.
Evidence of any one indicator from the following lists should not be taken on its own as proof that abuse is occurring. However, it should alert professionals to make further assessments and to consider other associated factors. The lists of possible indicators and examples of behaviour are not exhaustive and people may be subject to a number of abuse types at the same time.
Types of abuse:
Discriminatory abuse +
Types of discriminatory abuse
- Unequal treatment based on age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion and belief, sex or sexual orientation (known as ‘protected characteristics’ under the Equality Act 2010)
- Verbal abuse, derogatory remarks or inappropriate use of language related to a protected characteristic
- Denying access to communication aids, not allowing access to an interpreter, signer or lip-reader
- Harassment or deliberate exclusion on the grounds of a protected characteristic
- Denying basic rights to healthcare, education, employment and criminal justice relating to a protected characteristic
- Substandard service provision relating to a protected characteristic
Possible indicators of discriminatory abuse
- The person appears withdrawn and isolated
- Expressions of anger, frustration, fear or anxiety
- The support on offer does not take account of the person’s individual needs in terms of a protected characteristic
Hate Crime +
Hate crime is the targeting of individuals, groups and communities because of who they are.
It is any incident which is a criminal offence and which is thought, by you or someone else, to be motivated by a hostility or prejudice based on race, ethnicity, religious beliefs, gender, gender identity, disability, age, sexual orientation or any other actual or seeming difference.
This can include:
- Threats, bullying or intimidation
- Threatening or offensive mail, texts or emails
- Verbal abuse
- Damage to property
- Physical assaults
It is important to report all hate incidents, even if you think nothing can be done as it helps the police and other agencies identify areas of concern, patterns of behaviour and what is happening in our communities. Hate crimes are not only crimes against the targeted victim, but also against a particular group as a whole. Firm action will be taken against people who commit any acts of hatred.
We know that some victims may not wish to be identified, so we encourage victims to report crime anonymously to a third party reporting site to ensure that the police can do all they can to tackle hate crime in the community.
The police and the council will:
- Investigate all reported incidents of hate crime
- Take legal action if there is sufficient evidence to enable us to do this
- Keep in contact with you and let you know of our progress
- Support you during this process
Some organisations can offer support to help you decide if you want to make an official report or complaint. If you do, this will be forwarded to the police and the council to note or take action and for monitoring the numbers of incidents reported.
Below is a list of groups and local venues where you can make an anonymous report of hate crime.
Afghanistan and Central Asian Association
Room 68b, the Albany, Deptford SE8 4AG
admin@afghanistan-central-asian.org.uk
020 8469 0723
African Advocacy Foundation
76 Elmer Rd, London SE6 2ER
020 8698 4473
shani@africadvocacy.org
Catford and Bromley Synagogue
6 Crantock Road, London, SE6 2QT
admin@catfordsynagogue.org.uk
020 8698 9496
Citizens Advice Lewisham
Leemore Community Information Hub
Bonfield Road, Lewisham SE13 5EU
0800 231 5453
Goldsmiths Students’ Union
Dixon Rd, London SE14 6NW
020 7717 2511
welcome@goldsmithssu.org
Goldsmiths, University of London
8 Lewisham Way, New Cross, London SE14 6NW
020 7919 7050
studentcentre@gold.ac.uk
Lewisham Council
9 Holbeach Road, Catford, SE6 4TW
020 8314 7237
cer@lewisham.gov.uk
Lewisham Irish Community Centre
2A Davenport Road, Catford SE6 2AZ
020 8695 6264 manager@lewishamirish.org.uk
Lewisham Islamic Centre
363–365 Lewisham High Street, Lewisham SE13 6NZ
020 8690 5090
info@lewishamislamiccentre.com
Lewisham Library
199-201 Lewisham High St, London SE13 6LG
020 8314 8430
Juan.Rey-Torre@lewisham.gov.uk
Lewisham Refugee and Migrant Network
341 Evelyn Street, SE8 5QX
020 8694 0323
info@lrmn.org.uk
Lewisham and Southwark College
Lewisham Way, London SE4 1UT
020 3757 3340
Steven.Curran@lscollege.ac.uk
Lewisham Speaking Up
Deptford Albany, Douglas Way, SE8 4AG
020 8692 1862
info@lsup.org.uk
METRO
1st Floor Equitable House, 7 General, Gordon Square, Woolwich SE18 6FH
020 8305 5000
info@metrocentreonline.org
Second Wave Youth Arts
1 Creek Rd, London SE8 3BT
020 8694 2444
info@secondwave.org.uk
More information on Hate Crime can be found on the Lewisham Council Website
Domestic abuse +
Types of domestic abuse
Domestic abuse can be characterised by any of the indicators of abuse relating to:>
- Psychological
- Physical
- Sexual
- Financial or economic
- Emotional
Any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence, or abuse between two people aged 16 or over who are ‘personally connected’. This includes those who are, or have been, intimate partners, or relatives, regardless of gender or sexual orientation. This may include psychological, physical, sexual, financial, emotional abuse, and so-called honour-based violence. See the full definition here: Domestic Abuse Act 2021 - Statutory Guidance July 2022
Possible indicators of domestic abuse
- Low self-esteem
- Feeling that the abuse is their fault when it is not
- Physical evidence of violence such as bruising, cuts, broken bones
- Verbal abuse and humiliation in front of others
- Fear of outside intervention
- Damage to home or property
- Isolation – not seeing friends and family
- Limited access to money
Coercive or controlling behaviour is a core part of domestic violence +
A pattern of controlling or coercive behaviour can be well established before a single incident is ever reported to support services. In many cases the conduct of the perpetrator might seem innocent - especially if considered in isolation of other incidents - and the victim may not be aware of, or be ready to acknowledge, abusive behaviour.
"In many relationships, there are occasions when one person makes a decision on behalf of another, or when one partner takes control of a situation and the other has to compromise. The difference in an abusive relationship is that decisions by a dominant partner can become rules that, when broken, lead to consequences for the victim."
Building on examples provided within the Statutory Guidance, relevant behaviours to be aware of can include:
- Isolating a person from their friends and family
- Depriving them of their basic needs
- Monitoring their time
- Monitoring a person via online communication tools or using spyware
- Taking control over aspects of their everyday life, such as where they can go, who they can see, what to wear and when they can sleep
- Depriving them access to support services, such as specialist support or medical services
- Repeatedly putting them down such as telling them they are worthless
- Enforcing rules and activity which humiliate, degrade or dehumanise the victim
- Forcing the victim to take part in criminal activity such as shoplifting, neglect or abuse of children to encourage self-blame and prevent disclosure to authorities
- Financial abuse including control of finances, such as only allowing a person a punitive allowance
- Control ability to go to school or place of study
- Taking wages, benefits or allowances
- Threats to hurt or kill
- Threats to harm a child
- Threats to reveal or publish private information (e.g. threatening to 'out' someone)
- Threats to hurt or physically harming a family pet
- Assault
- Criminal damage (such as destruction of household goods)
- Preventing a person from having access to transport or from working
- Preventing a person from being able to attend school, college or University
- Family 'dishonour'
- Reputational damage
- Disclosure of sexual orientation
- Disclosure of HIV status or other medical condition without consent
- Limiting access to family, friends and finances
This is not an exhaustive list and you should be aware that a perpetrator will often tailor the conduct to the victim, and that this conduct can vary to a high degree from one person to the next.
See our Adult Safeguarding Pathway for Coercive Control Resources
Economic Abuse +
Economic abuse involves behaviours that interfere with an individual’s ability to acquire, use and maintain economic resources such as money, transportation and utilities. It can be controlling or coercive. It can make the individual economically dependent on the abuser, thereby limiting their ability to escape and access safety.
Examples of economic abuse
Examples of economic abuse include:
- Having sole control of the family income
- Preventing a victim from claiming welfare benefits
- Interfering with a victim’s education, training, or employment
- Not allowing or controlling a victim’s access to mobile phone/transport/utilities/food
- damage to a victim’s property
Indicators of Economic Abuse
There are some common warning signs to look out for in victims of economic abuse.
These include:
- A person often not having enough money
- There being a conflict with joint finances, such as one person controlling a couple’s money;
- Shopping habits including always using cash or not being able to buy something without a partner’s permission.
- Changes in someone’s working life, such as leaving a job they enjoyed
- If they suddenly stop socialising and seeing friends
- Their appearance changes, or they become overly anxious
Financial or material abuse +
Types of financial or material abuse
- Theft of money or possessions
- Fraud, scamming Age UK Avoiding Scams Guide
- Preventing a person from accessing their own money, benefits or assets
- Employees taking a loan from a person using the service
- Undue pressure, duress, threat or undue influence put on the person in connection with loans, wills, property, inheritance or financial transactions
- Arranging less care than is needed to save money to maximise inheritance
- Denying assistance to manage/monitor financial affairs
- Denying assistance to access benefits
- Misuse of personal allowance in a care home
- Misuse of benefits or direct payments in a family home
- Someone moving into a person’s home and living rent free without agreement or under duress
- False representation, using another person's bank account, cards or documents
- Exploitation of a person’s money or assets, e.g. unauthorised use of a car
- Misuse of a power of attorney, deputy, appointeeship or other legal authority
- Rogue trading – eg. unnecessary or overpriced property repairs and failure to carry out agreed repairs or poor workmanship
Possible indicators of financial or material abuse
- Missing personal possessions
- Unexplained lack of money or inability to maintain lifestyle
- Unexplained withdrawal of funds from accounts
- Power of attorney or lasting power of attorney (LPA) being obtained after the person has ceased to have mental capacity
- Failure to register an LPA after the person has ceased to have mental capacity to manage their finances, so that it appears that they are continuing to do so
- The person allocated to manage financial affairs is evasive or uncooperative
- The family or others show unusual interest in the assets of the person
- Signs of financial hardship in cases where the person’s financial affairs are being managed by a court appointed deputy, attorney or LPA
- Recent changes in deeds or title to property
- Rent arrears and eviction notices
- A lack of clear financial accounts held by a care home or service
- Failure to provide receipts for shopping or other financial transactions carried out on behalf of the person
- Disparity between the person’s living conditions and their financial resources, e.g. insufficient food in the house
- Unnecessary property repairs
Modern slavery +
Types of modern slavery
- Human trafficking
- Forced labour
- Domestic servitude
- Sexual exploitation, such as escort work, prostitution and pornography
- Debt bondage – being forced to work to pay off debts that realistically they never will be able to
Possible indicators of modern slavery
- Signs of physical or emotional abuse
- Appearing to be malnourished, unkempt or withdrawn
- Isolation from the community, seeming under the control or influence of others
- Living in dirty, cramped or overcrowded accommodation and or living and working at the same address
- Lack of personal effects or identification documents
- Always wearing the same clothes
- Avoidance of eye contact, appearing frightened or hesitant to talk to strangers
- Fear of law enforcers
A new local guidance document on Modern Slavery and Human Trafficking will be published in 2022, but professionals should also refer to the Lewisham Modern Slavery Victim Care Pathway.
Further Home Office information on identifying and reporting modern slavery
London Directory of Services
The Human Trafficking Foundation has created a Directory of Survivor Support Services in London, which is constantly updated.
Neglect and Acts of Omission
Types of neglect and acts of omission
- Failure to provide or allow access to food, shelter, clothing, heating, stimulation and activity, personal or medical care
- Providing care in a way that the person dislikes
- Failure to administer medication as prescribed
- Refusal of access to visitors
- Not taking account of individuals’ cultural, religious or ethnic needs
- Not taking account of educational, social and recreational needs
- Ignoring or isolating the person
- Preventing the person from making their own decisions
- Preventing access to glasses, hearing aids, dentures, etc.
- Failure to ensure privacy and dignity
Possible indicators of neglect and acts of omission
- Poor environment – dirty or unhygienic
- Poor physical condition and/or personal hygiene
- Pressure sores or ulcers
- Malnutrition or unexplained weight loss
- Untreated injuries and medical problems
- Inconsistent or reluctant contact with medical and social care organisations
- Accumulation of untaken medication
- Uncharacteristic failure to engage in social interaction
- Inappropriate or inadequate clothing
Organisational or institutional abuse +
Types of organisational or institutional abuse
- Discouraging visits or the involvement of relatives or friends
- Run-down or overcrowded establishment
- Authoritarian management or rigid regimes
- Lack of leadership and supervision
- Insufficient staff or high turnover resulting in poor quality care
- Abusive and disrespectful attitudes towards people using the service
- Inappropriate use of restraints
- Lack of respect for dignity and privacy
- Failure to manage residents with abusive behaviour
- Not providing adequate food and drink, or assistance with eating
- Not offering choice or promoting independence
- Misuse of medication
- Failure to provide care with dentures, spectacles or hearing aids
- Not taking account of individuals’ cultural, religious or ethnic needs
- Failure to respond to abuse appropriately
- Interference with personal correspondence or communication
- Failure to respond to complaints
Possible indicators of organisational or institutional abuse
- Lack of flexibility and choice for people using the service
- Inadequate staffing levels
- People being hungry or dehydrated
- Poor standards of care
- Lack of personal clothing and possessions and communal use of personal items
- Lack of adequate procedures
- Poor record-keeping and missing documents
- Absence of visitors
- Few social, recreational and educational activities
- Public discussion of personal matters
- Unnecessary exposure during bathing or using the toilet
- Absence of individual care plans
- Lack of management overview and support
Physical abuse +
Types of physical abuse
- Assault, hitting, slapping, punching, kicking, hair-pulling, biting, pushing
- Rough handling
- Scalding and burning
- Physical punishments
- Inappropriate or unlawful use of restraint
- Making someone purposefully uncomfortable (e.g. opening a window and removing blankets)
- Involuntary isolation or confinement
- Misuse of medication (e.g. over-sedation)
- Forcible feeding or withholding food
- Unauthorised restraint, restricting movement (e.g. tying someone to a chair)
Possible indicators of physical abuse
- No explanation for injuries or inconsistency with the account of what happened
- Injuries are inconsistent with the person’s lifestyle
- Bruising, cuts, welts, burns and/or marks on the body or loss of hair in clumps
- Frequent injuries
- Unexplained falls
- Subdued or changed behaviour in the presence of a particular person
- Signs of malnutrition
- Failure to seek medical treatment or frequent changes of GP
Psychological or emotional abuse +
Types of psychological or emotional abuse
- Enforced social isolation – preventing someone accessing services, educational and social opportunities and seeing friends
- Removing mobility or communication aids or intentionally leaving someone unattended when they need assistance
- Preventing someone from meeting their religious and cultural needs
- Preventing the expression of choice and opinion
- Failure to respect privacy
- Preventing stimulation, meaningful occupation or activities
- Intimidation, coercion, harassment, use of threats, humiliation, bullying, swearing or verbal abuse
- Addressing a person in a patronising or infantilising way
- Threats of harm or abandonment
- Cyber bullying
Possible indicators of psychological or emotional abuse
- An air of silence when a particular person is present
- Withdrawal or change in the psychological state of the person
- Insomnia
- Low self-esteem
- Uncooperative and aggressive behaviour
- A change of appetite, weight loss/gain
- Signs of distress: tearfulness, anger
- Apparent false claims, by someone involved with the person, to attract unnecessary treatment
Self-neglect +
Types of self-neglect
- Lack of self-care to an extent that it threatens personal health and safety
- Neglecting to care for one’s personal hygiene, health or surroundings
- Inability to avoid self-harm
- Failure to seek help or access services to meet health and social care needs
- Inability or unwillingness to manage one’s personal affairs
Indicators of self-neglect
- Very poor personal hygiene
- Unkempt appearance
- Lack of essential food, clothing or shelter
- Malnutrition and/or dehydration
- Living in squalid or unsanitary conditions
- Neglecting household maintenance
- Hoarding
- Collecting a large number of animals in inappropriate conditions
- Non-compliance with health or care services
- Inability or unwillingness to take medication or treat illness or injury
7 Minute Briefing - Self-Neglect and Alcohol and Substance Misuse - Teeswide Safeguarding Adults Board
Sexual abuse +
Types of sexual abuse
- Rape, attempted rape or sexual assault
- Inappropriate touch anywhere
- Non- consensual masturbation of either or both persons
- Non- consensual sexual penetration or attempted penetration of the vagina, anus or mouth
- Any sexual activity that the person lacks the capacity to consent to
- Inappropriate looking, sexual teasing or innuendo or sexual harassment
- Sexual photography or forced use of pornography or witnessing of sexual acts
- Indecent exposure
Possible indicators of sexual abuse
- Bruising, particularly to the thighs, buttocks and upper arms and marks on the neck
- Torn, stained or bloody underclothing
- Bleeding, pain or itching in the genital area
- Unusual difficulty in walking or sitting
- Foreign bodies in genital or rectal openings
- Infections, unexplained genital discharge, or sexually transmitted diseases
- Pregnancy in a woman who is unable to consent to sexual intercourse
- The uncharacteristic use of explicit sexual language or significant changes in sexual behaviour or attitude
- Incontinence not related to any medical diagnosis
- Self-harming
- Poor concentration, withdrawal, sleep disturbance
- Excessive fear/apprehension of, or withdrawal from, relationships
- Fear of receiving help with personal care
- Reluctance to be alone with a particular person
Sexual violence
Sexual violence includes any form of sexual activity (involving physical contact, words, or photographs) that takes place without the other person's full and informed consent. Rape and sexual assault are mostly carried out by someone known to the victim: a husband, boyfriend, friend, colleague or other family member.
Sexual violence can happen to anyone regardless of age, gender, race, sexual orientation, religion, class, or background.
Research shows that the majority of sexual violence is experienced by women and girls, but men and boys can also be victims. If you are a man who has experienced sexual violence, Lewisham Council and Refuge provide help and information and links to further resources to Support Men.
Sexual violence can include:
- Pressuring or forcing someone to do something sexual
- Touching someone sexually without their permission
- Unwanted sexting — sending sexually explicit texts and images to someone without their consent
- Unwanted sexual attention — for example 'wolf-whistling' and making sexualised comments about women's bodies
- Watching a sexual act take place without permission
- Engaging in sexual acts with someone who is too drunk, or too intoxicated, to give consent
- Engaging in a sexual act with someone who is asleep or unconscious
- Having sex with someone who cannot legally consent — for example, a boy or girl under the age of 16, or someone with a disability who does not have the capacity to understand the situation
- Making someone watch or appear in pornography against their will
- Preventing someone from using contraception
Understanding consent
When you're having sex, or doing something intimate with another person, it's important to be sure that they want to be doing it too — that they have consented. Even if you're in a relationship with someone it's important to make sure your partner agrees to any sexual act every time.
- Consent is showing or verbally communicating a clear 'yes' to your partner. If you're not sure if someone is consenting, ask
- To be able to consent, a person must have both the capacity to say yes and must understand what is happening and what they are agreeing to do
- The absence of "no" doesn't mean yes. Someone might have been pressured or frightened into doing something they don't want to — this means they haven't consented. If you are not sure if your partner is consenting, ask
- Everyone has the right to say no to any kind of sexual activity, or to change their mind at any time before or during sex
- It's also important to remember that there are some groups of people who cannot consent under law. If someone is not physically or mentally capable of making a decision to have sex — or they can't understand what they're agreeing to — they cannot give consent. For example, if someone is very drunk or intoxicated when they agree to sex, the law recognises that they don't have the capacity to give `true' consent
- The age of consent in the UK is 16
If you have been sexually assaulted or raped
If you have just been raped or sexually assaulted, try to remember that you are not alone and you are not to blame for what has happened. Here are some simple steps you can take to help ensure your safety:
- Find somewhere you feel safe
- You might be in shock, so wrap up warm
- Consider telling someone you trust about what happened. If you don't feel comfortable telling anyone yet, you can call the 24 hour National Domestic Abuse Helpline for support on 0808 2000 247
- Call 999 if you require urgent medical attention
You might want to consider contacting a Sexual Assault Referral Centre (SARC). SARCs provide support to victims of rape or sexual assault — including providing a confidential space for interviews, examinations and collecting evidence. Some may also offer counselling services. These services are available regardless of whether you feel you want to report to the police.
If you are considering reporting what happened, or simply want more information about your options, see Support Services in London.
Find out about the specialist services Refuge Athena Lewisham provides to victims of sexual violence.
Information for Professionals
Space for Self: The therapeutic model of the Rape and Sexual Abuse Support Centre (RASASC). The report evaluates the outcomes of using the RASASC therapeutic empowerment model for children and young people aged up to 25.
Who is an adult at risk?
Under The Care Act, an adult at risk is someone over 18 years old who: has care and support needs. is experiencing, or is at risk of, abuse or neglect. as a result of their care and support needs is unable to protect himself or herself against the abuse or neglect or the risk of it.
Perpetrators of Abuse
The person alleged to have caused harm
Abuse can occur anywhere and be caused by anyone. Adults at risk are sometimes abused by strangers, but more often, they are abused by someone known to them or in a position of trust or power. This may include:
- A partner, relative, friend or child.
- A neighbour or someone from the community network.
- A paid carer or volunteer.
- A health, social care worker or other professional.
- Another adult at risk.
- A non-carer or stranger.
Abuse can occur in any relationship. It often occurs where the person who is abusive is in a more powerful position than the person who is being abused. The person causing the harm may also be suffering with mental ill-health or substance misuse problems.
Abuse occurs when the abuser misuses such power either intentionally, or unintentionally, or for their own benefit or gain. We know from safeguarding data that Neglect and Acts of Omission is the most common type of reported abuse to local authorities in England and Lewisham. Much of this is unintentional, although still harmful, and can be caused by unpaid carer burn out, lack of support or assessment of unpaid carers, staffing problems and shortages in the care sector, or because poor practices have developed unchallenged. Cost of living also has an impact with adults experiencing financial or material (this can be items such as food being stolen) abuse from unpaid and paid carers, because of the pressures faced by many individuals and families.
The person who is abusive may have more power because they are more able than the person they are abusing.
They may also have more power because the adult at risk may be dependent on them in some way.
In some instances the abuser themselves may also be an adult at risk, for example another service user, or an adult with learning disabilities caring for a frail older parent. Resident on resident abuse in care homes, or patient on patient incidents are reported through safeguarding which can include very serious physical, psychological and sexual abuse cases.
There can often be a power imbalance between a member of staff, paid carer or a volunteer and an adult at risk.
It must be noted that some abusers deliberately seek out adults who appear to be at risk and exploit an existing vulnerability with the intention of abusing, harming, exploiting or manipulating that person. We know from evidence and research that criminal gangs, often sophisticated fraudsters, target individuals in this way linked to financial SCAMS which are increasingly being perpetrated online, although doorstep crimes are still prevalent.
How to report your concerns
If you suspect that you or an adult you care about may be at risk of abuse or neglect please complete the Adult Safeguarding Concern form and return to the Lewisham Adult Gateway as instructed in the form. Alternatively if you have concerns about the immediate safety of an adult at risk then please contact the Police on 999.
If you are a member of the public we recommend you make contact with the Lewisham Adult Gateway via telephone.
There are a number of other ways you can contact the Lewisham Adult Gateway
The team can be contacted Monday - Friday 9am - 5pm
Tel: 020 8314 7777 (select option 1) Tel: 020 8314 7766 (outside of office hours)
Fax: 020 8314 3014
Email Lewisham Adult Gateway
Contact details for the deaf / impaired hearing community
Minicom: 020 8314 3309
Text Message: 07730 637 194
Glide: LEWISHAM Adult Social Care / 07730 637 194
Please note – Glide is a free app which allows video messaging (for sign language).
It can be downloaded free of charge from the following sources:
Apple itunes
Google play
Microsoft app store
More information on the Lewisham Adult Gateway
If you believe that a criminal offence may have been committed and you would prefer to report your concerns anonymously please report them to Crimestoppers UK
What happens after you report your concerns
Once a report of suspected adult abuse or neglect is made, the organisation you reported your concerns to will take steps to ensure the immediate safety of the person and anyone else who may be affected. You can be assured that all reports of suspected abuse or neglect are taken seriously and are confidential.
Collecting information
When a report of suspected adult abuse is received further information will be gathered. If the adult at risk is unable to speak for themselves they can choose someone to act on their behalf such as a friend or family member. If this isn’t possible Adult Social Care can arrange for an independent person to do this, they are known as an Advocate.
They will talk to the person, or a suitable representative on their behalf, to find out what is happening and then work together to plan what can be done to help keep them safe and as independent as possible.
People involved
Where necessary Adult Social Care will investigate allegations of abuse with partner organisations and take appropriate action.
Meetings
Sometimes a meeting is needed. The individual, or the person who acts on their behalf, may be invited to a meeting called a safeguarding planning meeting. During this meeting concerns will be discussed and the Chairperson will ensure that everybody has their say.
The Chairperson will ensure that everything that was agreed to be done is being done, and decide if any further action is needed. A safeguarding plan may be agreed to continue to keep the person safe.
Sometimes they will need to arrange further meetings to review the safeguarding plan and make changes if necessary to ensure the person continues to remain safe.
What if you don’t want anything to happen?
If the abuse is happening to you, you have a right to say what you want to be done about it. You will always be asked what you want and who you want to be involved.
Sometimes there are other people who may also be in danger and the abuse is too serious for people to do nothing. Professionals have a duty of care to you and other people and may have to act against your wishes. If this has to happen you will always be told why.
What if you’re not happy?
If you’re not happy about the safeguarding adults process Lewisham Adult Social Care would like to know why. You can speak to the Chairperson who was involved in your meetings, or you can contact the Lewisham Safeguarding Adults Manager.
Positive Outcomes
This video Safeguarding Adults- An Independent Life After Abuse produced by the Social Care Institute for Excellence shows the positive outcomes the safeguarding process can have on a person who has been abused.
Six Safeguarding Principles
There are six safeguarding principles that underpin all safeguarding work:
Mental Capacity, DoLS and Advocacy
Mental Capacity Act Deprivation of Liberty Safeguards
The Mental Capacity Act (MCA) 2005 came into force during 2007. A number of government departments sponsored its implementation. The MCA is designed to protect and restore power to those vulnerable people who lack capacity. The MCA also supports those, over the age of 18, who have capacity and choose to plan for their future. It applies to everyone working in health and social care who is involved in the care, treatment and support of people aged 16.
At the heart of the MCA in terms of concepts and values are the five ‘statutory principles’. Consider the five principles as the benchmark. They should be used to underpin all acts done and decisions taken in relation to those who lack capacity.
Using the Mental Capacity Act
This new film below from Social Care Institute for Excellence explains the MCA and how it can protect the right to make choices. It's an introduction to the Act for people who need it, staff, carers and others.
Understanding Mental Capacity from the The Open University
This free course, Understanding mental capacity, describes the principles and criteria underpinning the assessment of mental capacity and decision making in the UK. The course begins by looking at what mental capacity – and the lack of it – means.
You will be introduced to various groups of people who are more likely to lack mental capacity, but you will also learn why it is relevant to everyone.
You will look at what can be done to help someone to make a decision themselves and the principles and steps that enable people to judge, fairly, whether someone has capacity or not.
You will be introduced to the legislation in the UK and will see how it supports and protects people who may lack capacity.
The course will appeal to those who support people aged 16 or over and who have to make decisions in order to address the variety of interpretation and inconsistent application of services in everyday provision. It will explain the law and how it is applied in a practical way for those making important decisions about other’s lives, such as health and social care staff, police, banks and insurance industry workers, and retailers.
Deprivation of Liberty Safeguards
The Deprivation of Liberty Safeguards (DoLS) provide additional protection for the most vulnerable people living in residential homes, nursing homes, hospital environments and supported housing through the use of a rigorous, standardised assessment and authorisation process. They aim to protect those who lack capacity to consent to arrangements made in relation to their care and/or treatment, but who need to be deprived of their liberty in their own best interest to protect them from harm. They also offer the person concerned the rights:
- To challenge the decision to deprive them of their liberty;
- For a representative to act for them and protect their interests; and
- The right to have their status reviewed and monitored on a regular basis.
DoLS help ensure that an institution only restricts liberty safely and correctly and only when all other less restrictive options have been explored. The Local Authority manages this process and reports to the local Safeguarding Adults Board. In March 2014 the Supreme Court judgement in the case of “P v Cheshire West and Chester Council and another” and “P and Q v Surrey County Council” lowered the threshold for a deprivation and significantly widened the scope of the Mental Capacity Act Deprivation of Liberty Safeguards themselves.
Lewisham Council's Adult Social Care has a dedicated Deprivation of Liberty Safeguards web page that provides general information, links to other sources of information and contact details for the Deprivation of Liberty Safeguards Team.
Independent advocacy under the Care Act 2014
Advocacy and the duty to involve
Local authorities must involve people in decisions made about them and their care and support. No matter how complex a person’s needs, local authorities are required to help people express their wishes and feelings, support them in weighing up their options, and assist them in making their own decisions.
When does the advocacy duty apply?
The advocacy duty will apply from the point of first contact with the local authority and at any subsequent stage of the assessment, planning, care review, safeguarding enquiry or safeguarding adult review. If it appears to the authority that a person has care and support needs, then a judgement must be made as to whether that person has substantial difficulty in being involved and if there is an appropriate individual to support them. An independent advocate must be appointed to support and represent the person for the purpose of assisting their involvement if these two conditions are met and if the individual is required to take part in one or more of the following processes described in the Care Act:
- A needs assessment
- A carer’s assessment
- The preparation of a care and support or support plan
- A review of a care and support or support plan
- A child’s needs assessment
- A child’s carer’s assessment
- A young carer’s assessment
- A safeguarding enquiry
- A safeguarding adult review
- An appeal against a local authority decision under Part 1 of the Care Act (subject to further consultation)
Judging ‘substantial difficulty’
Local authorities must consider, for each person, whether they are likely to have substantial difficulty in engaging with the care and support process. The Care Act defines four areas where people may experience substantial difficulty. These are:
- Understanding relevant information
- Retaining information
- Using or weighing information
- Communicating views, wishes and feelings
Supported decision-making toolkit for people with communication difficulties
Practicable steps for people with communication difficulties
LSAB 7 Advocacy Minute Briefing Advocacy
Who is an ‘appropriate individual’ to assist a person’s involvement?
If the person being supported doesn’t want that person to support them, that’s not an appropriate adult. You can’t force an advocate on someone.
Co-production workshop participant
Local authorities must consider whether there is an appropriate individual who can facilitate a person’s involvement in the assessment, planning or review process, and this includes four specific considerations. The appropriate individual cannot be:
- Already providing care or treatment to the person in a professional capacity or on a paid basis
- Someone the person does not want to support them
- Someone who is unlikely to be able to, or available to, adequately support the person’s involvement
- Someone implicated in an enquiry into abuse or neglect or who has been judged by a safeguarding adult review to have failed to prevent abuse or neglect
The role of an ‘appropriate individual’ under the Care Act is potentially fuller and more demanding than that of an individual with whom it is ‘appropriate to consult’ under the Mental Capacity Act (MCA). Under the Care Act the appropriate individual’s role is to facilitate the person’s involvement, not merely to consult them and make decisions on their behalf.
Information and advice
The Care Act places a duty on local authorities to ensure that all adults in their area have access to information and advice on care and support, and to keep them safe from abuse and neglect. Prior to making contact with the local authority, there may be some people who require independent advocacy to access information and advice.
Continuing health care
The advocacy duty in the Care Act applies equally to those people whose needs are being jointly accessed by the NHS and the local authority, or where a package of support is planned, commissioned or funded by both a local authority and a clinical commissioning group (CCG), known as a ‘joint package’ of care.
Independence
The independence of the service is an important consideration for all commissioners. For services to be meaningful and acceptable to those they are designed to support they must have the confidence of individuals, carers and the public.
Prisoners
From April 2015 local authorities will also be responsible for assessing and meeting the social care needs of adult prisoners (not just on discharge from prison but also while in custody). All prisoners will be treated as if they are resident in that area for the purposes of the Care Act and for as long as they reside in that prison. Prisoners will be entitled to the support of an independent advocate in the same circumstances as people in the community.
Social Care and Health have produced this video in British Sign Language on the provision of Independent Advocacy under the Care Act 2014.
Prevention
This video Safeguarding Adults - Helping People To Protect Themselves From Crime which has been produced by the Social Care Institute for Excellence, shows what care workers and others who are in contact with adults at risk can do to help them protect themselves from crime.
This video Safeguarding Adults - Looking Out For Each Other To Prevent Abuse which has been produced by the Social Care Institute for Excellence, can be helpful to highlight what the local community can do to protect themselves and those they care about.
Preventing abuse and neglect of adults with care and support needs - SCIE
Feeling lonely or isolated? - Age UK Silver Line
As we get older, we may find we spend more time on our own. This can sometimes feel lonely, boring or make us miss friends or family.
If you or someone you know is missing the joy of regular conversation,
The Silver Line Helpline run by Age UK is a free, 24-hour telephone service for older people across the UK.
We offer friendship, conversation, and support for people aged 55 or over, especially those who may be experiencing feelings of loneliness and isolation.
Find out more about the Silver Line
London Fire Brigade - Home Fire Safety Checker
Get started with the Home Fire Safety Checker
Metropolitan Police- Lewisham - Personal safety: how to stay safe
Tips and advice on keeping yourself protected from crime: from pickpocketing and personal robbery to harassment and dealing with violent situations.
Independent Age - Advice and support for older age
Independent Age have some great advice on what can cause falls, what you can do if you do fall and where to find out further information.
Staying steady on your feet
Lewisham and Greenwich NHS Trust offer a falls rehabilitation service which you can access via referral from your GP.
Age UK Lewisham and Southwark
Age UK Lewisham and Southwark exists to improve the lives of older people in the London Boroughs of Lewisham and Southwark, working towards a future in which older people are valued, safe and empowered to make choices about their lives.
Age UK Lewisham and Southwark aims to empower and enable older people to lead fulfilled lives by:
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Providing services and support that address poverty and isolation
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Protecting the human rights of local older people
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Promoting health and wellbeing
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Connecting older people with their communities
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Working positively with partners across all sectors
Protect yourself from fraud and cyber crime with Action Fraud
How much do you really know about fraud and cyber crime? Action Fraud has lots of helpful information and advice on how to keep you safe.
See this Web Page which has useful advice and services that exist locally: Lewisham Safeguarding Adults Board - SCAMS Information and Advice
Publications, Policies and Procedures
Adult Safeguarding Leaflets and Posters
Adult Safeguarding Posters - See it, Report it!
Adult Safeguarding Leaflet:
Infographic - It all Points to Prevention
Working with Fathers and Male Carer's Toolkit
A toolkit for professionals working with fathers and male carers.
Working with Fathers and Male Carer's Toolkit Checklist
A checklist that focusses professionals work when working with fathers and male carer's.
Working with Fathers and Male Carer's Toolkit Resources
A collection of resources for professionals working with fathers and male carer's in Lewisham.
LSAB Scams Easy Read Booklet
This booklet was made by Lewisham Speaking Up on behalf of the Lewisham Safeguarding Adults Board.
Read and download the Scams Easy Read Booklet
New! LSAB Cuckooing A Brief Guide for Professionals
A brief guide for professionals including information on
- What is Cuckooing
- Common Indicators of Cuckooing
- What can I do to help make the adult safe?
- Relationship-Based Practices
- Person-Centred Interventions
- Partnership Working
- Advice for Submitting an Adult Safeguarding
Concern
- Support for Lewisham Professionals
Annual Reports
The Care Act 2014 requires each Safeguarding Adults Board (SAB) to publish an annual report.
The Care Act (Schedule 2.4 (1) a–g) defines the minimum content of an annual report.
As soon as is feasible after the end of each financial year, a SAB must publish a report on:
- What it has done during that year to achieve its objective,
- What it has done during that year to implement its strategy,
- What each member has done during that year to implement the strategy,
- The findings of the reviews arranged by it under section 44 (safeguarding adults reviews) which have concluded in that year (whether or not they began in that year),
- The reviews arranged by it under that section which are ongoing at the end of that year (whether or not they began in that year),
- What it has done during that year to implement the findings of reviews arranged by it under that section, and
- Where it decides during that year not to implement a finding of a review arranged by it under that section, the reasons for its decision.
- The performance of member agencies and how effectively, or otherwise, they are working together should be included in the report.
The annual report must be sent to:
- The Chief Executive and leader of the local authority which established the SAB.
- Any local Policing body that is required to sit on the SAB.
- The local Health Watch organisation.
- The Chair of the local Health and Wellbeing Board.
Annual reports should form the basis for the consultation on the strategic plan for the coming year.
A SAB should seek assurance from its members that the annual report has been considered within their internal governance processes.
LSAB Annual Report 2023-24
Message from the Independent Chair
“I would firstly like to thank and pay tribute to my predecessor Professor Michael Preston-Shoot. It is clear that I have inherited a well organised and high performing Board following his tenure”.
This is my first year as the independent Chair of the Lewisham Safeguarding Adults Board (SAB) and I would firstly like to thank and pay tribute to my predecessor Professor Michael Preston-Shoot. It is clear that I have inherited a well organised and high performing Board following his tenure.
It has been a genuine pleasure to get to know the members of the Board during this past year, and I want to thank them for their welcome and their hard work. SABs bring together professionals from a range of agencies, and it requires skill, co-operation and a willingness to work together in order for a Board to function effectively. I have witnessed this in the highest order; a commitment to serve the residents of Lewisham to the best possible standards.
The Case Review Sub-Group has met on several occasions during the past year reviewing ten cases and managing four new SAR notifications. The Performance, Audit and Quality Sub-Group launched a new Information Sharing Agreement in January 2024 and also published an
Inter-Agency Escalation Policy. This Sub-Group is key to ensuring that learning from SARs are implemented in practice and it has been strengthened by some new members.
The Board also has excellent representation from people with lived experience. I am grateful for their willingness to serve, be heard, and to hold the Board to account for its actions.
Our understanding of domestic violence and the significant impact it has on women and girls continues to develop and this is why the Board has recommitted to making this a priority for 2024-25. We need to support the work on prevention and take urgent action to reduce the impact of this type of abuse.
We are also seeing a significant rise in the scale and type of frauds in society. This is something that affects us all, but it is the vulnerable who are most at risk as they are often less able to spot this. We co-produced an easy read guidance leaflet along with Lewisham Speaking Up and their service users. This will support the efforts to help prevent this type of crime within our local community.
This report also presents our priorities for the coming year. They are ambitious, and rightly so, as we continue to do all we can to help build safer and more resilient communities.
Finally, I would like to thank the Board’s Business Unit Team. They are simply amazing in delivering their significant administrative workload and keeping the SABs business moving forward by managing a wide range of actions plans. They also co-ordinate and deliver training, lead the work on policy development, along with the massive undertaking of managing the caseload of Safeguarding Adults Reviews.
Thank you.
Professor Keith Brown
Summary of Delivery in 2023-24
The Board continued to oversee the delivery of its strategic aims and objectives.
Key areas of work included:
Safeguarding Adults Reviews (SARs)
The Board continues to be busy with several notifications being submitted throughout the year. Details of the two published SARs from the reporting period and the Second National Analysis can be found below.
Learning and Development
The Board delivered over 40 learning activities during the last 12 months reaching a record number of participants. This included a focus on responding to sexual violence and awareness of neurodiversity, as well as a transitional safeguarding workshop which staff from the Business Unit helped to arrange.
Community Engagement
There were a number of events that were designed and delivered to engage members of the public and citizens who have lived experience of abuse and neglect. This included involvement with the Board’s development session. The feedback is used to help ensure that strategic priorities are relevant and to promote information to help with prevention.
Think Family
This was one of the key objectives for 2023-24 and involved a detailed project to develop some new guidance for the borough on this subject, as well as further toolkits to help support practitioners.
Self-Neglect
Important work continued throughout the year to develop new policy and procedures.
Statutory Advocacy
Advocacy is designed to empower people to have a voice if they are having difficulties taking part in the decision-making processes linked to health and social care matters.
This could be for a variety of reasons, including having a learning disability, mental or physical health issues, or being very elderly or frail.
“No decision about me, without me”.
Unfortunately this can be overlooked sometimes and we have relatively low use of our statutory advocacy services compared to other local boroughs:
The local authority can refer adults for advocacy support for any stage, of any of the following:
- s.9 Needs Assessment.
- s.10 Carer’s Assessment.
- s.25 The preparation of a Care and Support Plan or Support Plan.
- s.27 A review of Care and Support Plan or Support Plan.
- s.42 Safeguarding Enquiry.
- s.44 Safeguarding Adults Review (SAR).
Case Studies and Partners Work (All case studies have been anonymised.)
Metropolitan Police Service
Andrew first came to the attention of the police as a missing person several years ago and since then he has been reported missing multiple times. Andrew’s family have relayed their fears to Officers regarding his complex medical conditions and
other vulnerabilities. There have been occasions when Andrew has been found in the company of individuals known to have a criminal history, including drug dealers.
Andrew’s mental capacity is being reviewed and a therapeutic residential placement is being considered. It is hoped that a therapeutic setting, with the assistance of a chaperone in the community, will encourage Andrew to actively engage in key work sessions that could positively impact on improving his skills to enable him to live safely and independently in supported accommodation.
The Lewisham Safeguarding Adults Board is currently leading on developing some tri-borough guidance to help improve the response to missing adults episodes.
NHS South East London (SEL) Integrated Care Board (ICB)
The SEL ICB Adult and Child Safeguarding Policy was refreshed by the Lewisham team in the last year and a Safeguarding Supervision Policy has been developed.
The SEL Safeguarding Team contributed to the presentation at the assessment panel in March 2024 which supported Lewisham in its re-accreditation as a Borough of Sanctuary. To support this there has been an enhanced primary care approach for asylum seekers in the Home Office provided accommodation in Lewisham, to identify and mitigate any health or safeguarding concerns. The team also continued to provide support to GP practices and third sector organisations who have queries in relation to complex safeguarding cases, and an audit of GP safeguarding procedures has also taken place.
Following a request by the LSAB Board a review and audit of fire policies and procedures in older people’s care homes was conducted, including observations of mock fire emergency situations. 100% of the recommendations from this review have been completed by care homes. SEL ICB staff continue to support the delivery of the Learning Disability Mortality Review (LeDeR) programme in Lewisham, which reports to the Lewisham Learning Disability & Autism Health Stakeholder group.
South London & Maudsley NHS Foundation Trust (SLaM)
Staff at SLaM have been working hard over the last 12 months to restructure and refresh the way safeguarding is managed in the trust. This has resulted in the successful recruitment of a number of new staff members into a central safeguarding team, with a lead in each borough, and specialist domestic abuse and exploitation workers. A new set of operating procedures has also been developed and safeguarding procedures updated.
Lewisham Council - Adult Social Care (ASC)
Adult A had a diagnosis of cognitive impairment and other morbidities. The case was discussed at a multi-agency case conference, and a Safeguarding Enquiry commenced, due to concerns that a family member was making inappropriate decisions about care arrangements. The adult was engaged and a referral to the statutory advocacy provider was made, before a transfer to a hospital outside of the borough. Following an assessment of mental capacity related to discharge destination, and further discussions, the adult left hospital into the care of his spouse with a relevant and comprehensive package of care and wider facilitated support.
Considering the decline in the adult’s cognitive ability and the fact this was unlikely to improve due to a diagnosis of vascular dementia. The adult would continue to be at risk of further neglect, acts of omission, and or psychological abuse. Despite this the Safeguarding Enquiry was closed at the initial stage as requested by the adult and their spouse (Making Safeguarding Personal), although the allocated Social Worker continues to monitor the case and review the package of care.
During the last 12 months developmental activities include:
- Extensive Safeguarding Enquiries in relation to some care homes in the borough.
- Delivery of action plans related to safeguarding audits.
- Establishment of a domestic abuse specialist worker’s role and improved joint working with the domestic abuse service provider (Refuge - Athena).
- ASC wide review of safeguarding processes and practice.
- Improved ways of working in the Multi-Agency Safeguarding Hub (MaSH).
Lewisham and Greenwich NHS Trust (LGT)
Simon has attended the Emergency Department (ED) at the Trust 49 times in the last two years. He usually attends in an intoxicated state. Members of the public often call the London Ambulance Service for him. At times, members of LGT staff have brought Simon into the ED when he has been found collapsed outside the hospital. He has often attended with injuries, sometimes following an assault. He has also attended with chest infections and chest pain. He has often been doubly incontinent at presentation he is often verbally aggressive to staff but has never been violent.
Simon often leaves the Emergency Departments before his assessment is complete.
Simon has also attended multiple hospitals across London in the same timeframe, and has several underlying and serious health conditions. Simon told a member of the adult safeguarding team that he was street homeless following childhood abuse and criminality, but that he does now have a room at a supported housing placement.
LGT staff have tried to refer Simon to the local authority by using safeguarding procedures, but as yet this has been unsuccessful as Simon is choosing not to engage (this case has been escalated). Staff have also referred Simon to the Lewisham High Intensity User Panel at which patients are discussed to make safety plans as well as linking them in with appropriate local services.
Despite the great work by LGT staff there is still a need to improve the multi-agency response to cases like this, and consider how best to support chronic dependent drinkers like Simon, where there are also obvious safeguarding risks.
Statutory reviews are now more closely monitored and tracked, and new ways of working implemented to strengthen individual supervision sessions for staff.
Learning, Training and Development
As outlined below the number of learning events being provided by the Board and therefore the numbers of participants has grown significantly over the last 4-5 years.
This has been strongly influenced by Covid-19 and the move to online working, and although there is a growing appetite from some for in-person activities, these are not as well attended as online events and are difficult to ‘sell out’ with high drop out rates being very common. The maximum capacity for arranging events based on available resources is also now being reached as illustrated by the graphs above.
The use of the LSAB website has almost doubled in the last 4 years which coincides with the launch of the local Adult Safeguarding Pathway in 2021, although growth is now slowing as we probably start to maximise its potential reach.
National Adult Safeguarding Awareness Week November 2023
The Board supported (and helped to plan) the programme of online activities that was delivered across London between 20 and 24 November 2023, which included a main conference which linked with in-person hubs that had been established in some boroughs. 2,000 professionals attended the online programme that covered a wide range of topics. The same approach will also be used in 2024, although it is hoped the numbers that attend will be significantly higher.
There were also a series of three in-person ‘listen and learn’ workshops delivered in Lewisham during that week which were designed to ensure that the voice of local citizen’s and professionals informs the work of the Board. These were really well received and attended by a total of 70 people.
Communication and Engagement
SCAMS Leaflet
The Board were delighted to work with Lewisham Speaking Up again on this new easy read leaflet that was co-produced with their service users and published in the early part of 2024.
It is very detailed and covers all of the information that members of the public need to be able to identify the different types of SCAMS, how this can happen, and who to approach for advice and support.
Although this is an easy read document and aimed at adults living with a learning disability, it is a useful resource that can be used by anyone and we strongly recommend this.
Lewisham Safeguarding Adults Board - Scams Easy Read Booklet
Housing Summit
The Board facilitated the 2nd Housing Related Safeguarding Summit on 14 December 2023 following on the success of the first the previous year which is
designed to bring professionals together from across the housing sector, along with health, social care and other colleagues to discuss safeguarding related matters. This was attended by 44 professionals with the highlight being the video of participants of the hoarding support group that had being running as a trial in Lewisham during 2023.
View the video: Lewisham Hoarding Support Group 2023
Think Family
The Board has been working closely with the Lewisham Safeguarding Children Partnership on this subject which has resulted in the Think Family Practice Guidance being published, alongside a Working with Fathers and Carers Toolkit.
Lewisham Safeguarding Adults Board - Information for Professionals
This important area of work will continue on into 2024-25.
LSAB Social Media
Between 2019 and 2024 we’ve had circa 220,000 ‘impressions’ on Twitter.
We will keep this account but focus on Instagram now.
We have recently launched an Instagram account and will commit as much time as we can to try to reach a wider audience across Lewisham.
Safeguarding Information 2023-24
Table 1: Concluded Section 42 Enquiries 2023-24: Types of Abuse
Table 2: Lewisham Crime Context: 2023-24
Table 3: Age Demographics in Lewisham: Census Data 2021
Table 4: Concluded s.42 Enquiries: Times Series 2017-18 to 2023-24
Safeguarding Adults Reviews (SARs)
The period in scope for this review was 01.09.17 to 09.03.18, which is the date Joshua died. There were lengthy delays to the review largely due to repeated investigations by the Independent Office for Police Conduct (IOPC).
Joshua was a Black Caribbean man who first came into contact with mental health services in 2002, at the age of 19. He was a patient of Mental Health Forensic Services since 2006 and of the Community Mental Health Team since 2014. Joshua had nine admissions to hospital under the Mental Health Act (MHA)1983.
At the Coroner’s inquest the jury found system-wide failures contributed to his death. A Regulation 28 Report to prevent future deaths was issued to the Metropolitan Police Service and the London Ambulance Service. The jury recorded the medical cause of death as Acute Behavioural Disturbance (ABD) (in a relapse of schizophrenia) leading to exhaustion and cardiac arrest, contributed by restraint struggle, and being walked.
A key outcome from the case was that agencies should review relevant training and policies to strengthen anti-racist perspectives and to include the involvement of people with lived experience and their families and third sector organisations.
Arthur SAR Published 10 November 2023
Arthur was an 81-year-old Black British Caribbean man who lived in Lewisham with his wife, who was also his carer. In September 2021, Arthur was unlawfully killed by his son, ‘Anthony’ [pseudonym]. Arthur had physical disabilities including sight impairment.
Anthony lived alone in a flat provided by the local authority. He had been known to the police since the 1990’s and there had an escalating pattern of anti-social behaviour in his own home prior to the incident. Anthony also had a diagnosis of Treatment
Resistant Schizophrenia and had been known to mental health services since 2000.
Practitioners need to be aware of, and professionally curious about, familial abuse, with recognition of the hidden nature of older people who experience such abuse. Any concerns of familial abuse should be responded to appropriately including risk assessment, safeguarding procedures and referral to support services.
All of the published SARs in Lewisham can be read here:
Lewisham Safeguarding Adults Board - Safeguarding Adults Reviews
Adult 01 (Unpublished)
This review is being conducted in two parts due to ongoing criminal investigations. Practitioners have not been directly involved so far to prevent any potential prejudice of the police investigation, although this has still allowed the Board to share the initial and key learning points with agencies. The second part will be concluded once these parallel proceedings allow, and hopefully lead to the full report being published into the public domain. The case involves serious neglect and a focus on mental capacity.
Second National SAR Analysis 2019 to 2023
The second national analysis of Safeguarding Adults Reviews (SARs) in England was funded by Partners in Care and Health, supported by the Local Government Association (LGA) and the Association of Directors of Adult Social Services (ADASS).
Its purpose was to identify priorities for sector-led improvement as a result of learning from SARs completed between 2019 and 2023.
The analysis builds on the findings of the first national analysis, published in 2020, which considered learning from SARs completed between 2017 and 2019. Taken together, the analyses provide a significant knowledge base about adult safeguarding in England across all types of abuse and neglect. They highlight both the shifts that have taken place and the challenges that endure.
- 652 Safeguarding Adults Reviews (SARs) were considered.
- 1075 people were affected - 861 where there was specific detail.
- 128 Safeguarding Adults Board (SABs) involved (100%).
- 8 SABs had not published a SAR in this period.
Some reviews will have considered multiple types of abuse.
The data highlights that self-neglect continues to be a high risk issue as only 7% of concluded Safeguarding Enquiries in 2022-23 in England were for this subject.
The most prominent practice shortcomings were:
- Risk assessment and management.
- Attention to mental capacity.
- Recognition of the abuse or neglect.
These trends across England are mirrored in the findings from Safeguarding Adults Reviews in Lewisham.
Work of the Sub-Groups
Case Review Sub-Group
The Sub-Group oversees Safeguarding Adults Review (SAR) processes locally, and is now led by Joan Hutton the Director of Operations for Adult Social Care.
The group met 7 times during 2023-24 and considered or monitored 10 cases throughout the year, including 4 new SAR Notifications. A previously agreed review which had commenced was halted after it was agreed that no further learning could be extracted following on from a Learning Disability Mortality Review (LeDeR)involving the same adult.
The Board’s SAR Policy and Procedures October 2023 were reviewed during the reporting period taking into account new draft guidance produced by the London Safeguarding Adults Board.
Lewisham Modern Slavery and Human Trafficking (MSHT) Network
The Board continues to administrate and support the delivery of this multi-agency group which meets on a quarterly basis.
On 23 January 2024 the network held an online conference attended by 100 delegates including a speaker with lived experience who reinforced the good work from professionals she had benefited from in their approach:
“They believed in me, and saw me as a person and not just another case”.
Useful information on this subject can be accessed here: Lewisham Safeguarding Adults Board -Modern Slavery & Human Trafficking
A new learning resource was also published in October 2023 as an alternative to e-learning: Modern Slavery Awareness Workbook and there is also
Regular training available on this subject:
Lewisham Safeguarding Adults Board - Learning Zone
Performance, Audit and Quality Sub-Group
The group continued to meet throughout the year with a busy work programme. Most notably the Board published a new Information Sharing Agreement in January 2024 which is the first time this has been created specifically and uniquely for Lewisham after several years being linked in with a London wide agreement. This was a significant project and is a best practice document that any agency in the borough can refer to.
There is a dedicated webpage on this subject which is very useful: Lewisham Safeguarding Adults Board - Information Sharing
The Board also published a new Inter Agency Escalation Policy in July 2023 and Guidance on Improving our Approach to
Adult and Family Engagement in Jan 2024:
Lewisham Safeguarding Adults Board - Policy and Procedures
A Mental Capacity Audit was conducted in October 2023 which will result in an update to procedures across adult social care and the two local NHS Trusts.
Safeguarding audits have also been undertaken to help prepare for the Care Quality Commission’s (CQC) new inspection regime, and more generally to help partners ensure they have the right focus and priorities.
Self-Neglect Task and Finish Group
This group met throughout the year to lead the work on the consultation and development of the Multi-Agency Self Neglect Policy, Practice Guidance and Procedures. These were being finalised as we approached the end of the period. The new procedures will include the implementation of a new High Risk Panel that will consider the most serious cases in the borough.
Strategic Business Plan 2024-25
In line with the five priority areas there are a total of 19 Actions that are planned for 2024-25. This includes the development of new local guidance on the subject of Adult Sexual Exploitation (ASE); a continued focus on Out of Borough Placements; events designed to raise the profile of missing adults and homelessness; and the creation of a new training course for professional curiosity which is a feature in most SARs.
Full details can be read here:
Lewisham Safeguarding Adults Board - Partnership Compact and Strategic Business Plan 2024-2025
Download a copy of the LSAB Annual Report 2023-2024
Download a copy of the LSAB Annual Report 2022-2023
Download a copy of the LSAB Annual Report 2021-2022
Download a copy of the LSAB Annual Report 2020-2021
Download a copy of the LSAB Annual Report 2019-2020
Download a copy of the LSAB Annual Report 2018-2019
Safeguarding Adults Reviews
Read and download all of the published Safeguarding Adult Reviews Commissioned by Lewisham Safeguarding Adults Board.
Safeguarding Adults Review - Arthur - 10 November 2023
Lewisham Safeguarding Adults Board has today published the Safeguarding Adults Review Arthur.
Accompanying this report is a statement from the family of Arthur.
The Lewisham Safeguarding Adults Board has also produced a 7 Minute Briefing - Arthur - for Professionals.
Safeguarding Adults Review Joshua 7 June 2023
Lewisham Safeguarding Adults Board has today published the Safeguarding Adults Review Joshua.
The Lewisham Safeguarding Adults Board has also published a statement in relation to this review.
The Lewisham Safeguarding Adults Board has also produced a 7 Minute Briefing - Joshua - for Professionals.
Safeguarding Adults Review (SAR) Learning Event Amanda and Eileen Dean
Lewisham Safeguarding Adults Board held this important online event on Wednesday 22 February 2023 2pm - 4pm.
The event was hosted by our Independent Chair, Professor Michael Preston-Shoot and included presentations from the independent reviewers involved in these cases (Susan Harrison and Patrick Hopkinson) as well information on wider SAR themes, including a Q&A session. This high-profile and heavily subscribed event provided a significant learning experience for those who attended.
Recordings, Q&A and presentations from the event are available below.
Amanda
Eileen Dean
Questions and Answers from the Amanda and Eileen Dean SAR Learning Event
Questions and Answers from the Amanda and Eileen Dean SAR Learning Event 22-02-23
Safeguarding Adults Review for Eileen Dean 11 November 2022
Lewisham Safeguarding Adults Board has today published the Safeguarding Adults Review for Eileen Dean.
Accompanying this report is a statement from Eileen's family.
The Lewisham Safeguarding Adults Board has also published a statement in relation to this review.
The Lewisham Safeguarding Adults Board has also produced a 7 Minute Briefing - Eileen Dean - for Professionals.
Safeguarding Adults Review for Amanda 2 November 2022
Lewisham Safeguarding Adults Board has today published the Safeguarding Adults Review for Amanda.
Accompanying this report is a statement from the family of Amanda.
Lewisham Safeguarding Adults Board has also produced a 7 Minute Briefing - Amanda - for Professionals.
Safeguarding Adults Review for Mia 29 September 2021
Lewisham Safeguarding Adults Board has today published the Safeguarding Adults Review for Mia.
Lewisham Safeguarding Adults Board has also produced a LSAB 7 Minute Briefing - Mia - for Professionals.
19 July 2021 Safeguarding Adults Review – Adult Z
Lewisham Safeguarding Adults Board has today published the Safeguarding Adults Review for Adult Z.
Lewisham Safeguarding Adults Board has also produced a 7 Minute Briefing - Adult Z - for Professionals.
The key learning points from this Safeguarding Adults Review were mental ill health, the complexities of mental capacity assessment and providing emergency care in the community for adults with complex needs.
Friday 26 June 2020 - Safeguarding Adults Review – Mrs A & Miss G
Lewisham Safeguarding Adults Board has today published the Safeguarding Adults Review for Mrs A & Miss G.
Lewisham Safeguarding Adults Board has also produced a LSAB 7 Minute Briefing - Mrs A & Miss G - for Professionals.
Friday 12 June 2020 - Safeguarding Adults Review – Mr Tyrone Goodyear
Lewisham Safeguarding Adults Board has today published the Safeguarding Adults Review for Mr Tyrone Goodyear.
Accompanying this report is a statement from the family of Tyrone.
Lewisham Safeguarding Adults Board has also produced a 7 Minute Briefing - Tyrone Goodyear - for Professionals.
Zero Suicide Alliance provide a range of awareness training options, which provide a better understanding of the signs to look out for and the skills required to approach someone who is struggling, whether that be through social isolation or suicidal thoughts.
Friday 5 June 2020 - Safeguarding Adults Review - Executive Summary - Lee
Lewisham Safeguarding Adults Board has today published the Safeguarding Adults Review Executive Summary - Lee.
Lewisham Safeguarding Adults Board has also produced a 7 Minute Briefing – Lee - for Professionals.
During 2018 Lewisham Safeguarding Adults Board published two safeguarding adult reviews. The full reports and accompanying documents are available to read and download below.
Mr Michael Thompson - Safeguarding Adults Review - Full Report
Statement of the board in relation to the Safeguarding Adults Review - Mr Michael Thompson
Safeguarding Adult Review, Reflection and Development Briefing - Personalising Care and Improving Outcomes
Mr CS - Safeguarding Adults Review - Full Report (Includes board statement)
Mr CS - Safeguarding Adults Review - Practice Briefing
Guidelines On Risk Assessment for Smoking in Care Homes
Find out more about Safeguarding Adult Reviews and How to Make a Referral to the LSAB.
Watch the Carers Guide to Home Fire Safety
National Network for Chairs of Adult Safeguarding Boards
You can find all of the Safeguarding Adults Reviews published nationally in the National Network for Chairs of Adult Safeguarding Boards - SAR Library.
Partnership Compact and Strategic Business Plan 2024-2025
Introduction
This document describes how organisations and their representatives on the Lewisham Safeguarding Adults Board (LSAB) will work together in partnership to safeguard the residents of Lewisham in 2024-25. It is based on the statutory functions of Safeguarding Adults Boards as set out in the Care Act 2014, Care and Support Statutory Guidance.
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.
1.1 The aims of adult safeguarding:
• stop abuse or neglect wherever possible;
• prevent harm and reduce the risk of abuse or neglect to adults with care and support needs;
• 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 well-being of an adult; and
• then address what has caused the abuse or neglect.
1.2 Six key principles underpin all adult safeguarding work:
• Empowerment – people being supported and encouraged to make their own decisions and informed consent.
• Prevention – it is better to take action before harm occurs.
• Proportionality – the least intrusive response appropriate to the risk presented.
• Protection – support and representation for those in greatest need.
• Partnership – local solutions through services working with their communities. Communities have a part to play in preventing, detecting and reporting neglect and abuse.
• Accountability – accountability and transparency in delivering safeguarding.
1.3 Safeguarding duty: (this applies to an adult who)
• has needs for care and support (whether or not the local authority is meeting any of those needs) and;
• is experiencing, or at risk of, abuse or neglect; and
• 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.
2. What is abuse and / or neglect?
The criteria set out in section 1.3 above need to be met before the issue is considered as a concern under the statutory safeguarding duty. Exploitation is a common theme in the following list of the types of abuse and neglect.
• 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. A new definition is outlined in the Domestic Abuse Act 2021 including a description of ‘personally connected’.
• Sexual abuse: including rape, indecent exposure, sexual harassment, inappropriate looking or touching, sexual teasing or innuendo, sexual photography, subjection to pornography or witnessing sexual acts, indecent exposure and sexual assault or sexual acts to which the adult has not consented or was pressured into consenting.
• Sexual exploitation: This is when a sexual act takes place in exchange for things like food, shelter, protection, or to pay bills, and the victim may have been coerced or manipulated into this sexual act.
• Psychological abuse: including emotional abuse, threats of harm or abandonment, deprivation of contact, humiliation, blaming, controlling, intimidation, coercion, harassment, verbal abuse, cyber bullying, isolation or unreasonable and unjustified withdrawal of services or supportive networks.
• Financial or material abuse: including 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, or the misuse or misappropriation of property, possessions or benefits.
• Modern slavery: encompasses slavery, human trafficking, forced labour and domestic servitude. Traffickers and slave masters use whatever means they have at their disposal to coerce, deceive and force individuals into a life of abuse, servitude and inhumane treatment.
• Discriminatory abuse: including forms of harassment, slurs or similar treatment; because of race, gender and gender identity, age, disability, sexual orientation or religion (including Hate Crimes).
• Organisational abuse: including neglect and poor care practice within an 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. This may range from one off incidents to on-going ill-treatment. It can be through neglect or poor professional practice as a result of the structure, policies, processes and practices within an organisation.
• 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.
• 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.
3. The statutory functions of Safeguarding Adults Boards
As set out in Care and Support Statutory Guidance, each Safeguarding Adults Board should:
• identify the role, responsibility, authority, and accountability with regard to the action each agency and professional group should take to ensure the protection of adults;
• establish ways of analysing and interrogating data on safeguarding notifications that increase the SAB’s understanding of prevalence of abuse and neglect locally that builds up a picture over time;
• establish how it will hold partners to account and gain assurance of the effectiveness of its arrangements;
• determine its arrangements for peer review and self-audit;
• establish mechanisms for developing policies and strategies for protecting adults which should be formulated, not only in collaboration and consultation with all relevant agencies but also take account of the views of adults who have needs for care and support, their families, advocates and carer representatives;
• develop preventative strategies that aim to reduce instances of abuse and neglect in its area;
• identify types of circumstances giving grounds for concern and when they should be considered as a referral to the local authority as an enquiry;
• formulate guidance about the arrangements for managing adult safeguarding, and dealing with complaints, grievances and professional and administrative malpractice in relation to safeguarding adults (which includes whistleblowing: see 5.4.3 to 5.4.7 of the London Multi-Agency Adult Safeguarding Policy and Procedures);
• develop strategies to deal with the impact of issues of race, ethnicity, religion, gender and gender orientation, sexual orientation, age, disadvantage and disability on abuse and neglect;
• balance the requirements of confidentiality with the consideration that, to protect adults, it may be necessary to share information on a ‘need-to-know basis’;
• identify mechanisms for monitoring and reviewing the implementation and impact of policy and training;
• carry out Safeguarding Adults Reviews;
• produce a Strategic Plan and an Annual Report;
• evidence how SAB members have challenged one another and held other boards to account; and,
• promote multi-agency training and consider any specialist training that may be required; including considering any scope to jointly commission some training with other partnerships, such as the Lewisham Safeguarding Children’s Partnership Board.
The Strategic Business Plan for 2024-25 sets out how the LSAB partner agencies will collectively prioritise and deliver these functions over the next 12 months.
4. Lewisham Safeguarding Adults Board (LSAB) Terms of Reference
The LSAB works to prevent harm or neglect and to help those harmed by leading on and facilitating the following safeguarding adult activities for the borough:
• Strategic planning: activities such as consultation, setting goals and objectives, action planning and prioritisation, securing resources, tracking and review of implementation and goal achievement for safeguarding strategy. In addition, the LSAB will influence and link to strategic planning and commissioning across the partnership to advise and scrutinise in relation to safeguarding adults.
• Setting standards and guidance: activities such as setting standards to be achieved, developing policies and procedural guidance to guide practice towards those standards. Monitoring and auditing the implementation of these policies and procedures.
• Quality assurance: lead and ensure activities such as monitoring, audit and review of practice, review of serious cases, incorporation of research and national guidance are undertaken as required. Conducting audits to ensure the effectiveness of what is done by agencies individually and collectively to safeguard and promote the welfare of adults at risk. Commissioning Safeguarding Adults Reviews and / or other reviews of incidents or organisations when an adult dies or is seriously harmed and abuse or neglect is suspected or proven.
• Promoting participation: by people who use services and carers in safeguarding practice. Promoting awareness and action in the wider community.
• Awareness raising & publicity: activities such as public awareness campaigns, targeted publicity and educational strategies, raising awareness within services.
• Capacity building and training: activities such as training and workforce development.
• Relationship management: activities such as the negotiation and clarification of interagency roles and contributions, member agency compliance, troubleshooting and resolution of difficulties, liaison with wider partnerships and related areas of practice. In addition, undertake work as appropriate with the Lewisham Safeguarding Children’s Partnership Board, Safer Lewisham Partnership and Lewisham Health and Wellbeing Board to ensure that policy and procedures, training and all other activities are co-ordinated and coherent.
4.1 Care and Support Statutory Guidance
Members of a SAB are expected to consider what assistance they can provide in supporting the Board in its work. This might be through payment to the local authority or to a joint fund established by the local authority to provide, for example, secretariat functions for the Board.
Members might also support the work of the SAB by providing administrative help, premises for meetings or holding training sessions. It is in all core partners’ interests to have an effective SAB that is resourced adequately to carry out its functions.
Members who attend in a professional and managerial capacity should be:
• able to present issues clearly in writing and in person;
• experienced in the work of their organisation;
• knowledgeable about the local area and population;
• have a thorough understanding of abuse and neglect and its impact;
• understand the pressures facing front line practitioners;
• able to explain their organisation’s priorities;
• able to promote the aims of the SAB; and,
• able to commit their organisation to agreed actions*.
While board members representing their organisations are expected to have the authority to commit their organisation to agreed actions, those board members representing Sub-Groups or non-service provider organisations may not have the relevant authority. In their case their role is to liaise between the Board and the Sub-Group and take back to their own organisations any proposals or recommendations for action.
Each member of SAB must co-operate and contribute to the carrying out of a Safeguarding Adults Review (SAR) with a view to:
a) identifying lessons to be learnt from the adult’s case, and
b) applying those lessons to future cases.
4.2 The responsibilities of members of the LSAB
The Lewisham Safeguarding Adults Board has an Independent Chair and Deputy Chair from one of the Board’s partner agencies.
The LSAB expects board members to:
• develop and maintain effective working arrangements based on trust and mutual understanding;
• be an active partner in safeguarding and promoting the welfare of adults at risk of harm or neglect;
• contribute to the LSAB financially or by providing staff for particular tasks;
• collate and provide management information as required by the LSAB and contribute to quality assurance arrangements;
• share information to safeguard adults in line with agreed information sharing arrangements;
• commit to the work of the Board by undertaking allocated tasks or sourcing the appropriate support from within their agency to undertake the work and contributing to discussions;
• identify and support staff to participate in the interagency activities of the LSAB through their active membership of the Sub-Groups and / or Task & Finish Groups, and to progress of the work of the Board between meetings;
• ensure that the policies, procedures, guidance, tools and resources in the Lewisham Adult Safeguarding Pathway are disseminated and acted upon in an effective way within their own organisations;
• ensure that communications are cascaded through organisations, services and to front-line staff as appropriate;
• represent the LSAB and its activities within their own organisation and within any groups they represent on the Board;
• report difficulties with own organisation and between organisations to the LSAB and work with partners to find effective solutions.
4.3 Organisations represented on the LSAB
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Age UK Lewisham and Southwark
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Department for Work and Pensions – South London District
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Healthwatch Lewisham
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Lewisham & Greenwich NHS Trust
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Lewisham Adult Social Care
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Lewisham Children & Young People’s services
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Lewisham Speaking Up
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Lewisham Refugee and Migrant Network (LRMN)
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Lewisham Safeguarding Children Partnership (LSCP)
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Lewisham Housing Directorate
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Lewisham Adult Integrated Commissioning
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Lewisham Public Health
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Lewisham Safer Communities
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Lewisham Strategic Housing Services
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London Ambulance Service NHS Trust
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London Fire Brigade
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Metropolitan Police Service, Lewisham (South East BCU)
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National Probation Service, Lewisham and Bromley
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NHS South East London Integrated Care Service and Board
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South East London MIND
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South London & Maudsley NHS Foundation Trust
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999 Club
There will also be representatives from partner agencies on Sub-Groups.
4.4 Governance and accountability
• The LSAB is responsible for ensuring organisations are meeting their safeguarding obligations effectively and will hold them to account if they are not.
• As individuals, Board members are accountable to their own agencies but the Board as a whole will be accountable to the Department of Health and Social Care, and provides reports locally to the Health and Wellbeing Board and the Healthier Communities Select Committee. Its work may be scrutinised periodically by the Overview and Scrutiny Committee and is liable to be inspected at any time by the Care Quality Commission (CQC).
• The Board, through the independent chair, is accountable to the Chief Executive of the Local Authority, the Chief Executive of the NHS Integrated Care Board (ICB) and the Borough Commander of Police.
• These Executive Group of agencies may periodically meet to discuss the strategic direction of the Board, and additionally invite the London Fire Brigade Borough Commander, Chief Executive of Lewisham & Greenwich NHS Trust, and Chief Executive of the South London & Maudsley NHS Foundation Trust to join this group.
4.5 Equality and fairness
• The LSAB operates and supports the principles that actively value the benefits of
diversity, fair treatment, and equal access to, and outcomes from local service delivery.
• The LSAB will seek, so far as it is practicable, to ensure equality of representation and participation in the local democratic process of which it is a part.
• The LSAB will, through its composition and ways of working, seek to inform, support, involve and give a voice to all sections of the local communities it serves, with particular emphasis on the inclusion of black, Asian and minority ethnic groups, faith communities and those living with a disability. It will seek to ensure an appropriate gender balance in its membership, so far as this is practicable.
4.6 Dispute resolution between LSAB Members – Inter Agency Escalation Policy
Having different professional perspectives within safeguarding practice is a sign of a healthy and well-functioning partnership. This is also an indicator of effective professional curiosity, which we know from evidence and research, is a crucial factor in being able to prevent adult abuse and neglect. These differences of opinion are usually resolved by discussion and negotiation between the practitioners concerned. It is essential that where differences of opinion arise, they do not adversely affect outcomes for ‘adults at risk’ and are resolved in a constructive manner.
Pro-active and assertive professional challenge and resolution is an integral part of Inter-agency co-operation and joint working to safeguard adults at risk; and it is important to:
- Ensure professional disputes do not increase the risk to the person or obscure the focus on the adult.
- Ensure professional disputes between agencies are resolved in a timely, open, and constructive manner.
- Identify problem areas in working together where there is a lack of clarity and to promote resolution via amendment to protocols, procedures, and practice.
Professionals should follow the guidelines outlined in the LSAB Inter-Agency Escalation Policy
4.7 Conflicts of interest
Whenever a representative has a conflict of interest in a matter to be decided upon, the representative concerned shall declare such interest at or before discussions begin on the matter. The Chair shall record the interest in the minutes of the meeting and that representative shall take no part in the decision-making process.
5. The operational structure of the Lewisham Safeguarding Adults Board
5.1 The frequency of LSAB meetings
The Board meets four times a year. Board meeting dates will be set as far in advance as possible (normally 12 months) to ensure availability of all board members.
5.2 LSAB Sub-Groups
LSAB work activities are designed to achieve results in the most effective and efficient ways. This may include formal Sub-Groups meeting on a planned regular basis or through smaller specific Task and Finish Groups, workshops, or other consultative events.
Each Sub-Group have their own Terms of Reference (Appendices 3-4), are responsible for delivering specific LSAB Strategic Objectives, and may commission Task and Finish Groups to deliver specific pieces of work linked to these objectives. Members of these groups must understand the remit of the LSAB; that they are assisting the LSAB to meet its objectives; and have the capacity to undertake work for the Board.
Membership of these groups will reflect a range of agencies across Lewisham. They may also include individuals with specialist knowledge or the ability to add value to achieving and implementing planned objectives.
Members are expected to attend meetings; contribute to discussions and activities of the Sub-Group. They may be required to undertake agreed specific tasks, delivering these in a timely way, alerting the Sub-Group Chair or other identified lead officer in advance of any deadlines being missed.
Strategic Learning will be shared along with the Lewisham Safeguarding Children Partnership (LSCP) and Safer Lewisham Partnership (SLP) to share the learning from Safeguarding Adults Reviews, Child Safeguarding Practice Reviews and Domestic Homicide Reviews, enabling higher level strategic objectives to be developed and shared.
5.3 Attendance
Individuals identified as Board, Sub-Group and / or Task and Finish Group members are expected to regularly attend meetings. Where there is unavoidable absence, all organisations should ensure that there is a suitable substitute representative from their agency.
5.4 Administrative arrangements for the LSAB
The agenda and associated papers for each Board meeting are issued no later than five working days before the meeting by the LSAB Administrator.
Minutes of LSAB Board meetings are taken by the LSAB Administrator and circulated within 15 working days of the meeting.
6. Review
These terms of reference will be reviewed as required in response to significant change in guidance, legislation, or member organisations.
Strategic Business Plan 2024-25
LSAB Strategic Business Plan 2024 - 2025
Board Meeting Minutes
On this page you can find minutes of the Lewisham Safeguarding Adults Board meetings.
Information Sharing
Adult Safeguarding: Sharing Information
Sharing the right information, at the right time, with the right people, is fundamental to good practice in safeguarding adults.
Frontline professionals and volunteers should always report safeguarding concerns in line with their organisation’s policy. Policies should be clear about how confidential information should be shared between departments in the same organisation.
For Safeguarding purposes sensitive or personal information sometimes needs to be shared between the Local Authority and its safeguarding partners (including GP’s, health, the police, service providers, housing, regulators and the Office of the Public Guardian). This may include information about individuals who are at risk, service providers or those who may pose a risk to others. It aims to enable partners to share information appropriately and lawfully in order to improve the speed and quality of safeguarding responses.
The Care Act emphasises the need to empower people, to balance choice and control for individuals against preventing harm and reducing risk, and to respond proportionately to safeguarding concerns. The Act deals with the role of the safeguarding adults board’s (SAB’s) in sharing strategic information to improve local safeguarding practice. Section 45 ‘the supply of information’ covers the responsibilities of others to comply with requests for information from the safeguarding adults board.
Sharing information between organisations as part of day-to-day safeguarding practice is already covered in the common law duty of confidentiality, The *EU General Data Protection Regulation (GDPR) the Data Protection Act, the Human Rights Act and the Crime and Disorder Act. The Mental Capacity Act is also relevant as all those coming into contact with adults with care and support needs should be able to assess whether someone has the mental capacity to make a decision concerning risk, safety or sharing information.
*Also see The UK GDPR | ICO for further information.
LSAB Information Sharing Agreement Jan 2024
Lewisham Safeguarding Adults Board (LSAB) has an information sharing agreement that includes the whole partnership.
LSAB Information Sharing Agreement Jan 2024
Appendix A: Template ‘information sharing request’ form
Appendix B: Template ‘information sharing decision and update’ form
It remains the responsibility of organisations and the professionals they employ to ensure that they have a basis for processing that meets common law requirements and the requirements of the GDPR; and for public bodies that they are acting within their powers.
Why do we need to share adult safeguarding information?
Organisations need to share safeguarding information with the right people at the right time to:
- Prevent death or serious harm,
- Co-ordinate effective and efficient responses,
- Enable early interventions to prevent the escalation of risk,
- Prevent abuse and harm that may increase the need for care and support,
- Maintain and improve good practice in safeguarding adults,
- Reveal patterns of abuse that were previously undetected and that could identify others at risk of abuse,
- Identify low-level concerns that may reveal people at risk of abuse,
- Help people to access the right kind of support to reduce risk and promote wellbeing,
- Help identify people who may pose a risk to others and, where possible, work to reduce offending behaviour,
- Reduce organisational risk and protect reputation.
False perceptions about needing consent to share safeguarding information
Some frontline professionals and their managers can be over-cautious about sharing personal information, particularly if it is against the wishes of the individual concerned. They may also be mistaken about needing consent to share safeguarding information. The risk of sharing information is often perceived as higher than it actually is. It is important that professionals consider the risks of not sharing safeguarding information when making decisions and that these decisions are recorded.
How to address false perceptions
- Raise awareness about responsibilities to share information (profession or work role-specific guidance may help),
- Encourage consideration of the risks of not sharing information,
- Brief staff and volunteers on the basic principles of confidentiality the *EU General Data Protection Regulation and data protection,
- Improve understanding of the Mental Capacity Act,
- Provide a contact number for staff and volunteers to raise concerns,
- Be clear in procedures about when to raise a safeguarding concern,
- Assure staff and volunteers that they do not necessarily need to have evidence to raise a concern.
*Also see The UK GDPR | ICO for further information.
Complex networks between safeguarding partner agencies
The local authority has the lead responsibility for safeguarding adults with care and support needs, and the police and the NHS also have clear safeguarding duties under the Care Act 2014. Clinical commissioning groups and the police will often have different geographical boundaries and different IT systems. Housing and social care providers will also provide services across boundaries.
The Care Act 2014 (Section 6 [7]) places duties on the local authority and its partners to cooperate in the exercise of their functions relevant to care and support including those to protect adults. The safeguarding adults board should ensure that it ‘has the involvement of all partners necessary to effectively carry out its duties’.
Below is a simple flowchart of the key principles for information sharing. You can also download this flowchart.
Sharing information to prevent abuse and neglect
Sharing information between organisations about known or suspected risks may help to prevent abuse taking place. The safeguarding adults board has a key role to play in sharing information and intelligence on both local and national threats and risks. The board’s annual report must provide information about any safeguarding adults reviews. This can include learning to inform future prevention strategies. Designated adult safeguarding managers ‘should also have a role in highlighting the extent to which their own organisation prevents abuse and neglect taking place’.
What if a person does not want you to share their information?
Frontline workers and volunteers should always share safeguarding concerns in line with their organisation’s policy, usually with their line manager or safeguarding lead in the first instance, except in emergency situations. As long as it does not increase the risk to the individual, the member of staff should explain to them that it is their duty to share their concern with their manager. The safeguarding principle of proportionality should underpin decisions about sharing information without consent, and decisions should be on a case-by-case basis.
Individuals may not give their consent to the sharing of safeguarding information for a number of reasons. For example, they may be frightened of reprisals, they may fear losing control, they may not trust social services or other partners or they may fear that their relationship with the abuser will be damaged.
If a person refuses intervention to support them with a safeguarding concern, or requests that information about them is not shared with other safeguarding partners, their wishes should be respected. However, there are a number of circumstances where the practitioner can reasonably override such a decision, including:
- You have a lawful basis for sharing without consent under the GDPR & Data Protection Act 2018,
- The individual lacks the mental capacity to make that decision – this must be properly explored and recorded in line with the Mental Capacity Act,
- Other people are, or may be, at risk, including children sharing the information could prevent a crime,
- The alleged abuser has care and support needs and may also be at risk,
- A serious crime has been committed staff are implicated,
- The person has the mental capacity to make that decision but they may be under duress or being coerced,
- The risk is unreasonably high and meets the criteria for a multi-agency risk assessment conference referral,
- You have a legal obligation.
If none of the above apply and the decision is not to share safeguarding information with other safeguarding partners, or not to intervene to safeguard the person:
- Support the person to weigh up the risks and benefits of different options,
- Ensure they are aware of the level of risk and possible outcomes,
- Agree on and record the level of risk the person is taking,
- Offer to arrange for them to have an advocate or peer supporter,
- Offer support for them to build confidence and self-esteem if necessary,
- Record the reasons for not intervening or sharing information,
- Regularly review the situation,
- Try to build trust and use gentle persuasion to enable the person to better protect themselves.
If it is necessary to share information outside the organisation:
- Explore the reasons for the person’s objections – what are they worried about?
- Explain the concern and why you think it is important to share the information,
- Tell the person who you would like to share the information with and why,
- Explain the benefits, to them or others, of sharing information – could they access better help and support?
- Discuss the consequences of not sharing the information – could someone come to harm?
- Reassure them that the information will not be shared with anyone who does not need to know,
- Reassure them that they are not alone and that support is available to them.
If the person cannot be persuaded to give their consent then, unless it is considered dangerous to do so, it should be explained to them that the information will be shared without consent. The reasons should be given and recorded.
It is very important that the risk of sharing information is also considered. In some cases, such as domestic violence or hate crime, it is possible that sharing information could increase the risk to the individual. Safeguarding partners need to work jointly to provide advice, support and protection to the individual in order to minimise the possibility of worsening the relationship or triggering retribution from the abuser.
What if a safeguarding partner is reluctant to share information?
There are only a limited number of circumstances where it would be acceptable not to share information pertinent to safeguarding with relevant safeguarding partners. Safeguarding adults boards set clear policies for dealing with conflict on information sharing. If there is continued reluctance from one partner to share information on a safeguarding concern the matter would be referred to the board. It can then consider whether the concern warrants a request, under Clause 45 of the Care Act, for the ‘supply of information’. Then the reluctant party would only have grounds for refusal if it would be ‘incompatible with their own duties or have an adverse effect on the exercise of their functions’.
Professionals
Information for Professionals
Information for Professionals
The information in this section is for all staff engaged in safeguarding adults at risk. It gives practical pointers to help people assess the risk of abuse, recognise it when it does occur and respond to it appropriately. It will also help put front line safeguarding in a context of multi-agency, cross-borough work to prevent and investigate abuse across London.
While there are similarities between practice with children and adults at risk, there are significant differences and, to a large extent this is reflected in the definition of adults at risk which contributes to that complexity.
Services have a duty to safeguard all of their service users but provide additional measures for service users who are less able to protect themselves from harm or abuse.
‘Safeguarding adults’ covers a spectrum of activity from prevention through to multi agency responses where harm and abuse occurs.
Safeguarding Resources
The Lewisham Adult Safeguarding Pathway has lots of helpful adult safeguarding resources built into it and gives you a step by step guide.
The Lewisham Safeguarding Adults Board produces leaflets and posters on adult safeguarding which you can download for free.
Think Family
In April 2023, the Lewisham Safeguarding Adults Board (LSAB) and Lewisham Safeguarding Children Partnership (LSCP) jointly agreed to focus on Think Family as a strategic priority. Learning from Local Child Safeguarding Practice Reviews and Safeguarding Adults Reviews have highlighted the importance of adult and children’s services working collaboratively and taking a joined up, whole family approach.
Read more about Think Family in Lewisham
Skills for Care have collated practical and useful safeguarding resources for the Private Voluntary and Independent Sector. The information available includes recommendations, standards, guides and links to a whole host of related resources.
Jargon Buster
Think Local Act Personal have a useful Jargon Buster that can help professionals from fields other than social work understand the language that is commonly used in care and support work.
Disclosure and Barring Service
The Disclosure and Barring Service have produced guidance on 'Making Recruitment Easier'.
Learning from Safeguarding Adults Reviews for Care Providers
The Institue of Public Care and the Oxford Brookes University has produced a discussion paper on How Can Care Providers Learn From Safeguarding Adult Reviews? which looks at mechanisms to identify and share relevant learning from SARs with care providers.
Second National Analysis of Safeguarding Adult Reviews: April 2019 - March 2023
This second national analysis of Safeguarding Adult Reviews (SARs) in England identifies the headline findings.
Read more on the National Analysis on our about SAR's page.
Homelessness and Safeguarding
On this page you can find practice briefings, policies, toolkits and training opportunities on Homelessness and Safeguarding. We have also included a 7 minute briefing from a Lewisham Safeguarding Adults Review (SAR) where the adult was homeless and links to SAR reports from other areas where the adult was homeless.
If you’re a professional who is concerned that a Homeless person may be experiencing neglect (including self-neglect) and abuse and are unable to protect themselves. You can find advice for Submitting an Adult Safeguarding Concern in the Lewisham Adult Safeguarding Pathway.
Online learning
Homeless Link - Bitesize learning: Supporting adults and young people through safeguarding.
Homeless Link have created six bitesize (30-minute) sessions to give frontline staff working in homelessness services the knowledge and skills to better support people who are facing multiple disadvantage (also known as multiple and/or complex needs) and are at risk of or are experiencing homelessness.
The sessions are delivered by Fiona Bateman, Safeguarding Consultant from Safeguarding Circle and Bruno Ornelas, Head of Homelessness at Concrete and Safeguarding Consultant.
All sessions are free to watch, thanks to funding from The Department of Levelling Up, Housing and Communities, as part of the Capacity Building programme.
Rough Sleeper Mental Health Awareness
Backed by the Mayor of London's Rough Sleeping Innovation Fund, Westminster City Council and London Borough of Lambeth, this free course supports cross-sector professionals in recognising and working with the Mental Health needs of people who sleep rough and the unstably housed.
Fifteen leading experts (incl. service users, Sir Michael Marmot, Deputy Mayor James Murray, A. Prof Nick Maguire, Jane Cook DoH MHCLG amongst others) will discuss the context and complexity of need, approaches to engagement and support, recognising and working with risk and key mental health and substance use problems.
The course will also explore the use of legislation such as the Mental Health Act, navigating the NHS and helping those with ‘no recourse to public funds’.
Length: Four modules, duration: 30 - 45 mins of study per module.
Homeless Link - How homeless services can support LGBTQI+ women
This webinar from Homeless Link, delivered in 2023, provides an introduction to issues of sexuality and gender and the relationship to homelessness.
Online Adult Safeguarding Foundation Level Training and Workbooks
The Lewisham Safeguarding Adults Board runs regular Online Adult Safeguarding Foundation Level Training Sessions, and we also have a series of adult safeguarding workbooks.
All of our Safeguarding Adults Courses are available to Private, Voluntary and Independent organisations and commissioned care providers in Lewisham.
Find out more in our learning zone.
Practice Briefings and Guidance
Multi-Agency Self Neglect Policy, Practice Guidance and Procedures
This guidance is aimed at a wide range of professionals involved in working with people who may self-neglect and sets out the response that professionals should take to this complex issue.
Annex 2
Accompanying the Practice Guidance is the Self-Neglect High Risk Panel - Risk Assessment & Action Plan Template.
LSAB Guidance on Improving our Approach to Adult and Family Engagement
This guidance provides information on Adopting a Trauma Informed Approach, Understanding the Barriers to Seeking Help, Engagement Principles and Methods that can be Used for Engagement.
Alcohol Change UK - How to use legal powers to safeguard highly vulnerable dependent drinkers in England and Wales
This guide provides an accessible introduction to three pieces of legislation that can be applied to chronic, highly vulnerable, dependent drinkers so as to improve outcomes for them, their families and their communities. The guide also outlines the limits of these legal frameworks and when they should not be used.
The Kings Fund - Delivering health and care for people who sleep rough - Going above and beyond
This report aims to help local systems improve health outcomes among people who sleep rough and to support the ambition to end rough sleeping.
Homeless Link - Taking action following the death of someone sleeping rough - Briefing for Homelessness Services
This guidance details the steps that agencies can take should there be a death of a rough sleeper in their area.
Homeless Link - Autism and Homelessness Briefing for frontline staff
This briefing aims to provide frontline staff with information to better support people experiencing homelessness who are known or suspected to have autism. It includes suggestions of how to overcome challenges and case examples of two individuals with autism who were successfully supported to address their housing needs.
Homeless Link - Supporting LGBTIQ+ people in homelessness services - An introduction for frontline staff
This guidance, updated in June 2020 by The Outside Project, is written for staff who are new to LGBTIQ+ issues, or those seeking to make their service more inclusive, welcoming, and safe. It includes links to specialist agencies and resources to help you develop service provision tailored to individuals' needs.
7 minute Briefing Supporting staff to have conversations about health
Having conversations about health can be difficult for frontline workers. This briefing jointly produced by Groundswell, Homeless Link and Pathway outlines the key ways in which organisations can ensure their staff have the resources and support they need to feel more confident when having health-related conversations.
Accessing social care assessments using the Care Act – Homelessness - Guidance for frontline staff
This guidance sets out the basic principles of referral and assessment under the Care Act 2014 and the steps that support workers should take to ensure service users are fairly assessed under the Act.
Toolkits
Learning-Disabilities and Homelessness Toolkit
This toolkit is for services who support people experiencing homelessness who may also have learning disabilities.
Safeguarding Multiple Exclusion Homelessness Toolkit 2023
The focus of this tool is to improve multi-agency support for individuals who have an appearance of need for care and support and are experiencing multiple exclusion homelessness (MEH).
Research in Practice - Radical Safeguarding Toolkit for Homelessness
The co-produced toolkit offers a new approach to safeguarding adults experiencing homelessness and multiple disadvantages, rooted in the work of social justice movements.
The toolkit explores principles of power, autonomy, solidarity and accountability in safeguarding, supporting practitioners to consider intersectional and anti-oppressive approaches to work in this area.
Safeguarding Adults Reviews (SAR’s)
Analysis of SAR’s
National SAR Analysis - Briefing for practitioners - Analysis of Safeguarding Adults Reviews
This briefing summarises key findings from the landmark study ‘Analysis of Safeguarding Adult Reviews (SARs) April 2017 – March 2019’, with particular reference to professional practice in direct work with the individual at risk of abuse and/or neglect. It is therefore of particular relevance to the work of practitioners and others who have frontline contact with individuals. It aims to support practitioners to apply best practice in their direct work and thus achieve positive outcomes in adult safeguarding.
Adult Safeguarding and Homelessness: Learning from Safeguarding Adult Reviews
This briefing identifies the number of Safeguarding Adult Reviews (SARs) completed in England where homelessness has been a central feature. The learning from these SARs about good practice and practice shortfalls has enabled an evidence-base for positive practice to be developed. This evidence-base can be used by practitioners working with people experiencing homelessness to advocate for best practice.
Adult safeguarding and homelessness: A briefing on positive practice
This briefing is to assist senior leaders, such as members of Safeguarding Adults Boards (SABs), as well as commissioners, practitioners and operational managers who are working across relevant sectors and agencies in this field, to support people who are homeless and at risk of or experiencing abuse or neglect.
Safeguarding, homelessness and rough sleeping: An analysis of Safeguarding Adults Reviews
This report from Kings College London presents findings from an analysis of 14 Safeguarding Adults Reviews (SARs) where homelessness was a factor, and the results of a review of the literature relating to third sector and local authority policy and guidance on adult safeguarding and homelessness.
Policies
London Multi-Agency Safeguarding Policy and Procedures
Legislation
Strategies
DLUHC Ending Rough Sleeping For Good – September 2022
This strategy sets out how the whole of government is taking action to meet their ambition to end rough sleeping.
Lewisham’s Homelessness & Rough Sleeping Strategy 2023-26
This strategy builds on the hard work that already goes on a daily basis to prevent homelessness and reduce rough sleeping in Lewisham and will help support our teams in their mission to ensure everybody has a safe, secure place to call home.
Guidance
Duty to Refer
This guidance provides an overview of the duty to refer, which will help public authorities understand how to administer the duty.
Discharging people at risk of or experiencing homelessness
Guidance for staff involved in planning to discharge patients at risk of or experiencing homelessness, or who have no recourse to public funds.
Information Sharing
LSAB Information Sharing Agreement
Find out more on Information Sharing
Local Services Resources
Community directory to support health and wellbeing
999 Club
The Gateway Centre in Deptford for people who are experiencing homeless, or at risk of experiencing homelessness. The centre is open from 9am to 4pm on weekdays. The centre provide showers, food, phone charging, use of a phone or computer and wifi, laundry and postal address. The centre offer support with ID, claiming benefits, finding work, searching for housing, social integration and referrals to specialist agencies. They also have a women-only space called “The Sanctuary”.
South East London Mind
South East London Mind provides a range of high quality mental health support services for adult residents in the borough of Lewisham. This includes specialised support for people from Black, Asian, Minority Ethnic and Refugee communities, for new mums, and for anyone needing help with benefits.
Change Grow Live - New Direction
Free and confidential community drug and alcohol service. If you're a professional and you'd like to refer someone to the service, use the link above to visit their website.
Thames Reach - Deptford Reach
Deptford Reach community outreach service provides advice and support within communities across Lewisham and Southwark. They aim to target people at risk of homelessness and provide casework and support to prevent this from occurring.
Lewisham Housing Options
If you need housing advice call 020 8314 7007. The service will refer anyone homeless or at risk of homelessness to a housing solutions officer who will assess you by phone.
Find more adult safeguarding information in our Adult Safeguarding Pathway
Domestic Abuse and Safeguarding
Domestic Abuse in Lewisham
Between the 1 April 2022 and 31 March 2024 there were c.11,000 domestic abuse incidents reported to police locally. Lewisham is one of the highest risk boroughs in London in this regard with 17 of the 19 Wards in the top 50% in London for reports of domestic abuse to police.
Longstanding research indicates that adults who have care and support needs such as those living with a disability, or older adults, are more likely to be the victims of domestic abuse than the general population (we must not ignore other factors such as homelessness).
Compared to the high volume of police reporting there are relatively few Adult Safeguarding Concerns submitted for Domestic Abuse in Lewisham (between 50-100 each year).
What is domestic abuse?
The UK government’s definition of domestic violence 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.’
Domestic abuse also includes honour-based abuse and forced marriage.
Legal Definition
The legal definition of domestic abuse is: any incident of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 or over who are 'personally connected', regardless of their gender or sexuality.
Examples of people who are ‘personally connected’ include:
- relatives, including half and step relatives
- married couples, or couples who used to be married
- civil partners, or former civil partners
- people who have ever agreed to marry, or enter into a civil partnership agreement with each other
- people who have had an intimate relationship with each other
- people who are a parent of the same child, or have ever had a parental responsibility for the same child
There is no requirement for the victim and the perpetrator to cohabit although many will have. This often then provides perpetrators with personal knowledge about what might most traumatise or impact victims, making this crime particularly distressing and sometimes leaving victims at risk of future violence and abuse.
Who are counted as family members?
Family members are defined within the legislation as the father, mother, stepfather, stepmother, son, daughter, stepson, stepdaughter, grandmother, grandfather, grandson, or granddaughter, brother, sister, uncle, aunt, niece, nephew or first cousin (whether of full blood or of half blood or by marriage or civil partnership) of that person or of that person’s spouse, former spouse, civil partner, or former civil partner.
Domestic Abuse Act 2021
The Domestic Abuse Act 2021 aimed to raise awareness about the devastating impact of domestic abuse on victims and their families and to further improve the effectiveness of the justice system in providing protection for victims of domestic abuse and bringing perpetrators to justice.
The Act introduced a statutory definition to ensure that domestic abuse is properly understood, viewed as unacceptable and is actively challenged across statutory agencies and in public attitudes. It sets out who can be a victim of domestic abuse behaviours and establishes how victims need to be ‘personally connected’ to the perpetrator. It also makes clear that children are deemed to be victims of domestic abuse if they see or hear, or experience the effects of, the abuse. There is also no requirement that they live in the same household as the abuser.
Read the Domestic Abuse Act 2021
When the Care Act 2014 came into force on the 1 April 2015 this was the first time that Domestic Abuse had been formally recognised as a type of abuse within the legal framework underpinning adult safeguarding. There is still more to do in improving the profile of this subject, and the connection between the different responses that there can be in relation to Domestic Abuse, including through the local authority led safeguarding pathway.
The Domestic Abuse Act 2021 Statutory Guidance July 2022 cross-references back to the Care Act 2014, and outlines that there should be a safeguarding response when the legal duty and criteria is met.
Domestic abuse can be characterised by any of the indicators of abuse relating to
- Psychological
- Physical
- Sexual
- Financial or economic
- Emotional
Domestic abuse is rarely a one-off incident and it is the cumulative and interlinked types of abuse that have a particularly damaging effect on the victim. The ‘domestic’ nature of the offending behaviour is an aggravating factor because of the abuse of trust involved.
Possible indicators of domestic abuse
- Low self-esteem
- Feeling that the abuse is their fault when it is not
- Physical evidence of violence such as bruising, cuts, broken bones
- Verbal abuse and humiliation in front of others
- Fear of outside intervention
- Damage to home or property
- Isolation – not seeing friends and family
- Limited access to money
New and Emerging Characters of Domestic Abuse - Digital Domestic Abuse
Digital abuse is when someone monitors, stalks, harasses, threatens, controls or impersonates another person using technology. This could involve stalking through social media, harassment by text message or humiliation by posting pictures or videos, for example.
Digital abuse can happen to anyone but it most often happens alongside other types of domestic abuse.
Examples of digital abuse:
- Using the persons social media accounts without their permission.
- Posting information about the person online or by text/messenger.
- Creating a profile page without the persons permission.
- Sending the person threatening messages.
- Sending threatening messages to other people whilst pretending to be the person.
- Posting photos of the person without their consent (also known as revenge p*rn).
- Using spyware on the persons devices to track them.
- Taking away the person control of smart home devices such as cameras, lights, thermostats.
- Controlling the persons online bank accounts.
How does Domestic Abuse Link with Safeguarding?
Domestic abuse is perhaps most commonly thought of as violence between intimate partners, but it can take many other forms and be perpetrated by a range of people. Much safeguarding is therefore also domestic abuse but is often not recognised as such.
Making the connections between adult safeguarding and domestic abuse
Who needs safeguarding?
- Understand the definitions of safeguarding and domestic abuse, and how they link up for the person you are supporting.
- Be alert to patterns of coercive or controlling behaviour, as well as incidents of abuse.
- Always act to safeguard children who are living with or witnessing domestic abuse. - Remember to Think Family
- Take account of gender, sexuality, intergenerational issues and caring responsibilites.
Understanding the impact of domestic abuse
- Consider the likely impact of abuse on all adults and children involved. - Remember to Think Family
- Consider the additional likely impacts of abuse on people with additional care and support needs.
- Consider how these factors might affect the approach you take in working with the person at risk (and others in the household).
Barriers and challenges to ending abusive relationships
- There are many reasons why people may not leave abusive relationships.
- Additional and specific barriers may be present for ethnic minority people, older people, and people with disabilities.
- Confidentially asking routine questions about safety can aid disclosure.
- Accessible information and signposted services about abuse are crucial.
Working with people needing care and support who are experiencing domestic abuse
- There are a range of issues to consider, including the needs of a range of groups, people’s independence, self-esteem, previous experience of services, and parenting. - Remember to Think Family
- Taking time to build trust and confidence with the person being abused is important, accepting that they may not be able to describe or disclose all aspects of their situation initially, and that the issues may take time to explore fully.
- Avoid making assumptions based on stereotypes, particularly around older age, mental health and substance misuse.
- There is a risk of serious harm in forced marriage situations where one or both parties have care and support needs.
- Domestic abuse can involve the wider family and take different forms according to different family dynamics, especially when caring responsibilities are involved. - Read the 7 Minute Briefing - Arthur - for Professionals for further information.
Mental capacity, adult safeguarding and domestic abuse
- The Mental Capacity Act has five key principles, designed to protect and support the person
- An apparently unwise decision may be the result of coercion or controlling behaviour by another person
- Independent Mental Capacity Advocates (IMCAs) can support the abused person - Make a referral for an advocate POhWER
- IMCAs may not be specially trained in domestic abuse, but they can work alongside Independent Domestic Violence Advocates (IDVAs) or other workers from a specialist domestic abuse agency. - Contact the Lewisham Athena Service for an IDVA
Safeguarding Enquiries
- Take protective measures to ensure that any discussions with potential victims of abuse are conducted in a safe environment.
- Understand that victims of abuse may be reluctant to disclose what is happening to them, but that the conversation may be helping them to understand their situation better and build up trust. - Contact the Lewisham Athena Service for an IDVA
- Ask direct questions, in a safe environment.
- Keep good records of any discussions and interventions.
- Follow local policies, protocols and procedures at all times. - Lewisham Adult Safeguarding Pathway
Assessing and managing the risks of domestic abuse in safeguarding circumstances
- Understand how coercive and controlling behaviours may inhibit people disclosing or revealing the extent of domestic abuse.
- Understand local policies and procedures for safeguarding and risk assessments.
- Listen to and communicate respect towards the adult with care and support needs who is experiencing domestic abuse. Ensure they are at the centre of decision-making.
- Be aware of and vigilant against the potential of 'the rule of optimism', when professionals may place undue confidence in the capacity of families to care effectively and safely, affecting professional perceptions and recognition of risk of harm, abuse or neglect.
- Take any immediate protective measures that are needed.
- Understand how your local arrangements work in relation to safeguarding and Multi-Agency Risk Assessment Conferences. - Lewisham MARAC
- Use risk assessment forms as tools to aid professional judgement, not as ends in themselves. Use the DASH risk cheklist
- Work with the person at risk to ensure their experiences are central to your risk assessment.
- Collate information about static risk factors, as they are the most reliable indication of long-term risk.
- Use professional curiosity and judgement in risk assessment as everybody's circumstances are different.
- Gain support from local specialist domestic abuse agencies; they are experts in risk assessment and management. - Contact the Lewisham Athena Service for advice
Domestic abuse support services and legal action
- Ensure that you develop safeguarding and support arrangements that are personalised to the person you are working with.
- There are many types of national and local support schemes for people experiencing domestic abuse, including places of immediate safety.
- Be aware of the types of legal actions and sanctions (criminal and civil) that can be used in safeguarding and domestic abuse but rememer even when a victim has reported abuse to the police, there can be complex reasons they may not see through a prosecution - love, shame, guilt, isolation, fear of the process and language barriers to name just a few.
- Know where to go to get good legal advice, both for the person you are supporting, and to advise you of the options available.
- Ensure that information and advice is provided in an accessible way.
New! Safeguarding and Domestic Abuse 7 Minute Briefing
Help and support for people experiencing or at risk of abuse in Lewisham
Lewisham Council provides the Athena service which is a confidential, non-judgemental service to support those living in Lewisham who are experiencing gender-based violence. The service provides outreach programmes, independent advocacy, group support, refuge accommodation and a specialist service for women.
You can call the Athena Service for free on 0800 112 4052 or email Lewisham VAWG
The National Domestic Abuse Helpline is a team of highly-trained female advisers who can empower you to understand your options and support you to make any decisions about the future. They offer support to increase your safety, including finding a refuge place or other specialist services.
Other sources for support include The Men’s Advice Line, a confidential helpline for male victims of domestic abuse, and Galop, a specialist helpline for LGBTQ+ people.
Timekeeper Film
This film was commissioned by Lewisham Council and funded by the Home Office. It is based on the real experience of residents in Lewisham, the film tackles very sensitive issues.
Contact details for organisations who may be able to help you if you are the victim of domestic violence.
Helplines
Violence Against Women and Girls Helplines Poster
National Domestic Violence 24 hour helpline
Tel: 0808 2000 247
National Victim Support
Tel: 0808 1689 111
Women and Girls Network
For advice, information and support call 08088010660 or email advice@wgn.org.uk.
Childline
A counselling service for children and young people.
24 hour helpline: 0800 1111
Respect phone line
Advice and information on perpetrator programmes: 0845 122 8609
Phone line for male victims of domestic violence: 0808 801 0327
Imkaan
Support for Asian, black, minority ethnic and refugee women.
Tel: 020 7250 3933
Email
The National Stalking helpline
Offering support if you are a victim of stalking
Tel: 0808 802 300
Websites
London Victim & Witness Service (LVWS) Service Directory
Support is available to all victims and witnesses of crime in London whether or not the crime has been reported to the police.
London Violence Against Women and Girls
For information and advice and counselling, access to refuges in London and free legal advice.
Rights of Women
Rights of Women works to attain justice and equality by informing, educating and empowering women on their legal rights.
Women's Aid
Support, advice and information on all aspects of domestic violence.
Rape & Sexual Abuse Support Centre (RASASC)
Rape Crisis South London
Dogs Trust: Freedom Project
Offering free and confidential foster care for your dog enabling you to access temporary safe housing in the knowledge that your dog will be loved and cared for.
Paws Protect
Enabling survivors to leave for safety knowing that their cat will be in a loving home until they are able to be reunited.
Domestic Violence Intervention Project (DVIP)
Working to stop domestic violence and to reduce the harm it causes to women, children and families.
Financial Support Line and Casework Service - Money Advice Plus & Surviving Economic Abuse
Providing specialist advice for anyone experiencing domestic abuse who is struggling to manage their money.
Galop - LGBT+ anti-abuse charity
Supporting LGBT+ people who have experienced abuse and violence.
IKWRO Women's Rights Organisation
Providing advice and support to Middle Eastern, North African and Afghan women and girls living in the UK, who have experienced abuse, or are at risk of all forms of harmful cultural practices.
Japanese-speaking Casework Service
Offering outreach advice in Japanese to Japanese survivors of domestic abuse, who need help and support around domestic abuse, family law, housing etc.
Karma Nirvana
Working to end Honour Based Abuse in the UK.
Latin American Women's Rights Service (LAWRS)
An advice, information and advocacy service.
Mozaic Advocacy Service
A community-run project offering free, confidential and independent support and advice in South London.
Opaka
Helping women and children in the Polish community to improve health, wellbeing and happiness by stopping domestic abuse.
Safe Partnership
Helping victims of domestic violence and sexual abuse in England and Wales.
SignHealth Deaf Domestic Abuse Service
Deaf-led service for Deaf people who have or are experiencing domestic abuse.
Sistah Space
Supporting women of African and Caribbean heritage affected by domestic and sexual abuse.
Stonewall Housing
A national charity supporting lesbian, gay, bisexual, trans and queer (LGBTQ+) people of all ages who live in the UK and are experiencing homelessness or living in an unsafe environment.
Safeguarding in Care Homes Guidelines and Tools
NICE guideline on Safeguarding adults in care homes
The final guideline has now been published on the NICE website. You can also find the supporting evidence, tools and resources as well as all the stakeholder comments that were received during consultation and the responses to these comments. The comments were invaluable in helping NICE to develop and refine the guideline. They have also produced an equality impact assessment to support the guideline.
The recommendations from this guideline have been included in the NICE Pathway on safeguarding adults in care homes, which brings together everything which was said on safeguarding adults in care homes in an interactive flowchart. There is brief information about the guideline for people using services, carers and the public at ‘Information for the public’.
If you have any further queries, please contact SafeguardingAdults@nice
Health and Safety Executive Guidance - Violence and aggression at work
The Health and Safety Executive has refreshed their guidance for employers on Violence and aggression at work. The guidance includes information on topics including:
- What violence in the workplace is and how to prevent it
- Health and safety laws which are relevant to violence at work
- How to assess the risks of violent incidents at work
- Put the right controls in place to protect your workers from violence
- What incidents to report and how to learn from them
- Typical examples of how employers have reduced the risk of violence
and includes Advice for workers:
- How your employer and you can prevent violence
Modern Slavery and Human Trafficking
Lewisham Modern Slavery and Human Trafficking Conference 23 January 2024
The Lewisham Modern Slavery and Human Trafficking Conference was held 23 January 2024.
The conference was very well attended with representation from all local health and social care services. For those who were unable to make it on the day, the presentations from the Conference are available for you to read and download.
Modern Slavery in Supply Chains - London Borough of Lewisham
Responding to Modern Slavery and Human Trafficking in Lewisham - Human Trafficking Foundation
Modern Slavery and Human Trafficking Lewisham - Metropolitan Police Service
Operation Makesafe has been developed in partnership with London’s boroughs to raise awareness of child exploitation in the business community, such as hotels, licensed premises, taxi companies, shops, and care homes. The purpose of Operation Makesafe is to empower businesses and organisations to tackle child exploitation through increased awareness and training.
Links to further learning, advice and organisations that were shared at the Conference.
Modern Slavery: Duty to notify
Do you know that you have a duty to notify the Home Office of potential victims of modern slavery?
The Modern Slavery Fact-sheet can tell you more on your duty to notify.
The Home Office has published new modern slavery it's closer than you think campaign resources which brings together documents and promotional material related to the awareness campaign on modern slavery which you can use in your local campaigns.
Identification of victims
The Home Office has produced Modern Slavery Victims - Guidance, Referral and Assessment Forms which gives information on how to identify and refer potential victims of modern slavery/human trafficking to the national referral mechanism.
Lewisham Modern Slavery Victim Care Pathway
A new local guidance document on Modern Slavery and Human Trafficking will be published later in 2022, but professionals should also refer to the Lewisham Modern Slavery Victim Care Pathway
What is the National Referral Mechanism?
The national referral mechanism (NRM) is a victim identification and support process. The NRM is designed to make it easier for all agencies that could be involved in a trafficking case (eg the police, UK Visas and Immigration, local authorities, non-governmental organisations) to share information about potential victims and facilitate their access to advice, accommodation and support.
The guidance document gives information including:
- What the NRM is
- The referral process
- How to complete the referral forms
Slavery and human trafficking in supply chains: guidance for businesses
The Home Office provides Statutory guidance for organisations on how to ensure that slavery and human trafficking is not taking place in their business or supply chains.
Links to further information and resources
Lewisham Modern Slavery and Human Trafficking 7 Minute Briefing
Hope for Justice exist to bring an end to modern slavery by rescuing victims, restoring lives, and reforming society.
Hope for Justice also have comprehensive briefing documents that define human trafficking, outline the UK and global markets for the exploitation of human beings and analyse the current mechanisms for addressing this complex crime.
Human Trafficking Foundation (HTF) is a UK-based charity which grew out of the work of the All Party Parliamentary Group on Human Trafficking. HTF was created in order to support and add value to the work of the many charities and agencies operating to combat human trafficking in the UK.
London Directory of Support Services
The Human Trafficking Foundation has created a Directory of Survivor Support Services in London, which is constantly updated.
Gangmasters and Labour Abuse Authority (GLAA)
Sexual Assault and Sexual Abuse Information Resources
Hoarding & Self-Neglect
What is Hoarding?
The NHS defines Hoarding Disorder as:
“Where someone acquires an excessive number of items and stores them in a chaotic manner, usually resulting in unmanageable amounts of clutter”.
It's considered to be a significant problem if:
- The amount of clutter interferes with everyday living – for example, the person is unable to
use their kitchen or bathroom and cannot access rooms.
- The clutter is causing significant distress or negatively affecting the person's quality of
life or their family's – for example, they become upset if someone tries to clear the clutter
and their relationships with others suffer.
The clutter image rating clearly illustrates the wide range of clutter in different rooms from clear to extreme.
All professionals working with adults who hoard in Lewisham must utilise the Multi Agency Self-Neglect Policy, Practice Guidance and Procedures and the Lewisham Adult Safeguarding Pathway.
What is self-neglect?
The Care Act 2014 statutory guidance defines self-neglect as:
"A wide range of behaviour neglecting to care for one's personal hygiene, health, or surroundings and includes behaviour such as hoarding."
The term itself can be a barrier to working with the issues as some individuals do not identify with this term or description of their situation. As a result, it is important that practitioners seek to negotiate a common ground to understand the individual’s own description of their lifestyle rather than making possible discriminatory value judgements or assumptions about how it can be defined. In order to prevent self-neglect, it is essential to understand the wider complexity and possible underlying factors, which may present as, or include:
- Increased incidence of depression and low self-esteem.
- History of trauma, abuse (including childhood abuse and child sexual exploitation) or bereavement.
- Physical and mental health issues.
- Hoarding or no possessions at all.
- Reclusive or co-dependent, including on pets.
- Substance misuse.
- Self-harm.
All professionals working with adults who self-neglect in Lewisham must utilise the Multi Agency Self-Neglect Policy, Practice Guidance and Procedures and the Lewisham Adult Safeguarding Pathway.
LSAB Hoarding and Self-Neglect Briefing
Read our briefing on hoarding and self-neglect.
The British Psychological Society had produced a short leaflet Understanding Hoarding - When our relationship with
possessions goes wrong. The leaflet is intended for people with hoarding disorder and their friends and families.
GP Hoarding Awareness Leaflet
GP Awareness of Hoarding Disorder is very important. GP's can often be the first professional a person with a Hoarding Disorder discloses their living situation to.
This GP’s leaflet is a great tool for GP’s to keep on hand and was created by Clouds End CIC and was developed after a Hoarding Awareness Training session with GPs.
If you suspect that an adult you provide healthcare for may be at risk of abuse or neglect please complete the Adult Safeguarding Concern form and return to the Lewisham Adult Gateway as instructed in the form.
Alternatively if you have concerns about the immediate safety of an adult at risk then please contact the Police on 999.
The NHS has produced information on Hoarding Disorder including:
- Information on Hoarding disorder
- Why someone may hoard
- The difference between hoarding and collecting
- Signs of a hoarding disorder
- Why hoarding disorders are a problem
- What you can do if you suspect someone is hoarding
- How hoarding disorders are treated
New Training Resource from Safeguarding Adults in Gloucestershire
“Am I YOUR Job?” is a brand new trainer resource (training session plan and video) on Self-Neglect from Safeguarding Adults in Gloucestershire.
Making Safeguarding Personal in self-neglect workbook
This Making Safeguarding Personal in self-neglect workbook, produced by Research in Practice, draws on evidence from research and Safeguarding Adults Reviews (SAR's) to identify how making safeguarding personal can make a difference to the health, wellbeing and safety of people who are self-neglecting.
Research in Practice has produced a practice tool Working with people who self-neglect
The tools in this resource focus on different aspects of good practice:
- understanding self-neglect
- building a relationship
- planning and implementing intervention
- using the legal framework for care, support and protection
- creating a supportive organisational context.
Learning from London Safeguarding Adult Reviews
Self-neglect is a widespread societal issue that will impact a large number of local residents at a lower-level, and for some this will escalate and may become very serious, including life threatening. 60% of Safeguarding Adults Reviews (SAR) in England, which are the are most serious and high-profile safeguarding cases, involved self-neglect in the recently published 2nd National SAR Analysis, which you can read about here: Lewisham Safeguarding Adults Board - Safeguarding Adults Reviews
Please ensure that you refer to the local policy, guidance, and procedures and embed this into your ways of working. More briefings will follow.
Information for Adults you are working with who hoard
Below you can find a range of resources to support an adult who hoards.
Hoarding Ice Breaker Form
If clutter, disorganisation or hoarding is affecting your health (mental or physical health) and making you feel anxious, depressed or unwell, then it’s advisable to have a chat with your GP.
If you don’t know what to say or how to start the conversation, then simply download, print off and complete this Ice-Breaker document, and hand it to your GP, Social Worker or any other professional.
They should then start asking all sorts of questions to enable them to start working out what might be causing your symptoms, and discuss some options that will hopefully help make you feel better. There could be a number of different things causing you to feel unwell, so it’s best not to assume there’s just one cause, or just one treatment.
POhWER provide the Lewisham Advocacy Service to support residents with a variety of issues, where there may be difficulties with communication or understanding information.
Find out more avour the Lewisham Advocay Service Leaflet.
London Fire Brigade offer a service where they can visit an adult at home to provide personalised advice about fire safety. It's totally free, available 24/7, and they even fit free smoke alarms during the visit if you need them.
Find out more about Home Fire Safety Visits
Community Connections Lewisham are able to connect you with groups, activities and services in your local community that can support your health and wellbeing ~ bringing Lewisham to you!
You can phone them on 0330 058 3464, from 9:30am-4pm Monday-Friday (*except Thursdays when our line is open from 2-4pm). You can also get in touch using their online referral form, or visit the Thursday Morning Drop In.
This website provides information, support and advice for people who hoard and their loved ones.
There is also an online community that you can contribute to with your own experiences.
The self-kindness toolkit is packed with activities to support building resilience, coping with stress and worries, and connecting with others.
Inside the self-kindness toolkit:
- resilience
- problem solving
- making decisions confidently
- first aid
- sleep techniques
- coping with change
- creative activities
- connecting with others
- movement and mindfulness
If you suspect that an adult you work with may be at risk of abuse or neglect please complete the Adult Safeguarding Concern form and return to the Lewisham Adult Gateway as instructed in the form.
Alternatively if you have concerns about the immediate safety of an adult at risk then please contact the Police on 999.
Lewisham Policy, Procedures and Guidance
All professionals working with adults who self-neglect and hoard in Lewisham must utilise the following policies, procedures and guidance.
Multi Agency Self-Neglect Policy, Practice Guidance and Procedures
Annex 2
Accompanying the Practice Guidance is the Self-Neglect High Risk Panel - Risk Assessment & Action Plan Template.
Lewisham Adult Safeguarding Pathway
Guidance on Improving our Approach to Adult and Family Engagement
Self-Neglect and Hoarding Resources
Learning from Human Stories about Self-neglect - Webinar
Here you can find the slides and handout from the Learning from Human Stories about Self-neglect webinar held by Professor Michael Preston-Shoot.
Here you will find the resources from all of the Self-neglect and Hoarding Training held by the LSAB
Criminal Exploitation of Vulnerable Adults: County Lines & Cuckooing
What is cuckooing?
Cuckooing is when a person’s home is taken over for the purpose of criminal activity. It is most commonly seen in County Lines. This is where a drug dealer or group of drug dealers takes over the premises of a vulnerable person either by friendship, force, or a combination of both, before turning it into a base to store money, weapons, and prepare, and sell drugs from. A criminal will often befriend a vulnerable person, as comfort levels rise more criminals are brought to the home, adding to the activity, and taking over the property entirely. Cuckooing is typified by some form of power imbalance in favour of those perpetrating the exploitation. Whilst age may be the most obvious, this power imbalance can also be due to a range of other factors including gender, cognitive ability, physical strength, status, and access to economic or other resources.
- Can affect any vulnerable adult over the age of 18 years;
- Can still be exploitation even if the activity appears consensual;
- Can involve force and/or enticement-based methods of compliance and is often accompanied by violence or threats of violence;
- Can be perpetrated by individuals or groups, males or females, and adults or young people.
Lewisham Project ADDER (Addiction, Diversion, Disruption, Enforcement, Recovery)
The programme seeks to ensure that more people get effective treatment, with enhanced treatment and recovery provision, including housing and employment support, and improved communication between treatment providers and courts, prisons, and hospitals.
The Lewisham Project ADDER Team have produced an Are You Aware of Cuckooing leaflet.
For additional information on cuckooing, please see the 'Introduction to Cuckooing' presentation.
What to do if you suspect a property is being ‘cuckooed’?
Call the Metropolitan Police Service on 101 (or 999 in an emergency or crime in progress) to report your concerns.
You can also report your concerns online.
If you don’t want to speak to the police directly, you can call
Crimestoppers 0800 555 111.
or
Lewisham Council by telephone (non-emergency only) 0800 028 2028 or contact them by email.
What to do if you are a professional who is concerned
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.
How to Report Your Concerns
Modern Slavery and Human Trafficking Lewisham Victim Care Pathway
Professionals should also make a report to Police if you think someone may be a victim of exploitation, contact them on 101 or report it online.
Guidance
New! LSAB Cuckooing A Brief Guide for Professionals
A brief guide for professionals including information on
- What is Cuckooing
- Common Indicators of Cuckooing
- What can I do to help make the adult safe?
- Relationship-Based Practices
- Person-Centred Interventions
- Partnership Working
- Advice for Submitting an Adult Safeguarding
Concern
- Support for Lewisham Professionals
Criminal Exploitation of children and vulnerable adults: Updated County Lines Guidance
The government has published refreshed County Lines Guidance. The guidance is primarily aimed at frontline staff who work with children, young people and potentially vulnerable adults.
If you’re a professional working in social care, education, health, housing, benefits, law enforcement (police) and related partner organisations this guidance is for you.
Criminal exploitation of children and vulnerable adults is a geographically widespread form of harm that is a typical feature of county lines activity. It is a harm which is relatively little known about or recognised by those best placed to spot its potential victims.
The guidance is intended to explain the nature of this harm to enable you, the professional, to recognise its signs and respond appropriately so that potential victims get the support and help they need.
Like other forms of abuse and exploitation, county lines exploitation:
- Can affect any vulnerable adult over the age of 18 years;
- Can still be exploitation even if the activity appears consensual;
- Can involve force and/or enticement-based methods of compliance and is often accompanied by violence or threats of violence;
- Can be perpetrated by individuals or groups, males or females, and young people or adults; and
- Is typified by some form of power imbalance in favour of those perpetrating the exploitation. Whilst age may be the most obvious, this power imbalance can also be due to a range of other factors including gender, cognitive ability, physical strength, status, and access to economic or other resources.
As so little is known about this type of abuse the national picture on county lines continues to develop but there are recorded cases of:
- Both males and females being exploited;
- White British children and young people being targeted because gangs perceive they are more likely to evade police detection but a person of any ethnicity or nationality may be exploited;
- The use of social media to make initial contact with children and young people;
- Class A drug users being targeted so that gangs can takeover their homes (known as ‘cuckooing’).
Learning from Safeguarding Adults Reviews
Hampshire Safeguarding Adults Board has conducted a Thematic Safeguarding Adults Review on three cases of Cuckooing: Katie, James And Luke. Read about the cases, the findings and recommendations.
CONTEST and the Prevent Strategy
What is CONTEST and the Prevent Strategy?
The Prevent Strategy is one of the key elements of CONTEST, the Government's counter- terrorism strategy and it aims to stop people from being drawn into terrorist-related activity. Prevent has strong links to safeguarding because vulnerable adults and children can be susceptible to radicalisation and recruitment into violent extremist and terrorist organisations.
CONTEST has four strands:
- Protect: Strengthen our protection against terrorist attack.
- Prepare: Mitigate the impact of an attack.
- Pursue: Stop a terrorist attack.
- Prevent: Stop people from becoming terrorists or supporting terrorism by:
-
- responding to the ideological challenge of terrorism and the threat we face from those who promote it,
- preventing people from being drawn into terrorism and ensuring that they are given appropriate advice and support,
- working with sectors and institutions where there are risks of radicalisation that we need to address.
What does the Prevent Duty mean for Statutory Organisations in Lewisham?
Since 2015, statutory agencies have a duty under the Counter Terrorism & Security Act "to have due regard to the need to prevent people from being drawn into terrorism". This means that local authorities should:
- Establish strategic and operational links with other specified authorities,
- Facilitate the assessment of risk for specified authorities, including providing advice and sharing threat assessments based on the Counter Terrorism Local Profiles (CTLP),
- Provide a range of training products (including but not limited to Workshops to Raise Awareness of Prevent - WRAP) to all specified authorities,
- Understand the full range of bodies affected by the new duties, and ensure they understand their responsibilities,
- Embed Prevent into commissioning, procurement, and grant funding processes,
- Embed Prevent into Safeguarding Policies and ensure all providers are signed up to local Safeguarding arrangements. In Lewisham, work has been taking place to ensure that all relevant agencies are complying with their obligations under the 2015 Counter Terrorism & Security Act. This includes delivering briefings, training and advice.
Lewisham Prevent Service
London Borough of Lewisham Prevent are available to assist agencies in complying with their Counter Terrorism Act duties. The support offer includes:
- Prevent in Lewisham operates a Strategic Board
- Prevent Delivery Group
- Multi-Agency Safeguarding Panel – Channel
Compliance in Lewisham
- The provision of Workshops to Raise Awareness of Prevent (WRAP training for frontline staff),
- Management briefings regarding Prevent Duty compliance,
- Coordination of strategic and operational groups,
- The provision of Prevent-related resources and dissemination of relevant information.
Safeguarding vulnerable people against radicalisation and extremism
There have been several cases where extremist groups have attempted to radicalise vulnerable adults. This can include justifying political, religious, sexist, or racist violence, or to steer individuals towards an ideology of extremism and intolerance. A vulnerable adult might be groomed and radicalised into carrying out acts of violence and cause significant harm to others.
There are several ways in which vulnerable adults can be at risk of radicalisation.
- They can be groomed either online or in person by people seeking to draw them into extremist activity.
- Vulnerable adults can be radicalised online via networks or online chat platforms.
- Grooming can also be carried out by those who hold harmful, extremist beliefs, including peer or family members who have an influence over the person's life.
- People can be exposed to violent, anti-social, extremist imagery and narratives which can lead to normalising intolerance of others and extremist ideology.
All agencies play a vital role in ensuring vulnerable adults and our communities are safe from the threat of radicalisation, extremist ideologies and terrorism.
If you are concerned that a vulnerable adult or other family members may hold extremist views or are at risk of being radicalised, it is important to ensure that they receive support to protect them from being drawn into terrorism.
Making a Referral
If you are are a professional or work in the voluntary sector and are worried about a vulnerable person you should follow your own organisation’s safeguarding procedures.
If you are a member of the public your concerns should be reported to:
London Borough of Lewisham Gateway
020 8314 7777 (Lines are open Monday to Friday from 9am to 5pm)
Email
In an emergency always dial 999.
If you have any questions regarding Prevent in Lewisham contact the Prevent team by email.
Channel Awareness
This training package is for anyone who may be asked to contribute to, sit on, or even run a Channel Panel. It is aimed at all levels, from a professional required to input and attend a Channel Panel meeting for the first time, to a member of staff new to their role and organising a panel meeting. It covers an introduction to what Channel is, how it operates in the local area, and how to organise a Channel Panel for the first time. It also covers information sharing, including how, when and with whom to share information of a Channel case.
Public Advice
- If you see or hear anything that could be terrorist-related, trust your instincts and call the Anti-Terrorist Hotline on 0800 789 321.
- If you think you have seen a person acting suspiciously, or if you see a vehicle, unattended package or bag which might be an immediate threat, move away and call 999.
- If you are involved in an incident follow police advice to: 'RUN, HIDE AND TELL
- Download the citizenAID App , which provides safety and medical advice from Google Play, Apple App or the Windows Store, for free.
Prevent Support and Advice
You can contact the Prevent team directly and we will be more than happy to provide training, advice and support. However all referrals this should be done in addition to your usual safeguarding referral pathway.
Contact the Lewisham Prevent Team for support and information on fulfilling the duty.
Lewisham Prevent Service Training
Workshop to Raise Awareness of Prevent (WRAP)
Target Group: All professionals working with vulnerable adults in the Borough of Lewisham.
The session is intended to:
- Develop an understanding of the Prevent Strategy & roles within it.
- Develop existing expertise and professional judgement in relation to extremism and radicalisation or recruitment to extremist groups.
- Increase awareness of the national / international picture of extremism and terrorism.
- Raise awareness of the links between online risks and radicalisation.
- Improve confidence to raise concerns.
- Raise awareness of the Channel interventions, safeguarding the individual.
- Increase the whole organisations capacity to prevent extremism and safeguard vulnerable people.
The webinars will include a presentation and Q&A session.
Hosted by Lewisham Prevent Team
The training is for anyone who has been through the Prevent awareness eLearning or a Workshop to Raise Awareness of Prevent (WRAP), and so already understands Prevent and of their role in safeguarding vulnerable people.
The package shares best practice on how to articulate concerns about an individual and ensure that they are robust and considered.
It is aimed at anyone who may be able to notice signs of vulnerability to radicalisation and seeks to give them confidence in referring on for help if appropriate. It is also designed for those (for example line managers) who may receive referrals and need to consider how to respond, whether that be establishing more context, or reaching out to partner agencies for support.
The Lewisham Prevent Service offer bespoke training packages designed to meet the needs of the audience. Contact the Lewisham Prevent Service to find out more and book your training event.
E-Learning
Prevent Home Office awareness eLearning.
The Prevent awareness eLearning has recently been refreshed. This includes updates to reflect the recommendations from the Parsons Green review, updated information following the change in threat and recent attacks, and new case studies. A link to the training is below.
http://www.elearning.prevent.homeoffice.gov.uk
Prevent Referrals E-Learning
https://www.elearning.prevent.homeoffice.gov.uk/preventreferrals
Guidance and Further Reading
The Prevent Duty guidance for partners and Local Authorities
Information on Channel
Home Office guide for schools about social media and radicalisation
How people become radicalised
Scams Information and Advice
This booklet was made by Lewisham Speaking Up on behalf of the Lewisham Safeguarding Adults Board.
Read and download the Scams Easy Read Booklet
What is Fraud
Fraud is when a person lies to you, or ‘scams’ you, to gain an advantage, such as taking your money or learning private information about you.
This could be by email, text, phone or in person, either on the street or on your doorstep.
Criminals are turning to more sophisticated ways to take your money, whether through online offers, emails or telephone calls.
Scams affect the lives of millions of people across the UK. People who are scammed often experience shame and social isolation as a result.
With a little knowledge you can protect yourself from fraudsters.
Watch out for Scams like these
- Banking Fraud
- Cash Machine Fraud
- Cheque Scam
- Holiday Fraud
- Identity Theft
Watch this video from the Metropolitan Police Service on online shopping fraud
Watch this video from the Metropolitan Police Service on Impersonation Fraud
Investing in stocks and shares or any other commodity can be a successful way of making money. However, it can also lead to people losing their entire life savings. Fraudsters will persuade you to invest in all kinds of products. They will offer you high rates of return, particularly over longer periods of time, which often do not exist.
Common products that will be offered include binary options, virtual currency, carbon credits, wine, rare metals, gemstones, land and alternative energy. Often, initial investments will yield small returns as an incentive to invest further funds. However, larger investments or cashing out will be met with excuses or a penalty charge. Eventually contact with the fraudster will be impossible and all funds and bogus returns lost.
Fraudsters are organised and they may have details of previous investments you have made or shares you have purchased. Knowing this information does not mean they are genuine.
Criminals may direct you to well-presented websites or send you glossy marketing material. These resources do not prove they are a genuine company. Many fraudulent companies have a polished customer image to cover their illegal activities.
It is relatively easy to register a company with Companies House. This does not confirm or endorse that they can provide genuine investments. Indeed, emerging investment markets may be unregulated, making these open to abuse.
- Invoice and Mandate Fraud
- Payment in Advance Fraud
- Purchase Scam
Companies may be registered at prestigious addresses, for example Canary Wharf or Mayfair. This does not mean they operate from there. It is an accepted business practice to rent such a virtual office to enhance a business’s status. However, fraudsters are also aware of this and exploit it. The fraudster may put pressure on you by offering a ‘once in a lifetime opportunity’ or claim the deal has to be done quickly to maximise profit.
In addition - be wary of companies that offer to ‘recover’ any funds you have lost to any sort of investment scam. They may be linked to the company who initially defrauded you in the first place and may be targeting you again. This is known as ‘Recovery Fraud’.
How to protect yourself
- There are no get rich quick schemes. If it sounds too good to be true, it probably is.
Genuine investment companies will not cold call you. Be extremely wary of anyone who does.
- Research both what you have been offered, and the investment company. Speak to Trading Standards if you have concerns.
Before investing, check the Financial Conduct Authority register to see if the firm or individual you are dealing with is authorised (https://register.fca.org.uk/)
- Check the FCA Warning List of firms to avoid.
REMEMBER - Don’t be pressured into making a quick decision.
CAUTION - Seek independent financial advice before committing to any investment.
THINK - Why would a legitimate investment company call me out of the blue?
Sometimes, criminals advertise properties to rent when these properties don’t belong to them, or even don’t exist! Victims are then tricked into paying an upfront fee to rent the property.
In reality, the property does not exist, has already been rented out, or has been rented to multiple victims at the same time. The victim loses the upfront fee they have paid and is not able to rent the property they thought they had secured with the payment. Rental fraudsters often target students looking for university accommodation.
How to Protect Yourself
- Do not send money to anyone advertising rental properties online until you are certain the advertiser is genuine.
- If you need to secure accommodation in the UK from overseas, seek the help of the employer or university you are coming to, or get a friend, contact or relative to check the property exists and is available.
- Do not pay any money until you or a reliable contact has visited the property with an agent or the landlord.
- Ask for copies of tenancy agreements and any safety certificates such as Gas Electricity or HMO Licence.
- Do not be pressurised into transferring large sums of money. Transfer funds to a bank account having obtained the details by contacting the landlord or agent directly after the above steps have been followed. Be sceptical if you’re asked to transfer any money via a money transfer service like Western Union.
- Romance and Dating Fraud
Dating online is now one of the most popular ways for new couples to meet, with millions of people finding new relationships, romance and love this way. Unfortunately, amongst the genuine profiles are fake profiles set up by fraudsters. They are after your money, not your love. They are masters of manipulation, playing on your good nature and emotions to ultimately steal your money.
Criminals will build a relationship with online members, quickly asking to move communication off the dating website. This is so they can continue their contact with you, even if their profile is later identified by the site as fraudulent and subsequently deleted.
Fraudsters are often very flattering, appearing really interested in you within a short space of time. However, they will use a range of excuses as to why they can’t meet in person, such as they are stuck overseas, have a family emergency or have an issue with their business. They then start asking for money to help with their problems, assuring you they will pay it back as soon as they can. The fraudster may claim to be desperate to meet you as soon as this obstacle is overcome. This is all a scam and their true intention is to take as much money from you as they can.
How to Protect Yourself
- Stay on site.
- Keep all communication on the dating website you are using. Don’t be convinced by profile pictures, they may have been taken from somewhere else on the internet. You can check photos using a reverse image search on the internet through websites like https://www.tineye.com or https://reverse.photos
- Do your own research on the person – are they members of any other social networking sites? Can you confirm what they are telling you about themselves, such as where they work or where they live?
- Never send money to someone you have not met in person and be extremely wary of giving money to someone you have recently started a relationship with.
- Be wary of anyone asking you to receive money on their behalf and transfer it on. They may be using you to launder money.
- Talk to family and friends for advice, even if the other party is asking you to keep the relationship secret.
- Watch Metropolitan Police's video on Romance Fraud
REMEMBER - Stay on site! Never send money to someone you have not met in person, or receive/ transfer money on their behalf.
CAUTION - Be wary of continuing the relationship away from the dating website you initially made contact on.
THINK - Why are they so quick to declare their love for me? How do I know they are telling me the truth?
Remember:
Your bank, the police, or tax office will never ask you to attend your bank, withdraw, transfer or pay money over the phone or send couriers to collect your card or cash. Nor would they ask you to buy goods or vouchers.
This is a scam.
Hang up (Never give details or money following a cold call)
Take 5 (Seek a second opinion, tell someone what has happened)
Verify (if concerned, contact the company via a pre-confirmed method)
Friends Against Scams is a National Trading Standards (NTS) Scams Team initiative, which aims to protect and prevent people from becoming victims of scams by empowering communities to "Take a Stand Against Scams".
Friends Against Scams has been created to tackle the lack of scams awareness by providing information about scams and those who fall victim to them. This information enables communities and organisations to understand scams, talk about scams and cascade messages throughout communities about scams prevention and protection.
Friends Against Scams encourages communities and organisations to take the knowledge learnt and turn it into action.
Friends Against Scams Easy Read Resources Webpage
https://www.friendsagainstscams.org.uk/easyread
Anybody can join Friends Against Scams and make a difference in their own way.
Become a friend
If you would like to be a Friend Against Scams you can attend a short awareness session in person or complete the online training.
After this session you will be asked to start taking action to "Take a Stand Against Scams".
Click here for more information.
Beware if you receive a text message purporting to be from a trusted organisation such as your bank – can you be sure it’s genuine?
It is a good idea to follow the advice from Take Five
STOP
Taking a moment to stop and think before parting with your money or information could keep you safe.
CHALLENGE
Could it be fake? It’s ok to reject, refuse or ignore any requests. Only criminals will try to rush or panic you.
PROTECT
Contact your bank immediately if you think you’ve fallen for a scam and report it to Action Fraud.
Ten golden rules to prevent fraud
Remember these ten golden rules to help you prevent fraud and beat the scammers.
- Be suspicious of all ‘too good to be true’ offers and deals. There are no guaranteed get-rich-quick schemes.
- Don’t agree to offers or deals immediately. Insist on time to get independent or legal advice before making a decision.
- Don’t hand over money or sign anything until you’ve checked someone’s credentials and their company’s.
- Never send money to anyone you don’t know or trust, whether in the UK or abroad, or use methods of payment you’re not comfortable with.
- Never give banking or personal details to anyone you don’t know or trust. This information is valuable so make sure you protect it.
- Always log on to a website directly rather than clicking on links in an email.
- Don’t just rely on glowing testimonials. Find solid, independent evidence of a company’s success.
- Always get independent or legal advice if an offer involves money, time or commitment.
- If you spot a scam or have been scammed, report it and get help.
- Don’t be embarrassed about reporting a scam. Because the scammers are cunning and clever there’s no shame in being deceived. By reporting it, you'll make it more difficult for them to deceive others.
Get help or report a scam
If you think you’ve uncovered a scam, been targeted by a scam or fallen victim to fraudsters, contact Action Fraud on 0300 123 2040 or at Action Fraud.
Call the Police on 101 if you know the suspect or they’re still in the area.
Reporting crime, including fraud, is important. If you don’t tell the authorities, how do they know it’s happened and how can they do anything about it?
Remember that if you’re a victim of a scam or an attempted scam, however minor, there may be hundreds or thousands of others in a similar position. Your information may form part of one big jigsaw and be vital to completing the picture.
Scams Prevention Advice and Support From Lewisham Council
The Neighbourhood Watch and Scams Prevention Officer can provide support if you have been the victim of a scam. They can also give advice and talks on how to prevent scams, and discuss any concerns you have about scams.
Other useful Information
Age UK Avoiding Scams Guide
Crimestoppers Romance Fraud e-Booklet
Change People.org Keeping-Safe-Online-Easy-Read-Guide
Scam Marshals - play a role in helping National Trading Standards (NTS) Scams Team to stop scam mail (friendsagainstscams.org.uk)
Think Family
In April 2023, the Lewisham Safeguarding Adults Board (LSAB) and Lewisham Safeguarding Children Partnership (LSCP) jointly agreed to focus on Think Family as a strategic priority. Learning from Local Child Safeguarding Practice Reviews and Safeguarding Adults Reviews have highlighted the importance of adult and children’s services working collaboratively and taking a joined up, whole family approach.
The development of the Think Family Practice Guidance is designed to help define our Think Family approach and to support practitioners in achieving this.
The Board along with the Lewisham Safeguarding Children's Partnership has also produced a toolkit for professionals Working with Father's and Male Carers Toolkit, along with the toolkit are a Toolkit Checklist and a list of Local Resources which focus on men.
We have also produced a helpful Think Family Poster to support practitioners.
This important area of work will continue on into 2024-25. Read more about our priorities for 2024-2025.
South London and Maudsley NHS Foundation Trust Mental Health Think Family Strategy 2022-2025
The aim of the SLaM Think Family Strategy is prevention and recognition of family need and wellbeing and thereby trying to ensure positive outcomes for the whole family. Effective partnership working with families: parents, carers, young people and children, and other services is a key component of this strategy. It applies to adult mental health services, this includes Addictions, Older Adults and Learning Disability services, and Child and Adolescent services and aims to ensure improved partnership working across these services to enable seamless support for either or both parent and child.
Professional Curiosity
Professional Curiosity and Critical Evaluation
Professional Curiosity is the capacity and communication skill to explore and understand what is happening within a family (or an organisational setting) rather than making assumptions, accepting things at face value, or allowing your personal values or possible unconscious bias to influence the way that that you see and interpret risk.
This has been described as the need for practitioners to practice ‘respectful uncertainty’ in applying Critical Evaluation to any information they receive, or ‘thinking the unthinkable’.
Watch this YouTube Video: The journey from reflection towards reflexivity (relevant for all practitioners).
The following factors highlight the need to improve professional curiosity:
- The views and feelings of some adults can be very difficult to ascertain.
- Practitioners do not always listen to adults who try to speak on behalf of another adult and who may have important information to contribute.
- Carers can prevent practitioners from seeing and listening to an adult.
- Practitioners can be misinformed with stories they want to believe are true.
- Effective multi-agency work needs to be coordinated.
- Challenging carers and other professionals requires expertise, confidence, time and a considerable amount of emotional energy.
The key to effective safeguarding practice is to ask the right questions, including:
- Would I live here, and if not, why not?
- Would I be happy with this standard of care for a member of my family?
- What does good look like?
- Is there anything else going on in this person’s life which might be causing harm, or the potential for adult abuse or neglect?
Barriers to professional curiosity
It is important to note that when a lack of professional curiosity is cited as a factor in any safeguarding enquiry or review that this does not automatically mean that blame should be apportioned. It is widely recognised that there are many barriers to being professionally curious, some of which are set out below:
The ‘rule of optimism’.
Risk enablement is about a strengths-based approach, but this does not mean that new or escalating risks should not be treated seriously. The ‘rule of optimism’ is a well-known dynamic in which professionals can tend to rationalise away new or escalating risks despite clear evidence to the contrary.
Accumulating risk – seeing the whole picture.
Reviews repeatedly demonstrate that professionals tend to respond to each situation or new risk discretely, rather than assessing the new information within the context of the whole person, or looking at the cumulative effect of a series of incidents and information.
Normalisation.
This refers to social processes through which ideas and actions come to be seen as 'normal' and become taken-for-granted or 'natural' in everyday life. Because they are seen as ‘normal’ they cease to be questioned and are therefore not recognised as potential risks or assessed as such.
Professional deference.
Workers who have most contact with the individual are in a good position to recognise when the risks to the person are escalating. However, there can be a tendency to defer to the opinion of a ‘higher status’ professional who has limited contact with the person but who views the risk as less significant. Be confident in your own judgement and always outline your observations and concerns to other professionals, be courageous and challenge their opinion of risk if it varies from your own. Escalate ongoing concerns through your manager and by using more formal procedures if necessary.
Confirmation bias.
This is when we look for evidence that supports or confirms our pre-held view, and ignores contrary information that refutes them. It occurs when we filter out potentially useful facts and opinions that don't coincide with our preconceived ideas.
‘Knowing but not knowing’.
This is about having a sense that something is not right but not knowing exactly what, so it is difficult to grasp the problem and take action.
Confidence in managing tension.
Disagreement, disruption and aggression from families or others, can undermine confidence and divert meetings away from topics the practitioner wants to explore and back to the family’s own agenda.
Dealing with uncertainty.
Contested accounts, vague or retracted disclosures, deception and inconclusive medical evidence are common in safeguarding practice. Practitioners are often presented with concerns which are impossible to substantiate. In such situations, ‘there is a temptation to discount concerns that cannot be proved’. A person-centred approach requires practitioners to remain mindful of the original concern and be professionally curious:
- ‘Unsubstantiated’ concerns and inconclusive medical evidence should not lead to case closure without further assessment.
- Retracted allegations still need to be investigated wherever possible.
- The use of risk assessment tools can reduce uncertainty, but they are not a substitute for professional judgement, and results need to be collated with observations and other sources of information.
- Social care practitioners are responsible for triangulating information such as, seeking independent confirmation of information, and weighing up information from a range of practitioners, particularly when there are differing accounts, and considering different theories/ research to understand the situation.
Other barriers to professional curiosity.
Poor supervision, complexity and pressure of work, changes of case worker leading to repeatedly ‘starting again’ in casework, closing cases too quickly, fixed thinking/preconceived ideas and values, and a lack of openness to new knowledge are also barriers to a professionally curious approach.
Disguised Compliance
Disguised Compliance involves carers giving the appearance of co-operating with agencies to avoid raising suspicions and allay concerns.
There is a continuum of behaviours from carers on a sliding scale, with full co-operation at one end of the scale, and planned and effective resistance at the other. Showing your best side or ‘saving face’ may be viewed as ‘normal’ behaviour and therefore we can expect a degree of Disguised Compliance in all families; but at its worst superficial cooperation may be to conceal deliberate abuse, and professionals can sometimes delay or avoid interventions due to Disguised Compliance.
The following principles will help front line practitioner’s deal with Disguised Compliance more effectively:
- Focus on the needs, voice and lived experience of the adult.
- Avoid being encouraged to focus too extensively on the needs and presentation of the carers, whether aggressive, argumentative or apparently compliant.
- Think carefully about the engagement of the carers and the impact of this behaviour on the practitioner’s view of risk.
- Focus on change in the family dynamic and the impact this will have on the life and well-being of the adult. This is a more reliable measure than the agreement of carers in the professionals plan.
- There is some evidence that an empathetic approach by professionals may result in an increased level of trust and a more open family response leading to greater disclosure by adults.
- Practitioners need to build close partnership style relationships with families whilst being constantly aware of the adult’s needs and the degree to which they are met.
- There is no magic way of spotting Disguised Compliance other than the discrepancy between a carer’s account and observations of the needs and account of the adult. The latter must always take precedent.
- Practitioners should aim to ‘triangulate’ and cross-reference the information they have received to confirm or refute the facts that have been presented.
Professional Challenge - having different perspectives
Having different professional perspectives within safeguarding practice is a sign of healthy and well-functioning inter-agency partnerships. These differences of opinion are usually resolved by discussion and negotiation between the practitioners concerned, but it is essential that they do not adversely affect outcomes for adults and are resolved in a constructive manner.
If you have a difference of opinion with another practitioner, remember:
- Professional differences and disagreements can help find better ways to improve outcomes for adults and families.
- All professionals are responsible for their own actions in relation to case work.
- Differences and disagreements should be resolved as simply and quickly as possible, in the first instance by individual practitioners and /or their line managers.
- All practitioners should respect the views of others whatever the level of experience – remember that challenging more senior or experienced practitioners can be hard.
- Expect to be challenged; working together effectively depends on an open approach and honest relationships between agencies and professionals.
- Differences are reduced by clarity about roles and responsibilities, the ability to discuss and share problems, and by effectively networking.
Also see this briefing from the Somerset Safeguarding Adults Board: Mendip House Practice Briefing
Cultural Competence
Culturally competent safeguarding practice is essential in achieving the right outcomes, and for improving the well-being of adults from Black, Asian and Minority Ethnic (BAME) communities.
Lack of cultural awareness among practitioners can impact on their ability to effectively work with and support adults, and therefore deal with abuse and neglect appropriately. This can also result in poor practice or interventions, which in turn can reduce trust in statutory agencies and create barriers for engagement with and from minority ethnic communities.
It is important therefore that practitioners are sensitive to differing family patterns and lifestyles that vary across different racial, ethnic and cultural groups. At the same time they must be clear that abuse or neglect cannot be condoned for religious or cultural reasons.
All practitioners working with adults at risk and their carers whose faith, culture, nationality and recent history differs significantly from that of the majority culture, must be professionally curious and take personal responsibility for informing their work with sufficient knowledge (or seeking advice) on the particular culture and/or faith by which the adult and their family or carers live their daily lives.
Practitioners should be curious about situations or information arising in the course of their work, allowing the family to give their account as well as researching such things by discussion with other practitioners, or by researching the evidence base. Examples of this might be around attitudes towards, and acceptance of, services e.g. health and dietary choices.
In some instances reluctance to access support stems from a desire to keep family life private. In many communities there is a prevalent fear that social work practitioners will negatively interfere, and there may be a poor view of support services arising from initial contact through the immigration system, and, for some communities – particularly those with insecure immigration status – an instinctive distrust of the state arising from experiences in their country of origin.
Practitioners must take personal responsibility for utilising specialist services. Knowing about and using services available locally to provide relevant cultural and faith-related input to prevention, support and rehabilitation services for adults (and their family) will help support practice.
This includes:
- Knowing which agencies are available to access locally (and nationally).
- Having contact details to hand.
- Timing requests for expert support and information appropriately to ensure that assessments, care planning and review are sound and holistic.
Often for BAME communities, accessing appropriate services is a consistent barrier to them fully participating in society, increasing their exclusion and potential for victimisation.
Social Graces
The term ‘Social Graces’ is a mnemonic to help us remember some of the key features that influence personal and social identity. This helps to prompt a professional to have discussions with an adult in a more inclusive way, which in turn may help to improve their understanding of that person's life circumstances and risks they may be facing:
G Gender and Geography
R Race and Religion
A Age, Accent, Appearance and Ability
C Class and Culture
E Ethnicity, Education and Employment
S Sexual Orientation and Spirituality
Read here for more information: Social Graces: A practical tool to address inequality www.basw.co.uk
Lewisham Adult Safeguarding Pathway
Lewisham Adult Safeguarding Pathway
Lewisham Adult Safeguarding Pathway
I wholeheartedly support the Adult Safeguarding Pathway in Lewisham.
Safeguarding Adults Reviews in Lewisham and nationally regularly highlight missed opportunities to refer adult Safeguarding Concerns and to conduct adult Safeguarding Enquiries. The Pathway provides comprehensive guidance for all those working in and around adult safeguarding. It offers a framework for the prevention of abuse and neglect, including self-neglect, and for protecting individuals who have experienced or are at risk of abuse and neglect.
The Pathway has been informed by, and indeed references good practice guidance that has been published by the Local Government Association in partnership with the Association of Directors of Adult Social Services. The Lewisham Pathway therefore encapsulates the best evidence available for effective adult safeguarding. Accordingly, I encourage every agency in Lewisham to use the Pathway and the associated documentation, and link in with the work and training delivered by the Lewisham Safeguarding Adults Board.
I thank everyone who has contributed to the continuous development of the Pathway. It forms such an important component of the jigsaw of policies, procedures, practice and services that are designed to keep people safe.
Professor Keith Brown
Independent Chair
Lewisham Safeguarding Adults Board
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In this section of the website you will find all the local guidance, tools and forms you need to raise an Adult Safeguarding Concern, and for relevant practitioners to conduct an Adult Safeguarding Enquiry.
This supports each of the four stages outlined in the London Multi-Agency Adult Safeguarding Policy and Procedures.
If you also have any feedback on the Pathway, or want to generally share good practice including anonymised case examples of how you have helped to support adults in achieving positive outcomes, then please let us know and we will share and promote this via our regular e-Bulletins and training: LSAB@lewisham.gov.uk
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 +
Types of physical abuse
- Assault, hitting, slapping, punching, kicking, hair-pulling, biting, pushing.
- Rough handling.
- Scalding and burning.
- Physical punishments.
- Inappropriate or unlawful use of restraint.
- Making someone purposefully uncomfortable (e.g. opening a window and removing blankets).
- Involuntary isolation or confinement.
- Misuse of medication (e.g. over-sedation).
- Forcible feeding or withholding food.
- Unauthorised restraint, restricting movement (e.g. tying someone to a chair).
Possible indicators of physical abuse
- No explanation for injuries or inconsistency with the account of what happened.
- Injuries are inconsistent with the person’s lifestyle.
- Bruising, cuts, welts, burns and/or marks on the body or loss of hair in clumps.
- Frequent injuries.
- Unexplained falls.
- Subdued or changed behaviour in the presence of a particular person.
- Signs of malnutrition.
- Failure to seek medical treatment or frequent changes of GP.
Domestic violence or abuse +
Any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence, or abuse between two people aged 16 or over who are ‘personally connected’. This includes those who are, or have been, intimate partners, or relatives, regardless of gender or sexual orientation. This may include psychological, physical, sexual, financial, emotional abuse, and so-called honour-based violence. See the full definition here: Domestic Abuse Act 2021 - Statutory Guidance July 2022
LSAB Adult Safeguarding and Domestic Abuse 7 minute briefing
Domestic Abuse and Older People – Information from Safe Lives
Free online training for Female Genital Mutilation and Forced Marriage: Virtual College
Raise awareness of the signs of Coercive Control by using Lewisham's - Can you see the signs of coercive control? - Poster
Also see this very useful Web Page: Lewisham Safeguarding Adults Board - Domestic Abuse
Coercive or controlling behaviour is a core part of domestic violence. Coercive behaviour can include:
- Acts of assault, threats, humiliation and intimidation.
- Harming, punishing, or frightening the person.
- Isolating the person from sources of support.
- Exploitation of resources or money.
- Preventing the person from escaping abuse.
- Regulating everyday behaviour.
Possible indicators of domestic violence or abuse
- Low self-esteem.
- Feeling that the abuse is their fault when it is not.
- Physical evidence of violence such as bruising, cuts, broken bones.
- Verbal abuse and humiliation in front of others.
- Fear of outside intervention.
- Damage to home or property.
- Isolation – not seeing friends and family.
- Limited access to money.
Sexual abuse +
Types of sexual abuse
- Rape, attempted rape or sexual assault.
- Inappropriate touch anywhere.
- Non- consensual masturbation of either or both persons.
- Non- consensual sexual penetration or attempted penetration of the vagina, anus or mouth.
- Any sexual activity that the person lacks the capacity to consent to.
- Inappropriate looking, sexual teasing or innuendo or sexual harassment.
- Sexual photography or forced use of pornography or witnessing of sexual acts.
- Indecent exposure.
Possible indicators of sexual abuse
- Bruising, particularly to the thighs, buttocks and upper arms and marks on the neck.
- Torn, stained or bloody underclothing.
- Bleeding, pain or itching in the genital area.
- Unusual difficulty in walking or sitting.
- Foreign bodies in genital or rectal openings.
- Infections, unexplained genital discharge, or sexually transmitted diseases.
- Pregnancy in a woman who is unable to consent to sexual intercourse.
- The uncharacteristic use of explicit sexual language or significant changes in sexual behaviour or attitude.
- Incontinence not related to any medical diagnosis.
- Self-harming.
- Poor concentration, withdrawal, sleep disturbance.
- Excessive fear/apprehension of, or withdrawal from, relationships.
- Fear of receiving help with personal care.
- Reluctance to be alone with a particular person.
Psychological or emotional abuse +
Types of psychological or emotional abuse
- Enforced social isolation – preventing someone accessing services, educational and social opportunities and seeing friends.
- Removing mobility or communication aids or intentionally leaving someone unattended when they need assistance.
- Preventing someone from meeting their religious and cultural needs.
- Preventing the expression of choice and opinion.
- Failure to respect privacy.
- Preventing stimulation, meaningful occupation or activities.
- Intimidation, coercion, harassment, use of threats, humiliation, bullying, swearing or verbal abuse.
- Addressing a person in a patronising or infantilising way.
- Threats of harm or abandonment.
- Cyber bullying.
Possible indicators of psychological or emotional abuse
- An air of silence when a particular person is present.
- Withdrawal or change in the psychological state of the person.
- Insomnia.
- Low self-esteem.
- Uncooperative and aggressive behaviour.
- A change of appetite, weight loss/gain.
- Signs of distress: tearfulness, anger.
- Apparent false claims, by someone involved with the person, to attract unnecessary treatment.
Financial or material abuse +
Types of financial or material abuse
- Theft of money or possessions.
- Fraud, scamming.
- Preventing a person from accessing their own money, benefits or assets.
- Employees taking a loan from a person using the service.
- Undue pressure, duress, threat or undue influence put on the person in connection with loans, wills, property, inheritance or financial transactions.
- Arranging less care than is needed to save money to maximise inheritance.
- Denying assistance to manage/monitor financial affairs.
- Denying assistance to access benefits.
- Misuse of personal allowance in a care home.
- Misuse of benefits or direct payments in a family home.
- Someone moving into a person’s home and living rent free without agreement or under duress.
- False representation, using another person's bank account, cards or documents.
- Exploitation of a person’s money or assets, e.g. unauthorised use of a car.
- Misuse of a power of attorney, deputy, appointeeship or other legal authority.
- Rogue trading – eg. unnecessary or overpriced property repairs and failure to carry out agreed repairs or poor workmanship.
Possible indicators of financial or material abuse
- Missing personal possessions.
- Unexplained lack of money or inability to maintain lifestyle.
- Unexplained withdrawal of funds from accounts.
- Power of attorney or lasting power of attorney (LPA) being obtained after the person has ceased to have mental capacity.
- Failure to register an LPA after the person has ceased to have mental capacity to manage their finances, so that it appears that they are continuing to do so.
- The person allocated to manage financial affairs is evasive or uncooperative.
- The family or others show unusual interest in the assets of the person.
- Signs of financial hardship in cases where the person’s financial affairs are being managed by a court appointed deputy, attorney or LPA.
- Recent changes in deeds or title to property.
- Rent arrears and eviction notices.
- A lack of clear financial accounts held by a care home or service.
- Failure to provide receipts for shopping or other financial transactions carried out on behalf of the person.
- Disparity between the person’s living conditions and their financial resources, e.g. insufficient food in the house.
- Unnecessary property repairs.
Modern slavery +
Types of modern slavery
- Human trafficking.
- Forced labour.
- Domestic servitude.
- Sexual exploitation, such as escort work, prostitution and pornography.
- Debt bondage – being forced to work to pay off debts that realistically they never will be able to.
Possible indicators of modern slavery
- Signs of physical or emotional abuse.
- Appearing to be malnourished, unkempt or withdrawn.
- Isolation from the community, seeming under the control or influence of others.
- Living in dirty, cramped or overcrowded accommodation and or living and working at the same address.
- Lack of personal effects or identification documents.
- Always wearing the same clothes.
- Avoidance of eye contact, appearing frightened or hesitant to talk to strangers.
- Fear of law enforcers.
Further Home Office information on identifying and reporting modern slavery
LSAB Modern Slavery & Human Trafficking Web Page
Lewisham Modern Slavery Victim Care Pathway
Discriminatory abuse +
Types of discriminatory abuse
Unequal treatment based on age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion and belief, sex or sexual orientation (known as protected characteristics’ under the Equality Act 2010)
- Verbal abuse, derogatory remarks or inappropriate use of language related to a protected characteristic.
- Denying access to communication aids, not allowing access to an interpreter, signer or lip-reader.
- Harassment or deliberate exclusion on the grounds of a protected characteristic.
- Denying basic rights to healthcare, education, employment and criminal justice relating to a protected characteristic.
- Substandard service provision relating to a protected characteristic.
Possible indicators of discriminatory abuse
- The person appears withdrawn and isolated.
- Expressions of anger, frustration, fear or anxiety.
- The support on offer does not take account of the person’s individual needs in terms of a protected characteristic.
For more information, please refer to:
Discriminatory Abuse Webinar
Discriminatory Abuse Self- Assessment September 2023
Stop Hate UK
Metro Charity
Lewisham Speaking Up
Organisation or institutional abuse +
Types of organisational or institutional abuse
- Discouraging visits or the involvement of relatives or friends.
- Run-down or overcrowded establishment.
- Authoritarian management or rigid regimes.
- Lack of leadership and supervision.
- Insufficient staff or high turnover resulting in poor quality care.
- Abusive and disrespectful attitudes towards people using the service.
- Inappropriate use of restraints.
- Lack of respect for dignity and privacy.
- Failure to manage residents with abusive behaviour.
- Not providing adequate food and drink, or assistance with eating.
- Not offering choice or promoting independence.
- Misuse of medication.
- Failure to provide care with dentures, spectacles or hearing aids.
- Not taking account of individuals’ cultural, religious or ethnic needs.
- Failure to respond to abuse appropriately.
- Interference with personal correspondence or communication.
- Failure to respond to complaints.
Possible indicators of organisational or institutional abuse
- Lack of flexibility and choice for people using the service.
- Inadequate staffing levels.
- People being hungry or dehydrated.
- Poor standards of care.
- Lack of personal clothing and possessions and communal use of personal items.
- Lack of adequate procedures.
- Poor record-keeping and missing documents.
- Absence of visitors.
- Few social, recreational and educational activities.
- Public discussion of personal matters.
- Unnecessary exposure during bathing or using the toilet.
- Absence of individual care plans.
- Lack of management overview and suppor.t
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 May 2024
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 +
Types of neglect and acts of omission
- Failure to provide or allow access to food, shelter, clothing, heating, stimulation and activity, personal or medical care.
- Providing care in a way that the person dislikes.
- Failure to administer medication as prescribed.
- Refusal of access to visitors.
- Not taking account of individuals’ cultural, religious or ethnic needs.
- Not taking account of educational, social and recreational needs.
- Ignoring or isolating the person.
- Preventing the person from making their own decisions.
- Preventing access to glasses, hearing aids, dentures, etc.
- Failure to ensure privacy and dignity.
Possible indicators of neglect and acts of omission
- Poor environment – dirty or unhygienic.
- Poor physical condition and/or personal hygiene.
- Pressure sores or ulcers.
- Malnutrition or unexplained weight loss.
- Untreated injuries and medical problems.
- Inconsistent or reluctant contact with medical and social care organisations.
- Accumulation of untaken medication.
- Uncharacteristic failure to engage in social interaction.
- Inappropriate or inadequate clothing.
Safeguarding adults protocol: pressure ulcers and raising a safeguarding concern - GOV.UK
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 May 2024
Self-neglect +
Types of self-neglect
- Lack of self-care to an extent that it threatens personal health and safety.
- Neglecting to care for one’s personal hygiene, health or surroundings.
- Inability to avoid self-harm (including suicidal ideation).
- Failure to seek help or access services to meet health and social care needs.
- Inability or unwillingness to manage one’s personal affairs.
Indicators of self-neglect
- Very poor personal hygiene.
- Unkempt appearance.
- Lack of essential food, clothing or shelter.
- Malnutrition and/or dehydration.
- Living in squalid or unsanitary conditions.
- Neglecting household maintenance.
- Hoarding.
- Collecting a large number of animals in inappropriate conditions.
- Non-compliance with health or care services.
Inability or unwillingness to take medication or treat illness or injury.
Self-harm and suicide
The very serious concerns for a person who carries out an act of self-harm or attempts suicide may not constitute a Safeguarding Concern in isolation.
Agencies must consider the individuals whole circumstances, as they may be displaying other characteristics which also constitute self-neglect, as well as the self-harm or suicidal ideation.
Agencies should consider an individual’s physical and emotional ability to self-care. If a person is suffering from mental instability, it is likely this will have an overall impact on their wellbeing, which could include characterises of self-neglect detailed above.
The local self-neglect practice guidance (link below) does not include issues of risk associated with deliberate self-harm and suicidal ideation, although more information can be found here on this subject: Get Help with Mental Health
LSAB Hoarding & Self-Neglect Web Page
Multi-Agency Self-Neglect Policy, Practice Guidance and Procedures June 2024
Self-Neglect High Risk Panel - Risk Assessment & Action Plan Template.
London Fire Brigade: Help for Hoarders - Fire Safety Tips
Guidance for Reporting Falls Events as Adult Safeguarding Concerns May 2024
Read our Homelessness and Safeguarding Information page for guidance, tools and advice.
Lewisham Suicide Prevention Strategy 2022-25
2. Talk to the adult (unless it is not safe to do so)
Think about how you ask questions and how you can improve your understanding of a person's life circumstances: Lewisham Safeguarding Adults Board - Professional Curiosity
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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: The Think Family page where you will find the Lewisham Think Family Protocol, the Think Family Practice Guidance 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 'for the referrer' at the Concern Stage. This is for the local authority to determine, but referrers should pass on any evidence to help support decision making.
c. as a result of those needs is unable to protect himself or herself against the abuse or neglect or the risk of it.
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:
- Read The Caldicott Principles. These are relevant if you work in health and social care.
- Also see Information Sharing page which is full of advice, guidance and the local Information Sharing Agreement.
- Does the adult have the mental capacity to consent to the Safeguarding Concern being submitted now?
- Is there a need to provide statutory advocacy: Advocacy 7 Minute Briefing March 2023
- 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), Supported decision-making toolkit for people with communication difficulties Practicable steps for people with communication difficulties and Oldham SAB's Executive Functioning Guidance
- 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 and Alcohol Change UK Cognitive Impairment Guide and Alcohol Change UK How to use legal powers to safeguard highly vulnerable dependent drinkers guide.
- 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. This may be particularly relevant in domestic abuse cases if they continue to submit the concern. 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
- If the adult meets the safeguarding duty criteria, and is at risk of significant harm, and it is deemed they do have the mental capacity to refuse consent and to not engage with any Safeguarding Enquiry, then the local authority should consider seeking legal advice and the use of the Court of Protection, and or Inherent Jurisdiction: 39 Essex Chambers: Guidance on Use of Inherent Jurisdiction
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.
- If the Safeguarding Concern does not progress and you feel the appropriate steps have not been taken to reduce or remove the risk to the adult, then you might consider challenging this decision. Read the Inter-Agency Escalation Policy July 2023 for further information.
This links to the subject of Professional Curiosity as it is good practice to respectfully challenge safeguarding decisions that you believe are not appropriate read more on Professional Curiosity.
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 in this pathway, 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 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.
LSAB Managing Allegations against People in Positions of Trust (PiPoT) Framework July 2024
Under the provisions of the Care Act 2014 Care and Support Statutory Guidance (Statutory Guidance) Lewisham Safeguarding Adults Board is required to have a Framework for how allegations involving People in Positions of Trust (PiPoT) working with adults with care and support needs should be notified and responded to.
This framework expands upon the outline provided in the Statutory Guidance and the Data Protection Act 2018 (UK General Data Protection Regulation – GDPR) to provide individual agencies with the information they need to be able to respond effectively to any PiPoT allegations or concerns.
Concerns Stage 1: Guidance for Making Decisions on Adult Safeguarding Enquiries
The purpose of this guidance is to help with the consistency of decision making used to cause a Safeguarding Enquiry to be conducted. It is primarily for use by lead professionals working in the Local Authority at the point of receiving an adult Safeguarding Concern; although others may also find it helpful to refer to this guidance when responding to a concern of abuse or neglect, and deciding if this should be referred to, the Local Authority. If care providers are using this guidance, it is important to note that all Safeguarding Concerns must be notified to the Local Authority.
The guidance is not intended to replace, but support professional judgement, and links to the section in the London Multi-Agency Safeguarding Policy and Procedures which provides the procedural detail in relation to Safeguarding Enquiries (pages 66-78).
1. Legal definitions
The Care Act 2014 statutory guidance and Section 42 (1) criteria states that the Local Authority must make enquiries, or cause others to do so, if they reasonably have cause to suspect an adult:
a. Has needs for care and support (whether or not the local authority is meeting any of those needs) and;
b. Is experiencing, or at risk of, abuse and neglect; and
c. 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.
Referring agencies need to use their professional judgement, consider the views of the adult at risk, and where appropriate seek consent for sharing information on a multi-agency basis.
2. Consent and engagement with the adult in relation to a Safeguarding Enquiry
This can often been seen as crucial factors in determining if a Safeguarding Enquiry can progress, and may lead to decisions not to proceed that leave the adult still exposed to a risk of significant harm.
- Read The Caldicott Principles.
- Also see Information Sharing page which is full of advice, guidance and the local Information Sharing Agreement.
- Does the adult have the mental capacity to consent to the Safeguarding Enquiry?
- Is there a need to provide statutory advocacy: Advocacy 7 Minute Briefing March 2023
- 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), Supported decision-making toolkit for people with communication difficulties Practicable steps for people with communication difficulties and Oldham SAB's Executive Functioning Guidance
- 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 and Alcohol Change UK Cognitive Impairment Guide and Alcohol Change UK How to use legal powers to safeguard highly vulnerable dependent drinkers guide.
- If the adult does have the mental capacity to consent to the Safeguarding Enquiry, but refuses, professionals must be careful that they consider how to keep the adult safe. This may be particularly relevant in domestic abuse cases.
- A Safeguarding Enquiry can still proceed without the adult’s consent if ‘vital’ or ‘public’ interest considerations apply.
- If the adult meets the safeguarding duty/ criteria, and is at risk of significant harm, and it is deemed they do have the mental capacity to refuse consent and to not engage with any Safeguarding Enquiry, then consider seeking legal advice and the use of the Court of Protection, and or Inherent Jurisdiction: 39 Essex Chambers: Guidance on Use of Inherent Jurisdiction.
- See and use the Guidance on Improving our Approach to Adult and Family Engagement which includes an overview of Trauma Informed Practice.
- See and use the Multi-Agency Self-Neglect Policy, Practice Guidance and Procedures.
- Professionals must consider escalating decision making where necessary in more complex cases, and respectfully challenge decision making if necessary and appropriate Inter-Agency Escalation Policy July 2023
- This links to the subject of Professional Curiosity as it is good practice to respectfully challenge safeguarding decisions that you believe are not appropriate. Think about how you ask questions and how you can improve your understanding of a person's life circumstances: Lewisham Safeguarding Adults Board - Professional Curiosity
3. Managing the different levels of harm
In order to manage the large volume of adult Safeguarding Concerns which come under safeguarding adults’ policy and procedures, there is a need to differentiate between those concerns relating to low level harm/risk, and those that are more serious. Whilst it is likely that concerns relating to low level harm/risk will not progress beyond an Initial Enquiry Stage, the concern will be recorded by the Local Authority and proportionate action taken to manage the risks that have been identified. This may include: provision of information or advice; referral to another agency or professional; assessment of care and support needs.
The sharing of low level concerns helps the Local Authority to understand any emerging patterns or trends that may need to be taken into consideration when deciding whether safeguarding adults procedures need to continue.
Local Government Association - Making Safeguarding Personal Toolkit
LGA/ADASS Making Decisions on the Duty to Carry out a Safeguarding Enquiry
4. Using this guidance
The guidance is not designed in a way in which further actions are determined by achieving a score, it is there to provide guidance and key considerations for practitioners who are assessing the context, circumstances, seriousness and impact of the abuse that is occurring, as well as the risk of it recurring.
5. Other Safeguarding Enquiry
Local authorities may choose to undertake safeguarding enquiries for people where there is not a section 42 enquiry duty, if the local authority believes it is proportionate to do so, and will enable the local authority to promote the person’s wellbeing and support a preventative agenda (Care Act 2014 Care and Support Statutory Guidance 14.44).
Also see links under section 3 above.
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Safeguarding Principle - Proportionality
What does this mean for the professionals: A proportionate and least intrusive response is made balanced with the level of risk.
What does this for the Adult: "I am confident the professionals will work in my interest and only get involved as much as needed".
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6. The interface between Section 42 Enquiries and Safeguarding Adults Reviews (SAR)
As a matter of law an enquiry under Section 42 cannot be initiated in relation to an adult who is deceased. However, if the circumstances of the death mean that there are reasons to be concerned about risks to other adults, Section 42 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.
Where a Section 42 Enquiry has already commenced and the adult subsequently passes away, then as outlined above, the enquiry may need to be concluded if there are potential ongoing risk to other adults. Otherwise a multi-agency decision involving “interested others”, which could include family members, should be made regarding the enquiry potentially being suspended.
Where a death is suspected to be the result of abuse or neglect and the other SAR criteria are met, a SAR notification should be submitted to enable the Lewisham Safeguarding Adults Board (LSAB) to consider this under Section 44 of the Care Act.
How to make a SAR Referral to the Lewisham Safeguarding Adults Board
SAR Notifications must be submitted as soon as possible after the adult’s death. It should be noted that a brief investigation may be necessary to assemble the required information for the LSAB's Case Review Sub-Group to make a recommendation as to whether a SAR should take place. This investigation should aim only to gather sufficient information for that purpose, and should not aim to reach firm conclusions about what happened. This investigation should be recorded as an Other Enquiry.
The Care Act statutory guidance also gives examples of serious abuse or neglect cases where an adult “would have been likely to have died but for an intervention, or has suffered permanent harm or has reduced capacity or quality of life (whether because of physical or psychological effects) as a result of the abuse or neglect”. Under these circumstances, Section 42 Enquiries into what happened to that adult will still need to take place in parallel, to ensure the adult’s immediate safety and the safety of any others who may be at risk, but should be limited to those purposes rather than duplicating more thorough investigations into the history which may take place through a SAR.
The Local Authority (or delegated agency) may need to make initial enquiries to consider whether the conditions for a SAR are met, but should not describe these as Section 42 Enquiries. In these circumstances the meeting should be a Safeguarding Information Sharing Meeting and logged onto the case management system as an Other Enquiry. Where the suspected abuse or neglect has taken place in an organisational setting, and there may be potential risks to others, the meeting should be an 'Organisational Safeguarding Meeting' and consideration should be given to invoking the Provider Concerns Process.
7. Factors to be considered
7.1 Contextual Factors
The following table should be used to consider the context of the Safeguarding Concern alongside the broader issues such as: mental capacity; mental health; physical disability; learning disability; communication issues; possible coercive control and the relationship between the victim and any alleged perpetrator; where the victim lives; who do they rely upon for their care; what is the extent of their circle or network of supportive relationships.
Table 1: Contextual Factors
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1. The Abusive Act
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Less Serious More Serious
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Less serious concerns are likely to be dealt with at initial enquiry stage only, whilst the more serious concerns will progress to further stages in the safeguarding adults’ procedures.
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2. Seriousness of Abuse
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Less Serious More Serious
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Refer to table 2. Look at the relevant categories of abuse and use your knowledge of the case and your professional judgement to gauge the seriousness of the concern.
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3. Pattern of Abuse
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Isolated incident
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Recent abuse in an ongoing relationship
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Repeated abuse
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The volume of incidents, Safeguarding Concerns and or Quality Alerts about an individual adult, provider or locality should be carefully considered as part of the wider context of potential abuse, but no benchmark number set to automatically trigger an enquiry.
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4. Impact of Abuse on Victims
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No impact
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Some impact but not long-lasting
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Serious long-lasting impact
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Impact of abuse does not necessarily correspond to the extent of the abuse –different people will be affected in different ways. Views of the adult at risk will be important in determining the impact of abuse. Protected Characteristics such as disability should be considered as well as disproportionality.
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5. Impact on Others
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No one else affected
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Others indirectly affected
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Others directly affected
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Other people may be affected by the abuse of another adult. Are relatives, children or other adults distressed or affected by the abuse?
Are other people intimidated and/or their environment affected?
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6. Intent of Alleged Perpetrator(s)
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Unintended/ill-informed
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Opportunistic
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Deliberate/targeted
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Is the act/omission a violent/serious unprofessional response to difficulties in providing care? Is the act/omission planned and deliberately malicious? Is the act a breach of a professional code of conduct?
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7. Illegality of Actions
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Bad practice/Not illegal
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Criminal act
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Serious criminal act
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Seek advice from the Police if you are unsure if a crime has been committed. Is the act/omission poor or bad practice (but not illegal) or is it clearly a crime? (* See below)
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8. Risk of Repeated Abuse on the Victim
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Unlikely to recur
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Possible to recur
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Likely to recur
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Is the abuse less likely to recur with significant changes e.g. training, supervision, respite, support or very likely even if changes are made and/or more support provided?
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9. Risk of Repeated Abuse on Others
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Others not at risk
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Possibly at risk
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Others at serious risk
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Are others (adults and/or children) at risk of being abused: Very unlikely? Less likely if significant changes are made? This perpetrator/setting represents a risk/threat to other adults or children?
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*See: London Multi-Agency Safeguarding Policy and Procedures (pages 67-68)
7.2 Types and Level of Abuse
The second table should also be used in conjunction with Table 1. The issues described within the ‘Less Serious’ sections may be notified to the Local Authority, but these are likely to be managed at the Initial Enquiry Stage only, and may not progress to a Safeguarding Enquiry.
Concerns of a more serious nature should be referred to the Local Authority.
Advice for Submitting an Adult Safeguarding Concern
These concerns will receive additional scrutiny and progress further under Safeguarding Adults’ procedures. Where a criminal offence is thought or alleged to have been committed the Police will be contacted. Other emergency services should be contacted as required.
Table 2: Types and Level of Abuse
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Less Serious
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More Serious
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Discriminatory Abuse
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- Isolated incident of teasing motivated by prejudicial attitudes.
- Isolated incident of care planning that fails to address an adult’s specific diversity/equality associated needs for a short period.
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- Inequitable access to service provision as a result of a diversity or equality issue. The Protected Characteristics are:
1. Age
2. Disability (inc. learning disability)
3. Gender Reassignment
4. Marriage and Civil Partnership
5. Pregnancy and Maternity
6. Race
7. Religion or Belief
8. Sex
9. Sexual Orientation
- Recurring failure to meet specific care/support needs associated with diversity or equality.
- Being refused access to essential services.
- Denial of civil liberties e.g. voting, making a complaint.
- Humiliation or threats on a regular basis, recurring taunts.
- Hate crime which may result in injury/emergency medical treatment/fear for life/attempted murder/honour-based violence.
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Domestic Abuse
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- Isolated incident of abusive nature.
- Occasional taunts or verbal outbursts
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- Inexplicable marking or lesions, cuts or grip marks on a number of occasions.
- Alleged perpetrator exhibits controlling or coercive behaviour.
- Limited access to medical and dental care.
- Accumulations of minor incidents.
- Frequent verbal/physical outbursts.
- No access/control over finances.
- Stalking.
- Relationship characterised by imbalance of power.
- Threats to kill, attempts to strangle choke or suffocate.
Also see:
Financial Abuse.
AGE UK Avoiding Scams Guide
Physical Abuse.
Psychological Abuse.
Sexual Abuse.
The ‘SafeLives’ Domestic Abuse, Stalking and Honour Based Violence (DASH) Risk Identification Checklist should be used to determine the level of risk in domestic abuse cases and a referral made into MARAC where appropriate.
SafeLives Risk Identification Checklist
Domestic Abuse Statutory Guidance July 2022
LSAB Adult Safeguarding and Domestic Abuse 7 minute briefing |
Financial or Material Abuse
If any of these elements occur within the context of a family or intimate relationship, then this should be dealt with as Domestic Abuse.
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- Staff personally benefit from the adult’s funds e.g. accrue ‘reward’ points on their own store loyalty cards when shopping.
- Money not recorded safely and properly.
- Adult not routinely involved in decisions about how their money is spent or kept safe – capacity in this respect is not properly considered.
- Non-payment of care fees not impacting on care.
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- Adult’s monies kept in a joint bank account – unclear arrangements for equitable sharing of interest.
- Adult denied access to his/her own funds or possessions.
- Misuse/misappropriation of property or possessions of benefits by a person in a position of trust or control.
- Personal finance removed from the adult’s control.
- Ongoing non-payment of care fees putting an adult’s care at risk.
- Fraud/exploitation relating to benefits, income, property or will.
- Theft (this may include household items such as food).
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Modern Slavery
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- All Safeguarding Concerns about Modern Slavery are deemed to be more serious. A new local guidance document on Modern Slavery and Human Trafficking will be published later in 2022, but professionals should also refer to the Lewisham Modern Slavery Victim Care Pathway
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- Limited freedom of movement.
- Being forced to work for little or no payment.
- Limited or no access to medical and dental care.
- Forced marriage.
- Limited access to food or shelter.
- Be regularly moved (trafficked) to avoid detection or linked to drug dealing - ‘County Lines’.
- Removal of passport or ID documents.
- Sexual exploitation.
- Starvation.
- Organ harvesting.
- No control over movement/imprisonment.
- No access to appropriate benefits.
Modern Slavery and Human Trafficking - 7 Minute Briefing
London Directory of Services The Human Trafficking Foundation has created a Directory of Survivor Support Services in London which is constantly updated.
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Neglect & Acts Of Omission
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- Isolated missed home care visit where no harm occurs.
- Adult is not assisted with a meal/drink on one occasion and no harm occurs.
- Adult not bathed as often as would like – possible complaint.
- Not having access to aids to independence.
- Inadequacies in care provision that lead to discomfort or inconvenience- no harm occurs e.g. being left wet occasionally.
- Recurring missed medication or administration errors that cause no harm.
- Adult does not receive prescribed medication (missed/wrong dose) on one occasion – no harm occurs.
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- Recurrent missed home care visits where risk of harm escalates, or one missed visit where harm occurs.
- Hospital discharge without adequate planning and harm occurs.
- Ongoing lack of care to the extent that health and wellbeing deteriorate significantly e.g. pressure wounds, dehydration, malnutrition, loss of independence/confidence.
- Failure to arrange access to lifesaving services or medical care.
- Failure to intervene in dangerous situations where the adult lacks the capacity to assess risk.
Safeguarding adults protocol: pressure ulcers and raising a safeguarding concern - GOV.UK
Stop the Pressure: NHS Improvement
Pressure Ulcer Panel Process - University Hospital Lewisham Dec 2020
Pressure Ulcer Panel Process - In the Community Sept 2022
LSAB Guidance for Reporting Medication Incidents as Adult Safeguarding Concerns Jan 2022
Guidance for Reporting Falls Events as Adult Safeguarding Concerns May 2024
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Organisational Abuse
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- Lack of stimulation/ opportunities for adults to engage in social and leisure activities.
- Adults not given sufficient voice or involvement in the running of the service.
- Denial of individuality and opportunities for adults to make informed choice and take responsible risks.
- Care-planning documentation not person-centred.
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- Rigid/inflexible routines.
- Adult’s dignity is undermined e.g. lack of privacy during support with intimate care needs, sharing under-clothing.
- Inadequate risk assessment resulting in multiple adult on adult incidents within a care setting. See SCIE (Social Care Institute of Excellence): Resident-to-resident harm in care homes and residential settings
- Bad/poor practice not being reported and going unchecked.
- Unsafe and unhygienic living environments.
- Missed medication round resulting in more than one person not receiving their prescribed medication.
- Staff misusing their position of power over adults in their care (see DBS Briefing).
- Over-medication and/or inappropriate restraint used to manage behaviour.
- Widespread consistent ill-treatment.
NICE Guidelines: Safeguarding in Care Homes
Guidance for Reporting Falls Events as Adult Safeguarding Concerns May 2024
Disclosure and Barring Service (DBS) Briefing
Also see this briefing from the Somerset Safeguarding Adults Board: Mendip House Practice Briefing
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Physical Abuse
If any of these elements occur within the context of a family or intimate relationship, then this should be dealt with as Domestic Abuse.
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- Staff error causing little or no harm e.g. friction mark on skin due to ill-fitting hoist sling.
- Minor events that still meet criteria
- for ‘incident reporting’ accidents.
- Single incident - adult on adult in care setting causing little or no harm.
- Inexplicable marking found on one occasion.
- Minor event where adult lacks capacity in keeping themselves safe
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- Recurring missed medication or errors that affect more than one adult and/or result in harm.
- Incident involving adult on adult in care setting where injury occurs.
- Deliberate maladministration of medications.
- Covert administration without proper medical authorisation.
- Inappropriate restraint.
- Withholding of food, drinks or aids to independence.
- Inexplicable fractures/injuries.
- Multiple (more than 2) adult on adult incidents involving the same adult/s in care setting.
- Accumulations of minor incidents.
- Inexplicable marking or lesions, cuts or grip marks on a number of occasions.
- Assault.
- Grievous bodily harm/assault with a weapon leading to irreversible damage or death.
- Pattern of recurring medication errors or an incident of deliberate maladministration that results in ill-health or death.
LSAB Guidance for Reporting Medication Incidents as Adult Safeguarding Concerns Jan 2022
Guidance for Reporting Falls Events as Adult Safeguarding Concerns May 2024
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Psychological Abuse
If any of these elements occur within the context of a family or intimate relationship, then this should be dealt with as Domestic Abuse.
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- Isolated incident where adult is spoken to in a rude or inappropriate way – respect is undermined but no/little distress caused.
- Occasional taunts or verbal outburst.
- Withholding of information to disempower.
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- Treatment or behaviour that undermines dignity and esteem.
- Denying or failing to recognise adult’s choice or opinion.
- Coercive or controlling behaviour.
- Humiliation.
- Emotional blackmail e.g. threats or abandonment/harm.
- Frequent and frightening verbal outbursts or harassment.
- Basic human rights/civil liberties, over-riding advance directive.
- Prolonged intimidation.
- Vicious/personalised verbal attacks.
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Self-Neglect
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- Hoarding behaviour which doesn’t impact on the health and well-being of the adult or others.
- Isolated/occasional reports about unkempt personal appearance or property which is out of character or unusual for the adult.
- Incontinence leading to health concerns.
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- Multiple reports of concerns from multiple agencies.
- Ongoing lack of care or behaviour to the extent that health and wellbeing deteriorate significantly e.g. pressure sores, wounds, dehydration, malnutrition.
- Behaviour which poses a fire risk to the adult and others.
- Poor management of finances leading to risks to health, wellbeing or property.
- Hoarding behaviour impacting on the health and well-being of the individual and/or others.
- Life in danger if intervention is not made in order to protect the adult.
- Failure to seek lifesaving services or medical care where required.
Multi-Agency Self Neglect Policy, Practice Guidance and Procedures
Self-Neglect High Risk Panel - Risk Assessment & Action Plan Template
Guidance for Reporting Falls Events as Adult Safeguarding Concerns May 2024
Read our Homelessness and Safeguarding Information page for guidance, tools and advice |
Sexual Abuse (including sexual exploitation)
If any of these elements occur within the context of a family or intimate relationship, then this should be dealt with as Domestic Abuse.
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- Isolated incident of teasing or low-level unwanted sexualised attention (verbal) directed at one adult by another whether or not capacity exists.
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- Any sexualised touching or isolated or recurring masturbation without consent.
- Voyeurism without consent
- Being subject to indecent exposure.
- Grooming including via the internet and social media.
- Attempted penetration by any means (whether or not it occurs within a relationship) without consent.
- Being made to look at pornographic material against will/where consent cannot be given.
- Female Genital mutilation.
- Sex in a relationship characterised by authority inequality or exploitation e.g. receiving something in return for carrying out a sexual act.
- Sex without consent (rape).
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Enquiry Stage 2: Advice for Conducting an Adult Safeguarding Enquiry
1. The decision-making process
The Multi-Agency Adult Safeguarding Concern Form has been designed to provide all of the detailed and necessary information to allow colleagues in the Local Authority to effectively make a decision on if a Safeguarding Concern needs to progress to a Section 42 (or Other Enquiry) under the Local Authorities duty to do so within the Care Act 2014.
Please also refer to: Guidance for Making Decisions on Adult Safeguarding Enquiries
All of this Safeguarding data will be collated within the Local Authorities case management system (as the lead agency in the Borough) so that there is a central source of information and intelligence, which will allow this to be carefully monitored and assessed.
Also carefully consider if statutory advocacy is required: Advocacy 7 Minute Briefing March 2023
2. Enquiry routes
Once a decision is made that a Safeguarding Enquiry must be conducted under the Section 42 duty, the relevant team within the Local Authority will decide who is best placed to conduct this, directing it through one of the four strands (2.1 to 2.4) outlined below. When this is delegated outside of the Local Authority they will still retain the overall responsibility to co-ordinate the enquiry as the lead agency, and as such they will provide the quality assurance and oversight in relation to all Safeguarding Enquiries.
S42 Enquiry Report Template (Pdf) S42 Enquiry Report Template (Word Version)
Professionals should also read the London Multi-Agency Safeguarding Policy and Procedures (pages 66-78) for further information on conducting Adult Safeguarding Enquiries, using the checklists and detailed good practice guidance (target timescales are the bottom of this page).
2.1 Police investigation
If a Safeguarding Concern has been submitted to the Local Authority and it is identified that an element, or all of this Concern may be linked to criminal activity, then the early involvement of police is essential. Police investigations should be coordinated by the local police MaSH team who may also support other parallel actions or enquiry options, but this should always be police led.
See pages 67-68 of the London Multi-Agency Safeguarding Policy and Procedures for more information.
2.2 Standard delegation within the London Borough of Lewisham (LBL) Council
All social work staff within LBL can have Safeguarding Enquiries delegated to them, normally through one of the following four main strands:
- Neighbourhood Teams 1-4 (London Borough of Lewisham).
- Placements Team (London Borough of Lewisham).
- Hospital Social Work Team (University Hospital Lewisham).
- Mental Health Social Work Teams within South London and Maudsley (SLaM) NHS Foundation Trust.
There is a need for supervision and co-ordination of enquiries by Safeguarding Adults Managers (SAMs).
See pages 57-58 of the London Multi-Agency Safeguarding Policy and Procedures for more information.
2.3 External delegation
Safeguarding Enquiries or elements of them may also be routinely delegated outside of LBL to the following partners:
- Lewisham and Greenwich NHS Trust (LGT) Safeguarding Team, who may then sub-delegate across their internal divisions, including to the District Nursing Service.
- South London and Maudsley NHS Foundation Trust (SLaM).
- South East London (SEL) Integrated Care Board (ICB).
- Care and Nursing Homes.
- Home Care Providers.
- GP Practices.
- Other Service Providers.
Causing S.42 Enquiries Letter Template (Word)
SAMs will also need to supervise and co-ordinate these enquiries.
2.4 Referrals to Pressure Ulcer Panels (PUPs)
Potential Safeguarding Concerns linked to pressure ulcers can be challenging as it needs to be determined if this has been caused by poor quality care or evidence of neglect or omissions in care provision. This can occur due to other associated factors and may require input from a professional for clinical judgements to be considered:
The person’s physical and mental health.
- Multiple co-morbidities.
- State of overall skin condition of the person.
- Indicators of neglect of care provision in relation to hygiene and/or repositioning.
- Evidence of ineffective continence management.
- Evidence of ineffective nutritional and fluid management.
- Ineffective Pain management.
- Evidence of completed and accurate proactive risk and wound assessments and subsequent care planning.
- Accurate monitoring and recording in all documentation.
- The views of the service user, family and friends on treatment and care are recorded.
- Capacity and level of engagement of service users and others.
- Evidence of appropriate and timely referrals to members of multidisciplinary team.
- Views of others including professionals.
Pressure Ulcer Panel Process - University Hospital Lewisham Dec 2020
Pressure Ulcer Panel Process - In the Community Sept 2022
While Pressure Ulcers are a risk for people who are frail and not able to move easily, with good management and care these can be prevented. If an adult at risk has a pressure ulcer this should not been as a reason to automatically suspect abuse or neglect, although this should be carefully considered, and a Safeguarding Concern must always be submitted for a stage 3, 4, Unstageable, Deep Tissue Injury and Medical Device pressure ulcers.
If a Safeguarding Concern has been submitted for a pressure ulcer related matter the Local Authority will pass this case onto the relevant Pressure Ulcer Panel (PUP) to oversee the initial investigation:
- The Community PUP - overseen by the South East London, Integrated Care Board. (Care Home Only).
- The Acute Trust’s PUP - overseen by Lewisham and Greenwich NHS Trust. (Trust Acute and Community Service).
Health professionals will then inform the safeguarding process by conducting a Pressure Ulcer Synopsis and Root Cause Analysis (RCA) and submit the relevant reports to the appropriate PUP. The Lewisham Multi-Agency Safeguarding Hub (MaSH) will provide the initial support and oversight of pressure ulcer related cases until the RCA has been completed.
If the pressure ulcer amounts to the wilful neglect of an individual who lacks mental capacity, a crime under section 44 of the Mental Capacity Act 2005 may have occurred, and in these instances the police will be informed.
SAM’s should engage with the PUP’s to gain understanding of process and decision making of PUP professionals, alongside assisting to co-ordinate any other elements of the safeguarding enquiry if there is another aspect to this.
The PUP’s will attempt to conclude their investigation within 28 days, but this may not always be possible. Once the PUP’s have decided no further investigation by panel is required, the enquiry is closed to the panel and an action plan process is implemented. The SAM should then co-ordinate any further actions up to the point of the enquiry being closed overall.
3. Consent and engagement with the adult in relation to a Safeguarding Enquiry
These are often crucial factors in determining if a Safeguarding Enquiry can progress, and how effective it is, and may lead to decisions not to proceed that leave the adult still exposed to a risk of significant harm.
- Read The Caldicott Principles.
- Also see Information Sharing page which is full of advice, guidance and the local Information Sharing Agreement.
- Does the adult have the mental capacity to consent to the Safeguarding Enquiry?
- Is there a need to provide statutory advocacy: Advocacy 7 Minute Briefing March 2023
- 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), Supported decision-making toolkit for people with communication difficulties Practicable steps for people with communication difficulties and Oldham SAB's Executive Functioning Guidance
- 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 and Alcohol Change UK Cognitive Impairment Guide and Alcohol Change UK How to use legal powers to safeguard highly vulnerable dependent drinkers guide.
- If the adult does have the mental capacity to consent to the Safeguarding Enquiry, but refuses, professionals must be careful that they consider how to keep the adult safe. This may be particularly relevant in domestic abuse cases.
- A Safeguarding Enquiry can still proceed without the adult’s consent if ‘vital’ or ‘public’ interest considerations apply.
- If the adult meets the safeguarding duty/ criteria, and is at risk of significant harm, and it is deemed they do have the mental capacity to refuse consent and to not engage with any Safeguarding Enquiry, then consider seeking legal advice and the use of the Court of Protection, and or Inherent Jurisdiction: 39 Essex Chambers: Guidance on Use of Inherent Jurisdiction.
- See and use the Guidance on Improving our Approach to Adult and Family Engagement which includes an overview of Trauma Informed Practice.
- See and use the Multi-Agency Self-Neglect Policy, Practice Guidance and Procedures.
- Professionals must consider escalating decision making where necessary in more complex cases, and respectfully challenge decision making if necessary and appropriate Inter-Agency Escalation Policy July 2023
- This links to the subject of Professional Curiosity as it is good practice to respectfully challenge safeguarding decisions that you believe are not appropriate. Please Read This Guidance: Lewisham Safeguarding Adults Board - Professional Curiosity
4. The Challenge of Engagement and Self-Neglect
Only 5% of Section 42 Enquiries are related to Self-Neglect in Lewisham, but professionals must understand the significance of these complex cases as almost half of all Safeguarding Adults Reviews, and therefore some of the most serious cases of abuse nationally, are related to this subject.
When an adult is self-neglecting, relationship based work becomes crucial and having one worker as a single point of contact may be beneficial.
Using the label “hard to engage” is damaging and may result in other professionals believing there is little point in attempting to do so, and therefore should be avoided (“seldom heard” may be a more appropriate term).
Practitioners should work together if one is struggling to achieve meaningful engagement with the adult, as another may still be able to take the lead on behalf of an Enquiry Officer in managing and monitoring risk.
Practitioners should also consider the following in helping to improve engagement with adults:
- Creative, flexible and imaginative ways to communicate with adults, including working with faith, community leaders and non-safeguarding practitioners to achieve the best outcomes.
- Producing information in a number of ways to meet individual needs.
- Involving family members appropriately to help support adults.
- The use of advocacy to engage with adults.
- Training staff to enable and improve engagement with adults.
Multi-Agency Self Neglect Policy, Practice Guidance and Procedures
5. Making Safeguarding Personal during a Safeguarding Enquiry
Making Safeguarding Personal (MSP) is an initiative which aims to develop a person centred and outcomes focus to safeguarding work in supporting people to improve or resolve their circumstances.
What MSP Seeks to achieve:
- A personalised approach enabling safeguarding to be done with and not to people, using practical methods defined by the adults individual needs rather than those of the organisation.
- The outcomes an adult wants, by determining these at the beginning of working with them, and ascertaining if those outcomes were realised at the end.
- Improvement to people’s circumstances rather than on ‘investigation and conclusion’.
- Utilisation of person-centred practice rather than ‘putting people through a process’.
- Good outcomes for people by working with them in a timely way, rather than one constrained by timescales.
- Improved practice by supporting a range of methods for staff learning and development.
- Learning through sharing good practice.
- Further development of recording systems in order to understand what works well.
- Broader cultural change and commitment within organisations, to enable practitioners, families, teams and the Lewisham Safeguarding Adults Board to know what difference has been made.
Supporting people living with Dementia to be involved in adult Safeguarding Enquiries (March 2021)
Making Safeguarding Personal | Local Government Association
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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 support and information.
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". ……………………………………………………………………………………………………………………………………………
Local Government Association - Making Safeguarding Personal Toolkit
Plan & Review Stage 3: Multi-Agency Adult Safeguarding Planning Meeting Guidance
1. What is the purpose of a Multi-Agency Adult Safeguarding Planning Meeting?
The overarching purpose of a Multi-Agency Adult Safeguarding Planning Meeting is to bring together all of the relevant stakeholders, so that information and intelligence can be shared to determine what the appropriate actions should be to “sufficiently reduce, or remove the risk to the adult” (although it may also be appropriate for this to 'remain' in some circumstances).
This is a shift in terminology and emphasis away from trying to 'substantiate' reports of abuse, which can become combative between professionals and agencies, detracting from the efforts to improve the adult's wellbeing and safety.
See: Multi-Agency Adult Safeguarding Planning Meeting Form (Word) Multi-Agency Adult Safeguarding Planning Meeting Form (Pdf)
2. When might a Multi-Agency Adult Safeguarding Planning Meeting be needed?
A Planning Meeting may not be necessary in relation to all Section 42 Safeguarding Enquiries, but the following points should be used to help determine if one is required:
- Where the health and safety of the adult is, or maybe compromised, and a detailed (or initial) safeguarding plan is required.
- Where there have been previous Safeguarding Concerns and the issues have been repeated, and or, the risks are more acute than previously thought.
- Where multiple agencies (including providers) are needed in providing support and or protection, and there is a need to co-ordinate actions.
- In organisational or institutional cases where other adults are at risk of abuse or neglect. This may include where issues have affected residents of other Local Authorities.
- Where the abuse involved a member of staff/volunteer (position of trust), and this brings into question the safety of other adults, and or the service.
- Where there is the potential for parallel or overlapping criminal investigations by Police. In some instances a Planning Meeting may be required at short notice (1 day) following on from the initial Safeguarding Enquiries, if the issues identified place the adult at significant risk of harm, otherwise this should be arranged within 5 working days of a decision being made that one is necessary. With this in mind the following points made under each of the six Safeguarding Principles should be followed to ensure that Planning Meetings are utilised effectively and consistently. The objectives of a Safeguarding Enquiry are laid out on page 70 of the London Multi-Agency Safeguarding Policy and Procedures.
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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 support and information.
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".……………………………………………………………………………………………………………………………………………
The practitioner who is setting up and chairing a Planning Meeting (see section 3) must ensure that the adult’s views, wishes and opinions are effectively represented, and conduct the meeting in an appropriate manner, using appropriate adaptations if required, allowing for the full participation of the adult and or their representative(s).
2.1 If the adult does wish to attend the following points must be born in mind:
- The adult can bring someone to support them at the meeting. This might be a family member, friend or an Advocate (see section 3.2 of the London Multi-Agency Safeguarding Policy and Procedures), and or a legal representative.
- The meeting is about the adult and their views and wishes. The Chair of the meeting must ensure these are heard and listened to by everyone else.
- The meeting may need to decide what actions need to be taken, and by who, to make the adult safer and improve their wellbeing. This will be a group decision and the adult’s views will form part of this decision.
- A Safeguarding Plan may be agreed - this is about how the adult wants to be supported to be safe. Decisions about the adult’s welfare or care will need to be agreed with them.
- If the adult has been assessed as not having mental capacity to make a particular decision at that time, then it will need to be made in their ‘best interests’, and their views, wishes, feelings and beliefs must still be taken into account. Such decisions must be made in line with the Mental Capacity Act 2005 (Mental capacity should be carefully considered during every safeguarding enquiry- see section 3.1 of the London Multi-Agency Safeguarding Policy and Procedures.
- Think about how you ask questions and how you can improve your understanding of a person's life circumstances: Lewisham Safeguarding Adults Board - Professional Curiosity
2.2 If the adult does not wish to attend they may:
- Give their views in writing, or
- Ask someone to attend on their behalf, for example an advocate, friend or family member, or
- Ask the Safeguarding worker or Safeguarding Adults Manager to pass on their views.
Local Government Association - Making Safeguarding Personal Toolkit ………………………………………………………………………………………………………………………………………….
Safeguarding Principle - Prevention
What does this mean for the professionals: Strategies are developed to prevent abuse and neglect that promotes resilience and self-determination.
What does this mean for the adult: "I am provided with easily understood information about what abuse is, how to recognise the signs and what I can do to seek help". ……………………………………………………………………………………………………………………………………………
2.3 The Planning Meeting should consider:
- The longer-term ongoing support the adult will need.
- What learning can be shared across agencies to help prevent further re-occurrences. This is also linked to Section 44 of the Care Act 2014 - if the criteria for a Safeguarding Adults Review (SAR) is met.
- If a referral to the Provider Concerns Process should be made (see sections 5.7 & 5.8 of the London Multi-Agency Safeguarding Policy and Procedures)
- What training or education is needed to help prevent further re-occurrences of abuse.
- How information should be recorded and shared in line with the data protection legislation to help prevent further instances of abuse (see section 2.39 of the London Multi-Agency Safeguarding Policy and Procedures.
- Does the adult have the mental capacity to consent to the Safeguarding Enquiry?
- Is there a need to provide statutory advocacy: Advocacy 7 Minute Briefing March 2023
- 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), Supported decision-making toolkit for people with communication difficulties Practicable steps for people with communication difficulties and Oldham SAB's Executive Functioning Guidance
- 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 and Alcohol Change UK Cognitive Impairment Guide and Alcohol Change UK How to use legal powers to safeguard highly vulnerable dependent drinkers guide.
- If the adult does have the mental capacity to consent to the Safeguarding Enquiry, but refuses, professionals must be careful that they consider how to keep the adult safe. This may be particularly relevant in domestic abuse cases.
- A Safeguarding Enquiry can still proceed without the adult’s consent if ‘vital’ or ‘public’ interest considerations apply.
- If the adult meets the safeguarding duty/ criteria, and is at risk of significant harm, and it is deemed they do have the mental capacity to refuse consent and to not engage with any Safeguarding Enquiry, then consider seeking legal advice and the use of the Court of Protection, and or Inherent Jurisdiction: 39 Essex Chambers: Guidance on Use of Inherent Jurisdiction.
- See and use the Guidance on Improving our Approach to Adult and Family Engagement which includes an overview of Trauma Informed Practice. A lack of effective engagement should result in an escalation of the risks in some instances and not a closure of the case.
- See and use the Multi-Agency Self-Neglect Policy, Practice Guidance and Procedures. Including consideration of the use of the High-Risk Panel if the Enquiry and Review is not achieving the desired effect in reducing the risk to the adult.
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Safeguarding Principle - Proportionality
What does this mean for the professionals: A proportionate and least intrusive response is made balanced with the level of risk.
What does this mean for the adult: "I am confident professionals will work in my interest and only get involved as much as needed".
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- If the abuse or neglect is unintentional and has arisen because an informal carer is struggling to care for another person. An assessment of both the carer and the adult must be considered in relation to wellbeing principles and duties.
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Safeguarding Principle - Protection
What does this mean for the professionals: Adults are offered ways to protect themselves, and there is a co-ordinated response to safeguarding.
What does this mean for the adult: "I am provided with help and support to report abuse. I am supported to take part to the extent to which I want and to which I am able". ……………………………………………………………………………………………………………………………………………
- The details of the Safeguarding Concern and how this places the adult at risk of abuse or neglect.
- That there is clarity about the type of abuse that has occurred and that this is recorded effectively, considering types of abuse that are particularly under-recorded:
- Organisational Abuse
- Discriminatory Abuse
- Modern Slavery
- Domestic Abuse.
- If an enquiry does take place, that an appropriate risk assessment of the available information is conducted that informs decisions regarding how the investigation will be undertaken, by whom, and by when.
- How a Safeguarding Plan will be delivered to reduce or remove the risk of harm to the adult, and or others.
- Any potential risks to children and young people (or other adults at risk) and agreement on who will arrange a Child Protection referral, where necessary. Refer to the: The Think Family page where you will find the Lewisham Think Family Protocol, the Think Family Practice Guidance and resources.
- The link with other key processes and procedures e.g. personnel issues (including referrals to the Disclosure and Barring Service or a professional or regulatory body); Police investigations; other regulatory processes such as a NHS Serious Incident, and the link to Pressure Ulcer Panels (see section 6).
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Safeguarding Principle - Partnerships
What does this mean for the professionals: Local solutions through services working together within their communities.
What does this mean for the adult: "I am confident that information will be appropriately shared in a way that takes into account its personal and sensitive nature. I am confident that agencies will work together to find the most effective responses for my own situation".
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- How everyone involved in the enquiry will deliver the actions that are agreed as a result of the investigation in a manner consistent with Making Safeguarding Personal principles (MSP) and that the adult’s views and wishes are achieved as agreed.
Local Government Association - Making Safeguarding Personal Toolkit
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Safeguarding Principle - Accountability
What does this mean for the professionals: Accountability and transparency in delivering a safeguarding response.
What does this mean for the adult: "I am clear about the roles and responsibilities of all those involved in the solution to the problem".
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- That arrangements are in place to give feedback to the person raising the Safeguarding Concern if they are not in attendance at the Planning Meeting.
- How partners are going to monitor and measure the delivery of the agreed actions with MSP in mind.
- Issues relating to inequalities and or potential discrimination are identified and taken account of.
3. Who can convene a Multi-Agency Adult Safeguarding Planning Meeting?
An Enquiry Officer or a Safeguarding Adults Manager from the London Borough of Lewisham (LBL) can convene a Multi-Agency Adult Safeguarding Planning Meeting.
4. Who should attend a Multi-Agency Adult Safeguarding Planning Meeting?
There are a wide range of people who may be required to attend a Planning Meeting, including, but not limited to:
- The adult and or their representative (see 2.1).
- The Safeguarding Adults Manager or their equivalent.
- The Safeguarding Enquiry Officer.
- The person who raised the Safeguarding Concern (if they are a professional).
- Police manager.
- Other criminal justice agencies.
- NHS Trust manager and or relevant specialist.
- GP
- Care Quality Commission.
- Care Provider agency manager.
- Relevant LBL and or South East London (SEL) Integrated Care Board (ICB) Commissioner.
- Quality Assurance or Contracts Officer from LBL and or SEL ICB.
- The person/agency alleged to have caused the harm should have been given the opportunity to submit their representations. If this an agency, then a manager not directly involved in providing care in the case may be invited to attend.
- Any other relevant agency/service representative as deemed appropriate by the person chairing the meeting.
Whoever attends a Planning Meeting should be of sufficient seniority to make decisions within the meeting concerning the organisation’s role and the resources they may contribute to the agreed Safeguarding Plan.
Planning Meetings should be formally recorded and minutes taken, which should be shared with those attending. This should be completed within 5 working days of the Meeting.
5. Practical arrangements
Whilst there is a need to formally record the minutes from Planning Meetings, these should be set up as informally and flexibly as possible to meet the requirements of the adult and or their representative(s), whilst also helping ensure that professionals can contribute when these meetings are being set up at relatively short-notice.
It may be suitable and appropriate to set these meetings up online using video methods, or via telephone, or by being flexible in utilising meeting rooms that are accessible for those involved. Otherwise the chair of the Planning Meeting should consider:
- How to create a comfortable and welcoming environment.
- Whether the adult wishes to have a representative(s) with them and whether they will or should have an active or silent role (legal representative). This should be agreed with the adult, their legal representative and the chair ahead of the Planning Meeting.
- Any communication requirements or other accessibility issues.
- Location of facilities such as refreshments and toilets.
- How breaks will be agreed, if needed.
- Arrangements should the adult require a break or wish to clarify any points covered in the meeting.
- The adult and their representative(s) should not be required to join a room where other attendees have previously gathered, and where possible they should be in the room before other attendees join, having met and had a chance to talk with the chair ahead of the meeting.
- Meetings can also be in multiple parts to make them less intimidating (smaller groups) and more manageable for the adult, and include a separate and wider ‘professionals’ meeting.
- Where the venue is the adult’s own home, consideration should be given to how their home will be treated with respect, and how to maintain confidentiality if others not attending the meeting may also be present in the home.
See: Multi-Agency Adult Safeguarding Planning Meeting Form (Word) Multi-Agency Adult Safeguarding Planning Meeting Form (Pdf)
6. How do Planning Meetings link to Pressure Ulcer Panels and the Provider Concerns process?
6.1 Pressure Ulcer Panels
Any Section 42 Safeguarding Enquiry which has commenced as a result of a pressure ulcer related issue will normally be conducted via one of the two Pressure Ulcer Panels in the Borough of Lewisham, which are both overseen by a senior social work practitioner from within LBL.
If these are routine cases, then a separate Planning Meeting will not be required, unless one or more of the issues listed in section 2 of this guidance are also present in the case.
If a Planning Meeting is deemed to be necessary in relation to a pressure ulcer related case, then one should be convened within 5 working days of a decision being made that one is necessary, even if the case has not been brought to a conclusion by the relevant Pressure Ulcer Panel.
6.2 Provider Concerns
As described in section 2.3, one outcome from a Planning Meeting might be to make a referral to the Provider Concerns process if the criteria for this has been reached. The Planning Meeting may help to identify signs linked to provider concerns, allowing for early supportive actions to be taken by commissioning authorities in supporting social care providers. A referral for the Provider Concerns Process should be made through the applicable Contracts Officer from LBL/ SEL ICB, or through the Head of Safeguarding and Gateway at LBL.
Provider Concern Process Flowchart Oct 2022
Quality, Safeguarding and Provider Concerns Procedure Oct 2022
Provider Concerns Policy and Procedures - Oct 2022
7. Monitoring and review of Planning Meetings
The Operational Lead from LBL will provide operational oversight and monitor all activity linked to the Section 42 Enquiry process, including Planning Meetings, in conjunction with the Service Manager with overall responsibility for adult safeguarding within LBL.
The Service Manager within LBL will provide oversight of Planning Meetings, providing quality assurance to the Lewisham Safeguarding Adults Board through ongoing audit and reporting processes.
Stage 4: Closing the Enquiry
A Safeguarding Concern/Enquiry can be closed at any of the previous three stages of the procedure.
However, the following points should be used as a checklist to ensure the procedure has been closed effectively and appropriately:
- Anyone involved in the Safeguarding Concern/Enquiry should be advised on how and who to contact if there are further concerns about the adult at risk.
- There should be agreement on how any further concerns will be followed up.
- It is good practice where a care management assessment, Care Programme Approach (CPA), reassessment of care and support, health review, placement review or any other pre-booked review is due to take place following the safeguarding enquiry, for a standard check to be made that there has been no reoccurrence of concerns.
- Closure records should note the reason for this decision and the views of the adult at risk to the proposed closure. The SAM responsible should ensure that all actions have been taken, building in any personalised actions:
- Agreements with the adult at risk to closure.
- Referral for assessment and support.
- Advice and information provided.
- All organisations involved in the enquiry updated and informed.
- Feedback has been provided to the referrer (this is very important).
- Action taken with the person alleged to have caused harm.
- Action taken to support other service users.
- Referral to children and young people made (if necessary).
- Outcomes noted and evaluated by adult at risk.
- Consideration for a Safeguarding Adults Review (SAR).
- Any lessons to be learnt.
The SAM may decide to convene a multi-agency meeting at the closure stage so that the Safeguarding Enquiry process can be reviewed, to ensure that the "risk to the adult has been sufficiently reduced, or removed" (although it may also be appropriate for this to 'remain' in some circumstances), before being closed.
This will not always be required, but may be useful in the following circumstances:
- To ensure that in the most complex cases the risk management arrangements that have been put in place are being effective.
- Where multiple agencies (including providers) have been involved in offering support and or protection, and ongoing co-ordination is required.
- In organisational or institutional cases where other adults may also have also been at risk of abuse or neglect. This may include where issues have affected residents of other Local Authorities.
- Where the abuse involved a member of staff/volunteer (position of trust), and this brought into question the safety of other adults, and or the service.
- Where there may have been multiple ongoing enquiries by different organisations or other processes, including by Police and the Pressure Ulcer Panels.
- To consider if other legal or statutory actions or redress are needed. This may include a referral for a Safeguarding Adults Review (SAR - s.44 Care Act 2014).
Provider Concerns
One further outcome from a multi-agency meeting might be to make a referral to the Provider Concerns process if the criteria for this has been reached. This meeting may help to identify signs linked to provider concerns, allowing for early supportive actions to be taken by commissioning authorities in supporting social care providers. A referral for the Provider Concerns Process should be made through the applicable Contracts Officer from LBL/ SEL ICB, or through the Head of Safeguarding and Gateway at LBL.
Provider Concern Process Flowchart Oct 2022
Quality, Safeguarding and Provider Concerns Procedure Oct 2022
Provider Concerns Policy and Procedures - Oct 2022
The adult safeguarding process may be closed but other processes may continue, for example, a disciplinary or professional body investigation. These processes may take some time. Consideration may need to be given to the impact of these on the adult and how this will be monitored. Where there are outstanding criminal investigations and pending court actions, the adult safeguarding process can also be closed providing that the adult is safeguarded.
All closures no matter at what stage are subject to an evaluation of outcomes by the adult at risk. If the adult at risk disagrees with the decision to close safeguarding down their reasons should be fully explored and alternatives offered.
At the close of each enquiry there should be evidence of:
- Enhanced safeguarding practice ensuring that people have an opportunity to discuss the outcomes they wanted at the start of safeguarding activity.
- Follow-up discussions with adults at risk at the end of safeguarding activity to see to what extent their desired outcomes have been met.
- Recording the results by fully completing all of the data recording requirements within the LBL Case Management System (LAS) so this can be used to inform practice, and provide the necessary performance monitoring information for the Lewisham Safeguarding Adults Board.
Adult Safeguarding Pathway Resources
Adult Safeguarding Posters - See it, Report it!
Adult Safeguarding Leaflet:
Learning and Development Workbooks
The Introduction to Adult Safeguarding & Modern Slavery Awareness are the first two workbooks in our series on adult safeguarding.
- Introduction to Adult Safeguarding Workbook - March 2023
- Training Case Studies
- Modern Slavery Awareness Foundation Level Workbook October 2023
The roll-out of further Workbooks in this series will be linked to specific strands of adult abuse and neglect, and other adult safeguarding related subjects.
Adult Safeguarding Policy and Procedures Template
LSAB Adult Safeguarding Single Agency Policy and Procedures Template (for use by any agency updated January 2023).
Single Agency Policy Template For Small Community Organisations (September 2023)
Adult Safeguarding Pathway Forms and Templates
This booklet was made by Lewisham Speaking Up on behalf of the Lewisham Safeguarding Adults Board.
Read and download the Scams Easy Read Booklet
Think Family: Working with Fathers and Male Carer's Toolkit
A toolkit for professionals working with fathers and male carers.
Working with Fathers and Male Carer's Toolkit Checklist
A checklist that focusses professionals work when working with fathers and male carer's.
Working with Fathers and Male Carer's Toolkit Resources
A collection of resources for professionals working with fathers and male carer's in Lewisham.
Use of Statutory Advocacy
Advocacy 7 Minute Briefing March 2023
Tricky Friends
Good friends can make life really great. But friendships can be tricky. Watch our Tricky Friends video which will give you helpful advice on friendship.
Coercive Control
Raise awareness of the signs of Coercive Control by 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
London Fire Brigade: Help for Hoarders - Fire Safety Tips
Stop Hate UK: Hate Crime Posters for Lewisham
West Midlands Modern Slavery Victim Support Booklet
The Government has also produced a Support for Victims of Modern Slavery leaflet in 11 languages.
Migrant Help Sexual Assault and Sexual Abuse Information
Prevention
We can all help to prevent adult abuse and neglect by supporting the delivery of these key objectives:
1. Improve Public Awareness
This can be achieved by helping to support awareness building campaigns and by signposting adults to appropriate sources of information. One easy way to do this is by following @lewisham_sab on Twitter and supporting the campaigns we deliver.
2. Identify Adults who May be at Increased Risk
There are many factors which might increase the risks of adult abuse and neglect including: older age; physical, mental, sensory, learning or cognitive illness or disability; and having to rely on others for health and social care support.
3. Identifying & Responding Effectively to Abuse
Organisations and individuals working to improve their understanding and early identification of the different types of adult abuse, so that an effective response can be achieved in conjunction with the adults views and wishes.
4. Consistent & Widespread Application of Policies & Procedures
It is important for organisations delivering services to adults to have appropriate policies and procedures which are developed in line with guidance from the Lewisham Safeguarding Adults Board, and embedded into the practice of all professionals. See: Pathway Resources
5. Focus on Equality & Narrowing Inequality
Adults from financially deprived backgrounds are more likely to become an ‘identified’ victim of adult abuse and neglect, and it is less likely that an adult from some ethnic minority communities will be engaged with statutory services in Lewisham. All professionals can help to improve reporting and equal access to protective services.
This Government Guidance provides some excellent information and resources to help reduce inequality: Inclusion Health: Applying All Our Health (May 2021)
6. Help Adults to Protect Themselves
Every organisation delivering services to adults at risk of abuse and neglect can identify ways in which they can help to inform, and support adults in protecting themselves from abuse.
See this Web Page which has useful advice and services that exist locally: Lewisham Safeguarding Adults Board - SCAMS Information and Advice
7. Provide Information, Advice & Advocacy
Individual organisations will know the communication needs of their client groups, and as such are best placed to provide bespoke adult safeguarding information in the most appropriate formats, methods and languages. See: Pathway Resources
More information on the Statutory Advocacy Provider in Lewisham can be found here: https://www.pohwer.net/lewisham
8. Provide Access to Training & Education
Organisations have a responsibility to provide access to up to date and relevant adult safeguarding training for their staff and volunteers, and additional support for the person (s) responsible for leading on this subject within that agency.
Infographic - It all Points to Prevention
All Points Towards Prevention Infographic November 2023
9. Support Broader Wellbeing Strategies
There is a clearly established link between the prevention of adult abuse and broader health and wellbeing strategies, including the reduction of social isolation and loneliness. Organisations can help to engage adults in these type of strategies, which will also indirectly help to prevent adult abuse.
Preventing abuse and neglect of adults with care and support needs - SCIE
This video Safeguarding Adults - Helping People To Protect Themselves From Crime which has been produced by the Social Care Institute for Excellence, shows what care workers and others who are in contact with adults at risk can do to help them protect themselves from crime.
This video Safeguarding Adults - Looking Out For Each Other To Prevent Abuse which has been produced by the Social Care Institute for Excellence, can be helpful to highlight what the local community can do to protect themselves and those they care about.
Feeling lonely or isolated? - Age UK Silver Line
As we get older, we may find we spend more time on our own. This can sometimes feel lonely, boring or make us miss friends or family.
If you or someone you know is missing the joy of regular conversation,
The Silver Line Helpline run by Age UK is a free, 24-hour telephone service for older people across the UK.
We offer friendship, conversation, and support for people aged 55 or over, especially those who may be experiencing feelings of loneliness and isolation.
Find out more about the Silver Line
London Fire Brigade - Home Fire Safety Checker
Get started with the Home Fire Safety Checker
Metropolitan Police- Lewisham - Personal safety: how to stay safe
Tips and advice on keeping yourself protected from crime: from pickpocketing and personal robbery to harassment and dealing with violent situations.
Independent Age - Advice and support for older age
Independent Age have some great advice on what can cause falls, what you can do if you do fall and where to find out further information.
Staying steady on your feet
Lewisham and Greenwich NHS Trust offer a falls rehabilitation service which you can access via referral from your GP.
Age UK Lewisham and Southwark
Age UK Lewisham and Southwark exists to improve the lives of older people in the London Boroughs of Lewisham and Southwark, working towards a future in which older people are valued, safe and empowered to make choices about their lives.
Age UK Lewisham and Southwark aims to empower and enable older people to lead fulfilled lives by:
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Providing services and support that address poverty and isolation
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Protecting the human rights of local older people
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Promoting health and wellbeing
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Connecting older people with their communities
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Working positively with partners across all sectors
Protect yourself from fraud and cyber crime with Action Fraud
How much do you really know about fraud and cyber crime? Action Fraud has lots of helpful information and advice on how to keep you safe.
See this Web Page which has useful advice and services that exist locally: Lewisham Safeguarding Adults Board - SCAMS Information and Advice
Please let us know if you have any thoughts or ideas in relation to prevention.
There are two ways that you can get in contact with us, by email or letter.
Email Us
Postal Address: Lewisham Safeguarding Adults Board, C/o London Borough of Lewisham, 3rd Floor, Laurence House, Catford, London, SE6 4RU.