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 +

Hate Crime +

Domestic abuse +

Coercive or controlling behaviour is a core part of domestic violence +

Economic Abuse +

Financial or material abuse +

Modern slavery +

Organisational or institutional abuse +

Physical abuse +

Psychological or emotional abuse +

Self-neglect +

Sexual abuse +

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?

An “Adult at Risk” is defined as any person aged 18 years and over who is or may be in need of community care services by reason of mental health issues, learning or physical disability, sensory impairment, age or illness and who is or may be unable to take care of him/herself or unable to protect him/herself against significant harm or serious exploitation.

Since the publication of ADASS Best Practice Document: ‘Safeguarding Adults’ (2005), the range of people considered to be vulnerable has been widened to include, people encountering domestic abuse, substance misusers and asylum seekers.

When a young person reaches the age of 18 the responsibility for their well being may transfer to adult service providers.

Perpetrators of Abuse

The person alleged to have caused harm

Abuse can occur anywhere and be perpetrated 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. 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 vulnerable adult
• A non-carer or stranger

Abuse can occur in any relationship. It often occurs where the person who is abusing is in a more powerful position than the person who is being abused.

Abuse occurs when the abuser misuses such power either intentionally, or unintentionally or for their own benefit or gain.

The person who is abusing 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.

In any formal caring situation, the person providing the care is held in a position of trust.

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 vulnerable, with the intention of abusing, harming, exploiting or manipulating that person.

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.

SCIE free online Mental Capacity Act e-learning

This course explores the Mental Capacity Act 2005, including best interests decision-making, and how to support people to make their own decisions.

The course is for everyone who looks after or cares for someone, for example, doctors, nurses, care assistants, social workers, and family members.

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 a vulnerable adult 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

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:

• Providing services and support that address poverty and isolation

• Protecting the human rights of local older people

• Promoting health and wellbeing

• Connecting older people with their communities

• Working positively with partners across all sectors

Find out how Age UK Lewisham can help you. 

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.

About Us and How To Contact Us

The overarching purpose of the Lewisham Safeguarding Adults Board (LSAB) is to help and safeguard adults with care and support needs by:

• Assuring itself that local safeguarding arrangements are in place as defined by the Care Act 2014 and statutory guidance;
• Assuring itself that safeguarding practice is person-centred and outcome-focused;
• Working collaboratively to prevent abuse and neglect where possible;
• Ensuring agencies and individuals give timely and proportionate responses when abuse or neglect have occurred; and
• Assuring itself that safeguarding practice is continuously improving and enhancing the quality of life of adults in its area.

The Board meets four times a year and has an Independent Chair.

In Lewisham the Board believes that "Safeguarding is Everyone's Business". Its pledge to the people in Lewisham is that by working together and in partnership the risk of abuse or harm can be reduced by raising awareness of safeguarding of adults. As intelligence is gathered from across the partnership activity trends can be analysed and areas of concern identified so that preventative measures can be applied to keep people safe.

**Do not contact the Independent Safeguarding Adults Board to report Safeguarding Concerns. You need to contact Adult Social Care Gateway at Lewisham Council. Please see "How to Report a Safeguarding Adult Concern" section below. Please also consider the transmission of personal information when making a referral to the Council. **

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.

How to Report a Safeguarding Adult Concern

If you suspect that you or an adult you care about may be at risk of abuse or neglect call Lewisham Adult Gateway on 020 8314 7777 alternatively if you have concerns about the immediate safety of an adult at risk then please contact the Police on 999.

There are a number of ways you can contact Gateway

The Gateway can be contacted Monday - Friday 9am - 5pm

Tel: 020 8314 7777 (select option 1)

Fax: 020 8314 3014

Email Gateway

You can also follow us on Twitter @lewisham_sab

Safeguarding Adults Reviews & How to Make a Referral

Lewisham Safeguarding Adults Board (LSAB) will arrange a Safeguarding Adults Review (SAR) when an adult in Lewisham dies as a result of abuse or neglect, whether known or suspected, and there is concern that partner agencies could have worked more effectively to protect the adult.

We will also arrange a SAR if an adult in Lewisham has not died, but the LSAB knows or suspects that the adult has experienced serious abuse or neglect.

We are also free to arrange for a SAR in any other situations involving an adult in Lewisham with needs for care and support.

The Department of Health's Safeguarding Care and Support Statutory Guidance guides the reviews we carry out.

Should the LSAB carry out a review we have a LSAB SAR Policy & Procedures October 2023 that we work to, which explains in detail what you can expect us to undertake for the Lewisham Community.

Read our published Safeguarding Adult Reviews.

Make a referral to the Board for a Safeguarding Adults Review

If you would like to refer a case to us for the boards consideration for a Safeguarding Adults Review to be commissioned please use our dedicated notification form.

---

Second National Analysis of Safeguarding Adult Reviews: April 2019 - March 2023

This work was commissioned by the Local Government Association (LGA) and the Association of Directors of Adult Social Services (ADASS) as Partners in Care and Health (PCH), supporting councils to improve the way they deliver adult social care and public health service.

Introduction

Methodology

Types of abuse and neglect

Areas of specific interest

The individuals whose circumstances were reviewed in the SARs

Themes emerging from the SAR learning

Direct work

Organisational features

SAB governance

National context

Recommendations made by SARs

SAB governance of SAR decision-making

Key questions for SABS

Conclusions and improvement priorities

LSAB Structure and Members

The current membership of the LSAB:

• Age UK Lewisham and Southwark

• Department for Work and Pensions – South London District

• Healthwatch Lewisham

• Lewisham & Greenwich NHS Trust

• Lewisham Adult Social Care

• Lewisham Children & Young People’s services

• Lewisham Speaking Up

• Lewisham Refugee and Migrant Network (LRMN)

• Lewisham Safeguarding Children Partnership (LSCP)

• Lewisham Housing Directorate

• Lewisham Adult Integrated Commissioning

• Lewisham Public Health

• Lewisham Safer Communities

• Lewisham Strategic Housing Services

• London Ambulance Service NHS Trust

• London Fire Brigade

• Metropolitan Police Service, Lewisham (South East BCU)

• National Probation Service, Lewisham and Bromley

• NHS South East London Integrated Care Service and Board

• South East London MIND

• South London & Maudsley NHS Foundation Trust

• 999 Club

Governance and operational structure

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.

Lewisham Safeguarding Adults Board Structure

 

The LSAB Compact and Strategic Business Plan 2024-2025 describes how these 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 and Support Statutory Guidance, issued and updated from time to time by the Department of Health and Social Care.

Adult Safeguarding Leaflets and Posters

Adult Safeguarding Posters - See it, Report it!

• LSAB Adult Safeguarding Poster Version 1
• LSAB Adult Safeguarding Poster Version 2
• LSAB Adult Safeguarding Poster Version 3

Adult Safeguarding Leaflet:

• Easy Read Version
• English Version 1 (links to above poster)
• English Version 2 (links to above poster)
• English Version 3 (links to above poster)
• Translated Bengali Version
• Translated Hindi Version
• Translated Urdu Version

Infographic - It all Points to Prevention 

• All Points Towards Prevention Infographic November 2023

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 

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 2022-2023

Message from the Independent Chair

“One particular area of concern locally is the resourcing of mental health services, both for people with severe forms of mental distress requiring an inpatient bed, and for those living in the community, but in need of wrap-around mental health support”.

It is my pleasure to introduce this annual report which describes the work that has been done and the progress that has been made in keeping adults safe from abuse and neglect. We are slowly emerging from the worst of the Covid-19 pandemic but it continues to have an impact emotionally and practically for everyone. Services are having to readjust their ways of working, and for citizens the health, emotional and social impacts of the pandemic continue to be felt.

We are also experiencing a significant cost of living crisis, with a seemingly endless rise in the use of food banks and in poverty. We are only beginning to capture the data about the impact of this crisis on adult safeguarding, and I expect that next year’s annual report will reflect on what health, housing and social care services have witnessed. The Board has sought assurance from the local authority and its partners about the measures put in place to support citizens affected by the cost of living crisis.

We have continued to see the impact of financial austerity on public services. One particular area of concern locally is the resourcing of mental health services, both for people with severe forms of mental distress requiring an inpatient bed, and for those living in the community, but in need of wrap-around mental health support. We will continue to engage with mental health service providers and focus on improving the quality of practice.

The management of Safeguarding Adults Reviews continues to be a major focus of the Board’s work. It is reassuring that partner agencies are referring cases for consideration where an adult has died or experienced significant harm as a result of abuse and neglect. The Board has also kept a focus on how practice has improved and services developed, through webinars and assurance reporting, following the implementation of recommendations from completed reviews.

The Board has refreshed its Strategic Business Plan, a statutory requirement, to ensure that there is a clear focus on priority areas for assurance reporting and targeted task and finish work.

The Board has continued its work on developing its collation and reporting on performance data, and is actively supporting the local authority in its preparation for a forthcoming inspection by the Care Quality Commission. We have engaged directly with people with lived experience of adult safeguarding, but there is more that we must do in order to learn from those who have experienced abuse and neglect. This is one of my personal priorities.

I would like to thank Martin Crow and Vicki Williams who have supported me and taken forward much of the Board’s work. The Board’s web pages are a particular excellent example of the work they have put in. I also thank all of the Board’s partners for their contribution to adult safeguarding in Lewisham.

Professor Michael Preston-Shoot

Summary of Delivery in 2022-23

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 in this area of work which reflects the willingness of local professionals to seek transparency in relation to their practice. 

Learning and Development

The Board continues to invest heavily in this subject providing free to access courses in a range of subject areas. The Board supported the National Safeguarding Awareness Week in November 2022 by helping to provide a very extensive learning programme in London and nationally. 

Community Engagement

The Board routinely communicates and engages with around 200 local organisations in Lewisham, and continues to expand on this
outreach. A first of its kind Citizen’s Assembly was delivered by the Board in October 2022, which was co-produced and delivered by over a dozen local Voluntary and Community Sector Organisations. 

Seeking Assurance

An audit of safeguarding practice and delivery was completed by selected partners, and the trends used to develop the Board’s strategic priorities. The Housing Related Safeguarding Audit was finalised with a ‘Summit’ in December 2022 attended by a wide range of agencies. The Lewisham Adult Safeguarding Pathway was also reviewed in November 2022 based on feedback from local practitioners.

Partners Work

Metropolitan Police Service  

PC Chesca Rogers won a well-deserved national safeguarding award in 2022, as well as being recognised within the Metropolitan Police Service, for her outstanding work on the Domestic Abuse and Violence Disclosure Scheme (Clare’s Law).

Chesca has helped an incredible number of people in the last 2-3 years, as well as recommending changes to this national scheme to ensure this was more accessible during the Covid-19 pandemic period.

“Clare’s Law is the most empowering thing I have ever worked on giving people the ability to safeguard themselves and their children. I would encourage anyone to use it as it is completely confidential and the person being enquired about will never know about this. You would check reviews about products before you buy online, so why not do the same about a potential partner”.

See here for more information on Clare's Law

Lewisham and Greenwich NHS Trust

The following case example helps to illustrate Clare’s Law in action:

A woman attended the Emergency Department (ED) at the University Hospital of Lewisham with injuries that suggested an assault. She reported that she was intoxicated but had no memory of an assault. The ED team made a safeguarding referral to the trust safeguarding team and she was admitted to a ward. The safeguarding advisor gained consent for a referral to the Independent Domestic Violence Advisor (IDVA) and suggested that the medical photography team record the injuries. 

A police report was discussed with the woman but she declined this. The IDVA then worked with the woman and discovered that she had just moved in with a new partner, and she had a history of experiencing domestic abuse in past relationships.

The IDVA supported the woman to make a Clare’s Law application to the Metropolitan Police, and the disclosure came back with some very concerning information about the history of the new partner. The woman decided to end the relationship and with the support of the IDVA she then made a report to the police, who requested the photographs. The IDVA offered a refuge referral, and the woman declined initially, but after further housing enquiries, this offer was remade and accepted. The IDVA also provided the woman with a voucher for food.

 “Thank you for everything. I felt really looked after”.

Lewisham Council - Adult Social Care

It has been 18 months since the Adult Multi-Agency Safeguarding Hub (MaSH) Team was established, which now addresses all of the Safeguarding Concerns that come into the local authority via Adult Social Care. During this time significant progress has been achieved and the team has been expanded, including the recent recruitment of a specialist domestic abuse Officer who will help to strengthen links with partners. 

Relationships with health colleagues have continued to improve and the time taken to effectively deal with pressure ulcer cases has significantly reduced. The link with adult mental health services has also been strengthened and there is now a dedicated mental health liaison social worker within the MaSH team, who will help to take forward the plan for further integration with South London and Maudsley NHS Foundation Trust (SLaM).

The amount of work that the MaSH Team has completed in the past year has also continued to grow, with around 500 referrals a month being managed, along with the 500 Police Merlin reports that are also triaged each month. Work is in progress to help make this system more efficient, and the MaSH Team will continue to develop their wider practice to help keep those most at risk of abuse and neglect in Lewisham safe from harm.

Learning, Training and Development

Amanda and Eileen Dean SAR Learning Event 22 February 2023

A record 1,248 people attended 35 learning and development events delivered by the Board during the last 12 months, which is significantly higher than any previous year.​ This was bolstered by over 400 people attending the online and joint learning event for the Amanda and Eileen Dean SARs which is the single largest activity ever held by the Board, that attracted attention from across London and the wider U.K.

This event was recorded and can be viewed here: Safeguarding Adults Reviews

We recommend you take the time to watch this video linked to these very high profile cases.

The success of the Board’s learning events are carefully analysed and are routinely scored as having a ‘significant impact’. 

Lewisham Adult Safeguarding Pathway

Another record 97,128 hits were achieved on the Board’s website (25% increase on the previous year), many of which were on the Lewisham Adult Safeguarding Pathway pages.

The Pathway was first published in April 2021 and has been constantly updated since then whenever the legal framework has changed, national guidance has been produced, or local policies created or updated. The ambition is to ensure every organisation (around 500 in Lewisham) and professional delivering services to, or working with adults at risk, are regularly accessing the Pathway.

 Please ensure you use the Lewisham Adult Safeguarding Pathway

Communication and Engagement

Citizen’s Assembly - Corbett Community Library: 7 October 2022

This Assembly, which was the first of its kind for the Board, was planned in a lot of detail, and delivered in conjunction with a wide range of Voluntary and Community Sector Agencies, and attended by 25 residents (plus carers) from Lewisham. 

 

 In total there were 250+ pieces of evidence and feedback was captured which has been collated, shared, and used to help shape the delivery of services locally. 

The most prevalent type of abuse disclosed by those attending was Domestic Abuse with people sharing their stories about the ways this was being experienced: 

Financial in nature, including the misuse or withholding of the adult’s benefits.

Familial abuse with younger adults abusing their parents or other family carers.

Female Genital Mutilation (FGM). This was highlighted as a significant issue with (east) African communities and unlikely to reach the attention of statutory services.

There may also be some inter-connectedness with ‘neglect’ by family members with caring responsibilities.

Safeguarding Information 2022-23

 

Table 2: Police MERLIN and Crime Report Investigation System (CRIS)

The MERLIN system is the way in which police share intelligence about adults where there are wider ‘vulnerability’ concerns, although this does not match the Care Act 2014 criteria in relation to ‘adults at risk’. Local police attended an average of 68 incidents per month in relation to adults with a “mental health crisis” (London average = 52), which in 8/9 of the months reported was in the top 10 in London.

 

 

 

The Domestic Abuse and Violence Against Women & Girls (VAWG) Strategy was published in December 2021. In the shorter term the aim was to continue improving awareness which would result in increased reporting, including within Adult Social Care, which should then reduce as interventions and prevention measures develop. 

Safeguarding Adults Reviews (SARs)

‘Amanda’. This review was published on 2 November 2022. 

 Amanda was a white woman who was born and grew up in southeast London. She died in May 2019 at age 57. At a young age, doctors had diagnosed Amanda with paranoid schizophrenia. Amanda developed a dependence on drugs and alcohol and used different substances at different times in her adult life.

The Care Home where Amanda lived provided her with 24-hour care and support. In 2018-2019 some of Amanda’s social life revolved around street drinking. When she was intoxicated Amanda was susceptible to falling and sustaining injuries. 

On 15 May 2019 Amanda did not return to The Care Home. Amanda did sometimes go missing for short periods of time. On this occasion, when she did not return quickly, family members began their own enquiries. The police responded by searching an unused garage in the borough. The garage was derelict and along with adjacent garages was due to be demolished as part of a redevelopment programme. It had been used as a rough sleeping site. To stop this activity, the entrance to the garage was boarded up in May 2019. On 5 July 2019 the police found Amanda’s body in the back of the garage. She had been missing for just under two months.

Read the 7 Minute Briefing for professionals to see the key learning points.  

‘Eileen Dean’. This review was published on 11 November 2022.

Eileen Dean was a 93-year-old white British woman who had moved into a care home in Lewisham in June 2020.  Although her capabilities were reduced by dementia, Eileen remained happy and contented.

"The Adult" is a white British man who was 62 years old when he physically assaulted Eileen. He had initially been admitted to a general medical ward at the University Hospital Lewisham (UHL) operated by Lewisham and Greenwich NHS Trust in July 2020 following alcohol withdrawal seizures.

 The Adult was detained under Section 2 of the Mental Health Act 1983 (MHA) on 3 Sept 2020, and eventually transferred to the inpatient psychiatric unit at UHL, and later discharged to the same care home as Eileen in December 2020.

The Adult was diagnosed with Wernicke-Korsakoff Syndrome, which has an established link in academic literature with aggressive behaviour. Between 5 August 2020 to 4 September 2020, there were at least 34 recorded incidents of The Adult’s violence or threats to patients or staff, including The Adult threatening to use a bread knife, scissors and dinner trays as weapons.

At 12.30am on 4 January 2021 Eileen Dean was assaulted whilst lying in bed by The Adult. Eileen sustained significant injuries and died in hospital later that day.

Read the 7 Minute Briefing for professionals to see the key learning points.

SAR Notifications between April 2018 and March 2023

 

During this period there were 21 SAR Notifications:

14 Female                       7 Male

The age range for the subjects of SAR Notifications is much lower than for Safeguarding Enquiries.

From these Notifications 9 SARs have been completed between April 2015 and 31 March 2023 and all have been published in the public domain. 

The dominant subject area that is prevalent in the Notifications is mental ill-health, which is a feature in 66% of the published SARs and 3 further ongoing reviews.  

In comparison mental ill-health was the Primary Support Reason in only 5% of the concluded s.42 Enquiries conducted in Lewisham in 2020-21 and 2022-23 (16% in  England).

 Adults from Black British, Black African and Black Caribbean backgrounds were  disproportionally more likely to be the subjects of a SAR Notification linked to mental ill-health.

Work of the Sub-Groups

Case Review Sub-Group                       

The Sub-Group oversees Safeguarding Adults Review (SAR) processes locally, and is led by the Board’s Independent Chair Professor Michael Preston-Shoot.

The group met 6 times during 2022-23 and considered or monitored 9 cases throughout the year, including 4 new SAR  Notifications.

A new joint protocol has been developed over the last year between the two safeguarding partnerships in the Borough, and the Safer Lewisham Partnership Board, which more clearly defines which statutory review process will take precedence when a case meets the criteria for more than one.

The board also contributed to the National SAR Library which holds all of the reviews which have been published in Lewisham since April 2015.

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.

Colleagues from the Human Trafficking Foundation also underpin this work, and in July 2022 they gave a presentation to the Board updating them on the local, regional and national picture. 

 In the last year the Borough has also been successful in joining other local authority areas in conducting National Referral Mechanism (NRM) decisions locally (rather than by the Home Office) for under 18’s. This is helping to speed up decision making dramatically and ensure victims of MSHT are receiving the care and support they require. 

Performance, Audit and Quality Sub-Group

This group continued to meet quarterly throughout the year to analyse and monitor the Board’s performance indicators and other relevant safeguarding information. This activity also plays a significant part in informing the ongoing development of the Board’s strategic objectives. The group provided the necessary governance for the LSAB Safeguarding Audit that was conducted during 2022-23. The findings from this were reviewed by partners at the Board’s Development Session in March 2023, which included a chance to constructively challenge each organisations individual self-assessment.

The Housing Related Safeguarding Audit has led to a further review of local Self-Neglect Policy and Procedures and the creation of a working group to take this forward. This group are considering the most suitable options for escalating risks in relation to this subject. This will lead to a follow-up and Second ‘Summit’ in December 2023. 

New! June 2024 - Self-Neglect and Hoarding Multi-Agency Policy, Practice Guidance and Toolkit from the LSAB

As promised in 2023, a review of the self-neglect and hoarding policy has been reviewed and published in June 2024.

Self-Neglect and Hoarding Multi-Agency Policy, Practice Guidance and Toolkit from the LSAB

Annex 2

Accompanying the Practice Guidance is the Self-Neglect High Risk Panel - Risk Assessment & Action Plan Template.

The group also commissioned a Hospital Discharge audit which will be reported on in next years’ Annual Report.

Liberty Protection Safeguards (LPS) Task and Finish Group

This group met periodically again throughout the year but has now been stood down as the Government have announced that

the Mental Capacity (Amendment) Act 2019 will not now be implemented in this current period of parliament, and as such the current Deprivation of Liberty Safeguard (DoLS) regime will prevail. There will be a review of DoLS procedures locally during 2023-24.  

Strategic Business Plan 2023-24

 

In line with the five priority areas there are a total of 22 Actions that are planned for 2023-24. This is the most ambitious work programme the Board has had since it became a statutory body in 2015.  

Full details can be read here:

LSAB Partnership Compact and Strategic Business Plan 2023-24

 

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

1. Age UK Lewisham and Southwark

2. Department for Work and Pensions – South London District

3. Healthwatch Lewisham

4. Lewisham & Greenwich NHS Trust

5. Lewisham Adult Social Care

6. Lewisham Children & Young People’s services

7. Lewisham Speaking Up

8. Lewisham Refugee and Migrant Network (LRMN)

9. Lewisham Safeguarding Children Partnership (LSCP)

10. Lewisham Housing Directorate

11. Lewisham Adult Integrated Commissioning

12. Lewisham Public Health

13. Lewisham Safer Communities

14. Lewisham Strategic Housing Services

15. London Ambulance Service NHS Trust

16. London Fire Brigade

17. Metropolitan Police Service, Lewisham (South East BCU)

18. National Probation Service, Lewisham and Bromley

19. NHS South East London Integrated Care Service and Board

20. South East London MIND

21. South London & Maudsley NHS Foundation Trust

22. 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.

• LSAB Main Board Meeting Minutes 19/10/2022
• LSAB Main Board Meeting Minutes 18/01/2023
• LSAB Main Board Meeting Minutes 20/07/2023
• LSAB Main Board Meeting Minutes 26/10/2023

Policy and Procedures

The introduction of the Care Act 2014 put adult safeguarding on a statutory footing for the first time, embracing the principle that the ‘person knows best’. It laid the foundation for change in the way that care and support is provided to adults, encouraging greater self-determination, so people maintain independence and have real choice.

There is an emphasis on working with adults at risk of abuse and neglect to have greater control in their lives to both prevent abuse and neglect from happening, and to give meaningful options for dealing with it should it occur.

For professionals who work in Care & Support settings the Care Act provides clearer guidance, and supports pathways to working in an integrated way, breaking down barriers between organisations.

The Association of Directors of Adult Social Services (ADASS), NHS London, the Metropolitan Police, and the London Clinical Commissioning Council have produced London Multi-Agency Adult Safeguarding Policy & Procedures Lewisham Safeguarding Adults Board follows these procedures.

LSAB Adult Safeguarding Single Agency Policy and Procedure Template

This good practice template can be used and modified by any agency. The template outlines the sections that need to be inserted by the agency to include their individual procedures, details and arrangements.

Download Single Agency Policy and Procedures Template (for use by any agency) January 2023

Self-Neglect and Hoarding Multi-Agency Policy, Practice Guidance and Toolkit from the LSAB

Read our Policy and Practice Guidance 2024 on self-neglect and hoarding.

Annex 2

Accompanying the Practice Guidance is the Self-Neglect High Risk Panel - Risk Assessment & Action Plan Template.

Lewisham Modern Slavery Partnership and Victim Care Pathway

Lewisham Modern Slavery Victim Care Pathway

Lewisham Modern Slavery Partnership Strategy (Oct 2022)

Modern Slavery and Human Trafficking 7 Minute Briefing 

Modern Slavery and Human Trafficking 7 Minute Briefing

LSAB Guidance for Reporting Medication Incidents as Adult Safeguarding Concerns Jan 2022

LSAB Guidance for Reporting Medication Incidents as Adult Safeguarding Concerns Jan 2022

Guidance for Falls Events as Adult Safeguarding Concerns

Guidance for Falls Events as Adult Safeguarding Concerns (Jan 2023)

Inter-Agency Escalation Policy

Inter-Agency Escalation Policy (July 2023)

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.

New! 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.

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

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.

New! LSAB Adult Safeguarding and Domestic Abuse 7 Minute Briefing

The LSAB Adult Safeguarding and Domestic Abuse 7 minute briefing includes information on 

• The Law
• Lewisham Overview
• Questions for you to consider 
• What you can do prevent a reoccurence

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’.

Useful Links

On this page we have listed links to organisations that we think you will find helpful

Age UK Lewisham & Southwark

Care Act Factsheets from GOV.UK

Care Quality Commission Safeguarding People

Carers Trust

Community Connections

Crimestoppers UK

Department of Health and Social Care

Disclosure and Barring Service

Gangmasters and Labour Abuse Authority

General Medical Council

Get Safe Online

Health & Care Professions Council

Hourglass - Safer Ageing

IAPT (Improving Access to Psychological Therapies) - NHS

Independent Age - Advice and support for older age

Iranian and Kurdish Women’s Rights Organisation

Jargon Buster

Lewisham Council - Adult Social Care

Lewisham Council Policing and Public Safety

Lewisham Wellbeing Map

Local Government Association (LGA) and the Association of Directors of Adult Social Services (ADASS) Safeguarding Network

Mayors Office for Policing and Crime

Metropolitan Police Lewisham

Ministry of Justice

Modern Slavery and Exploitation Helpline

Neighbourhood and Home Watch Network

NHS England

No Recourse to Public Funds Network

Office of the Public Guardian

Patient - Safeguarding Information

Rape Crisis South London

Refuge - Lewisham Athena Service

Revenge p*rn helpline

Skills for Care

Social Care Institute for Excellence - Safeguarding

Survivors UK - Male Rape & Sexual Abuse

Victims Choice

Victim Support

The LGA and the Association of Directors of Adult Social Services (ADASS) Safeguarding Network have worked with key partners to bring together a consolidated list of key safeguarding resources for council, care provider and wider partners' staff.

LSAB Learning Zone

All of our Safeguarding Adults Courses are available to Private, Voluntary and Independent organisations and commissioned care providers in Lewisham.

Subscribe to our E-Bulletin to be among the first to find out about the Adult Safeguarding Training we offer. 

Please note:

All the learning events that the Lewisham Safeguarding Adults Board provide are free of charge to the delegate. However, a lot of time, resource, and public expense is used in planning and delivering these activities, so if you register, please make a full commitment to attending. If you do not, you may prevent someone else from being able to participate.

Please cancel your booking if your circumstances change or contact us by email as soon as possible so that a replacement can be considered.

Repeat non-attenders may be barred from registering for our events in the future.

Safeguarding Adults Training+

Adult Safeguarding Workbooks+

e-Learning+

Guide to Common Safeguarding Words and Phrases+

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

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

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)

• LSAB 7 Minute Briefing – Mia

• Isle of Wight -Safeguarding Adults Board - Howard - SAR
• Bexley Safeguarding Adults Board - Ms AB - SAR
• Northampton Safeguarding Adults Board - SAR Jonathan

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

• Care Act 2014
• Homelessness Reduction Act 2017
• Data Protection Act 2018
• EU General Data Protection Regulation (GDPR)

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

A community directory to support health and wellbeing includes local organisations, voluntary and community groups and local businesses.

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

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

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

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: Raising community awareness of child exploitation - 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.

• First case of someone being prosecuted for Organ Harvesting in London: Organ harvesting: Trafficked for his kidney and now forced into hiding - BBC News
• Lewisham Modern Slavery Victim Care Pathway - this is full of resources and agencies that can help to support victims. Lewisham Safeguarding Adults Board - Lewisham Safeguarding Adults Board > Concerns Stage 1: Advice for Submitting an Adult Safeguarding (safeguardinglewisham.org.uk)
• There are specialist agencies such as Karma Nirvana working to prevent forced marriage.
• Human Trafficking Foundation report on Voice of British survivors

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

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 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)

• Workers Checklist
• Workers Rights
• Exploitation Poster- English
• Modern Slavery Government Advice - English

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 2^nd 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

• Session Form
• Clutter Image Rating
• Home Environment Index
• Homes Scale
• Hoarding Interview
• Saving Inventory
• Reasons for Saving
• Some Techniques
• Hoarding Reading List
• Consent for Services
• How to Talk to Someone with Hoarding

Criminal Exploitation of vulnerable adults: County Lines & Cuckooing

What is cuckooing?

Criminal gangs target the homes of vulnerable people to be used for drug dealing – a process known as “cuckooing” after the “Cuckoo” bird that invades other bird’s nests. Victims are often left with little choice but to co-operate.

Drug dealers will often approach the vulnerable person offering money or free drugs to use their home for dealing. In some instances after providing free drugs, the dealers will then force the person to sell drugs for them in order to ‘re-pay’ their drug debts.

These criminals are selective about who they target, a lot of the time victims are lonely, isolated, frequently drug users themselves and can already be known to the police.

“Cuckooing” means the drug dealers can operate from a property rather than the street, which is out of sight from the police making it a very attractive option. They can then use the premises to deal drugs from, which is difficult for the police to monitor.  

What to do if you suspect a property is being ‘cuckooed’?

Call Metropolitan Police Service on 101 or 999 in an emergency to report drug-related information.

If you don’t want to speak to the police directly, you can call Crimestoppers anonymously on 0800 555 111.

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’).

What to do if you are a professional who is concerned

Any practitioner working with a vulnerable person who they think may be at risk of county lines exploitation should follow their local safeguarding guidance and share this information with Lewisham Council’s social care services. If you believe a person is in immediate risk of harm, you should contact the police.

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 

Multi-agency guidance on tackling Cuckooing

Canterbury City and Kent County Council's and their partnership have produced multi-agency guidance on tackling Cuckooing which can be applied locally.

Tackling Cuckooing Multi-Agency Guidance.

For additional information on cuckooing, please see the 'Introduction to Cuckooing' presentation. 

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

Social Housing and Safeguarding

All social housing providers must have appropriate safeguarding arrangements in place for tenants who have care and support needs. The Care Act 2014 requires you to support and train your staff.

Visit the LSAB Learning Zone for information on free e-learning, courses available in Lewisham and other learning opportunities.

Self-Neglect and Hoarding Multi-Agency Policy, Practice Guidance and Toolkit from the LSAB

Read our Policy and Practice Guidance 2024 on self-neglect and hoarding.

Annex 2

Accompanying the Practice Guidance is the Self-Neglect High Risk Panel - Risk Assessment & Action Plan Template.

Housing Related Safeguarding Summit December 2023

The second annual Housing Related Safeguarding Summit was held 14 December 2023. The Summit was very well attended with representation from all Lewisham Social Housing Providers and local health and social care services. For those who were unable to make it on the day, a recording of the Summit is below. 

The presentations from the Summit are available for you to read and download.

• Imogen Blood Housing Summit Presentation
• Hoarding Support Group - Housing Summit Presentation
• Martin Corbett Preventing Future Fire Deaths - Housing Summit Presentation
• LSAB Housing Summit Presentation

New analysis: How your home affects your health. Moving to healthy homes

Housing Related Safeguarding Audit July 2022

The aim of this Audit was to examine cases where an adult was living in uninhabitable conditions that may have posed a risk to their health or wellbeing, and to ascertain what the adult safeguarding response was, or could have been, in these instances.

The key objective of the audit was to draw out learning to inform the development of best practice in Lewisham, between the council, housing providers and other relevant agencies. The auditor was also asked to identify and draw learning from any potentially discriminatory practice.

Read and download the full report below to find out more.

Housing Related Safeguarding Audit July 2022

Adult Safeguarding for Housing Staff

SCIE has produced an introductory video on Adult Safeguarding for housing staff.

A guide for staff on promoting sexuality, relationships and consent in housing with care services

Written by Dr Adi Cooper – City & Hackney Safeguarding Adults Board

This guide focuses on older people, sexuality, intimacy and relationships in housing with care. It looks at non-sexual and sexual relationships and individual sexual behaviour. This is not an easy subject and each case is unique, but this guide aims to steer you through how to respond and think about situations of this nature. Just because a person is old, it does not diminish their desire for companionship, intimacy and love and yet often this basic right may be denied, ignored or stigmatised. Older people in housing with care who wish to and are capable of expressing choice, should be supported to develop or maintain any relationship of their choosing. 

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.

Safeguarding Information for Carers

Spotting signs of abuse: Information for carers

It's not always easy to spot the symptoms of abuse. Someone being abused may make excuses for why they're bruised, they don't want to go out or talk to people, or they're short of money.

It's important to know the signs of abuse and, where they are identified, gently share your concerns with the person being abused. If you wait, hoping the person will tell you what's been happening to them, you could delay matters and allow the abuse to continue. 

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.

Physical abuse +

Domestic violence or abuse +

Sexual abuse +

Psychological or emotional abuse +

Financial or material abuse +

Modern slavery +

Discriminatory abuse +

Organisation or institutional abuse +

Neglect and acts of omission +

Self-neglect +

The Care Act defines a carer as someone who ‘provides or intends to provide care for another adult’ (but not as a volunteer or contracted worker).

There are three main considerations in relation to safeguarding, domestic abuse and carers.

Carers may cause harm, through abuse or neglect of the person they care for, they may be caused harm by the person they care for, or they may be important observers and reporters of harm by others. Some people with care and support needs are intentionally abusive to their carers. However, others may not have capacity to choose not to be abusive; their disability may cause abusive behaviour, as in some cases involving people with dementia, support to address domestic abuse should be offered if abuse is causing a carer’s physical or mental health to deteriorate, or preventing them from caring for another adult. The carer may feel unable to leave or seek help for themselves due to fear of leaving the person they care for with the perpetrator, or fear of being unable to care for them on their own. The Local Authority has a duty to assess a carers needs for support to maintain their well-being – including protection from abuse.

If you are a Carer and live in Lewisham and think that you need an assessment of your needs please contact the Adult Social Care Gateway

Tel: 020 8314 7777

Email: Gateway@lewisham.gov.uk

Opening hours:

Monday - Friday 9am - 5pm

Carers - Information and Support

Imago – Maximising Wellbeing of Unpaid Carers - Supporting Unpaid Carers to access the support they need.

Other Useful Links for Carers

• Age UK – Helping an older loved one or friend
• Alzheimer’s Society – Understanding and supporting someone with dementia
• Carers Trust – Help & Information
• Carers UK – Looking after someone - information and support for carers
• Citizens Advice – Carer help and support
• Dying Matters – Information for carers supporting someone approaching the end of their life
• Mind – How to cope when supporting someone else

Professionals using too much jargon?

If you're finding it difficult to navigate the mind field of jargon that can often be used by professionals in the care and support occupations Think Local Act Personal have a useful Jargon Buster that can help carers understand the language that is commonly used in care and support work.

Information for Professionals Supporting Carers

If you're a profesional supporting a Carer there's lots of helpful information on the ADASS Supporting Carers Hub.

Local Support for Young Carers and Young Adult Carers is offered by Carers Lewisham.

Read more in our Information for Professionals section.

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 

………………………………………………………………………………………………………………………………………………

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

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

Domestic Abuse

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

Domestic Abuse Act 2021 - Statutory Guidance July 2022

New! LSAB Adult Safeguarding and Domestic Abuse 7 Minute Briefing

Read the LSAB Adult Safeguarding and Domestic Abuse 7 minute briefing which includes information on 

• The Law

• Lewisham Overview

• Questions for you to consider 

• What you can do prevent a reoccurence

Domestic Abuse and Older People – Information from Safe Lives

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

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

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

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

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

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

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

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

Sexual Abuse

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

Psychological Abuse

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

Financial or Material Abuse

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

Modern Slavery

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

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

Lewisham Modern Slavery Victim Care Pathway

Discriminatory Abuse

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

For more information, please refer to:

Discriminatory Abuse Webinar

Discriminatory Abuse Self- Assessment (September 2023)

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

www.stophateuk.org

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

Metro Charity

Lewisham Speaking Up

Organisational Abuse

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

NICE Guidelines: Safeguarding in Care Homes

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

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

Neglect and Acts of Omission

– including ignoring medical, emotional or physical care needs, failure to provide access to appropriate health, care and support or educational services, the withholding of the necessities of life, such as medication, adequate nutrition and heating.

Pressure Ulcers: Safeguarding Adults Protocol

Stop the Pressure: NHS Improvement

Pressure Ulcer Panel Process - University Hospital Lewisham Dec 2020

Pressure Ulcer Panel Process - In the Community Sep 2022

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

Self-Neglect

– this covers a wide range of behaviour neglecting to care for one’s personal hygiene, health or surroundings and includes behaviour such as hoarding.

Self-Neglect and Hoarding Multi-Agency Policy, Practice Guidance and Toolkit from the LSAB

Read our Policy and Practice Guidance 2024 on self-neglect and hoarding.

Annex 2

Accompanying the Practice Guidance is the Self-Neglect High Risk Panel - Risk Assessment & Action Plan Template.

LSAB Self-Neglect and Hoarding Multi-Agency Policy, Practice Guidance and Hoarding Toolkit June 2024 

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

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

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

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

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

………………………………………………………………………………………………………………………………………............

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".

…………………………………………………………………………………………………………………………...............................

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 at the Concern stage: 

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

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

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

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

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

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

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

…………………………………………………………………………………………………………………………...............................

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 Eight Caldicott Principles (updated from seven in December 2020).
• Does the adult have the mental capacity to consent to the Safeguarding Concern being submitted now?
• Is there 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 if they continue to submit the concern. This may be particularly relevant in domestic abuse cases. The adult must be informed that a Safeguarding Concern has been submitted, unless it is unsafe or impractical to do so.
• A Safeguarding Concern can still be submitted without the adult’s consent if ‘vital’ or ‘public’ interest considerations apply (see 2.1 above). For more information read: LGA/ADASS Guidance on What Constitutes a Safeguarding Concern - Sept 2020

4. Gather as much information as possible

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

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

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

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

5. Submit the Adult Safeguarding Concern

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

How to Report Your Concerns About an Adult

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

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

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

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

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

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

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

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

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

Disclosure and Barring Service (DBS) Briefing

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

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

New! 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.

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

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.

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

Principals to Inform PiPOT - National Safeguarding Adults Network

ADASS - Top Tips for Dealing with Allegations for PiPOT

Concerns Stage 1: Guidance for Making Decisions on Adult Safeguarding Enquiries

1. Purpose of this guidance

This guidance has been developed to assist practitioners in assessing the context, seriousness and level of risk associated with an adult Safeguarding Concern, and in doing so, 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).

2. 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.

Advice for Submitting an Adult Safeguarding Concern.

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 Guidance on What Constitutes a Safeguarding Concern - Sept 2020

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

Other Safeguarding Enquiries can be used when all of the Section 42 (1) criteria have not been met (see section 2), but the Local Authority still considers it "necessary and proportionate" to conduct a safeguarding enquiry. This could be linked to promoting an individual’s well-being as outlined in Section 1 of the Care Act, or for carers who do not qualify under Section 42. More detail on this subject is provided here (Page 7): ADASS Advice Note   

…………………………………………………………………………………………………………………………...........................

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".

……………………………………………………………………………………………………………………….......................

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

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
1. The Abusive Act	Less Serious                                           More Serious			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.
2. Seriousness of Abuse	Less Serious                                           More Serious			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.
3. Pattern of Abuse	Isolated incident	Recent abuse in an ongoing relationship	Repeated abuse	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.
4. Impact of Abuse on Victims	No impact	Some impact but not long-lasting	Serious long-lasting impact	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.
5. Impact on Others	No one else affected	Others indirectly affected	Others directly affected	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?
6. Intent of Alleged Perpetrator(s)	Unintended/ill-informed	Opportunistic	Deliberate/targeted	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?
7. Illegality of Actions	Bad practice/Not illegal	Criminal act	Serious criminal act	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)
8. Risk of Repeated Abuse on the Victim	Unlikely to recur	Possible to recur	Likely to recur	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?
9. Risk of Repeated Abuse on Others	Others not at risk	Possibly at risk	Others at serious risk	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?

*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
	Less Serious	More Serious
Discriminatory Abuse	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.	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.
Domestic Abuse	Isolated incident of abusive nature. Occasional taunts or verbal outbursts	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.	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.	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).
Modern Slavery	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	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.
Neglect & Acts Of Omission	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.	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. Pressure Ulcers: Safeguarding Adults Protocol Stop the Pressure: NHS Improvement Pressure Ulcer Panel Process - University Hospital Lewisham Dec 2020 Pressure Ulcer Panel Process - In the Community Sept 2022 LSAB Guidance for Reporting Medication Incidents as Adult Safeguarding Concerns Jan 2022 Guidance for Reporting Falls Events as Adult Safeguarding Concerns Jan 2023
Organisational Abuse	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.	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 Jan 2023 Disclosure and Barring Service (DBS) Briefing Also see this briefing from the Somerset Safeguarding Adults Board: Mendip House Practice Briefing
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.	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	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 Jan 2023
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.	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.	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.
Self-Neglect	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.	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. Self-Neglect and Hoarding Multi-Agency Policy, Practice Guidance and Toolkit from the LSAB Read our Policy and Practice Guidance 2024 on self-neglect and hoarding. Annex 2 Accompanying the Practice Guidance is the Self-Neglect High Risk Panel - Risk Assessment & Action Plan Template. Guidance for Reporting Falls Events as Adult Safeguarding Concerns Jan 2023 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.	Isolated incident of teasing or low-level unwanted sexualised attention (verbal) directed at one adult by another whether or not capacity exists.	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).