Safeguarding adults

The Care Act 2014 put Safeguarding Adults on a statutory footing. s42 Enquiry by local authority

(1)This section applies where a local authority has reasonable cause to suspect that an adult in its area (whether or not ordinarily resident there)
(a)has needs for care and support (whether or not the authority is meeting any of those needs),
(b)is experiencing, or is at risk of, abuse or neglect, and
(c)as a result of those needs is unable to protect himself or herself against the abuse or neglect or the risk of it.

(2)The local authority must make (or cause to be made) whatever enquiries it thinks necessary to enable it to decide whether any action should be taken in the adult’s case (whether under this Part or otherwise) and, if so, what and by whom.

What does ‘needs for care and support’ mean?

If the adult has any physical or mental impairment or illness and as a result of this or related to this a need arises in two or more of the following domains and it would have significant impact on their wellbeing, then they have needs for care and support:

• Managing and maintaining nutrition;
• Maintaining personal hygiene;
• Managing toilet needs;
• Being appropriately clothed;
• Being able to make use of the adult’s home safely;
• Maintaining a habitable home environment;
• Developing and maintaining family or other personal relationships;
• Accessing and engaging in work, training, education or volunteering;
• Making use of necessary facilities or services in the local community including public transport, and recreational facilities or services; and
• Carrying out any caring responsibilities the adult has for a child.

It is a Care Act 2014 needs assessment that determine whether a person has care and support needs, however, if we reasonably believe that the person has care and support needs and we are concerned that they are being abused or neglected then we should consider making a referral to the Local Authority for consideration of s42 enquiry.

When we are dealing with a concern around any type of abuse and neglect it is essential that we consider whether the person has care and support needs, as this will inform our responsibilities and actions we need to take.

• Assault, hitting, slapping, punching, kicking, hair-pulling, biting, pushing
• Rough handling
• Scalding and burning
• Physical punishments
• Inappropriate or unlawful use of restraint
• Making someone purposefully uncomfortable (e.g. opening a window and removing blankets)
• Involuntary isolation or confinement
• Misuse of medication (e.g. over-sedation)
• Forcible feeding or withholding food
• Unauthorised restraint, restricting movement (e.g. tying someone to a chair)

Please note that it may be physical abuse, i.e. a person hits someone else but if these two people are ‘personally connected’ as set out in s2 Domestic Abuse Act 2021 i.e. family members, partners, married couple, ex partners etc then this constitute Domestic Abuse and should be reported as such.

In April 2021, the Domestic Abuse Act 2021 came into force. S1 of the Act sets out what Domestic Abuse is:

• Physical or sexual abuse;
• Violent or threatening behaviour;
• Controlling or coercive behaviour;
• Economic abuse;
• Psychological, emotional or other abuse

Please note that it is Domestic Abuse when the two people are personally connected (s2 Domestic Abuse Act 2021). People are personally connected when:

• They are, or have been, married to each other;
• They are, or have been, civil partners of each other;
• They have agreed to marry one another (whether or not the agreement has been terminated);
• They have entered into a civil partnership agreement (whether or not the agreement has been terminated);
• They are, or have been, in an intimate personal relationship with each other;
• They each have, or there has been a time when they each have had, a parental relationship in relation to the same child
• They are relatives

Furthermore, it is important that we use the term Abuse, as many will not see themselves as subjected to Violence as it may be emotional, control and coercion or financial.

In addition to the above categories; Honour Based Violence is also a form of Domestic Abuse which Adults At Risk can be subjected to, please navigate to HBV page

• Rape, attempted rape or sexual assault
• Inappropriate touch anywhere
• Non- consensual masturbation of either or both persons
• Non- consensual sexual penetration or attempted penetration of the vagina, anus or mouth
• Any sexual activity that the person lacks the capacity to consent to
• Inappropriate looking, sexual teasing or innuendo or sexual harassment
• Sexual photography or forced use of pornography or witnessing of sexual acts
• Indecent exposure

Please note that if the perpetrator of sexual abuse and the victim are ‘personally connected’ as set out in s2 Domestic Abuse Act 2021 i.e. family members, partners, married couple, ex partners etc then this constitute Domestic Abuse and should be reported as such.

• Enforced social isolation – preventing someone accessing services, educational and social opportunities and seeing friends
• Removing mobility or communication aids or intentionally leaving someone unattended when they need assistance
• Preventing someone from meeting their religious and cultural needs
• Preventing the expression of choice and opinion
• Failure to respect privacy
• Preventing stimulation, meaningful occupation or activities
• Intimidation, coercion, harassment, use of threats, humiliation, bullying, swearing or verbal abuse
• Addressing a person in a patronising or infantilising way
• Threats of harm or abandonment
• Cyber bullying

• Theft of money or possessions
• Fraud, scamming
• Preventing a person from accessing their own money, benefits or assets
• Employees taking a loan from a person using the service
• Undue pressure, duress, threat or undue influence put on the person in connection with loans, wills, property, inheritance or financial transactions
• Arranging less care than is needed to save money to maximise inheritance
• Denying assistance to manage/monitor financial affairs
• Denying assistance to access benefits
• Misuse of personal allowance in a care home
• Misuse of benefits or direct payments  in a family home
• Someone moving into a person’s home and living rent free without agreement or under duress
• False representation, using another person's bank account, cards or documents
• Exploitation of a person’s money or assets, e.g. unauthorised use of a car
• Misuse of a power of attorney, deputy, appointeeship or other legal authority
• Rogue trading – e.g. unnecessary or overpriced property repairs and failure to carry out agreed repairs or poor workmanship

• Human trafficking
• Forced labour
• Domestic servitude
• Sexual exploitation, such as escort work, prostitution and pornography
• Debt bondage – being forced to work to pay off debts that realistically they never will be able to

• Unequal treatment based on age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion and belief, sex or sexual orientation (known as ‘protected characteristics’ under the Equality Act 2010)
• Verbal abuse, derogatory remarks or inappropriate use of language related to a protected characteristic
• Denying access to communication aids, not allowing access to an interpreter, signer or lip-reader
• Harassment or deliberate exclusion on the grounds of a protected characteristic
• Denying basic rights to healthcare, education, employment and criminal justice relating to a protected characteristic
• Substandard service provision relating to a protected characteristic

• Discouraging visits or the involvement of relatives or friends
• Run-down or overcrowded establishment
• Authoritarian management or rigid regimes
• Lack of leadership and supervision
• Insufficient staff or high turnover resulting in poor quality care
• Abusive and disrespectful attitudes towards people using the service
• Inappropriate use of restraints
• Lack of respect for dignity and privacy
• Failure to manage residents with abusive behaviour
• Not providing adequate food and drink, or assistance with eating
• Not offering choice or promoting independence
• Misuse of medication
• Failure to provide care with dentures, spectacles or hearing aids
• Not taking account of individuals’ cultural, religious or ethnic needs
• Failure to respond to abuse appropriately
• Interference with personal correspondence or communication
• Failure to respond to complaints

• Failure to provide or allow access to food, shelter, clothing, heating, stimulation and activity, personal or medical care
• Providing care in a way that the person dislikes
• Failure to administer medication as prescribed
• Refusal of access to visitors
• Not taking account of individuals’ cultural, religious or ethnic needs
• Not taking account of educational, social and recreational needs
• Ignoring or isolating the person
• Preventing the person from making their own decisions
• Preventing access to glasses, hearing aids, dentures, etc.
• Failure to ensure privacy and dignity

• Lack of self-care to an extent that it threatens personal health and safety
• Neglecting to care for one’s personal hygiene, health or surroundings
• Inability to avoid self-harm
• Failure to seek help or access services to meet health and social care needs
• Inability or unwillingness to manage one’s personal affairs

Chapter 14 Care and Support Statutory Guidance set out that Workers across a wide range of organisations need to be vigilant about adult safeguarding concerns in all walks of life including, amongst others in health and social care, welfare, policing, banking, fire and rescue services and trading standards; leisure services, faith groups, and housing. GPs, in particular, are often well-placed to notice changes in an adult that may indicate they are being abused or neglected. Findings from serious case reviews have sometimes stated that if professionals or other staff had acted upon their concerns or sought more information, then death or serious harm might have been prevented.

Safeguarding is everyone’s responsibility, and it is important that you know the different abuse types and understand what your responsibility is to respond to safeguarding concerns. Please ensure that you have read the SD17 Policy, and that your mandatory training is completed.  

If you are concerned for an adult and you want to talk this through with someone, please contact Trust Wide Safeguarding Duty Hub for case consultation, advice, and support.

Some service users/patients will not have Care & Support Needs as set out in Care Act 2014, this does not mean that we do not need to do anything about the abuse or neglect they are at risk of or subjected to. Actions to take could include reporting a crime to the Police, report to Local Authority Quality/Commissioning Team, Domestic Abuse Risk Assessment, Referral to MARAC, referral to IDVA or sexual abuse services to name a few.

• View the safeguarding adults flow chart.

The Safeguarding Adults Service consist of three Safeguarding Adults Teams

Mental Health Care Division Knowsley, St Helens, Halton and Warrington
Hanna Roslund, Named Professional Safeguarding Adults
Sophie Smith, Specialist Lead

Mental Health Care Division Liverpool and Sefton
Carla Whittaker, Named Nurse Safeguarding Adults
Nick Woods, Specialist Lead
Alex Hayden, Specialist Lead

Community Care Division
Leigh Tindsley, Adult Safeguarding Lead
Margy Green, Safeguarding Adults Specialist Nurse
Hannah Molyneux, Safeguarding Adults Specialist Nurse
Jenny Tennant, Safeguarding Adults Specialist Nurse
Angela Tyrer, Safeguarding Adults Specialist Nurse