This page is used with kind permission by Wessex LMCs
Safeguarding vulnerable adults is a complex area of practice. The potential client group is wide ranging from adults who are incapable of looking after any aspect of their lives to people experiencing a short period of illness/disability.
This short guidance aims to provide some support for decision making in relation to referrals to Adult Social Services about incidents of possible abuse.
Definitions used within the Department of Health are as follows:
A vulnerable adult is a person aged 18 or over, who is or may be in need of community care services by reason of mental or other disability, age or illness; and who is or may be unable to take care of him or herself, or unable to protect him or herself against significant harm or exploitation.
Adult Abuse. . .
Abuse is defined as… a violation of an individual’s human and civil rights by any other person or persons. (DH, 2000)
Abuse may be:
• a single act or repeated acts
• an act of neglect or a failure to act
• multiple acts, for example, an adult at risk may be neglected and also being financially abused.
Abuse is about the misuse of power and control that one person has over another.
Intent is not an issue at the point of deciding whether an act or a failure to act is abuse; it is the impact of the act on the person and the harm or risk of harm to that individual. In many cases it may be a criminal offence.
Abuse can take place in settings such as the person’s own home, day or residential centres, supported housing, educational establishments, or in nursing homes, clinics or hospitals.
The seriousness or extent of abuse is often not clear when anxiety is first expressed. It is important, therefore, when considering the appropriateness of intervention, to approach reports of incidents or allegations with an open mind.
Harm. . .
In determining what justifies intervention and what sort of intervention is required, The Law Commission defines harm as including but not limited to:
(1) ill treatment (including sexual abuse, exploitation and forms of ill treatment which are not physical);
(2) the impairment of health (physical or mental) or development (physical, intellectual, emotional, social or behavioural);
(3) self-harm and neglect; or
(4) unlawful conduct which adversely affects property, rights or interests (for example, financial abuse).
The importance of this definition is that in deciding what action to take, consideration must be given not only to the immediate impact on and risk to the person, but also to the risk of future, longer-term harm.
Seriousness of harm or the extent of the abuse is not always clear at the point of the alert or referral. All reports of suspicions or concerns should be approached with an open mind and could give rise to action under the Safeguarding Adults policy and procedures.
Types of Abuse. . .
Abuse can be something that is done, or omitted from being done, to a person. It can be:
- physical e.g. hitting, slapping, pushing, kicking, misuse of medication, restraint or inappropriate sanctions
- sexual e.g. rape and sexual assault, or sexual acts to which the vulnerable adult did not, or could not consent or had to consent to under pressure
- psychological e.g. emotional abuse, threats of harm or abandonment, deprivation of contact, humiliation, blaming, controlling, intimidation, coercion, harassment, verbal abuse, isolation or withdrawal from services or supportive networks
- financial or material e.g. theft, fraud, exploitation, pressure in connection with wills, property, inheritance or financial transactions, or the misuse or misappropriation of property, possessions or benefits
- neglect and acts of omission e.g. ignoring medical or physical care needs, failing to provide access to appropriate health, social care or educational services, withholding the necessities of life [such as medication, adequate nutrition and heating]
- discriminatory e.g. racism, sexism or acts based on a person’s disability, age or sexual orientation. It also includes other forms of harassment, slurs or similar treatment such as disability hate crime.
- hate crime, defined as any crime that is perceived by the victim, or any other person, to be racist, homophobic, trans-phobic or due to a person’s religion, belief, gender identity or disability. It should be noted that this definition is based on the perception of the victim or anyone else and is not reliant on evidence.
- institutional abuse occurs when the routines, systems and regimes of an institution result in poor or inadequate standards of care and poor practice which affects the whole setting and denies, restricts or curtails the dignity, privacy, choice, independence or fulfilment of adults at risk.
It should always be considered as to whether children are in any way involved with the situation of abuse, particularly where parents have substance misuse, mental health or learning disability issues. Under these circumstances, an referral should always be made to the local Children’s Social Services Department.
When to refer?
Step 1: Identify adults who may be vulnerable
Many of the warning signs are similar to the risk factors for safeguarding in children. e.g. impaired capacity, learning disability, drugs and alcohol, chaotic lifestyle.
Step 2: Has harm or abuse occured?
- If harm or abuse has occurred, or where an individual is at risk, a referral should be made to Adult Social Services.
- Always consider whether there are any doubts about an adult’s decision-making capacity as a mental capacity act assessment may be necessary in order to support actions that may be required.
- In addition, consider whether there are any children at risk and make appropriate referrals.
- Make an adult safeguarding referral dependent on geographical location.
- If a GP wishes to discuss an issue where there is a concern, prior to making a formal referral, you can contact the Hampshire County Council Safeguarding Helpline on 01962 847214 (office hours) to talk to an Adult Safeguarding Co-ordinator. There may be a short delay in returning your call so please leave name and contact number.
- Please note information may need to be shared without consent where individuals are judged at risk of significant harm.
Step 3 : Next steps
- within 24 hours of referral: the Adult Social Services Team Manager will decide if the case should be dealt with under adult safeguarding procedures
- within 7 days: Adult Services will convene multi agency strategy planning meeting (GP to provide a clear report of concerns if unable to attend meeting)
Concise Practice Policy for Vulnerable Adults. This is practical and can be adapted and personalised for any surgery. The contact numbers may need changing depending on your practice location.
Safeguarding Adults Policy - Any Surgery
Practice Policy for Adult Safeguarding. Again this is practical if a little more detailed than the one above. The contact numbers may need changing depending on your practice location. We are most grateful to the SHIP safeguarding team.
Dorset Safeguarding GP referral - this has the proforma for making a referral and some useful contacts for Bournemouth & Poole and the rest of Dorset both in and out of hours.
BMA Adult Safeguarding Toolkit, July 2011. What is safeguarding? Which adults may be vulnerable? What constitutes abuse and neglect? When should concerns about patient safety be reported?