Topic outline

  • 1. Definition

    The safeguarding duties apply to an adult who:

    • Has needs for care and support (whether or not the local authority is meeting any of those needs);
    • Is experiencing, or at risk of, abuse or neglect;
    • 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 (The Care & Support Act 2014, and the Care & Support Statutory Guidance 2016).

    • 2. Categories and Indicators of Abuse

      There follows a number of nationally recognised categories or types of abuse as defined in the Care Act (2014). It is important to note, however, that many situations may involve a combination of such categories.

      It must also be remembered that some instances of abuse will constitute a criminal offence, e.g. physical or sexual assault, rape, theft, and fraud. When allegations of abuse suggest that a criminal offence may have been committed it is imperative that the Police should be contacted as a matter of urgency. Criminal investigation by the Police will take priority over all other lines of enquiry but does not take away the need for the safeguarding process to be continued see also Police Involvement in the Safeguarding Process Procedure.

      After each category definition is a range of indicators which, if present separately or in clusters, may suggest the possibility of some type of abuse. None of them are conclusive that abuse has taken place but should alert to the possibility of abuse. The lists are not exhaustive but are provided to stimulate thought and awareness as to the possible indicators of abuse.

      In all cases consideration should be given to the context of the person's behaviour and what is the norm for that individual's pattern of behaviour or medical history.

      Exploitation, in particular, is a common theme in the following list of the types of abuse and neglect.

      • 2.1 Physical Abuse

        Physical Abuse - Including assault, hitting, slapping, pushing, misuse of medication, restraint or inappropriate physical sanctions.

        • 2.2 Domestic Violence and Abuse

          In 2013, the Home Office announced changes to the definition of domestic abuse.

          Domestic Abuse is:

          “Any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 or over who are, or have been, intimate partners or family members regardless of gender or sexuality. This can encompass, but is not limited to, the following types of abuse:

          • Physical;
          • Sexual;
          • Psychological;
          • Financial;
          • Emotional.

          Controlling behaviour is: a range of acts designed to make a person subordinate and/or dependent by isolating them from sources of support, exploiting their resources and capacities for personal gain, depriving them of the means needed for independence, resistance and escape and regulating their everyday behaviour.

          Coercive behaviour is: an act or a pattern of acts of assault, threats, humiliation and intimidation or other abuse that is used to harm, punish, or frighten their victim.” (Home Office March 2013)

          The Government definition, which is not a legal definition, includes so called 'honour’ based violence, female genital mutilation (FGM) and forced marriage, and is clear that victims are not confined to one gender or ethnic group.

          It has been widely understood for some time that coercive control is a core part of domestic violence.  As a result, the inclusion of this in the latest definition highlights the importance of recognising coercive control as a complex pattern of overlapping and repeated abuse perpetrated within a context of power and control.

          Without the inclusion of coercive control in the definition of domestic violence and abuse, there may be occasions where domestic violence and abuse could be regarded as an isolated incident.  As a result, it may be unclear to victims what counts as domestic violence and abuse – for example, it may be thought to include physical violence only.  We know that the first incident reported to the police or other agencies is rarely the first incident to occur; often people have been subject to violence and abuse on multiple occasions before they seek help.

          See also: Domestic Violence and Safeguarding Adults, including Forced Marriage Procedure, Multi-Agency Risk Assessment Conference (MARAC).

          MARAC forms:

          “Honour based violence is a crime or incident, which has or may have been committed to protect or defend the honour of the family and/or community.” (Crown Prosecution Service/Association of Chief Police Officers). It is a collection of practices, which are used to control behaviour within families or other social groups to protect perceived cultural and religious beliefs and/or honour. Such violence can occur when perpetrators perceive that a relative has shamed the family and/or community by breaking their honour code.

          The Anti-Social Behaviour, Crime & Policing Act 2014 makes it a criminal offence to force someone to marry.  A forced marriage is where one or both people do not (or in cases of people with learning disabilities, cannot) consent to the marriage and pressure or abuse is used.  It is recognised in the UK as a form of violence against women and men, domestic/child abuse and a serious abuse of human rights.  A forced marriage differs from an arranged marriage, in which both parties consent to the assistance of their parents or a third party in identifying a spouse.  Forced marriage can be a particular risk for people with learning difficulties and people lacking capacity.

          See also: Sunderland Safeguarding Children Board, Female Genital Mutilation Procedure.

          The Right to Choose: Multi-agency statutory guidance for dealing with forced marriage.

          • 2.3 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.

            • 2.4 Sexual Exploitation

              Including rape, prostitution, sexual photography, subjection to pornography or witnessing sexual acts and sexual assault or sexual acts to which the adult has not consented or was pressured into consenting.

              • 2.5 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.

                • 2.6 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.

                  • 2.7 Modern Day Slavery

                    Modern Day 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.  

                    Click here to access Sunderland's Modern Day Slavery Guidance 

                    See also Local Authority Adult National Referral Mechanism Pathway 

                    See also the Police Transformation Unit Modern Day Slavery Poster, a useful 1 page guide for staff and public.

                    See also the Modern Day Slavery support organisations:

                    Unseen: www.unseenuk.org

                    Hope for Justice: www.hopeforjustice.org


                    Further information is also available on the Government's website: Modern Day Slavery.


                    • 2.8 Discriminatory Abuse

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

                      • 2.9 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. (See Equalities Act 2010).

                        • 2.10 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.

                          • 2.11 Self-Neglect

                            This covers a wide range of behaviour neglecting to care for one’s personal hygiene, health or surroundings and includes behaviour such as hoarding.  See also Sunderland's Self Neglect Guidance document, which has been refreshed and reissued for 2019 and includes in the appendix an at a glance 'Self-Neglect on a page' guide, as a quick reference for staff who are dealing with a suspected or confirmed self-neglect case.

                            The Self Neglect on a Page guide is also available as a separate document.

                            There is also a Self Neglect 7-Minute Briefing 1-page summary document 

                             

                            • 2.12 Multiple Abuse

                              The following signs are not attributed to a specific category but could nevertheless indicate the possibility of abuse from one or multiple categories previously stated.

                              • Difficulty getting access to the individual;
                              • Difficulty in interviewing the person alone;
                              • Isolation of the individual;
                              • Agency hopping;
                              • Repeated visits by the person to a General Practitioner or Accident & Emergency Department for no obvious medical reason or where there is no change in medical condition;
                              • Reluctance to seek General Practitioner help;
                              • Refusal of support by a known or previously trusted carer;
                              • One or more agencies reveal concerns.

                              • 2.13 Female Genital Mutilation

                                The FGM Mandatory Reporting Duty guidance can be found at the Government's website: Mandatory Reporting of Female Genital Mutilation - Procedural Information

                                Female Genital Mutilation (FGM) involves all procedures that include the partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons and is a criminal offence.  FGM is an unacceptable practice for which there is no justification.  The practice is medically unnecessary, extremely painful and has serious health consequences, both at the time when the mutilation is carried out and in later life.

                                The age at which girls undergo FGM varies enormously according to the community. The procedure may be carried out when the girl is newborn, during childhood or adolescence, just before marriage or during the first pregnancy. FGM constitutes a form of child abuse and violence against women and girls, and has severe short-term and long-term term physical and psychological consequences. In England, Wales and Northern Ireland, the practice is illegal under the Female Genital Mutilation Act 2003.

                                FGM is illegal in England and Wales under the FGM Act 2003 (“the 2003 Act”). It is a form of child abuse and violence against women. FGM comprises all procedures involving partial or total removal of the external female genitalia for non-medical reasons.  

                                Section 5B of the 2003 Act introduces a mandatory reporting duty which requires regulated health and social care professionals and teachers in England and Wales to report ‘known’ cases of FGM in under 18s which they identify in the course of their professional work to the police. The duty applies from 31 October 2015 onwards.  

                                ‘Known’ cases are those where either a girl informs the person that an act of FGM – however described – has been carried out on her, or where the person observes physical signs on a girl appearing to show that an act of FGM has been carried out and the person has no reason to believe that the act was, or was part of, a surgical operation within section 1(2)(a) or (b) of the FGM Act 2003.  

                                The duty applies to all regulated professionals (as defined in section 5B(2)(a), (11) and (12) of the 2003 Act) working within health or social care, and teachers. It therefore covers: 

                                • Health and social care professionals regulated by a body which is overseen by the Professional Standards Authority for Health and Social Care (with the exception of the Pharmaceutical Society of Northern Ireland). This includes those regulated by the: 

                                • General Chiropractic Council 

                                • General Dental Council 

                                • General Medical Council 

                                • General Optical Council 

                                • General Osteopathic Council 

                                • General Pharmaceutical Council 

                                • Health and Care Professions Council (whose role includes the regulation of social workers in England)

                                • Nursing and Midwifery Council  

                                • Teachers - this includes qualified teachers or persons who are employed or engaged to carry out teaching work in schools and other institutions, and, in Wales, education practitioners regulated by the Education Workforce Council;  

                                • Social care workers in Wales. 

                                Please also see Sunderland's Female Genital Mutilation Procedure and the information on the North & South of Tyne Safeguarding Children Partnership Procedures here 

                                • 2.14 Hate Crime

                                  Hate crime is defined as any crime that is perceived by the victim, or any other person, to be racist, homophobic, transphobic 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.  Hate crime (and anti-social behaviour) can be reported by the public using the Sunderland City Council on-line form: www.sunderland.gov.uk/report-asb 

                                  Professionals can also use this form if they are concerned that an adult at risk of abuse or neglect whom they are supporting/delivering services to is a victim of hate crime, but are strongly recommended to also raise a formal safeguarding adults concern with the Safeguarding Adults Team, using the Safeguarding Adult Concern (SAC) form.


                                  • 2.15 Mate Crime

                                    Mate crime happens when someone is faking a friendship in order to take advantage of a vulnerable person. Mate crime is committed by someone known to the person. They might have known them for a long time or met recently. A ‘mate’ may be a ‘friend’, family member, supporter, paid staff or another person with a disability.  See also http://www.whorya.co.uk, a website with information & resources about mate crime, developed by South Tyneside Council and University of Sunderland.

                                    • 2.16 Extremism, Radicalisation and Prevent

                                      The Prevent duty statutory guidance can be found at: Prevent Duty Guidance (2015)

                                      See also the Home Office Prevent Training Catalogue and Virtual College's Home Office approved Prevention of Extremism & Radicalisation Training

                                      ‘Extremism’ is defined in the 2011 Prevent strategy as vocal or active opposition to fundamental British values, including democracy, the rule of law, individual liberty and mutual respect and tolerance of different faiths and beliefs. We also include in our definition of extremism calls for the death of members of our armed forces, whether in this country or overseas.

                                      ‘Radicalisation’ is the process where someone has their vulnerabilities or susceptibilities exploited towards crime or terrorism – most often by a third party, who have their own agenda. Being drawn into terrorism includes not just violent extremism but also non-violent extremism, which can create an atmosphere conducive to terrorism and can popularise views which terrorists exploit.  

                                      ‘Prevent’ is part of the UK’s counter terrorism strategy, preventing people from becoming involved in terrorism or supporting terrorism. It is a safeguarding issue”

                                      The current UK definition of ‘terrorism’ is given in the Terrorism Act 2000 (TACT 2000). In summary this defines terrorism as an action that endangers or causes serious violence to a person/people; causes serious damage to property; or seriously interferes or disrupts an electronic system. The use or threat must be designed to influence the government or to intimidate the public and is made for the purpose of advancing a political, religious or ideological cause”.

                                      Where you have a Prevent concern that an adult is at risk of being radicalised, follow the multi-agency safeguarding concern policies and procedures

                                      • If you are an employee or volunteer, go to www.sunderland.gov.uk/safeguarding and click on 'How to report a safeguarding concern' which provides a link to download the Safeguarding Adult Concern (SAC) form and the secure email address to send this to (this is the preferred way of making a referral). Alternatively, you can report a concern by Tel: 0191 520 5552 (anytime) - this is the Local Authority Contact Centre number. You should make it clear that you are raising a safeguarding concern under the Prevent agenda (radicalisation/extremism). By coming in via the front door at the Council’s customer service network the concern will be assessed by trained social care professionals who will make an assessment around the safeguarding thresholds and will share that information with the Prevent leads in social care services who will agree next steps with relevant partners (e.g. special branch);
                                      • If you are a member of the public, go to www.sunderland.gov.uk/safeguarding and click on the 'Report a safeguarding concern - members of the public' link on that page.  If you are worried about someone:
                                        • In an emergency, please call: 999;
                                        • If there is no immediate risk, call the police on: 101.

                                      If you are a member of the public and you are worried about your own safety or worried about the safety of someone else, please report a safeguarding concern.  Alternatively, you can report a concern by Tel: 0191 520 5552 (anytime) or email HealthandWellbeing@sunderland.gov.uk for more information.

                                      See also the Prevent Process Referral Flowchart

                                      • 2.17 Abuse by another Adult at Risk

                                        There may be times when an Adult at Risk may experience abuse from another person who can be identified as an Adult at Risk in these circumstances whilst it may be important to be sensitive to the circumstances of the situation and other factors such as Mental Capacity. As in all Safeguarding cases the principles of Making Safeguarding Personal should be applied to ensure the desired outcome of the adult experiencing abuse has been sought. It is essential to consider that those experiencing abuse in these situations can expect the same response as any person at risk of abuse. Whilst steps may have been taken to safeguard both individuals it is essential that a safeguarding referral is also submitted. It is also important to note that the needs of the person at risk who is the alleged subject of abuse should be addressed separately from the needs of the person alleged to be causing them harm.

                                        • 2.18 Carers and Safeguarding

                                          Circumstances in which a carer (for example, a family member or friend) could be involved in a situation that may require a safeguarding response include:

                                          • A carer may witness or speak up about abuse or neglect;
                                          • A carer may experience intentional or unintentional harm from the adult they are trying to support or from professionals and organisations they are in contact with; or
                                          • A carer may unintentionally or intentionally harm or neglect the adult they support on their own or with others.

                                          Assessment of both the carer and the adult they care for must include consideration of both their wellbeing. Section 1 of the Care Act (2014) includes protection from abuse and neglect as part of the definition of wellbeing. As such, a needs or carer’s assessment is an important opportunity to explore the individuals’ circumstances and consider whether it would be possible to provide information, or support that prevents abuse or neglect from occurring, for example, by providing training to the carer about the condition that the adult they care for has or to support them to care more safely.

                                          Where a carer speaks up about abuse or neglect, it is essential that they are listened to and that where appropriate a safeguarding enquiry is undertaken and other agencies are involved as appropriate.

                                          If a carer experiences intentional or unintentional harm from the adult they are supporting, or if a carer unintentionally or intentionally harms or neglects the adult they support, consideration should be given to:

                                          • Whether, as part of the assessment and support planning process for the carer and/or, the adult they care for, support can be provided that removes or mitigates the risk of abuse. For example, the provision of training or information or other support that minimises the stress experienced by the carer. In some circumstances the carer may need to have independent representation or advocacy; in others, a carer may benefit from having such support if they are under great stress or similar; and
                                          • Whether other agencies should be involved; in some circumstances where a criminal offence is suspected this will include alerting the police, or in others the primary healthcare services may need to be involved in monitoring.

                                          Other key considerations in relation to carers should include:

                                          • Involving carers in safeguarding enquiries relating to the adult they care for, as appropriate;
                                          • Whether or not joint assessment is appropriate in each individual circumstance;
                                          • The risk factors that may increase the likelihood of abuse or neglect occurring; and
                                          • Whether a change in circumstance changes the risk of abuse or neglect occurring.

                                          • 2.19 Abuse of Trust - PiPoT (People/Person in a Position of Trust)

                                            A relationship of trust is one in which one person is in a position of power or influence over the other person because of their work or the nature of their activity. There is a particular concern when abuse is caused by the actions or omissions of someone who is in a position of power or authority and who uses their position to the detriment of the health and well-being of a person at risk, who in many cases could be dependent on their care. There is always a power imbalance in a relationship of trust.  This can also be known as reporting alleged abuse by PiPoT (People/Person in a Position of Trust), and should be reported to the Safeguarding Adults Team.

                                            Always consider other adults and children who may be at risk. For further information regarding Safeguarding Children please refer to: www.safeguardingchildrensunderland.com