Topic outline

  • 1. The Concern

    A concern is a suspicion, allegation or disclosure that an adult as defined in the Care Act 2014 is experiencing or is at risk of abuse or neglect.

    It must always be taken seriously even if the person raising the concern remains anonymous.

    The first priority should always be to ensure the safety and well-being of the adult in question and, when the adult has capacity to make their own decisions, to aim for any action to be in line with their wishes as far as appropriate. The safeguarding process should be experienced as empowering and supportive – not as controlling and disempowering. Practitioners must always seek the consent of the individual before taking action or sharing personal information. However, consent is not required where the best interests of the individual or others at risk demand action - in circumstances where there is a risk to others, reasonable suspicion of a crime, in the public interest, being coerced or controlled, person has mental health issues affecting their choices; there may also be circumstances where consent cannot be obtained because the adult lacks capacity to give it.

    It is important to remember that a Concern can be made without an incident of abuse taking place, or alleged to have taken place. If there are concerns that someone is at risk, then a concern should be raised. By raising a concern, risks can be addressed and managed; the likelihood of abuse or neglect may be reduced or prevented from occurring. (See Preventative Strategies in Safeguarding Adults: Practice Guidance).

    • 2. The Alerter

      An Alerter is the person who raises a concern about abuse or neglect or uncovers abuse or neglect. Anyone can be an Alerter. Abuse may be identified in a wide range of contexts and therefore concerns can be expressed by a variety of different people. For example:

      • Paid staff and volunteers within the Local Authority;
      • Paid staff and volunteers within health services/agencies/Hospital settings;
      • Paid staff/volunteers within partnership agencies;
      • Police;
      • Volunteers and paid staff within voluntary services/agencies;
      • Care staff (paid and volunteers), nursing staff, agency staff and managers within independent care homes and domiciliary care agencies;
      • Paid staff and volunteers within educational services;
      • Students on placement within services where adults may be vulnerable and at risk of abuse or neglect;
      • Probation staff;
      • Staff from housing services including sheltered housing schemes and supported living schemes;
      • Carers, friends, family/relatives, neighbours, members of the public/community;
      • Service Users, patients or other adults at risk;
      • Members of the public.

      The above is not an exhaustive list.

      An Alerter may find out about abuse or neglect in a number of ways. They could:

      • Be told about abuse by the adult at risk;
      • Be told by someone else who knows or works with the adult at risk;
      • They might observe signs and symptoms that would indicate the person is being abused or neglected;
      • They may witness the abuse themselves;
      • They may hear something that concerns them;
      • They may be told by another worker that something is wrong.

      The above is not an exhaustive list.

      It may be that there are repeated instances or patterns of abuse and that we need to look beyond single instances as patterns can indicate more serious problems or care concerns.

      An Alerter may not be reporting that abuse or neglect has occurred (unless personally witnessed). They are passing over information that someone has told them or providing information on what they suspect to be abuse or neglect. As such, an Alerter does not have to have evidence or provide any 'proof'. An Alerter acting in good faith should not be criticised or disciplined in any way should the outcome be that there is no cause for concern. They will be deemed to have acted in their Duty of Care or moral responsibility.

      Where an Alerter is a member of staff within an agency, a Responsible Person/Safeguarding Lead in that agency should ensure the original Alerter is notified as to whether the concern they raised resulted in a Safeguarding Adults Concern to the Local Authority and whether that concern determined that an enquiry should be made, or whether there was any other course of action.

      Where an Alerter is concerned that the person they have alerted to have not taken action or that a person has not been safeguarded, they should share those concerns with the Local Authority.

      An Alerter plays an important role in the safeguarding process. Alerters may be the person involved in supporting the Adult at Risk throughout all stages or be asked to undertake specific tasks particularly if they are a member of staff or volunteer in a partner agency.

      Any Alerter providing support who is not a member of staff in a partner or voluntary agency can seek advice from the Safeguarding Adults Team.

      Alerters should take note of the following at all stages:

      • Be continually aware of signs and symptoms (see Definitions, Categories and Indicators of Abuse Procedure);
      • Abuse and neglect does occur, so take the suspicion, allegation or disclosure seriously;
      • Remain calm;
      • The Duty of Care or moral responsibility dictates the need to act. Do not try to 'ignore' or 'forget' any concerns. If someone else comes forward with the same concerns and it becomes clear that you didn't, disciplinary action could result;
      • Do not delay. If in any doubt, don't wait, bring the concerns forward and act, even on instinct, that something is 'wrong' or 'doesn't seem right';
      • Consider the immediate risk or danger to the alleged perpetrator or others;
      • Consider the need for medical treatment;
      • Consider the need to inform the Police;
      • Take the appropriate steps to preserve any evidence;
      • Create opportunities for the safe sharing of information. If someone is wanting to talk about something, try to provide a private space for the disclosure to take place;
      • Do not interrogate or cross-examine the alleged victim;
      • Do not talk in the presence of an alleged or suspected perpetrator. Do not contact the perpetrator;
      • Do not put yourself at risk.

      • 3. Guidance When Someone is about to Disclose

        If you become aware that someone is about to make a Safeguarding disclosure (about a person who is at risk), you should inform the person that depending on what is disclosed, the information may need to be passed on. Whilst this may stop the person from disclosing it is important to be clear and transparent about what your responsibilities are to allow the adult to make an informed decision about whether they want to disclose. If they then choose not to disclose and you are a member of staff in a partner or voluntary agency you need to inform your line manager and maintain a written record.

        You need to reassure the adult that if they subsequently need to speak to you or anyone else about anything they can do so.

        If someone discloses that they have needs for care and support and are experiencing or at risk of abuse and neglect; and as a result of those care and support needs are unable to protect themselves from either risk of, or the experience of abuse or neglect in line with S.42 of the Care Act, you should ask the person what their preferred outcome is so that this is clear from the point of disclosure.

        An Alerter should:

        • Remain calm and try not to show shock or disbelief;
        • Listen carefully to what is being said and demonstrate that they are actively listening by maintaining eye contact (if possible) and making affirmative gestures such as nodding the head;
        • Reassure the person that they are doing the right thing in disclosing;
        • Confirm that the information disclosed will be treated seriously;
        • Give the person information about the next steps that will be taken.

        If someone discloses that they have experienced or are experiencing abuse or neglect the Alerter should not:

        • Press the person for details. Alerters are not investigators; they are simply listening to what the person has to tell them. If there is a need to clarify something that has been said, open-ended questions should be asked, such as "What did you mean by that?”. Care should be taken that words are not put into the person's mouth by asking leading questions such as "When you said that did you mean....?";
        • Stop someone who is freely recalling significant events, as they may not speak about it again;
        • Promise to keep secrets. Even if the person asks the Alerter not to tell anyone, it must be explained, in a way that the person can understand, that they have a Duty of Care to pass on the information. It may help to explain that the information is only being passed to those who 'need to know' and that this is being done because of the concerns about them or about others who may be at risk;
        • Give unrealistic expectations or guarantees regarding confidentiality or safety by saying, for example, "Don't worry this will never happen to you again";
        • Be judgemental;
        • Tell anybody that doesn't need to know;
        • Contact the alleged perpetrator or anyone who might be in touch with him or her.

        • 4. Guidance When Abuse and Neglect is Uncovered

          As guidance the following is useful for anyone when abuse or neglect has been uncovered but particularly important for anyone who is a member of staff or volunteer within a partner agency where abuse or neglect is uncovered.

          You should:

          1. Assess whether anyone is at risk or is in immediate danger and take any reasonable steps within their role to protect any person who may be at immediate risk or harm, for example:
            • Call the Police without delay if a crime is taking place or is believed to have just taken place;
            • Call an ambulance or GP if someone needs urgent medical attention;
            • Separate the alleged victim and alleged perpetrator, only if it is safe to do so;
            • Any other immediate action to ensure people are safe;
            • Consider the need for referral to the Sexual Assault Referral Centre (SARC) where there are concerns involving Rape or Sexual Assault (the Police will usually arrange this if they are undertaking an investigation). In all other cases professionals can make a direct referral to the SARC;
            • Where concerns relate to an unexplained injury/ non-accidental injury which do not include allegations of rape or sexual assault the need for an appropriate medical examination should be made via either the persons GP, or Accident and Emergency services (if this is the place that the person has presented at).
          2. Take reasonable steps to preserve any evidence, if at a potential crime scene (see Police Involvement in the Safeguarding Process);
          3. Report concerns, verbally, to their line manager or to the person identified in their own Individual Agency Guidance as soon as is practicably possible and where this is appropriate;
          4. Make a written account of what has happened, or of what has been noticed or said, as soon as possible; remembering to record facts and not to make assumptions where this is appropriate;
          5. Avoiding contamination of evidence by taking Care to ensure that forensic and other evidence is not contaminated. You can avoid contaminating evidence by:
            • Disturbing a 'scene' as little as possible, sealing off areas if possible;
            • Where appropriate and possible remove victim's clothing and bag each item separately;
            • Discouraging washing/bathing/eating/drinking/smoking and use of the toilet in cases of sexual assault;
            • Not cleaning or allowing further use by others of a toilet used by the victim since the alleged incident in cases of sexual assault;
            • Not handling items which may hold DNA evidence;
            • Putting any bedding, clothing which has been removed, or any significant items given to you (weapons etc) in a safe dry place in bags, e.g. bin liners if practical;

          You should not:

          • Approach, confront or interview the alleged perpetrator unless this is within their role and it is necessary to do so to ensure the safety or well-being of others. If necessary, the Alerter should try to obtain advice (preferably from the Police) before doing so (see Police Involvement in the Safeguarding Process Procedure);
          • Interview the victim or potential witnesses beyond the initial 'seeking of information' to establish basic facts. This is the responsibility of the police or the person/agencies making the enquiry;
          • Alert the alleged perpetrator.

          You can contribute to obtaining evidence by making a note of your observations in relation to the condition and attitude of the people involved and any actions you have taken. However, you are not investigating.

          • 5. Guidance on Producing Written Accounts

            As guidance the following is useful for anyone when abuse or neglect has been uncovered but particularly important for anyone who is a member of staff or volunteer within a partner agency where abuse or neglect is uncovered.

            For those who have a responsibility to produce and submit a written account the following is useful guidance:

            • Write it as soon as possible to ensure that detailed information, events or facts are not forgotten;
            • Only include factual information including dates/times. Do not include your own personal views or feelings or make any personal judgements or assumptions. If it is felt necessary to include this ensure that this is clearly indicated in the account and state the reason(s) why;
            • If recounting a disclosure, try to write down exactly what the person said, using their words;
            • Be aware that any written account may be required later as part of a legal action or disciplinary procedure;
            • Include any views of the adult concerned and what they want or expect to happen. It is essential that the adult is fully involved and it should be clear in written records when there is likely to be or has been any deviation from this. Any reason for this should be clearly communicated to the adult and a written record detailing this should be kept;
            • Write down the setting and whether anyone else was present;
            • If writing by hand, ensure that the handwriting is legible (although it is advisable to encourage electronic means to record events);
            • Sign the account, date and time it;
            • Give the written account to the person to whom the concerns need to be reported (do not ask anyone else to do this).

            Written accounts about concerns and disclosures of abuse are strictly confidential.

            Such information should only be entered into a record book or file (electronic or otherwise) which is inaccessible to the alleged perpetrator or to those who do not need or have right to the information. It is the responsibility of the person receiving the written account to file it appropriately and in line with Data Protection, taking into account individual agency confidentiality and filing procedures.

            • 6. Professional Accountability and Action

              What needs to be done when abuse or neglect is uncovered will depend upon the situation including:

              • Who uncovers the abuse or neglect or suspects abuse or neglect;
              • The type of abuse and neglect;
              • The views of the person concerned;
              • The views of any carer/advocate;
              • Whether other people are at risk;
              • Whether a crime is being or has been committed.

              There is a responsibility or 'Duty of Care' which is shared by all staff and volunteers, at all levels, across all sectors, to take appropriate action where there is a suspicion, concern or allegation of abuse or neglect. They have an individual responsibility to make known their concerns in order that full consideration can be given as to whether or not further action is needed. Most workers, for example care workers, nurses, doctors and social workers are also expected to do so under their professional Code of Conduct and under relevant legislation or guidance (see Legal Framework Procedure). A failure to do this is a failure in a person's Duty of Care and could be perceived as negligent practice, which may lead, in some cases, to disciplinary or other action.

              Where a member of staff or volunteer in a partner agency identifies abuse or neglect the safeguarding and whistle blowing policies and procedures should be followed to ensure an appropriate person is notified and that any need to immediately safeguard an adult at risk can be taken. Partner agencies should have in place their own Individual Agency Guidance, linked to this overall Safeguarding Adults Procedural Framework. This Guidance should clearly indicate roles and responsibilities and should make clear the reporting procedures for that agency. Each member of staff should ensure that they have access to these internal guidelines so that they are aware of their responsibilities. All members of staff or volunteers should ensure that they have read their own Individual Agency Guidance so it is clear to whom they report.

              Agencies should also ensure that all Alerters and/or carers are supported, in whatever way, appropriate to the situation. Concerns must be taken seriously and any immediate or ongoing support provided, as appropriate.

              If the person alerting their concerns feels that the person to whom they have reported their concerns does not take them seriously or has not acted appropriately, they should report their concerns to a more senior manager or to the Safeguarding Adults Lead in their own agency.

              If it is believed that the manager/s may be implicated in the abuse, or the worker does not feel able to discuss it with him/her they should refer to their agency guidance on 'whistle-blowing' or 'speaking out' and contact the Safeguarding Adults Team if urgent for advice.

              • 7. Action Where a Crime has been Committed or Suspected

                Where a crime is being or has been committed the police should be notified. Where the adult concerned does not want the police to be notified or a safeguarding concern to be made, any responsibilities in respect of duty of care or moral responsibility should be clearly explained when it is appropriate to do so. Whether or not a criminal act is committed does not depend on the consent of the victim, where there is a wider public interest or concern that others may be at risk a Police prosecution could still be taken forward. Criminal investigation by the Police takes priority over all other enquiries but not over the adult’s well-being. Close cooperation and coordination among the relevant agencies is critical to ensure safety and well-being is promoted during any criminal investigation process. Where a crime is suspected and reported the police will then be under a duty to investigate. This may be in circumstances when the individual does not want this.

                • 8. Action by the Public

                  Everyone has a role to play in identifying and responding to abuse and neglect.

                  Members of the public have a moral responsibility to bring concerns to the attention of someone who is in a position to help and not ignore abuse and neglect. There may be the feeling that telling someone may actually make things worse for the person concerned but it is important that things are not simply ignored in the hope that they get better.

                  Members of the Public can alert and refer their concerns by:

                  • Contacting Emergency Services - 999 - if they feel the person is in immediate danger;
                  • Contacting Northumbria Police Main Switchboard if the concerns are of a possible criminal nature;
                  • Contacting the Local Authority’s People Directorate, if they are aware that the person they have concerns about is receiving support through Adult Services;
                  • Contacting the appropriate health service (see Useful Contacts), if they are aware that the person they have concerns about is receiving support through health services;
                  • Contacting the Safeguarding Adults Team for advice via the Local Authority’s People Directorate.

                  • 9. Anonymous Alerts or Safeguarding Concerns

                    All Alerts will be taken seriously, even if the Alerter remains anonymous.

                    All requests for anonymity by the Alerter will be fully respected. It cannot, however, be guaranteed, especially if the Alerter's information becomes an essential element in any subsequent legal proceedings. In addition, The Data Protection Act 1998 removes the blanket confidentiality of third party information (see Legal Framework Procedure).

                    If someone does decide to remain anonymous, they must consider that, by doing so, they may impede or delay the safeguarding process. If they do not give sufficient details or information, it may be difficult to proceed and in some instances to safeguard. The person must also understand that they will not be given any feedback or outcomes in relation to their concern and may not know if their concerns have been looked into appropriately. Also it would not be possible to provide the person with any support, if required.

                    • 10. False or Malicious Allegations

                      Whilst all allegations are taken seriously on occasions an allegation may be identified as false or malicious. On these occasions appropriate action will be taken. This will include for example notification to police, employer or relevant person or disciplinary action. In some instances this may include providing guidance or support to a person.

                      • 11. Whistleblowing

                        See also Whistleblowing Procedure.

                        Whistleblowing is a process that enables employed staff or volunteers to raise serious concerns in the workplace and to have these concerns properly addressed.

                        There may be allegations or concerns of abuse which implicate a member or members of staff. A member of staff may have concerns about the conduct or behaviour of a colleague. Despite working closely together or even socialising outside of work, the Duty of Care necessitates the matter being raised, in accordance with the Safeguarding Adults Procedures.

                        Front-line staff are often the first to see or suspect misconduct, but are often worried about raising concerns. They may worry that they are being disloyal to their colleagues or are worried about the consequences of coming forward. It is recognised that whistleblowing is often seen in a negative light and that this negativity has been perpetuated for many years. Consequently, it is difficult for staff to see the positives, but this needs to be encouraged. A good starting point is to ensure open, honest and effective communication amongst staff teams and within services. Where this is the case, staff should begin to feel more confident and positive about coming forward with ideas, thoughts, suggestions and concerns. All managers must ensure that they listen to their staff and support them in this.

                        Each agency should have in place their own Whistleblowing Policy, which should outline the process for support in such instances. All workers need to be aware of any whistleblowing policies within their own agency. The Policy should be effective in supporting staff to come forward with their concerns, and relay confidence that they will be supported throughout the process.

                        The quality function of the Integrated Commissioning Team (Local Authority) can provide guidance and support to agencies to assist in developing and implementing effective whistleblowing policies.

                        • 12. Role of the Responsible Person/Safeguarding Lead

                          Concerns identified by a paid employee or volunteer should be reported to the appropriate person identified within each agency - usually the Alerters line manager. The person who receives the information from the Alerter is called the Responsible Person (however, in some organisations the Responsible Person and the Safeguarding Lead can be the same person). 

                          It is important, therefore, that each agency clearly identifies who (which role/job title) is the Responsible Person and Safeguarding Lead within their agency. This should be written into Individual Agency Guidance.

                          It is the role of the Responsible Person/Safeguarding Lead to receive and review the information provided and apply the safeguarding thresholds to determine the level of harm. The Responsible Person/Safeguarding Lead should also review action taken by the Alerter, including any immediate safeguarding measures and whether any additional measures need to be taken to lower any risk level. Based on that information, the Responsible Person/Safeguarding Lead completes the SAC Form to notify the Safeguarding Adults Team.  If appropriate and in accordance with Individual Agency Guidance the Responsible Person may need to consult with the Safeguarding Adults Lead in their own agency.

                          • 13. Considerations for the Responsible Person/Safeguarding Lead

                            In order to confirm which course of action needs to be taken, the Responsible Person/Safeguarding Lead must firstly confirm:

                            • Did the abuse or neglect happen in Sunderland?

                            If the above applies then it is appropriate to use Sunderland safeguarding procedures and Safeguarding Adults Concern Form after applying the Safeguarding Adults Threshold Risk Assessment Guidance.

                            If a concern relates to abuse or neglect that has happened in another Local Authority area; this authority's procedures will apply.

                            • 14. Concerns Originating Within Own Agency

                              If the information received from an Alerter relates to concerns about abuse or the risk of abuse occurring within their own agency, then it is the responsibility of that agency to respond to the concerns and apply the Safeguarding Adults - Threshold Risk Assessment Guidance to support decision making as to the level of harm, in relation to that concern. This should be included on the SAC Form which is subsequently completed. If the Alerter has not already sought the views of the adult in question, the Responsible Person/Safeguarding Lead should at the earliest opportunity seek to ascertain the views of the individual concerned, including their views in respect of raising any concerns for service or support. It is not the role of the Responsible Person/Safeguarding Lead to investigate, interview or interrogate at this stage.

                              The Responsible Person/Safeguarding Lead should:

                              • Ensure that all relevant immediate actions have been taken to make that person safe (has medical treatment been sought, have the Police been contacted etc.) – see Managing the Duty to Make Enquiries and consider actions within their role that can safeguard anyone who may continue to be at risk, for example:
                                • Suspension of a member of staff;
                                • Change of service provision for a service user who is an alleged perpetrator ensuring involvement of relevant professionals/advocates/carers;
                                • Contact the Single Point of Contact within the Police for advice or information, if needed (see Police Involvement in the Safeguarding Process Procedure);
                                • Involvement of a social worker/ relevant health professional.
                              • Ensure the person who may have been abused or is at risk of abuse is immediately given the appropriate assistance in accordance with their wishes and preferences to ensure his or her safety or support;
                              • Ensure clear communication with the adult/advocate to determine what action or outcomes they want.

                              The Responsible Person may need to consult with their Organisation's Safeguarding Lead. The correct procedure and expectations will be set out in the organisation’s Individual Agency Guidance document.

                              Please note: Neither the Alerter or the Responsible Person/Safeguarding Lead should contact an alleged perpetrator until agreements are made that this is the required enquiry or this is essential to safeguard the adult or others at risk. If it is necessary to suspend a member of staff, ensure that any explanation does not jeopardise any subsequent investigation.

                              Other considerations include the following:

                              • If a crime has been suspected or known to have taken place, the Police must be informed;
                              • If a child is at risk, children's services (Together For Children) should be contacted - Children's Safeguarding Tel: 0191 5205560, see also the Sunderland Safeguarding Children Partnership website 'Reporting Concerns' webpage for more information and referral forms;
                              • What the adult and/or carer wants to happen, what they consent to and whether they have capacity or need an assessment of capacity;
                              • Ensure that appropriate support is provided to the Alerter, including support to complete a Written Account, if necessary;
                              • Ensure a completed Written Account is stored/filed appropriately;
                              • Ensure that all staff who support the service user, and others affected by the incident, have guidance and access to support;
                              • Remind staff of the importance of confidentiality (not to discuss details with other staff or service users, or to discuss outside of the workplace);
                              • Any relevant organisational procedures have been actioned, for example:
                                • Complaints Procedure;
                                • Serious Incident Report;
                                • Disciplinary Procedures.
                              • Reports or notices are made to the relevant regulatory or commissioning body, for example:
                              • Secure all written material which may be used as evidence, for example, written reports, diary records, service user files or staff files;
                              • Completing the Safeguarding Adults Concern (SAC) Form - see Section 16 Safeguarding Adults Concern Form;
                              • Consent to a raising a concern - see Section 17 Consent to a Concern.

                              • 15. Decision to Refer to the Local Authority

                                Once the above has been considered and all relevant information gathered the Responsible Person/Safeguarding Lead must make a decision as to whether it is appropriate to refer to the Safeguarding Adults Team in the local authority. The Responsible Person/Safeguarding Lead needs to complete the SAC Form which is available on the Sunderland Council Safeguarding Adults webpage 'Report a Safeguarding Concern - Professionals & Volunteers' and also on the Sunderland Safeguarding Adults Executive Board website. This is where the form should always be accessed from to ensure the most up to date version is always the one used.

                                When the Responsible Person or the Safeguarding Adults Lead in an individual agency raises a concern, the Safeguarding Adults Concern (SAC) Form should clearly be related 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 Responsible Person should in the first instance seek support and advice in completing a SAC Form and what to include in it from their line manager or the Safeguarding Adults Lead within their own agency. If advice is still required this can be sought by contacting the Local Authority to discuss the situation.

                                The decision to refer should usually be made within the same working day as the concern has been initially determined. However, it is recognised that, in some cases, information vital to the decision to refer may not be immediately available and that in seeking to make sure that we are meeting the principles of Making Safeguarding Personal by involving the adult/carer/advocate, this may take longer.

                                It is important to understand the circumstances of abuse and neglect, including the wider context such as whether others may be at risk of abuse, whether there is any emerging pattern of abuse, whether others have witnessed abuse and the role of family members and paid staff or professionals. The circumstances surrounding any actual or suspected case of abuse or neglect will inform the response.

                                • 16. Safeguarding Adults Concern Form

                                  A Safeguarding Adults Concern (SAC) Form (see Sunderland Council's Safeguarding Adults webpage 'Report a Safeguarding Concern - Professionals & Volunteers') must be completed when it is determined by a Responsible Person or the Safeguarding Adults Lead in a partner agency that it is appropriate to do so (see Managing the Duty to Make Enquiries). The adult must satisfy the below criteria to be referred to the local authority.

                                  The adult:

                                  • 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.

                                  All sections of the SAC Form need to be completed where professionals and partners are referrers. It is important to have as much information as possible. The form should be completed by an agency representative, professional or someone suitably experienced to apply the Safeguarding Adults Threshold Risk Assessment Guidance to identify the level of harm; this should be clearly stated on the form. The Local Authority will use the form to determine whether they need to make enquiries or seek enquiries to be made. In light of the responsibility to adhere to the principles of Making Safeguarding Personal, the process should be transparent with the Adult at Risk consulted about what outcomes they want or expect. There will be a facility on the form to place this information.

                                  The Responsible Person/Safeguarding Lead must ensure that any immediate action taken, including safeguarding measures, in response to the concern being raised and any monitoring and review arrangements which have been arranged or agreed are specified.

                                  The form should be sent securely to the Safeguarding Adults Team, by following the guide at the bottom of the SAC Form.

                                  • 17. Consent to a Concern

                                    See also Mental Capacity Act 2005 and Deprivation of Liberty Safeguards Procedure.

                                    Practitioners should wherever practicable seek the consent of the adult before taking action. However, there may be circumstances when consent cannot be obtained. This could be because it is not safe to do so or because the adult lacks capacity to give consent but it is in their best interests to raise a SAC and/or make an enquiry. Whether or not the adult has capacity to give consent, action may need to be taken if:

                                    • There is risk to the individual that is high (life or limb);
                                    • Others are or will be put at risk if nothing is done; or
                                    • Where it is in the public interest to take action because a criminal offence has occurred.

                                    Sometimes a person who is experiencing abuse or neglect decides they do not want help or support to stop the abuse or neglect. If they have the mental capacity to make such a decision and no one else is at risk, professionals may not have a remit to intervene. The Duty of Care, however, takes away the option to do nothing. It is important to:

                                    • Make reasonable endeavours to see the person in a safe and confidential environment;
                                    • Ensure, where possible, that the person has the opportunity to speak without the alleged perpetrator present;
                                    • Ascertain, where possible, the person is not being pressured, threatened or manipulated by the alleged perpetrator into saying that they do not want any action taken;
                                    • Ensure the person has the full information required to be able to decide what action to pursue. The use of accessible information, interpreters, personal assistance or advocates must be considered, as appropriate;
                                    • Take reasonable steps to ensure the person understands the level of risk involved and the possible consequences of not taking any action.

                                    If all of the above is taken into consideration and the person for whom there are concerns still decides they do not want help or support to stop the abuse or neglect, a SAC Form must still be completed, with this clearly indicated. Information on any actions taken to provide support or monitor the situation should be provided. Should the person change their mind, circumstances change or the risk increases, another referral with updated information should be completed and submitted to the Local Authority.

                                    The SAC Form can be found on the Sunderland Council Safeguarding Adults webpage 'Report a Safeguarding Concern - Professionals & Volunteers'.