essay on safeguarding adults

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• v.43(1); 2019 Feb

Adult safeguarding under the Care Act 2014

Katherine johnson.

1 Hertfordshire Partnership University NHS Foundation Trust

Billy Boland

Safeguarding adults is everybody's business, and it is now standard practice for clinicians to undertake safeguarding training as part of their mandatory training in the UK. Nevertheless, safeguarding work is complex and can involve significant dilemmas for professionals. The Care Act 2014 has introduced a number of differences in the way safeguarding is approached, emphasising the overall well-being and choice of the patient rather than merely focusing on their safety. This paper sets out to illustrate evolving safeguarding demand and practice, and aid clinicians in protecting people at risk by describing how they can approach challenging presentations.

Declaration of interest

Safeguarding adults in England and Wales is set out in the Care Act 2014. 1 The new law came in to being in April 2015 and superseded earlier documents that sought to protect vulnerable adults, 2 or ‘adults at risk of harm’, 3 from abuse. The Care Act itself brought together a wide range of social care concerns and activities, including personalisation, social care assessment and Mental Health Act 117 aftercare, as well as safeguarding, in a single statute. 4 This aimed to create ‘ a legal framework so key organizations and individuals with responsibilities for adult safeguarding can agree on how they must work together and what roles they must play to keep adults at risk safe’ . 5

In Scotland, the Support and Protection Act 2007 ‘seeks to protect and benefit adults at risk of being harmed’. The Act ‘requires councils and a range of public bodies to work together to support and protect adults who are unable to safeguard themselves, their property and their rights'. 6 In Northern Ireland, Adult Safeguarding Prevention and Protection in Partnership was published in July 2015. 7 It makes it clear that ‘safeguarding is everyone's business and that as good citizens we should all strive to prevent harm to adults from abuse, exploitation or neglect’.

Definitions

The term ‘vulnerable adult’ was a term used in No Secrets to describe those adults who may need to be subject to safeguarding. 2 However, in 2011, the Law commission recommended that this concept should no longer be used, as the label of vulnerability was not appropriate and could be ‘stigmatising, dated, negative and disempowering’. 3 The Care Act uses the term ‘adult at risk’ and also, at times, ‘adult with care and support needs’.

Most doctors will be used to definitions of abuse from statutory training in child protection and adult safeguarding, which is now a mandatory training requirement. Full details of forms of abuse under the Care Act are included in the Care Act statutory guidance. 8 It should be noted that services now have responsibilities to ensure that carers are also considered within the safeguarding context. Care Act statutory guidance note 14.45 recognises the circumstances in which a carer could be involved in a situation that may require a safeguarding response and provide information on how to manage these.

A ‘concern’ is used technically in the Act as the point at which the statutory authority is notified by someone that an adult at risk of harm is suspected to be the subject of abuse.

‘Enquiries’ are the investigations that the statutory authority makes in order to determine whether abuse has taken place, and whether the individual would benefit from safeguarding.

Safeguarding activity

Statistics gathered in the first 6 months following the implementation of the Care Act suggest that the number of adult safeguarding cases doubled during this period. 9 During the year following implementation of the Act, the Local Government Association undertook a series of six Care Act stocktakes to help them to understand the implications of the Act for local authorities. These stocktakes suggested that the rise in safeguarding referrals has continued, with 73% of councils involved in stocktake 6 reporting an increase in the levels of activity, and 34% stating that they had increased greatly. 10 By contrast, figures gathered by NHS Digital in their Safeguarding Adults: Annual Report for 2015–2016 11 indicate that 102 970 Section 42 enquiries were reported for the period 2015–2016, compared with 103 445 referrals during the period 2014–2015. It is difficult to directly compare statistics across these two reports in light of changes in terms of reference used within the safeguarding proceedings and therefore the reports. However, it should be noted that a total of 184 860 safeguarding concerns and 8365 ‘other enquiries’ were reported for the 2015–2016 period, suggesting that the rate of overall referral was greater than the recorded number of enquiries given above. When these are considered alongside the ‘referral’ rates from the previous year, it appears that the level of safeguarding concerns being raised has indeed increased. Statistics for 2016–2017 support this trend, showing 109 145 individuals under a safeguarding enquiry starting during the period measured, an increase of 6% from the previous year. 12

Guiding principles

As with all aspects of the Care Act, the concept of well-being underpins safeguarding practice, with ‘protection from abuse and neglect’ cited as one of the key elements of promoting individual well-being. 8 Within this, the Care Act guidance also outlines six fundamental principles for safeguarding ( Box 1 ).

Six Principles of Safeguarding 8

Empowerment

People being supported and encouraged to make their own decisions and informed consent

It is better to take action before harm occurs

Proportionality

The least intrusive response appropriate to the risk presented

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 safeguarding practice

In line with these principles, the Care Act focuses on early identification and prevention of potential abuse and neglect, rather than specifying thresholds for intervention. Any actions proposed should take into account the needs, goals and wishes of the patient, ensuring that their consent is gained before any action is taken. To support this aim, Making Safeguarding Personal (MSP), a sector-led safeguarding initiative, has also been introduced to help develop a more outcome-focused response. 13

The MSP ‘temperature check’ in 2016 14 recorded a number of positive outcomes in places where MSP was being implemented. Patients reported feeling more in control, with professional meetings declining but smaller patient meetings becoming more common. Overall, the results suggested that while MSP takes no longer than traditional approaches to implement, there is evidence to suggest that it leads to better outcomes and savings in time and resources.

Responsibilities

‘Effective safeguarding cannot be achieved without a large number of organizations and individuals working closely together, and there being an explicit recognition that safeguarding is everyone ' s concern.’ 15

The local authority is required under Section 42 of the Care Act to take a leading role in coordinating safeguarding enquiries, and may do this either through making enquiries themselves or by ensuring that others do so. Guidance for carrying out Section 42 enquiries is set out in paragraphs 14.63–14.67 of the Care Act Statutory Guidance. 8 Section 43 of the Care Act also requires local authorities to establish a Safeguarding Adults Board for its area, with the objective of helping and protecting adults that meet safeguarding eligibility criteria, through coordinating and ensuring the effectiveness of each of its members. A useful diagram showing the simplified responsibilities of key parties can be found in the Safeguarding Adults paper produced by the Care Quality Commission (CQC), the Association of Directors of Adult Social Services, NHS England, the Local Government Association and the Association of Chief Police Officers. 16

Alongside local authorities and other partner agencies, individual clinicians should seek to work with individuals at an early stage to promote well-being and independence, with the aim of preventing abuse and neglect from occurring. 15 Further to this, the focus should be upon identifying abuse or neglect early and raising a safeguarding concern. Care Act guidance states: ‘ No professional should assume that someone else will pass on information which they think may be critical to the safety and wellbeing of the adult. If a professional has concerns about the adult ' s welfare and believes they are suffering or likely to suffer abuse or neglect, then they should share the information with the local authority and, or, the police if they believe or suspect that a crime has been committed ’. 8 The safeguarding process can be time consuming, and it is important that clinicians continue to offer appropriate care and treatment to the patient. Where appropriate, clinicians should also attend safeguarding meetings in order to provide a more cohesive and robust plan of support.

Although not all concerns will be escalated to become Section 42 enquiries, this will be decided by the relevant safeguarding team, who will have overall responsibility for the decision on whether an enquiry is required. The team will consider the criteria as outlined in S.42(1) Care Act ( Box 2 ). They will also consider issues such as mental capacity 17 and consent, which will be explored in more detail in the case examples below.

Care Act Safeguarding eligibility criteria 1

• (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):
• (2) has needs for care and support (whether or not the authority is meeting any of those needs);
• (3) is experiencing, or is at risk of, abuse or neglect; and
• (4) as a result of those needs is unable to protect himself or herself against the abuse or neglect or the risk of it.

Where clinicians have concerns that important factors are not being acknowledged, these can be raised with the enquiry officer and through initial strategy discussions and case conferences, which will be held during the safeguarding enquiry process. All individuals involved in the process will be included in determining whether allegations of abuse are substantiated and in developing an appropriate plan with the patient. Whereas under previous guidance, the emphasis was often on taking professionally proscribed measures to ensure patient safety, statutory Care Act guidance states that ‘professionals and staff should not be advocating “safety” measures that do not take account of individual well-being, as defined in Section 1 of the Care Act’. 8 As in the assessment of social care needs, practitioners should approach safeguarding concerns in an inclusive, outcomes-focused, person-centred manner, and the emphasis should be on ‘sensible risk appraisal, not risk avoidance’. 18 It should be made clear to the individual that they will be included at all stages of the enquiry and that factors such as their wishes, preferences, history and lifestyle will be taken into account throughout the process. Outcomes should be primarily patient determined. While there may be occasions when views of those involved in the process differ, decisions are made in a multidisciplinary manner with the patient's wishes at the forefront, with overall responsibility for reaching consensus falling to the safeguarding manager.

Safeguarding dilemmas

The case studies below highlight some of the factors and considerations which may be pertinent to safeguarding processes.

Case Example 1: Cheryl – Consent, Coercion and Domestic Violence

Cheryl is a 30-year-old woman with a diagnosis of severe anxiety and depression. She is living with her partner, Julian, and two children, both of whom are under a Child Protection Plan. There have been a number of concerns raised over recent months about Julian, who will often present as verbally aggressive towards professionals. Julian will also ensure that he is present at all of Cheryl's appointments. Cheryl comes to her out-patient appointment with a black eye which Julian states is due to walking into a door frame. Her psychiatrist manages to speak to Cheryl alone and Cheryl tells her that in fact Julian has hit her the evening before. Cheryl asks her psychiatrist not to tell anyone and says that she does not want police involved or for any action to be taken. Cheryl's psychiatrist feels that Cheryl has capacity to make this decision, but is concerned about the risks to Cheryl and her children. Cheryl's psychiatrist raises a Safeguarding Adults concern and also contacts Children's services to ensure they are aware of the incident.

Unlike previous guidance, which emphasised the duty to report and act on all allegations of abuse, the Care Act emphasises empowerment and the patient's right to choice and control over how and with whom information is shared. In this instance, Cheryl is refusing consent to contact police or for a safeguarding investigation to take place. Since Cheryl has capacity to refuse to report abuse to police or for a safeguarding enquiry to be undertaken, a risk assessment will need to be made in regards to whether others are at risk (public interest), a serious crime is taking place (public interest) or Cheryl's life is in danger (vital interest). In line with principles of protection and proportionality, if there is an identified risk in either of these areas, the investigating team may decide to overrule their consent and continue with the safeguarding investigation, involving only professionals and not friends or family members.

In light of Julian's behaviour, consideration should also be given to whether Cheryl's decision is being made under the influence of coercion and control, in which case Cheryl's consent may be overridden and a safeguarding investigation commenced. This new offence of ‘coercive and controlling behaviour in intimate and familial relationships’ was introduced into the Serious Crime Act 2015 as a way of providing better protection to victims experiencing continuous abuse. 8 In cases such as these, the individual may present as having capacity in relation to a decision but in fact be unable to make this decision owing to coercion or control. In these cases, the individual will not fall under the auspice of the Mental Capacity Act. This kind of enquiry is often complex and will require a range of professionals to work with the person to identify appropriate safeguarding options. In serious cases, the situation may ultimately require application to the inherent jurisdiction of the High Court, 15 who may legally be able to act against the wishes of the individual to safeguard them from further harm. Similarly, police now have the ability to use a Domestic Violence Protection Order under Sections 24–33 of the Crime and Security Act 2010 to remove an alleged perpetrator from the family home for a period of up to 28 days with or without consent from the person alleged to be experiencing abuse. 19

Should it be decided that safeguarding needs to proceed, with or without Cheryl's consent and involvement, there is a need to undertake ‘safe enquiry’, ensuring that any investigation does not increase risk to Cheryl. The Local Government Association guide to adult safeguarding and domestic abuse 20 provides a useful and comprehensive guide to dealing with these situations within the safeguarding context.

Finally, if Cheryl refuses consent and none of the above risk factors are present, this decision should be respected and Cheryl should be supported in considering other avenues outside the safeguarding agenda. Information may still need to be shared with children's services if there is a perceived risk to the children, which will need to be addressed under child safeguarding procedures.

Case Example 2: Layla – Unintentional Abuse, Carer Safeguarding and Mental Capacity

Layla is a 77-year-old woman with physical mobility difficulties and early symptoms of Alzheimer's disease. She is currently in a relationship with Giles, a 78-year-old man who also has physical mobility issues. Layla and Giles both attend Layla's Care Programme Approach meeting, during which Layla's psychiatrist notices that Layla's hair and clothes are unclean and she has lost weight. He asks Layla about this, who replies that Giles does not help her with her personal hygiene or give her food regularly. Giles explains that he is doing his best but is struggling to care for Layla at the moment owing to his physical health, and that he did not want to contact anyone for help as Layla does not want carers involved. He also discloses that he has found caring for Layla more difficult recently, as on a number of occasions she has lashed out at him and caused him minor injuries. Layla's psychiatrist is concerned that Layla is being neglected and raises a safeguarding concern.

This case study, while on the face of it simple, in fact outlines complex issues around unintentional abuse, carer safeguarding and mental capacity.

In this case study, a safeguarding alert has been raised owing to what appears to be unintentional neglect of Layla, which has arisen because Giles is struggling to care for her. Unintentional abuse is a recognised issue under the Care Act, and guidance is clear that the unintentional nature of this does not change the fact that it is a form of abuse or make the need for action any less important.

In this case example, professionals will need to consider Layla's capacity in relation to a range of safeguarding-related decisions, for example, whether she has capacity to decide whether to allow carers into the home, and whether she can consent to information being shared as part of a safeguarding enquiry. 15 The Care Act works together with the Mental Capacity Act 2005, and if Layla is found to lack capacity, an Independent Mental Capacity Advocate (IMCA) must be made available to her. Unlike most best-interests decision situations, an IMCA may be required even if there is an appropriate friend or family member who could support Layla.

If Layla is found to have capacity in these areas but also appears to have substantial difficulty in engaging with safeguarding processes, it may be appropriate for a Care Act Advocate to be involved. This is a new role under the Care Act which is used where a person with capacity demonstrates substantial difficulty in being involved in decision-making and does not have an appropriate friend or family member to support them. Where there is no appropriate individual, the local authority must provide an independent advocate. 21

Also pertinent in this case is that one of the major changes to safeguarding processes introduced by the Care Act is the need to provide safeguarding responses for carers who may be experiencing abuse due to their caring role. Since it has been identified that Giles is experiencing physical abuse from Layla in the course of his caring role, this avenue will need to be considered as a framework for providing him with appropriate support. Although the primary focus is likely to remain on safeguarding Layla, consideration will also need to be given to providing a more appropriate package for Giles as carer to help prevent further abuse to both parties. 8 In this instance, there is no indication that Giles lacks capacity; however, it should be remembered that where an alleged perpetrator lacks mental capacity, they are entitled to support from an IMCA throughout the safeguarding proceedings. 8

Case Study 3: Alexis – Organisational Abuse

Alexis is a 42-year-old Black British man living in a residential placement owing to his moderate learning disability and physical mobility issues. Alexis attends a routine out-patient appointment, during which he discloses that one of the staff members at the placement has left him sitting in the bath for an extended period of time on a number of occasions. Alexis also shares some racially derogatory names which he says the staff member has been calling him when he asks for help. Alexis's psychiatrist decides to raise a safeguarding concern.

This case example allows us to consider issues round organisational abuse, including neglect and poor practice within an institution or specific care setting, and action which will need to be taken in these instances, as set out in the Care Act statutory guidance. 8

In situations such as this, the safeguarding investigation will need to include Alexis's residential placement. The placement should be made aware that, as instructed by Care Act guidance, where a complaint or allegation has been made against a member of staff, they ‘should be made aware of their rights under employment legislation and any internal disciplinary procedures’. 8

The local authority does not have the right to direct Alexis' care home as to what actions to take against their staff; however, they should report concerns to the CQC and continue to monitor the situation. Since this is a care setting, the local authority must also advise other placing authorities of the concerns so that appropriate measures can be taken to safeguard all other residents as well as Alexis. Since Section 44 of the Mental Capacity Act makes wilful neglect or mistreatment of an adult who lacks capacity a criminal offence, should Alexis be deemed to lack capacity, police involvement may be required in the safeguarding process. 15

Conclusion: implications for patients and carers

The introduction of the Care Act 2014 has had a number of implications for patients and carers requiring support under the safeguarding framework. One of the positive developments in regards to individual empowerment is that the Act places a greater emphasis on individual self-determination and desired outcomes. Patients now have a more robust framework protecting their rights to make decisions about their lives, with new advocacy requirements ensuring that their voices are heard. Prevention principles have removed some of the previous thresholds which would have prevented those in the early stages of abuse or neglect from being overlooked, and require services to be more proactive in preventing the escalation of abuse.

However, it could be argued that the Care Act's emphasis on patient outcomes and goals could come at the price of leaving some individuals unsafeguarded who would previously have been supported under a less flexible framework. Services may need to develop new ways of responding to these concerns, ensuring that front-line staff across the multidisciplinary team work together to ensure that needs are met and risks are mitigated as far as possible. There are also questions over where this leaves family members, friends and other members of social networks who will continue to worry about the well-being of the vulnerable person. There is scope under Care Act legislation for support to be offered to carers under the safeguarding framework, and it may be that support can be offered to carers in this situation. For example a carer's assessment may be considered to discuss the effects of the caring role, including worry caused by these concerns.

About the authors

Katherine Johnson is a Think Ahead consultant social worker, Hertfordshire Partnership University NHS Foundation Trust, UK; Billy Boland is a consultant psychiatrist in community psychiatry, Hertfordshire Partnership University NHS Foundation Trust and vice chair (elected), Faculty of General Adult Psychiatry, Royal College of Psychiatrists, UK

What is safeguarding?

It is important to be clear about who the formal safeguarding process applies to.

In this section we will define  adult safeguarding . See our  safeguarding children  resource for information in that area.

The Care Act statutory guidance defines adult safeguarding as:

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. This must recognise that adults sometimes have complex interpersonal relationships and may be ambivalent, unclear or unrealistic about their personal circumstances.

Introduction to safeguarding adults e-learning course

This definition hints at the challenges of safeguarding, but it is important to be clear about which adults we are discussing. A local authority must act when it has ‘reasonable cause to suspect that an adult in its area (whether or not ordinarily resident there):

• has needs for care and support (whether or not the authority is meeting any of those needs),
• is experiencing, or is at risk of, abuse or neglect, and
• as a result of those needs is unable to protect himself or herself against the abuse or neglect or the risk of it.’ (Care Act 2014, section 42)

So safeguarding is for people who, because of issues such as dementia, learning disability, mental ill-health or substance abuse, have care and support needs that may make them more vulnerable to abuse or neglect.

Who is at a higher risk?

• People with care and support needs, such as older people or people with disabilities, 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.

Further reading from SCIE

• Safeguarding key concepts
• Ten kinds of abuse and their indicators
• What are the six principles of safeguarding?
• Roles and responsibilities of safeguarding

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Writing a social work essay on adult safeguarding

Writing a social work student essay on adult safeguarding by professor jill manthorpe, director of the social....

  by Professor Jill Manthorpe, director of the Social Care Workforce Research Unit, King’s College London . Writing an essay on aspects of adult safeguarding is likely to be intellectually interesting as well as useful in practice. Many people find it brings together different parts of an academic course – law, ethics, risk analysis and social policy, for example. If you are seeking a job in adult services, knowledge of adult safeguarding is likely to be important in selling yourself as up-to-date and conscious of the social work role. Your essay question may offer a steer about whether the focus of your work should be on policy or practice. Policy is easy to research since there has been much interest in revising national guidance and research on policy effectiveness. The literature also provides opportunities to compare different systems internationally. Like many areas, discussion in the literature generally has the benefit of hindsight and so we have limited examples of practice where abuse was prevented or stopped in its tracks. Care needs to be taken in seeing accounts of practice as inadequate without knowledge of the context. Good essays on adult safeguarding will: • be aware of the law; • note that social workers’ practice takes place in an organisation that has policy and procedures on this subject, and that adults have rights to refuse help at most time. You might find it helpful to draw on learning around the Mental Capacity Act , other legal provision, risk management and the limits of regulation. In the context of personalisation , you will doubtless find material that talks of the risks from growing use of personal budgets . You will need to make judgements about whether this is balanced and proportionate. Finally, like most subjects, care is needed about definitions. Watch out for essay titles that may be asking you to look at just one type of abuse or focus on one client/user group. This needs to be prominent in your answer. Do you have questions about essays? Get advice from fellow students on CareSpace Keep up to date with the latest developments in social care Sign up to our daily and weekly emails

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Home — Essay Samples — Psychology — Adult — The Care Act 2014 – The Major Changes In Safeguarding Adults

The Care Act 2014 – The Major Changes in Safeguarding Adults

• Categories: Adult Constitution

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Published: May 7, 2019

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Article Contents

Introduction, policy and organisational context of adult safeguarding in ireland, legislative context for adult safeguarding, acknowledgements.

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Adult Safeguarding Legislation—The Key to Addressing Dualism of Agency and Structure? An Exploration of how Irish Social Workers Protect Adults at Risk in the Absence of Adult Safeguarding Legislation

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Sarah Donnelly, Marita O'Brien, Adult Safeguarding Legislation—The Key to Addressing Dualism of Agency and Structure? An Exploration of how Irish Social Workers Protect Adults at Risk in the Absence of Adult Safeguarding Legislation, The British Journal of Social Work , Volume 52, Issue 6, September 2022, Pages 3677–3696, https://doi.org/10.1093/bjsw/bcac003

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Adult safeguarding is characterised by competing debates related to core concepts including policy and legislative frameworks. In some countries, to reconcile the dualism of agency and structure, conflict and ambiguity are legislated for through the introduction of adult safeguarding legislation (ASL). This study set out to explore how the absence of ASL in the Irish context impacts safeguarding processes. A qualitative approach involving semi-structured interviews ( N  = 14) and focus groups ( N  = 2) with social workers, explored variables from adult safeguarding cases that contribute to positive outcomes in the absence of ASL, and where legislation could have helped, using a critical incident technique. Four themes emerged: practices and processes; coercive control and undue influence; information sharing and multiagency cooperation; and inability to access services. Whilst in the majority of cases existing policy and legislation achieved successful outcomes, legislative powers such as a duty to cooperate, to share information and powers of entry were deemed necessary. This study suggests limits to safeguards and protections within current policy. It illustrates the dualism that often exists between the agency of social workers to act to safeguard adults at risk and the structural rules, relationships and resources that can restrict the context of action in absence of legislation.

Adult safeguarding is increasingly attracting policy and practice interest internationally ( Sethi et al. , 2011 ). Initially developed as a response to concerns about elder abuse and the abuse, particularly sexual abuse, of adults with learning disabilities in the 1980s and 1990s ( Dixon et al., 2021 ; Cooke, 1995 ), it has become an important feature of adult protection systems and social work practice across many jurisdictions, most notably in the UK, the USA, Canada and Australia. This has led to important organisational challenges in ensuring that adult safeguarding responsibilities are delivered in ways that ensure positive outcomes for all stakeholders ( Graham et al. , 2017 ). However, problems remain, for example, in terms of the issue of dualism where despite the expectation that social workers and other professionals need to protect adults at risk there is often a structural context of action which is limiting ( Gleeson and Knights, 2006 ). In some countries, to reconcile the dualism of agency and structure, conflict and ambiguity are legislated for through the introduction of specialist or dedicated adult safeguarding legislation (ASL). This article reports on a national study that examined social work practitioners’ experiences of navigating adult safeguarding cases in Ireland and explored the challenges in safeguarding adults at risk in the absence of ASL.

Ireland currently relies on a range of criminal and civil law, alongside adult protection policy and guidance to inform policy and practice. Addressing safeguarding as a public policy issue at a government level has been a relatively new development, characterised by largely reactionary policy responses. For example, the reporting of high-profile cases of the mistreatment of adults with disabilities and/or older persons, most notably with the Aras Attracta inquiry about the mistreatment of residents with severe intellectual disabilities has led to the establishment of guidelines and policies to protect all adults at risk of abuse, harm or neglect in all government-funded services by the Health Service Executive (HSE) in 2014. The policy included a number of principles with which to promote the welfare of vulnerable people and safeguard them from abuse including a requirement that all services must have a ‘no tolerance’ approach to any form of abuse ( HSE, 2014 ). It also led to the establishment of a range of bodies including a National Safeguarding Office, a National Safeguarding Committee and National Adult Safeguarding Teams to implement the policy.

The current services organisational model in Ireland reflects a single-agency model with multiple responders ( Graham et al. , 2017 ). In each area, a safeguarding and protection social work team works in partnership with all relevant service providers to provide an expert advisory service and to investigate reports on concerns of alleged abuse. One of the limitations of the policy is that it extends to older persons and social care directorates, leaving out mental health and acute care sectors. Social workers employed in these agencies carry out safeguarding investigations within the remit of their everyday casework.

The international literature suggests that, where problems in policy occur, legal frameworks are sometimes sought. These can set out overarching principles and scope of adult safeguarding, and either establish or clarify, response pathways. Such frameworks may also fill significant legal protection ‘gaps’ when adults lack capacity, experience or are at risk of abuse ( Anand et al. , 2014 ; Kaspiew et al. , 2016 ). Specific ASLs generally articulate the definitions, principles, pathways and scope of safeguarding, whilst promoting public and professional awareness ( Ife, 2001 ) and provide parity of treatment for adult protection alongside child protection ( Montgomery et al., 2016 ). ASLs may also encourage shared understandings, more consistent approaches in practice over time in conjunction with common training and promoting coordination between agencies ( Stevens, 2013 ; Montgomery et al., 2016 ).

Despite the appeal of such laws, they are not without their critics. It has been argued that ASLs may privilege a legalistic ‘top-down’ approach to what are often complex social problem and risks individualising the problem to the vulnerabilities of the adult at risk ( Sherwood-Johnson, 2014 ). It may also be that unintended outcomes occur (even in jurisdictions operating within a policy framework), including dilemmas for professionals in seeking to balance the needs of individuals for safety and protection whilst adhering to core values of human rights, independence, self-determination and autonomy. It is often the case that potentially intrusive professional involvement in adults’ lives occurs with or without their consent ( Harbison et al. , 2012 ; Keeling, 2017 ).

Recent ASL introduced in jurisdictions such as England and Scotland seeks to address these conundrums by striking a balance between safeguarding against harm and respecting people’s need for autonomy. A wide range of powers and duties are included as in the Scottish example, the Adult Support and Protection Act (Scotland), 2007 , while at the same time proportionate to the threshold of harm. For example, there is a distinction between initial inquiries and fuller investigation, recognising the agency of social workers and professional judgement; stronger actions are authorised in response to higher thresholds of serious harm, such as removal for assessment, interviewing persons privately and having access to records, all welcomed by practitioners ( Mackay et al. , 2012 ).

Although Ireland has not implemented a dedicated ASL, a number of Acts make reference to the protection of rights and reporting of abuse. The European Convention on Human Rights 2003 imposes negative, positive and procedural obligations on States in respect to a range of rights that are important to safeguarding adults (e.g. no one shall be subjected to torture, inhumane, degrading treatment or punishment). The Health Act 2007, Care and Support of Residents in Designated Centres for Persons (Children and Adults with Disabilities) Regulation 2013 makes specific reference to the protection required for registered providers to notify the Health Information and Quality Authority (HIQA) of any adverse events including allegations or suspected abuse of residents. The Criminal Justice (Withholding of Information on Offences against Children and Vulnerable Persons) Act 2012 makes it an offence for any person to withhold information on certain offences (includes rape, sexual assault and false imprisonment) against children and vulnerable persons from An Garda Síochána. The Domestic Violence Bill, 2018 legislated for the crime of coercive control.

In 2017, the Adult Safeguarding Bill, 2017 was introduced as a private member’s Bill in the Seanad, the upper house of the Irish parliament. The Bill aimed to put in place additional protections and supports for adults. Two key processes were proposed. Part 2 establishes an independent National Adult Safeguarding Authority, with the power to investigate, enter any premises, direct the Executive (the HSE) or local authority to make available health or social care, legal, accommodation or other services including emergency supports (Section 11:3). Part 3 provides for mandatory reporting by specified/named persons/professionals and others. The proposed Bill has not yet been signed into law.

As discussed above, there is growing evidence that adult protection interventions are often constrained by the structural context for action. For example, O’Donnell et al. (2015) highlight a number of inconsistencies, and contradictions, in the Irish system. In particular, they argue that there is a need to address the dichotomy between a client’s right to self-determination, and a social workers’ duty to protect their well-being in the absence of a legal framework or mandate to access the resources needed to do this. They concluded that a legislative underpinning to adult safeguarding procedures and practice guidelines was urgently required ( O’Donnell et al., 2015 ). Repeated concerns have also been expressed about the inadequacy of legal protections for adults at risk: ‘People should not be subjected to significantly deteriorating care and service quality to the point their very lives are at risk because of legal limitations’ ( Dunnion, 2020 ). The HSE has recognised that social workers are operating in a ‘legal lacuna’ in the absence of ASL ( HSE, 2019 , p. 9). The Oireachtas (which is the parliament in Ireland) Joint Committee on Health (2017) has stated ‘that there is an urgent need for legislation and that this legislation is crucial in providing protection to adults at risk’ ( Oireachtas Joint Committee on Health, 2017 , p. 1).

The study reported below set out to explore, from the perspective of social workers, how the absence of ASL in the Irish context may be impacting on adult safeguarding processes. In particular, it sought to shed light on how practitioners were navigating cases in the absence of ASL and to explore what benefits or challenges ASL would bring if enacted in the Irish context.

Study design

A qualitative approach involving focus groups (FGs) and semi-structured interviews were used to explore differing social work perspectives across specialities involved in adult safeguarding casework. A critical incident technique approach was used to gather first-hand experiences and observations of factors significant to the process and outcome of safeguarding cases ( Flanagan, 1954 ).

Data collection

A purposeful sampling approach was used to recruit participants, nationally, for the FGs and interviews. The HSE National Safeguarding Office and the Irish Association of Social Workers acted as collaborators and assisted with access to the population. An email invitation was issued to all relevant social workers in each organisation asking them to participate Participants interested returned signed consent forms by email.

Two face to face FGs were held in July 2019. Fourteen interviews were conducted via telephone between July and September 2019. FGs and interviews were audio-recorded and fully transcribed. FGs lasted between 95 and 137 min. Interviews lasted from twenty-five to ninety-three minutes.

Ethical permissions

The recruitment, data collection, handling and protection procedures were approved by the University Research Ethics Committee in 2019. Participants were advised that if during the interview/ FG discussion if any participant reported practices were not complying with legal mandates, they would be re-directed to their employing organisation and/or safeguarding authorities (HSE). A distress protocol was developed but not required to be used, during the course of the fieldwork.

The management of research data met the requirements set out under General Data Protection Regulations (GDPR) and Irish data protection legislation.

Data analysis

The interview topics were informed by consideration of the key issues raised in an earlier review of the literature (see Donnelly et al. , 2017 ). Both researchers were involved in the five stages of the framework analysis as outlined by Ritchie and Spencer (1994) . To familiarise ourselves with the data, recordings were listened to, and transcripts read, noting initial codes prior to meetings. From these initial notes, data were analysed using a licensed version of NVivo 12 Pro. Using these processes, a set of preliminary codes were generated, and illustrative extracts coded. To develop the framework, we used the key topics explored in our interview guide as the basis of our framework categories. One of the researchers (M.O’B.) indexed and applied the framework to all FGs and interview data. Data that did not fit the framework but was perceived as important were coded under ‘Other’. Extracts from NVivo for each category were reviewed by both researchers and summarised and charted for each interview. Mapping and interpretation involved reading the charted data separately, then meeting to discuss interpretations. This led to a set of themes that captured key areas where current legislation and safeguarding policy appeared to be insufficient to protect adults at risk. A final stage was the sharing and confirmation of these findings with participants via email.

A total of eight safeguarding and protection social workers participated in two FGs: one urban: FG1 ( N  = 5 participants) and one suburban: FG2 ( N  = 3 participants). FGs included both professional and team leader grades with six females and two male participants.

A total of fourteen registered social work practitioners were interviewed, ten females and four males. Table 1 provides details.

Interview participant’s roles, locations and reference

Data analysis revealed a number of key themes: practices and processes; coercive control and undue influence; information sharing and multiagency cooperation; and inability to access services, which will now be outlined.

Practices and processes

Participants reported that, in the majority of cases, effective outcomes were achieved when using existing policy and legislation. Whilst the majority of participants agreed that ASL is required in limited situations, there was consensus that the least restrictive approaches were important in the first instance, through relationship building and gaining consent for the intervention. Participants commented on considerable inconsistencies in current practices between Community Health Office areas in relation to roles and responsibilities of safeguarding and protection teams, interagency working and the resourcing of supports and interventions.

…there are huge regional discrepancies and if this referral was in another part of the country, it wouldn't be taken on (P13).

At times, the process of discharge from hospital to community was problematic, with ambiguity and a lack of clarity in relation to which social worker should follow up on actions where there were adults at risk.

A consensus was evident about how ASL if enacted should support the enforcement of policy, and provide clarity about professional roles, thresholds, responses, pathways but also consequences when policy was not adhered to. The value of relationship-building in empowering adults who are vulnerable to have the confidence to take control and act to protect themselves was also seen as critically important. Participants also believed that codes of practice should be central to legislation, offering clear guidance, whilst at the same time leaving room for creative ways of working to ensure safeguarding structures do not stymie opportunities for social workers to act in a person-centred way.

Participants described several enablers to safeguarding processes. These included the engagement with local Gardaí, for example, having ‘a chat’ with the person of concern or visiting the adult at risk’s home to check if they are safe. They also commended improved policies and training for bank staff in situations of financial abuse, and the appointment of a Designated Safeguarding Liaison Officer in the Department of Social Protection.

Participants were keen to point out that any new legislation should not be a panacea or replacement for competent, thoughtful practices that were human rights compliant ‘…legal provisions should be designed to safeguard and should not impinge upon a person's autonomy or human rights in doing so’ (FG2). Thus, a number of concerns emerged about cautioning excessive or immediate use of the law without exploring other options which may have an equally beneficial outcome: ‘the expectation will be from our other professionals who are far more risk-averse that we would be to initiate proceedings, even if it is not in the client’s best interest as we see it in terms of what their will and preference is’ (FG1).

We talk about expectation that people will report but we also defer to consent of course at all times …… in our work by and large we make the assumption that people have capacity and can make decisions for themselves; they have the right to self-determination…But by and large, if we are dealing with a cohort of people who have capacity, can make decisions for themselves how does that sit with mandatory reporting? (P10)

Coercive control and undue influence

The mother she was quite happy with it but the daughter didn’t want people coming into the house so she would be quite I suppose a combination of her being threatening towards them and being verbally abusive … all of our efforts none of them provided really satisfactory solution over any period of time (P15).

People want the abuse to stop but they don’t want the relationship to finish. And we have to respect that.. But then, there are times when our intervention is so, it has to be so direct and accusatory that it will destroy the relationship. So, that’s a difficult dilemma for us (P6).

A concern was expressed that the Domestic Violence Act , 2018 , could not be applied to the crime of coercive control within non-intimate relationships in their practice contexts.

She was like a honey pot to certain people who flocked around her and stayed with her and were with her and obviously used her to access resources, her resources (P3).

What we’re trying to do, respect their wish to be as independent as possible and allow them to associate as they have a right to choose you know. But reduce the risk because of the people they actually associate with (P4).

Where does the impact of coercive control come into the capacity to make decisions and how do those two interact and cross each other, that’s a key (P7).

Where coercive control involved the misuse of money and assets, participants suggested there may be a need for more specialist, multi-disciplinary assessments focusing on the concept of ‘executive functioning’ to ascertain whether the adult at risk could benefit from supported decision-making in relation to their ability to manage their finances and assets.

Participants highlighted that legislation to provide for power of entry is required in some situations where there is an immediate concern for the safety of an individual. They described situations where an adult at risk would consent to entry; however, a family member refuses access, and attempts to negotiate access have been protracted and failed. In these situations, many participants believed they should be able to go to the district court to seek an order to gain power to enter and that the law should clarify thresholds in these circumstances.

Right of entry or the right of removal would be helpful, we’ve had a couple of cases locally where just I suppose it’s the flip side of assistive technology, the family members got bugs and recording devices on the premises (P9).

Information sharing and multiagency cooperation

When he returned to live at home, there was a serious adult protection matter. So we looked to get information from TUSLA, given he had had extensive involvement with them. And due to GDPR and other factors the information wasn’t shared or couldn’t be shared..the only way it could be shared was with consent of the parents who were the person’s causing concern….it took us 10 months to get the information (P5).

GDPR has made things very difficult and I’m not sure the legislation was written to cause the trouble, it has caused. The person causing it (abuse) is not named anymore. In terms of pattern forming because that’s part of the stuff that we would look at when we get preliminary screens (FG2).

We had an interesting one where they had a system of you know previously good relationship of submitting preliminary screenings, and a lot of that related to where there was peer to peer (abuse). A report had come in then in relation to a staff member, we gave the advice to the nursing home) and then based upon that then we received a legal letter from (the nursing home), looking to take our member of staff to court because of the advice that we were giving (P1).

We view people in private nursing homes in the same way as people living in the community- the nursing home is their home, and they need protected the same way as everyone else however HIQA don’t deal with individual cases (P6).

Legislation does change things, if the legislation has a duty to cooperate, to have a safeguarding committee that has a bit of bite, that would be much better. I want to sit with the guards and the guards see it as part of their job. I want to sit with the consultant or the mental health team and they understand that safeguarding is as much their business as it is mine. That they can’t throw me half the information on something, and I make a miracle happen (P11).

Participants stressed that a legislative duty to cooperate needs to extend beyond the health and social care sector and the Gardaí, it should also include the Department of Social Protection, financial institutions and local authorities.

Inability to access services

A significant barrier to the actioning of safeguarding plans was the inability of social workers to access health and social care services to manage risk. Participants were unanimous in identifying this as a critical factor to achieving positive outcomes in safeguarding work. The data revealed many situations where the HSE failed to provide home care supports which were deemed to be essential to safeguarding plans, particularly in situations of unintentional neglect, where the person’s will and preference are to remain living at home, but their care needs are such that their family no longer have the capacity or financial resources to meet their care needs, for example where hospital discharge care plans could not be resourced.

Biggest issue I have in working in the area of safeguarding in the community is the lack of supports to offer as part of a safeguarding plan. It is easy to identify the risks and write up a plan of what might reduce the risk but the resources are not there to back this up -simple resources like access to daycare and respite to provide an outlet for the person, and to relieve the stress of carers (FG1).

it’s that old thing that always happens where they’ve put the cart before the horse. You know people are trying to push you know half-baked legislation through without the principle of a right to services and if it was in place then a huge investment into the health service would be needed and that’s not going to happen… (P16).

He’s got a very complex brain injury and he’s 22 … without any right to services and without any resources, we go in sort of with a begging cup … there’s no point in having safeguarding there if you haven’t got care there (P14).

Little or no access to housing or supported accommodation also created significant barriers in safeguarding work. The difficulties in securing a place of safety for older people experiencing domestic violence was highlighted, with one participant pointing out that women’s refuges are not an appropriate placement option for older women.

If they are having problems managing at night-time and the person they are caring for becomes physically aggressive, their only option is to ring the emergency services (P9).

Hence, the majority of participants believed legislation was required which would compel the HSE and other public bodies to provide for assessment, assistance, services and resources for early intervention and preventive safeguarding work as well as crisis response and longer-term interventions.

This study suggests that there are limits to the safeguards and protections which current policy measures offer social workers in adult safeguarding practice in the Irish context. The themes illustrate the tension and conflict that often exists between the agency of social workers to act to safeguard adults at risk of harm and the structural rules, relationships and resources that can restrict the context of action. While the agency of social workers is constrained by the structural context they must operate within, the study findings indicate that this disruption (or conflict) often stimulated creative and pragmatic adult safeguarding practices ( Gleeson and Knights, 2006 ). They suggest that, on a daily basis, social workers engage with the adult safeguarding system to achieve positive outcomes for adults at risk. However, there are clearly situations where mediating issues of agency and structure becomes problematic; risk becomes difficult to manage, and limited options are available to ensure the human rights of clients. As discussed above, the question remains whether the introduction of ASL would resolve these dilemmas and contradictions?

The findings provide some answers to this question. Social workers emphasised that, in the majority of cases, effective outcomes could be achieved by drawing upon existing policy, criminal and civil law. It was evident, however, that, in some situations such safeguards were inadequate. A striking example is where social workers were not able adequately to protect residents of private nursing homes because of legal gaps. This is concerning given that there is substantial evidence of abuse, both hidden and explicit in the nursing and residential home sectors with only a fraction of the abuse becoming known to authorities and professionals ( Cooper et al. , 2008 ; Cambridge et al. , 2011 ; Moore, 2017 ). Hence legislative change in this area is essential.

Central to ethical adult safeguarding is effective multi-disciplinary working ( Stewart et al., 2018 ). Particular challenges were reported by participants about the capacity and willingness of agencies to share information effectively and in a timely manner. GDPR restrictions tend to blur lines of responsibility and authority to share information when balancing rights of privacy and the prevention of harm ( Law Reform Commission, 2019 ). These systemic problems were found in Scotland before the introduction of ASL; for example, lack of information sharing and coordination within and between agencies and failure to appropriately investigate serious allegations of abuse ( Mental Welfare Commission and the Social Work Services Inspectorate, 2004 ). Likewise, Serious Case Reviews and Safeguarding Adult Reviews in England have concluded that a lack of information sharing between agencies has resulted in vulnerable individuals being unnecessarily exposed to harmful or abusive situations ( Preston-Shoot, 2017 ). Many participants in this study suggested that a legislative requirement to share information and for multi-agency collaboration and cooperation was urgently required. Benefits of more collaborative working include better use of resources, reduced opportunities for vulnerable individuals to slip through the net and effective investigations leading to positive outcomes ( Fyson and Kitson, 2012 ).

A considerable lack of consistency of practice, in terms of available resources, roles and responsibilities among social workers from the different specialities was a significant finding. To resolve these inconsistencies, codes of practice were suggested as a means of clearly setting out thresholds and the roles, responsibilities and accountability of the different professionals and organisations involved in safeguarding. To aid the transition towards a multi-agency approach, key terms and thresholds, including risk and vulnerability, need to be standardised from the outset, with practitioners having a clear understanding of what information is needed to enable an informed decision to be made ( Shorrock et al., 2019 ).

Adult protection systems require a proactive and a planned approach ( Anand et al. , 2014 ). Fundamental to the prevention and effectiveness of safeguarding interventions is access to resources; the study findings indicate that this was not possible for participants. Effective safeguarding needs to do more than simply wait for a situation to reach crisis point ( Keeling, 2017 ) and legislation has the potential to empower the agency of social workers to take decisive action in a timely manner. For example, a duty to provide assistance would enable social workers to put services in place, particularly where carers are struggling. This could pre-empt the need for more serious interventions, such as removing the adult at risk to a place of safety. ASL can offer a very public appearance of doing something about a problem, but its effectiveness, as observed by Harbison et al. (2012) , will depend on the provision of adequate funding for proper support services and programmes in the community. In the absence of a statutory entitlement to home care in Ireland, ASL including the duty to provide assistance could be of benefit.

Coercive control and undue influence in non-intimate relationships were another area of practice identified in the study. It was often the case that lack of specific legislative provisions, such as a power of entry or to interview an adult at risk in private when family members or alleged perpetrators are in proximity, significantly impacted opportunities for protection. While available legislation such as the Domestic Violence Act, 2018 was deemed helpful, not being drafted with the necessary adult safeguarding lens, limits its usefulness and poses a significant risk to the safety and wellbeing of those in non-intimate relationships, a clear impediment to a rights-based approach.

Issues of interdependency in familial relationships as well as the challenge of assessing capacity within the context of undue influence was noted. Participants’ experiences suggest that we need to consider the more sophisticated concept of ‘human interdependence’ ( Tronto,1993 , p.102) and the inter-dependent nature of everyday living and caregiving ( Rabiee, 2013 ) in adult safeguarding work. Many participants engaged in relationship building with the person in the hope that over time, and through building trust, that changes could be negotiated which could potentially reduce the level of risk ( Mackay and Notman, 2017 ). The implication is that it is often the quality of these interactions rather than legal measures that lead to successful outcomes ( Stewart et al. , 2018 ).

Although ASLs can fill legal protection gaps, the counterargument they can be a means of enabling the state to intervene in the lives of adults, with or without their consent, therefore, striking a balance between protection and rights is critical. It is often the case that policy frameworks and legislative mandates to report can be ignored on grounds of the belief that it is an infringement on individual’s right to privacy and self-determination as well as professional judgement ( Mackay et al. 2012 ; Donnelly, 2019 ).

Such contradictions affect social work interventions. Practitioners are required to engage in supported decision-making in safeguarding processes, whilst operationalising anti-oppressive practice, giving due consideration to an individual’s age, race, gender, religion, culture, language, disability, sexuality and capacity. A key to such interventions is the need to balance a duty to protect whilst supporting client autonomy. Legislative processes that are not overtly prescriptive but provide the tools to act when all other interventions have failed may resolve such dilemmas. For example, Stevens et al. (2017) explored the issue of power of entry as provided for under Scottish safeguarding legislation. They concluded that non-essentialist conceptions of vulnerability, autonomy and privacy enabled social workers to take a more nuanced approach where adults at risk have capacity to make decisions, thus enabling them to balance decisions about autonomy and private life alongside the duty to protect.

Our study suggests that agency without authority to take action is not effective in safeguarding the wellbeing of adults at risk of harm. There is a need therefore for ASLs to be informed by human rights principles (in particular, proportionality) if it is to strike a balance between safeguarding against harm and respecting people’s decisions ( Australian Law Reform Commission, 2017 ). It has also been demonstrated that if social workers have such mandated powers, they can develop proportionate ways of deploying them as evidenced in Scotland ( Mackay and Notman, 2017 ). Legislation by itself, however, is not a panacea and cannot guarantee safeguarding in each and every situation and currently there is a concerning lack of empirical research, needed to determine the actual, as opposed to presumed, strengths and weaknesses of different approaches ( Montgomery et al., 2016 ).

Study limitations

This study used a purposeful sampling approach and is therefore non-representative and cannot be extrapolated to the wider population of social workers. Similarly, the findings are not generalisable to the practices of other professionals and organisations in this field, for example, doctors, nurses, the police, third sector organisations and financial institutions for example who may express other views and perspectives of ASL.

Another limitation of the study is that findings relate to the Irish context where there may be cultural nuances and systemic issues which are different to other jurisdictions.

One potential strength is that this is only the second study to explore the topic of adult safeguarding in the Irish context and can be viewed to make an important contribution to the literature.

Whilst the current policy measures in place offer variable protection for adults at risk in Ireland, the findings from the study suggest that additional legal provisions are required and that some safeguarding procedures should be placed on a statutory basis to ensure that practices and processes are delivered in a standardised way. A key benefit of having a standalone ASL statute is that it can become a significant means of bridging legal and policy silos ( Mackay and Notman, 2017 ) and can offer jurisdictions the opportunity to reprioritise service provision across the preventative-protection continuum. For professionals working in adult safeguarding area, ASL has the potential to enable them to use powers to take action when all other avenues of intervention have failed. In doing so, such interventions can provide adults at risk, victims and survivors additional legal protections, as well as clearly defined reparation processes.

The authors would like to thank Professor Jim Campbell for his assistance in preparation of the article. The authors would also like to thank Senator Colette Kelleher for commissioning this research and for her continued advocacy work in the area of adult safeguarding in Ireland. We would also like to sincerely thank the Irish Association of Social Workers and the HSE National Safeguarding Office for their assistance in the recruitment of participants.

This research was funded by Senator Colette Kelleher via University College Dublin Foundation [R19821].

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Oireachtas Joint Committee on Health . ( 2017 ) Report on Adult Safeguarding , Dublin, Ireland , Joint Committee on Health . available online at: https://data.oireachtas.ie/ie/oireachtas/ committee/dail/32/joint_committee_on_health/ reports/2017/2017-12-13_report-adult-safeguarding_en.pdf . (accessed 10th August 2021).

Preston-Shoot M. ( 2017 ) ‘What Difference Does Legislation Make? Adult Safeguarding Through the Lens of Serious Case Reviews and Safeguarding Adult Reviews, available online at: http://ssab.safeguardingsomerset.org.uk/ wpcontent/uploads/SW-SCRs-SARs-Report-Final-Version-2017.pdf . (accessed 10th August 2021).

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Stewart A. , MacIntyre G. M. , Cusker P. ( 2018 ) ‘Conclusion and key messages’, in MacIntyre G. , Stewart A. , McCusker P. (eds), Safeguarding Adults: Key Themes and Issues , New York, NY , Red Globe Press , pp. 189 – 98 .

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Safeguarding Adults: Key Themes and Issues

• School of Social and Political Science

Research output : Book/Report › Book

Abstract / Description of output

Keywords / materials (for non-textual outputs).

• adult protection
• adult safeguarding
• social work

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• https://www.macmillanihe.com/page/detail/safeguarding-adults-gillian-macintyre/?sf1=barcode&st1=9781137381002

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• Adults Social Sciences 100%
• Adult Arts and Humanities 100%
• Practice Social Sciences 71%
• Guides Social Sciences 28%
• Legislation Arts and Humanities 28%
• Practitioners Psychology 28%
• Reading Social Sciences 14%
• Mental Health Social Sciences 14%

Research output

Research output per year

Safeguarding Adults at Risk of Suicide and Self-Harm

Research output : Chapter in Book/Report/Conference proceeding › Chapter

• Automutilation 100%
• Suicide 100%
• Physician 40%
• Protection 20%

T1 - Safeguarding Adults

T2 - Key Themes and Issues

A2 - MacIntyre, Gillian

A2 - Stewart, Ailsa

A2 - McCusker, Pearse

PY - 2018/2/13

Y1 - 2018/2/13

N2 - Safeguarding adults is a rapidly evolving area of professional practice and this timely new text book provides an authoritative guide that critically engages with the recent developments and encapsulates some of the emerging approaches to contemporary adult safeguarding practice. Written by a collection of authors with a wealth of academic and practice experience, and with a strong focus on multi-disciplinary working, the text covers key topics such as:- Safeguarding adults who lack capacity, or whose level of capacity is unknown or unclear- Common issues and tensions surrounding the various UK laws and policies that seek to safeguard adults with mental health problems- Safeguarding older adults, with a unique and insightful focus on the perspective of carers- Current limitations in practice, including the blurred nature of the boundaries between informal and legally mandated care, relating to the safeguarding of people with learning disabilities.Illustrated throughout by engaging case studies to help readers apply what they have learnt to everyday practice, this comprehensive guide to safeguarding adults is essential reading for students across a broad range of health and social care disciplines, as well as practitioners looking for an up-to-date source of reference.

AB - Safeguarding adults is a rapidly evolving area of professional practice and this timely new text book provides an authoritative guide that critically engages with the recent developments and encapsulates some of the emerging approaches to contemporary adult safeguarding practice. Written by a collection of authors with a wealth of academic and practice experience, and with a strong focus on multi-disciplinary working, the text covers key topics such as:- Safeguarding adults who lack capacity, or whose level of capacity is unknown or unclear- Common issues and tensions surrounding the various UK laws and policies that seek to safeguard adults with mental health problems- Safeguarding older adults, with a unique and insightful focus on the perspective of carers- Current limitations in practice, including the blurred nature of the boundaries between informal and legally mandated care, relating to the safeguarding of people with learning disabilities.Illustrated throughout by engaging case studies to help readers apply what they have learnt to everyday practice, this comprehensive guide to safeguarding adults is essential reading for students across a broad range of health and social care disciplines, as well as practitioners looking for an up-to-date source of reference.

KW - adult protection

KW - adult safeguarding

KW - social work

SN - 9781137381002

BT - Safeguarding Adults

PB - Red Globe Press

Essay on Safeguarding Vulnerable Adults

Students are often asked to write an essay on Safeguarding Vulnerable Adults in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Safeguarding Vulnerable Adults

What is safeguarding.

Safeguarding means protecting people from harm, abuse, and neglect. It’s important for everyone, but especially for vulnerable adults.

Who are Vulnerable Adults?

Vulnerable adults are people who are at risk of harm because they have difficulty protecting themselves. This can be because of old age, illness, disability, or other factors.

What are the Different Types of Abuse?

There are many different types of abuse, including physical, sexual, emotional, and financial abuse. Neglect is also a form of abuse.

What are the Signs of Abuse?

There are many signs of abuse, including unexplained injuries, changes in behavior, and financial problems. It’s important to be aware of these signs so you can report them if you see them.

What can You Do to Help?

If you think someone is being abused, you can report it to the authorities. You can also offer support to the person who is being abused.

250 Words Essay on Safeguarding Vulnerable Adults

Safeguarding is like protecting people from harm. It’s a way of making sure they’re safe and being treated well. When we talk about safeguarding vulnerable adults, we mean protecting grown-ups who might need extra help to stay safe.

Vulnerable adults can be anyone who has trouble taking care of themselves or protecting themselves from harm. This could include people with disabilities, older people, or people with mental health problems.

Why is Safeguarding Important?

Safeguarding is important because vulnerable adults can sometimes be taken advantage of or abused. They might be tricked into giving money or signing papers they don’t understand. They might be neglected or not given the care they need. Safeguarding helps to protect these vulnerable adults from harm.

What Can We Do to Safeguard Vulnerable Adults?

There are many things we can do to safeguard vulnerable adults. One important thing is to be aware of the signs of abuse or neglect. These can include things like bruises, cuts, or other injuries. They can also include changes in behavior, like becoming withdrawn or quiet. If you see any of these signs, it’s important to report them to the authorities.

Another important thing is to make sure vulnerable adults have access to the support and services they need. This could include things like housing, food, and medical care. It’s also important to make sure they have someone to talk to and someone who can advocate for them.

Safeguarding vulnerable adults is a community effort. We all have a role to play in making sure that these vulnerable adults are safe and protected. By working together, we can create a safer world for everyone.

500 Words Essay on Safeguarding Vulnerable Adults

What is safeguarding vulnerable adults.

Safeguarding vulnerable adults is about protecting people who might not be able to protect themselves from harm or abuse. This group includes elderly people, those with disabilities, or individuals facing mental health challenges. It’s important because everyone deserves to live a life free from harm and abuse. This essay talks about why it’s important to protect these adults and how it can be done.

Why It’s Important

Imagine if you were in a situation where you couldn’t take care of yourself, and there was no one to help you. It would be scary, right? That’s the reality for some adults in our communities. They might not be able to speak up if they’re being hurt or if someone is taking advantage of them. That’s why it’s crucial for others to step in and help protect these individuals. By doing so, we ensure that everyone, no matter their ability, has a chance to live safely and happily.

Types of Abuse

Abuse can come in many forms. It’s not just about hitting or yelling. For vulnerable adults, it can also mean taking their money, not caring for them properly, or making them feel alone and scared. Sometimes, the person doing the harm is a stranger, but other times, it could be someone they know and trust, like a family member or caregiver. Understanding these different types of abuse helps us recognize when someone might need our help.

How to Protect Vulnerable Adults

Protecting vulnerable adults starts with paying attention. If you notice someone seems unhappy, scared, or hurt, it’s important to tell an adult you trust. This could be a teacher, parent, or someone else who can help. There are also professionals whose job is to protect people from harm. They can step in and make sure the person is safe.

Education is another key part. Learning about what makes someone vulnerable and how to spot signs of abuse can empower us to act when something isn’t right. Schools and communities often have programs to teach people about these important issues.

Working Together

It takes everyone working together to protect vulnerable adults. This means families, friends, neighbors, and professionals all keeping an eye out for signs of abuse and taking action when needed. It also means creating a community where everyone feels valued and protected. When people know they have others looking out for them, they feel safer and more secure.

Safeguarding vulnerable adults is a responsibility we all share. By understanding what makes someone vulnerable, recognizing the signs of abuse, and knowing how to help, we can make a big difference in the lives of those who need it most. Let’s commit to keeping our communities safe for everyone, no matter their age or ability.

That’s it! I hope the essay helped you.

If you’re looking for more, here are essays on other interesting topics:

• Essay on Safeguarding the Environment
• Essay on Safeguarding
• Essay on Safe Driving

Apart from these, you can look at all the essays by clicking here .

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The Care Act 2014: a new legal framework for safeguarding adults in civil society

The Journal of Adult Protection

ISSN : 1466-8203

Article publication date: 14 August 2017

Penhale, B. , Brammer, A. , Morgan, P. , Kingston, P. and Preston-Shoot, M. (2017), "The Care Act 2014: a new legal framework for safeguarding adults in civil society", The Journal of Adult Protection , Vol. 19 No. 4, pp. 169-174. https://doi.org/10.1108/JAP-06-2017-0024

Emerald Publishing Limited

Copyright © 2017, Emerald Publishing Limited

Many of us may be able to remember the general air of excitement that surrounded the writing and publishing of “No Secrets” ( Department of Health, 2000 ) and “In Safe Hands” ( Welsh Assembly Government, 2000 ), although we might wish we were young enough not to! At the time, the documents generated mixed feelings amongst service users/customers and carers as well as professionals/practitioners. To some they were a major step forward on the road to raise the status of “vulnerable adult protection” (as it was then known) closer to that already enjoyed by child protection and domestic violence; to others it was a missed opportunity to go even further along that road; and to a small number it was a step too far when the perception was that existing legislation provided sufficient protection and any increased powers amounted to state intrusion into the private lives of adults.

The constitutional situation across the four countries of the UK meant that England and Wales had slightly different structures put in place to respond to situations of abuse and neglect, while Scotland and Northern Ireland were responsible for their own processes and took different approaches. Even within England and Wales, “No Secrets” and “In Safe Hands” were issued as guidance to Local Authorities under existing legislation and, as such, did not place any requirements on any other agencies or organisations to cooperate with the Local Authority. In fact, it could be argued that Local Authorities did not have to act in accordance with guidance if they could see good reason why not. Indicative of the anomalous position of the guidance is the situation in England regarding the requirement of Local Authorities to produce multi-agency policies and procedures to protect vulnerable adults – it is interesting to note how they had to produce multi-agency policies and procedures, but no other agency was required to work with them to do so!

“No Secrets” was published in March 2000 and required the above-mentioned policies and procedures to be forwarded to the Department of Health by October 2001. When one of us (PM) took up the post of Vulnerable Adult Protection Coordinator with Coventry City Council in mid-2003, he discovered that the Council had not submitted its policy and procedure to the Department and that in fact the Council had not even finalised them. When he advised the Department of Health of this, they did not seem unduly surprised or bothered and when he did submit them later that year their receipt was not acknowledged; when he chased the Department six months later to confirm that they had received them and to ask for feedback on them, he was told they had received them, and, if they have had any negative comments to make, they would have been in contact. Not really what you would want or expect if the Department and the government were really committed to making vulnerable adult protection a reality and to have a real impact on the lives of vulnerable adults and the services designed and intended to protect them. However, given that both “No Secrets” and “In Safe Hands” were launched with no key performance indicators and were announced as being “cost-neutral” perhaps we should not have been surprised.

the terminology of “vulnerable adults” was considered by some if not many to be discriminatory and labelling of the very people it was trying to empower by making it appear that they were some way the cause of their being abused and neglected;

the definition of “a vulnerable adult” was interpreted by some Local Authorities to require the adult to be in receipt of community care services to meet it;

the definition of “abuse” was seen as too vague and open to interpretation, being based as it was on the violation of the individual’s human rights rather than specific acts;

a definition of “abuse” that is based on the violation of someone’s human rights by another person or persons does not enable the protection of those who self-neglect, a particular issue before and subsequent to the implementation of the Mental Capacity Act 2005;

there was no duty on anybody to act under the multi-agency policies and procedures – there was not even a date when they had to be implemented, only returned to the Department of Health, a date that was not enforced;

not only was there no duty to act, but if the Local Authority, which invariably meant the local Adult Social Services Department, wanted to do so, it had no or few powers under which it could intervene; and

“Vulnerable adult protection” was seen by other agencies, particularly health organisations and, to a lesser extent, the Police, as the task of Social Services and, having made a referral, they would often withdraw involvement.

We are not saying that the above are all true or correct, but they are accurate reflections of perceptions and criticisms of “No Secrets” in the early 2000s. There was a groundswell amongst professionals directly involved with “vulnerable adults” and the organisations and agencies established to support and campaign on their behalf that was lobbying Ministers and the Department of Health to review “No Secrets” with a view to revising it to make it more effective. What followed was not a review of “No Secrets” but a consultation on a review of “No Secrets”, perhaps reflective of the lack of political will at that time to tackle the issue.

The Consultation on a Review of “No Secrets” was held in 2008/2009, with a response from the government in early 2010 that said it would establish an Inter-Departmental Ministerial Group, introduce legislation to put Safeguarding Adults Boards (SABs) on a statutory basis and issue multi-agency practice guidance. Before this could all happen, a General Election led to a change of government, with the newly-elected Coalition deciding to scrap its predecessor’s proposals in favour of a review of the chaotic plethora of legislation supporting – or not – adult social care that would propose a simplified legislative structure that would incorporate safeguarding within it. While frustrating in many ways, from a purely safeguarding perspective, which would otherwise continue to be under-valued, under-resourced and under-powered, this did make a lot of sense and was seen as likely to produce a more coherent base for work in safeguarding adults in the long run.

The Care and Support Bill was published in 2011, based very much on the recommendations of the Law Commission’s review of adult social care legislation, which took place between 2008 and 2011. This proceeded through a consultation process of its own, in the process of which it became the Care Bill and then the Care Act, receiving Royal Assent in May 2014 and coming into effect, in part, in April 2015. Statutory guidance was developed to support the implementation of the Act. The first edition of this was published in October 2014 by the Department of Health, barely six months after the Royal Assent; perhaps not surprisingly, the second edition was published in March 2016. The second edition was necessary to cover some aspects of the Care Act, which appeared to have been “shelved” by the government, some that were decided to be unwise and some that were considered necessary to be added. All of this is somewhat redolent of a piece of statutory guidance that was rushed and not properly thought through.

The Act, of course, only applies to England; Scotland already had its own legislation relating to adult protection, Wales had developed its own, which had important similarities as well as differences to the Care Act 2014 and Northern Ireland had not decided whether to introduce new legislation or not. This seemingly anarchic situation across the UK did, and still does, provide an opportunity for a research project that examines the processes by which the Care Act came to take the form it did and to compare it, and how it is implemented, with the legislation, or lack of it, in the other three countries.

In terms of adult safeguarding, the Care Act 2014 did contain framework legislation that placed SABs on a statutory footing. It required SABs to publish annual reports and strategic plans. Under certain circumstances it placed a duty on SABs to commission Safeguarding Adults Reviews (SARs), which replaced Serious Case Reviews (SCRs), with discretion to commission SARs in other circumstances. SABs were to have three statutory members, the Local Authority, Clinical Commissioning Group and Police, with discretion then as to how wide and inclusive the remaining Board membership was drawn. SABs were given the power to request information and Local Authorities the duty to conduct safeguarding enquiries. The adult safeguarding provisions were part of a general requirement in the Care Act 2014 to promote people’s wellbeing, with agencies being under a statutory duty to cooperate both at strategic and operational levels.

The Care Act 2014 did not follow Scottish legislation (the Adult Support and Protection (Scotland) Act 2007) in that no new protection orders were created; nor, despite strong advocacy, was an adult safeguarding power of entry created. Wales has similarly eschewed protection orders but has created an adult safeguarding power of entry in their Social Services and Well-being (Wales) Act 2014. Perhaps less well known, but nonetheless significant, is the fact that the Care Act 2014 has not given SABs the power to require statutory and other partners to contribute to resourcing its activities; nor do SABs have effective sanctions if agencies do not cooperate in terms of its adult safeguarding responsibilities at local level.

Subsequent developments have also shown some equivocation. Self-neglect was included in adult safeguarding arrangements for the first time in England in the Care Act 2014, but in key respects the second edition of the statutory guidance ( Department of Health, 2016 ) demonstrates some unease by appearing to limit the occasions when a safeguarding enquiry might be triggered in self-neglect cases. This example, and the failure to legislate for either an adult safeguarding power of entry or protection orders, arguably demonstrates ongoing unease with giving the state powers to intervene, despite evidence of the effectiveness of the Scottish adult protection system (see e.g. Preston-Shoot and Cornish, 2014 ). It is therefore important to recognise that the Care Act 2014 was a compromise, that there is nothing inevitable about the legal rules that were developed, and that they are the result of how competing perspectives, and arguably interests, are ultimately in some form reconciled.

Going forward, it becomes imperative to evaluate the different legislative and policy arrangements, and the four nations of the UK provide a perfect case study for research in that respect. It becomes equally imperative to look at outcomes from the perspectives of practitioners, service users and carers, especially because the statutory guidance ( Department of Health, 2016 ) places great emphasis on Making Safeguarding Personal, which requires a major culture shift in how health and social care agencies in particular have historically delivered adult safeguarding services. Some legislation is hard for practitioners and their organisations to understand, whilst some is experienced as hard to implement. The Data Protection Act 1998 and the Mental Capacity Act 2005 are two cases in point. What, one wonders, might practitioners and managers, across health and social care agencies and beyond, say about the Care Act 2014? SARs, and their predecessor SCRs, also highlight that legal literacy and safeguarding literacy across professions and agencies is variable ( Braye et al. , 2015 ), reinforcing again the need to track the experience of implementation of the provision of the Care Act 2014.

In 2015, a multi-disciplinary research team obtained funding from the Economic and Social Research Council to run a seminar series to consolidate and advance knowledge around safeguarding adults under the new legislative and policy framework. The research team comprises the following people: Alison Brammer, Keele University (Principal Investigator); Pete Morgan, Independent Consultant and the University of Warwick; Paul Kingston, University of Chester; Jonathan Parker, Bournemouth University; Bridget Penhale, University of East Anglia (Norwich), Michael Preston-Shoot, University of Bedfordshire and Alex Ruck-Keene, Barrister (39 Essex Chambers, London) and the University of Manchester.

The series aims to explore how the new law emerged through a policy process, the challenges of interpretation that emerge and how practitioners and their organisations can be supported to deliver the intentions and requirements of the Care Act 2014 and to keep people safe from abuse and harm.

theorise the process of law reform, exploring the interplay in making law between research and practice evidence, policy advocacy and political debate;

evaluate the new landscape for adult safeguarding, for example, the contested inclusion of self-neglect and the omission in England of a power of entry, and to appreciate the challenges in interpreting and implementing the new powers and duties;

examine accountability and responsibility to and for safeguarding adults in civil society;

develop the evidence-base for learning adult safeguarding law that instils an ethical, social justice commitment alongside technical legal knowledge;

establish an inter-disciplinary network uniting academic and practitioner perspectives, health and adult social care providers with civil society organisations providing welfare services, to assist with interpreting, learning and evaluating the new provisions; and

effectively disseminate work undertaken in seminars to academic, practitioner, service user and carer audiences.

To achieve the objectives, the seminar structure was devised to develop three distinct themes. The focus in year one was on how law is made, reflecting on contributions of researchers, civil society organisations, pressure and advocacy groups, statutory health and welfare agencies, and judicial decision making, including a comparative perspective. The focus in second year, currently underway, is on interpreting the law, including new concepts, such as Making Safeguarding Personal, dignity and wellbeing, and new accountabilities. The third and final year of the series will focus on learning law. How might new adult safeguarding powers and duties be taught and what can be learned from SARs, case law and investigations by the Local Government and the Health Services Ombudsman. Each theme is examined from academic, service user, statutory and third-sector organisation perspectives.

Seminar participants

The series aims to create a strong network of individuals and organisations concerned with adult safeguarding and with the capacity to engage in further collaborative research, policy and practice development, and conferences. Over the first year, seminars were held at Keele University, Bournemouth University and the University of Bedfordshire. Each seminar has been well attended with in the region of 40-60 delegates. The series to date has been truly multi-disciplinary with an impressive range of organisations and disciplines represented including the Department of Health, Local Authorities, Police authorities, health authorities, Association of Directors of Adult Social Services, Care Quality Commission, Civil society and third-sector organisations concerned with social and welfare services including Action on Elder Abuse, ASIST and Alternative Futures, Social Care Institute for Excellence, academics and educators, training and consultancy organisations and solicitors and barristers.

An open access dedicated website has been developed to support the series and can be found at: https://safeguardingadults.wordpress.com

The site includes presentations from the seminars, in video and print form, a discussion forum, and a live Twitter feed. Summaries of key issues from each of the seminars, links to publication outputs from the seminars and to other key works in the field of safeguarding and suggested pre-reading also appear on the site. Contact information about the seminar network and announcements about the seminar programme and other related events are also posted. The website also provides a forum for collating views expressed by members on any consultation documents of relevance to adult safeguarding. In addition the site hosts blogs during the life of the seminar series, and these are likely to continue beyond the series completion date.

Places at seminars may be reserved by e-mail to [email protected]. Any queries about the series should also be directed to this e-mail address. At the seminars themselves and in between seminars, there is an active Twitter feed @SALLY2016_18 #SafeguardingAdults.

We are delighted that this special issue of the journal provides a compilation of four papers based on presentations given at one of the seminars that took place in 2016, together with an additional legal paper (more on that later). The theme for the seminar was safeguarding in the devolved nations, so we are delighted to have papers from each of the devolved nations; the papers are as follows.

Our first paper is by John Williams, of Aberystwyth University and the focus is on Wales. The paper explores recent changes to adult safeguarding in Wales (including background information) that have been introduced as part of the Social Services and Well-being (Wales) Act 2014 and discusses their potential impact. Although the Act introduced a number of changes in adult safeguarding in Wales, not least the duty to make enquiries, statutory powers of barring and removal were not included. As a recently implemented statute, the legislation is still in the process of becoming established and care and health practitioners are becoming used to the changes required by the legislation. Although no official data on the impact of the new legislation are available yet, it is likely that the lower threshold that has been set for referrals will mean an increase in caseloads and the need for practitioners to react to both low- and high-risk cases. The paper provides a detailed examination of the provisions of the Act that are related to safeguarding and identifies that more research and evaluation of the different approaches to safeguarding across the UK are needed.

The second paper in the issue is from Scotland, which has had legislation in the form of the Adult Support and Protection (Scotland) Act since 2007, implemented from 2008. In this paper, Kathryn Mackay of the University of Stirling, together with colleague Mary Notman explore the potential value of having a specific, separate statue on adult safeguarding. The paper details the powers and duties mandated by the Act and relate these to the overall context of the broader Scottish legislative framework in relation to adult protection. The authors utilise a case study of one specific Local Authority in Scotland to explore the merits of and issues raised by the Act; this is achieved through consideration of the different forms of data contained in the annual reports on adult protection activity produced by the authority. From the data obtained, the use of Protection Orders is quite limited – as intended within the Act. It also appears that effective identification; investigations and interventions require staff to be skilled, knowledgeable and well supported. However, a lack of reports and data at national level means that comparison between the local and national data is quite limited. The paper provides an appraisal of the implementation of the legislation in recent years and considers developments that have taken place in both England and Wales. A need for comparative research across the different nations of the UK is highlighted.

The following paper in the issue is by Lorna Montgomery of Queen’s University, Belfast and her colleague Joyce McKee. The paper examines the current model of adult safeguarding in Northern Ireland. The distinctive features of Northern Irish society have shaped its adult safeguarding policy and practice in ways which differ from those in England, Scotland and Wales and the paper provides an analysis of adult safeguarding, legislation, policy and practice in this context. Usefully, the paper also includes insights from the Regional Adult Safeguarding Officer for Northern Ireland (McKee). A number of strengths, limitations and challenges of Northern Irish legal and policy frameworks, and practice systems in relation to safeguarding are discussed. This includes an emphasis on changes in the way that adult safeguarding has been conceptualised, together with a focus on prevention and early intervention activities. It appears that organisations from community, voluntary and faith sectors have important roles in the continuing development of policy and practice in Northern Ireland.

The fourth paper in this issue is by Adi Cooper and Claire Bruin from England. It is now two years since the implementation of the Care Act (2014) in April 2015, and this paper explores the impacts of the Act on adult safeguarding partnerships and practice. The paper considers a range of areas, including wellbeing and safety, safeguarding activity and process, changing criteria and definitions, Making Safeguarding Personal, SABs, SARs, and advocacy. The authors, an Independent Chair of two SABs, and a Senior Manager in adult social care in a Local Authority, present information from published sources, experience and networks in the professional sphere. The paper argues that the impact on adult safeguarding and SABs has been greater than originally envisaged in a range of areas. This appears to be as a result of aspects of adult safeguarding having been given statutory status in the Act, and a new framework put in place. The authors consider that this provision has resulted in added impetus to cultural change in adult safeguarding practice.

The final paper in this issue is by Tim Spencer-Lane of the Law Commission. Some readers of the journal of long-standing will be aware that there have been previous papers from Tim (on behalf of the Law Commission) in the journal in relation to legal and regulatory reforms that have a bearing on safeguarding. Examples of these are the Regulation of Health and Care Professions ( Spencer-Lane, 2012 ) and the reform of the law relating to Adult Social Care ( Spencer-Lane, 2010, 2011 ), which culminated in the Care Act 2014. This current paper, written following the recent consultation exercise and work by the Law Commission on potential reform of the Deprivation of Liberty Safeguards, provides an overview of the Law Commission’s final report and recommendations on the reform of the Deprivation of Liberty Safeguards under the Mental Capacity Act, together with some discussion of implications.

We hope that this issue has provided information and food for thought for readers and will stimulate both discussion and potentially, practice development. We also hope that it will stimulate some interest in the seminar series and that some readers will be able to attend future seminars and join in the ongoing discussion and debates relating to safeguarding and legal literacy.

Braye , S. , Preston-Shoot , M. and Cornish , S. ( 2015 ), “ Learning lessons about self-neglect? An analysis of serious case reviews ”, The Journal of Adult Protection , Vol. 17 No. 1 , pp. 3 - 18 .

Department of Health ( 2000 ), No Secrets: Guidance on Developing and Implementing Multi-Agency Policies and Procedures to Protect Vulnerable Adults from Abuse , The Stationery Office (TSO) , London .

Department of Health ( 2016 ), Care and Support Statutory Guidance Issued Under the Care Act 2014 , 2nd ed. , TSO , London .

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Spencer-Lane , T. ( 2010 ), “ A statutory framework for safeguarding adults? The law commission’s consultation paper on adult social care ”, The Journal of Adult Protection , Vol. 12 No. 1 , pp. 43 - 9 .

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Further reading

Department of Health ( 2005 ), “ Mental Capacity Act ”, TSO, London .

Department of Health ( 2009 ), “ Safeguarding adults report on the consultation on the review of ‘No Secrets’ ”, TSO, London .

Department of Health ( 2012 ), “ Draft Care and Support Bill ”, TSO, London .

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• Open access
• Published: 17 November 2021

Recognition of risk and prevention in safeguarding of children and young people: a mapping review and component analysis of service development interventions aimed at health and social care professionals

• Duncan Chambers 1 ,
• Anna Cantrell 1 &
• Andrew Booth 1  

BMC Health Services Research volume  21 , Article number:  1241 ( 2021 ) Cite this article

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The term ‘safeguarding’ covers the protection of health, wellbeing and human rights. Effective safeguarding enables people (particularly children, young adults and other vulnerable people) to live free from fear of abuse, harm or neglect. The UK Children Act 2004 required key agencies, including health and social care providers, to consider the need to safeguard children and promote their welfare. Within a larger evidence synthesis project, we sought to identify and map service development interventions (excluding provision of training) aimed at improving awareness of safeguarding and identifying at-risk children and young people in health and social care settings.

We searched fourteen health and social care databases from 2004 (date of Children Act) to October 2019 and updated the review via a citation search in March 2021.

Studies of any design were eligible if they described or evaluated an intervention (other than training) aimed at health or social care professionals in the United Kingdom and designed to improve recognition of risk in the context of safeguarding children and young people. Studies with no intervention (e.g. qualitative studies) were included to explain why interventions work or fail to work. Included studies were summarised using narrative synthesis. Risk of bias of included studies and overall strength of evidence were assessed using standard methods. We used a 5-item checklist (“TIDieR-Lite”) to map intervention components.

Thirty-nine publications were included, of which 31 dealt with service developments, six with use of data and two with other initiatives. Promising service development initiatives include liaison nurses, assessment clinics, secondment, joint protocols and a ‘hub and spoke’ model. Initiatives involving use of routine data appeared promising and unlikely to generate significant additional costs. However, the quality of the evidence was generally low, with a shortage of controlled and long-term studies.

Conclusions

Health and social care services wishing to improve awareness of child safeguarding issues may benefit from looking beyond high-quality training provision. Future research should focus on service-relevant outcomes and ensure the active involvement of young people and their families/carers.

Peer Review reports

The term ‘safeguarding’ refers to measures designed to protect health, wellbeing and human rights, allowing people (especially children, young people and vulnerable adults) to live without fear of abuse, harm or neglect. The term is primarily used in the UK and Ireland, although the underlying concept is relevant to all health and care systems. The UK Children Act 2004 placed a responsibility on key agencies, including those in health and social care, to consider the need to safeguard children and promote their welfare. It follows that health and social care professionals at all levels need to be aware of safeguarding issues and procedures, although the amount and type of involvement with safeguarding will vary widely between professional groups.

The primary method of promoting safeguarding awareness is through provision of appropriate training, and various risk assessment tools and scales are available to health and social care professionals. However, broader organisational and cultural factors may also help or hinder people in recognising risk of abuse and taking appropriate action. Examples include co-operation between different organisations and professional groups, particularly at the interface of health and social care, and the use of information and data to promote safeguarding.

This paper presents and analyses data from a broader mapping review of research evidence on interventions to promote child safeguarding awareness in health and social care settings [ 1 ]. For this review, we aimed to identify organisational interventions and initiatives aimed at health and social care professionals that extended beyond the provision of training. The resulting narrative synthesis should be of value to research commissioners and decision-makers in health, social care and integrated care systems.

Methods are reported in full in the technical report [ 1 ]. Briefly, the research was carried out in two stages. We systematically retrieved and coded UK research and policy documents to gain a contemporary picture of safeguarding issues and practice. Similar methods of searching and study selection were used for both stages. We undertook quality assessment of each primary UK study that reported a recognised study design.

We searched fourteen health and social care databases (ASSIA - Applied Social Sciences Index and Abstracts, CINAHL - Cumulative Index to Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, HMIC - Health Management Information Consortium, IBSS - International Bibliography of the Social Sciences, MEDLINE, PsycINFO, Sociological Abstracts, Social Care Online, Social Policy and Practice, Social Services Abstracts, Social Sciences Citation Index, and Social Work Abstracts from 2004 (date of Children Act) to October 2019. Citation tracking of the included national policy and guidance documents was conducted on Google Scholar. Searches for UK grey literature were conducted within the main database searches given that Social Care Online and Social Policy and Practice index grey literature. We updated the review in March 2021 by performing a citation search of all the originally included studies through Google Scholar.

Search results were uploaded to EPPI-Reviewer 4 (Evidence for Policy and Practice Information and Co-ordinating Centre, University of London, London, UK) for title and abstract screening. Screening was performed by a team of three reviewers. Individual records were screened by one team member, with a 10% sample being checked by a second reviewer for accuracy and consistency.

To be included in the systematic review, studies had to meet the following inclusion criteria:

Population – Children and young adults (aged up to 18) and/or other service users (family members or other carers) in health and social care settings.

Intervention - Interventions (other than training and awareness raising) aimed at health and social care professionals looking after children and young adults (aged up to 18) in health and social care settings and aimed at improving recognition of children at risk of physical, sexual or emotional abuse or neglect. Eligible interventions included, but were not limited to, new service models and job roles, and initiatives to improve the use of routinely collected data. Interventions that had training as the exclusive or main component were excluded.

Outcomes – Improved knowledge and understanding of (risk factors for) abuse among practitioners. Improved rates of early identification of possible abuse. Qualitative outcomes, including feasibility and acceptability of interventions to professionals and young people. Any reported data on costs, resource use or cost-effectiveness. Other outcomes of interest included explanatory factors for why interventions are thought to work and findings of relevant cultural/organisational studies.

Comparator – no intervention; comparisons with practice as usual were eligible for inclusion.

Study design – we included primary literature from the UK (any design either quantitative or qualitative, including local service evaluations that met the eligibility criteria and contained relevant empirical data).

Other limitations – For inclusion publications were required to be written in the English language and published since 2004 (the date of the Children Act).

Full papers were reviewed for all references that appeared to meet the inclusion criteria. Screening of full texts followed a similar process to that for title and abstract screening. Queries were resolved by discussion. Systematic and non-systematic reviews were coded for separate analysis.

Data extraction (coding) was completed in EPPI-Reviewer 4. Data from included studies comprised study design, intervention/initiative (where applicable), population/setting, results and key limitations. We extracted details from policy/guidance documents using a separate purpose-designed form. Data extracted were based in part on a safeguarding checklist produced by the National Society for the Prevention of Cruelty to Children ( https://learning.nspcc.org.uk/safeguarding-checklist (accessed 4 March 2021).

We coded all studies that were suitable for quality (risk of bias) assessment, based on use of a recognised design and a corresponding assessment tool. Quality assessments were performed using tools developed by the Joanna Briggs Institute, the CASP tool for qualitative studies and AMSTAR for systematic reviews. Quality assessment was performed by a single reviewer, with a 10% sample checked for accuracy and consistency. Assessment of the overall strength (quality and relevance) of evidence for each research question was incorporated within an accompanying narrative synthesis. The synthesis was descriptive and studies were grouped by intervention type (service development, use of routinely collected data and other) and setting (health care, social care or both).

For studies reporting sufficient details, we used the 5-item TIDieR-Lite checklist (By Whom, What, Where, To What Intensity, How Often) to map intervention components. This modification of the TIDieR framework had been used by the authors in a previous review [ 2 ].

Patient and public involvement

The Sheffield Evidence Synthesis Centre public advisory group was involved throughout the project. In December 2019, the group discussed:

which groups of health/social care professionals need to be aware of safeguarding children/young people?

what might be the barriers to awareness and appropriate action?

Group members identified diverse health (particularly allied health) and care professionals in need of safeguarding awareness beyond those covered by studies included in this review. The Group found it challenging to identify barriers, raising the possibility that this question might be more usefully targeted for consultation with professionals.

Results of literature search

The PRISMA flow diagram for the review is presented in Fig.  1 .

PRISMA flow diagram

Study characteristics and risk of bias

Characteristics of the included studies are summarised in Tables  1 , 2 , 3 and 4 . The majority of studies included in the current analysis used a cross-sectional design, while others were audits or surveys that were not designed as formal research studies. Only one study (two publications) [ 26 , 27 ] met our criteria for quality assessment. The study lacked a control group and responses to most assessment questions were ‘no’ or unclear, suggesting a high risk of bias (see Appendix 4 of the full report [ 1 ]).

Service development

The 31 included papers in this group were divided almost equally between health settings (11 papers), social care settings (10) and services integrated across both systems (10). Table  1 summarises papers dealing primarily with the NHS. Two included papers provide overviews of safeguarding in the NHS [ 7 ] and of therapeutic services for children who have experienced sexual abuse [ 3 ]. Both studies identified areas for improvement in awareness and safeguarding practice. Similarly, interviews with child protection nurses identified pressures in primary care that could reduce the ability of the health system to respond to child protection needs [ 4 ]. These studies were published in 2009 to 2012 so may not fully reflect the current situation. Tompsett et al. noted the existence of conflicts around involvement of GPs in child protection and safeguarding, some GPs seeing their role as primarily referral to social services while other stakeholders anticipated a higher degree of involvement [ 39 ].

Other papers report specific service development initiatives within primary care or hospital settings. Studies show that specialist health visitors [ 6 ] and dentists performing a comprehensive oral assessment [ 12 ] have the potential to contribute to improved awareness and assessment of child protection needs. In the hospital setting, a nurse child protection co-ordinator improved the referral process [ 5 ] and an outpatient clinic was established to meet the needs of children with suspected female genital mutilation (FGM) [ 8 , 9 ]. Finally, Kaye et al. developed a process for increasing awareness of risks associated with parental mental illness and ensuring that children of those presenting with mental illness are assessed for risk and safeguarded as necessary [ 11 ].

Ten papers (Table  2 ) focused on initiatives classified as social care (mainly services provided by local authorities or the voluntary sector, rather than the NHS). These papers described and/or evaluated methods [ 13 , 14 , 15 ], service models [ 17 , 22 ] and initiatives aimed at safeguarding specific groups such as trafficked children or those in local authority care [ 16 , 18 , 19 , 20 , 21 ]. The papers mainly reported cross-sectional evaluations based on qualitative interviews and/or document reviews. Some initiatives appeared promising [ 14 , 17 , 22 ] but problems were also identified, particularly difficulties across agencies with different priorities and world views when working together to improve safeguarding [ 16 , 20 ].

The ten papers that spanned health and social care (Table  3 ) reflected similar themes to those from social care. Promising initiatives to promote awareness included local authority partnership child sexual exploitation services (though other related services worked less well) [ 30 ]; joint protocols between adult mental health and children’s social services [ 32 ]; and a paediatric dentistry liaison service [ 31 ] based in a hospital but working between community and social services. In contrast to these positive local examples, studies with a national focus often identified deficiencies in the availability of services and/or training [ 24 , 29 ] or variations in the delivery of a specific intervention [ 23 ]. In one study, integrated working between health and social services was hampered by a lack of compatible record systems [ 28 ].

As before, most evaluations in this group were cross-sectional and based on interviews or survey responses rather than numerical data. One exception used long-term data from 1989 onwards to analyse trends in assessment and referral [ 26 ]. Only one group of authors included a comparison group, within a study that included routine data on a small number of patients [ 31 ].

Use of data

Six included studies (Table  4 ) documented initiatives involving use of routine data to improve awareness of safeguarding at the system level in health and/or social care [ 33 , 35 , 36 , 37 ]. Studies in primary care settings (a sexual health clinic [ 35 ] and several general practices [ 36 ]) suggested that it is possible to improve data collection in clinical practice to improve identification of possible safeguarding issues. A community dental service developed and evaluated a pathway to follow up missed appointments and share information with other professionals if necessary [ 34 ]. The pathway supported early and consistent sharing of information and improved dental team confidence. The two studies conducted in hospitals revealed variation in the handling of missed appointments [ 33 ] and in procedures for referring young children with fractures for paediatric assessment [ 37 ]. Although a limited sample, these studies suggest that reduction in variation between hospitals may represent one way of improving use of data that are collected routinely and thus improving outcomes for children experiencing or at risk of abuse.

The most recent study investigated sharing of data between health visitors and emergency department (ED) staff in relation to children under 5 years old attending with burns [ 38 ]. This prospective multicentre study found that 59% of children with burns lived in families with risk factors for maltreatment. Many risk factors noted on health visitors’ records were not recorded by ED staff despite being part of a standard form. The study authors concluded that sharing of records between community (health visitor) and acute (ED) services would improve awareness and assessment of safeguarding risks.

Other interventions

Only two studies reported other initiatives [ 40 , 41 ]. One qualitative study explored reporting of possible abuse by primary healthcare professionals [ 40 ]. The other study looked at how cases of child neglect are managed over time and concluded that a new approach is needed, involving collection of evidence that could be used in care proceedings if necessary [ 41 ].

• Component analysis

Ten included studies were classified as suitable for component analysis using the TiDIER-Lite checklist: comprising seven studies (eight papers) on service development and three studies on use of data.

The eight service development interventions suitable for component analysis (Appendix 1, Supplementary Table  1 ) comprised new roles [ 5 , 22 , 28 , 31 ], a new service for children with actual or suspected FGM [ 9 , 10 ]; and two initiatives aimed at safeguarding specific groups (migrant/trafficked children [ 19 ] and children attending the ED with fractures [ 11 ]). The new roles all involved liaison between health and social care and are staffed by nurses/health visitors. The TIDieR-Lite framework makes it possible to compare similar roles. For example, a liaison role based in an acute hospital [ 5 ] requires higher levels of staffing than a similar post based in a dental hospital [ 22 ]. All the interventions in this group are relatively high intensity, reflecting the complex needs of the groups being served, and the frequency of intervention is flexible depending on need. For example, Bajaj et al. reported that monthly meetings are held to discuss child protection concerns but a co-ordinator is available for advice on a daily basis [ 5 ].

These findings, though based on a small number of studies, suggest that different services may have identified similar needs for service models that help different agencies to work together in safeguarding by promoting joint working and information sharing.

Component analysis was possible for five studies of initiatives involving better use of data (Appendix 1, Supplementary Table  2 ). All the initiatives involved data collected in clinical settings and hence required processes to be as simple as possible without sacrificing rigour. Three of the studies reported on development and piloting of the data collection instrument [ 34 , 35 , 36 ], which would be important when introducing a new procedure into routine clinical practice.

Evidence of effectiveness, feasibility and acceptability

The nature of the included studies made it difficult to establish evidence of the interventions for raising awareness, let alone longer-term effects on actions to prevent abuse. Interventions were identified as ‘promising’ based mainly on interviews with or surveys of professionals who delivered and/or received them. Interventions supported by relatively stronger evidence from before/after or time series studies were a liaison and discharge co-ordinator role [ 5 ]; an ED risk assessment protocol [ 11 ]; child protection conferences [ 13 ]; and improved data coding in general practice [ 36 ]. A case series study of a paediatric liaison nurse service had a comparison group but the main finding concerned its effectiveness in promoting interdisciplinary working [ 31 ].

Evidence on feasibility largely identified barriers to the implementation of new interventions in safeguarding. Barriers mainly involved existing pressure on services [ 4 ] and difficulties in integrated working between different services and/or professional groups [ 28 , 39 ]. Cost was rarely identified as a barrier because very few studies reported on cost or resource implications. Acceptability was also rarely highlighted but one study reported that some GPs saw their role in safeguarding as limited to referral to social services and had concerns about more active involvement [ 39 ].

Main findings

This review sought to establish what interventions (other than those based on provision of training or information) have been evaluated for promoting awareness and supporting prevention of harm in safeguarding children and young people in UK health and social care settings. A further objective was to identify evidence on outcomes related to effectiveness, feasibility and acceptability of the interventions. We defined awareness broadly to include the facility of the wider system, not just individuals, to process relevant information and respond appropriately. The majority of included studies covered development of services (including those spanning health and social care), while just four studies explored more effective use of routinely collected data to support safeguarding.

We identified several promising service development initiatives, particularly involving new roles or processes to promote effective working between health and social care [ 22 , 31 , 32 ]. At the same time, interagency working was frequently identified as a challenge to the successful implementation of initiatives [ 16 , 20 ].

Only four studies explored initiatives involving use of routine data to improve awareness of potential safeguarding risks, for example identifying children who regularly miss scheduled health appointments [ 33 ]. Improved recording or coding of data [ 36 ] and reduction of variation between institutions [ 37 ] appear to be promising approaches.

Strengths and limitations

A key strength of this review is its focus on interventions and initiatives beyond staff training to raise awareness of safeguarding issues. It includes interventions in health, social care and integrated settings, reflecting the diverse services where safeguarding awareness is required and the diverse professional groups who are involved.

We included studies published between 2004 (date of important legislation affecting safeguarding) and 2020. The included studies demonstrate how the evidence base has evolved over time and allow identification of perennial themes. One limitation of this approach is that older papers are likely to be less relevant to current practice. Our inclusion criteria were also broad, with no restrictions on study design and both quantitative and qualitative studies were included. This allowed us to identify potentially promising interventions that might otherwise have been overlooked or neglected. On the other hand, the weak design of many of the included studies means that further evaluation would be required before considering the interventions for wider implementation.

The review was conducted rapidly by a small team. Methodological strengths include a thorough search, including citation searching, and use of the TIDieR-Lite framework to characterise interventions. Study quality was assessed using standard tools when study design and reporting made this possible. Unfortunately, quality assessment was only possible for one of the included studies (two publications) [ 26 , 27 ] and the results suggested a high risk of bias.

We used several methods to abbreviate the review process, as appropriate for a rapid mapping review of the relevant literature. Verification of items for inclusion/exclusion was limited to a 10% sample and undertaken retrospectively. Inclusion of items was informally checked by team discussion of uncertainties during later stages of the review. A further methodological short-cut was the use of one checklist (the JBI checklist for quasi-experimental studies) to cover several different study designs. This was not a significant limitation for our study given that so few included studies were suitable for formal quality assessment.

Limitations of the evidence base included lack of long-term follow-up, control groups and data on service-relevant outcomes. This may partly reflect different research cultures between healthcare and social care research. None of the included studies reported on costs or value for money. Limitations in reporting constrained our ability to draw conclusions from the component analysis. There was a particular lack of studies on safeguarding in the transition from adolescence to adulthood.

Relationship to previous research

We believe this to be the first synthesis of evidence on service development and related interventions aimed at increasing safeguarding awareness in health and social care. Our work also differs from most previous reviews in that it covers the whole range of health and social care settings. The full technical report [ 1 ] includes a review of reviews of international evidence on this topic, containing 27 relevant reviews. Many of the reviews deal with safeguarding awareness in specific roles (e.g. school nurse, health visitor, paramedic or GP) or settings (e.g. five reviews covered safeguarding in EDs). Other than these groups, few topics had a significant volume of review-level evidence.

This mapping review is also distinctive in its focus on evidence from the UK. Most research performed in UK settings is of relatively low quality in terms of risk of bias. Higher-level overviews and policy documents produced by government departments, NHS bodies and other stakeholders were included in the full report but few of them included consideration of service development issues [ 1 ]. The limited evidence base around safeguarding girls and young women from female genital mutilation was identified as a research priority by the National Institute for Health and Care Excellence (NICE) and was one of the factors underlying the commissioning of this research [ 1 ]. This paper extends the information available to decision-makers through the use of systematic searching, quality assessment and component analysis of interventions and initiatives. Despite its UK focus, it may be of interest to decision-makers in other health and social care systems, particularly in the context of efforts to integrate health and social care.

Implications for service delivery and research

The findings of this review imply that health and social care services wishing to improve awareness of child safeguarding issues may benefit from looking beyond the most apparent measure of high-quality training provision. While safeguarding is relevant to all staff, roles vary between those who are a first point of contact for identifying safeguarding concerns (e.g. A&E staff, dentists), those for whom safeguarding forms a major background to their daily work (e.g. school nurses, health visitors) and those who provide specialist support within a safeguarding pathway. Promising service development initiatives include liaison nurses [ 5 , 31 ], assessment clinics [ 10 ], secondment [ 22 ], joint protocols [ 32 ], and a ‘hub and spoke’ model [ 17 ]. We identified few studies on the use of data but this approach appears promising and analysis of routinely collected data is unlikely to involve significant costs. However, service providers need to consider the legal and ethical acceptability of data recording and ensure protection of confidentiality for service users.

In terms of research, there is a clear need to continue and extend mapping and evaluation of service initiatives beyond previously reported work [ 42 ]. Longer-term studies with outcomes relevant to service users are needed. Research intended to support effective safeguarding is likely to require active inter-agency collaboration. Research to optimise the use of routine data to identify children at risk of abuse could involve the development of innovative analytical tools. However, improvements in the quality and consistency of data coding would also be valuable. Safeguarding of older adolescents has also been identified as a research need.

Although not investigated in our review, involvement of children/young people and families/carers is likely to be essential for successful design and implementation of safeguarding interventions. Evaluations should also investigate costs/resource use and barriers to successful implementation at different levels of the health and social care system.

Availability of data and materials

Any additional data not included in this report and its supplementary files are available on request. All queries should be submitted to the corresponding author.

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Acknowledgements

We thank the members of the Sheffield Evidence Synthesis Centre Public Advisory Group for their contributions.

This report presents independent research funded by the National Institute for Health Research (NIHR) Health Services & Delivery Research programme (project number HSDR16/47/17). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HS&DR programme or the Department of Health and Social Care.

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DC contributed to the project co-ordination, study selection, data extraction and quality assessment and wrote the first draft of the paper. AC contributed to the information retrieval, study selection, data extraction and quality assessment. AB contributed to the information retrieval, study selection and report writing. All authors commented on drafts of the paper and approved the final version.

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Chambers, D., Cantrell, A. & Booth, A. Recognition of risk and prevention in safeguarding of children and young people: a mapping review and component analysis of service development interventions aimed at health and social care professionals. BMC Health Serv Res 21 , 1241 (2021). https://doi.org/10.1186/s12913-021-07257-8

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Published : 17 November 2021

DOI : https://doi.org/10.1186/s12913-021-07257-8

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Safeguarding the Vulnerable Adults from Abuse Essay Sample

According to Care Act 2014, safeguarding adults is defined as protecting an adult’s rights to live in safety, free from abuse, neglect or harm in the society. Safeguarding in health and social care relates to the measures, actions and practices taken to protect vulnerable adults by promoting their overall well being.

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Here in this essay sample we are going to describe some factors that may contribute to an individual being more vulnerable to abuse, how does mental health make you vulnerable to abuse and how can communication difficulties lead to abuse. With the principles of safeguarding, we will talk about the types of abuse that play major role in the safeguarding adults based on their abuse.

Now, let’s take a look at the risk factors for abuse that contribute to adult’s vulnerability.

Risk Factors that increases the adult’s vulnerability to abuse and harm

• Lack of Mental Capacity:

Lack of mental capacity can be the most important factor of vulnerable adult being abused. It is mostly found in older people or someone with mental disability or illness. The age and illness are the most common factors that increase the vulnerability of the adults. Due to these mental problems and issues, many adults feel unsafe in the society and are unable to protect themselves while they are subjected to abuse or neglect.

The risk of abuse due to lack of mental clarity can be greater in the following conditions:

• A person with cognitive impairment
• A person who is suffering from depression
• A person with alcohol abuse
• A person poor relationships in the family
• A person who is physically or verbally torched
• A person with behavioural problems

Therefore, Safeguarding laws and policies of the government protects these mentally vulnerable people. Safeguarding in the health and social care supports the prevention of older people or vulnerable adults from abuse, harm or neglect. Older people and vulnerable adults are the most sensitive people in the society and are at great risk of abuse by their families, friends or even care takers in care homes.  Thus, healthy people who are contact with them should have a responsibility to raise their voice against the abuse and take actions as soon as possible before it happens.

•  Communication Difficulties:

Many vulnerable adults are mistreated due to language delays in their speech which creates unusual interaction. This communication difficulties leads to abuse of the mentally disabled vulnerable adults and children. Many children and adults with impairment have been identified as the serious cases of abuse and neglect just. The individuals who came from different backgrounds and social class are also need to face abuse and neglect because of the lack of language knowledge among the friends and society. Communication problems are one of the most obvious causes of neglect.

Thus, safeguarding the vulnerable adults from abuse is the initiative to protect those who are more at the risk of abuse due to lack of proper communication.  Studies have shown that disabled adults are more likely to experience abuse than their peers. Therefore, safeguarding them is the major responsibility under the laws of health and social care services.

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•  Low Self Esteem

In many cases of abuse of vulnerable adults, the low self esteem has been one of the main causes. The low self esteem of a person can be due to many reasons and factors and can be very serious issue of vulnerable person abuse under the domestic violence. If the victims of the abuse have low self esteem then it can cause them to stay under the depressive and abusive state of relationships.

Thus, safeguarding in the health and social care protects people with low self esteem from any kind of abuse and harm.

•  Experience of abuse:

Past experiences of the abuse can also be the reason that increases the vulnerability of the person to abuse and harm.

•  The physical dependence on others:

Children, adults and old person who have physical dependence on others are most at the risk of abuse in the society.  The physical dependence can be a physical condition or disorder in which a person uses tolerance forming drug which causes unpleasant physical symptoms results them to physically unable. Thus, being dependent on others for personal care and activities in the day to day life increases the risk of abuse and harm by physically able person.

These are the main factors that increase the vulnerability of the adults to abuse and harm. Now, let’s take a look at the reports that have noticed some factors of serious cases.

Some of the factors featured in reports from serious case are

• Lack of access to health and social services.
• Ineffective working partnership between services
• Social isolation and exclusion
• Stigma and discrimination
• Vulnerable People who are receiving care and support but having families that does not involve in their care.
• Fail in identifying the signs of abuse
• Poor staff recruitment processes

Types of Abuse in the society

• Physical abuse: Any physical violence, mistreatment, misuse of vulnerable person’s medication can be related to physical abuse.
• Psychological abuse : It includes the emotional abuse of the vulnerable adults who are threatened, humiliated, blamed or harassed by verbal or communication abuse.
• Financial abuse : This is abuse comprises of financial related causes of fraud, exploitation, black mailing under pressure of a person for property or financial transactions or any kind of misuse of any type of possessions or benefits of the person.
• Neglect and acts of omission : It includes ignore the person care, treatment, support in the needs of special medical or physical disability which creates failure in the access of adequate health and social care services.
• Discriminatory abuse : It based on the inequality such as racism, sexism or abuse based on the person disability or backgrounds.
• Modern slavery : This kind of abuse is mostly related to the slavery of the person and cases of human trafficking.
• Organisational abuse : As the word suggests that this abuse is related to neglect or harm of the person at workplace, institution, care homes, hospitals etc due to poor care practices.

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Principles of Safeguarding

The principles of Safeguarding in health and social care to create the key aspects of understanding how safeguarding works in the health and social care and reminds the human rights to every individual. The core principles of safeguarding are listed below:

Empowerment – This principle empower the vulnerable adults by aware them about their rights to make their own choices by informed consent.

Prevention – Safeguarding focuses on preventing the abuse, harm or neglect before it happens and support, care and represent those who are in greatest needs.

Proportionality – Safeguarding measures must be taken in proportionality of the risk. The proportionate and less intrusive response must be appropriate for the risk appeared.

Protection – Protection ensures that those who are in need must be provided with adequate care services to protect them physically, mentally and emotionally.

Partnership – Communities including businesses, local authorities and organization have their role in preventing, detecting and reporting neglect, abuse and harm of vulnerable adults.

Accountability – There must be responsibility and transparency of processes to fulfil accountability of the health and social care services in safeguarding.

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Safeguarding and Protection of Vulnerable Adults Essay Sample

Introduction of topic.

1. Understand the legislation, regulations and policies that underpin the protection of vulnerable adults 1.1 Analyse the difference between the concept of safeguarding and the concept of protection in relation to vulnerable adults

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The concepts of safeguarding of vulnerable adults is that is about the protection from maltreatment, preventing the impairment of a person health and making sure that vulnerable adults are living in suitable environments that are consistent with the provision of safe and effective care. This ensures the safety of a person. Safeguarding is about how to keep a person safe from the above and look at how it can prevent vulnerable adults or children suffering abuse by ensuring that service providers report these incidents. The protection of adults plays an important part in the safeguarding and promotion of their health and well-being. Protection of vulnerable adults is critical and crucial as part of the wider work to safeguarding.

An emphasis of safeguarding came from the Joint Chief Inspectors Report on Arrangements to Safeguard Children (2002) and states that any agencies working with children have a duty to minimise the risks of harm to their welfare and take any action if there were any cause of concern. An emphasis was also made on about partnership working and this came in the formation of Local Safeguarding Boards (LSBs). There have been a similar emphasis on the protection of vulnerable adults as prior to 2000 local authorities did not have a legal duty to investigate any reports of abuse against an adult over the age of 18 who was deemed vulnerable in Wales. In 2000 the Welsh Government set out the In Safe Hands document that tells Local Authorities Social Services departments their duties in the protection of vulnerable adults. These duties are very similar to the safeguarding of children where they should take a partnership approach in the prevention and reporting of abuse and meet the training needs of staff who working with this client group.

1.2 Evaluate the impact of policy developments on approaches to safeguarding vulnerable adults in own service setting

Within my own setting, the impact of policy developments on approaches to safeguarding vulnerable adults can be extensive. The first is that the policies first set out what a vulnerable adult is and in my setting all the adults are classed as vulnerable because of their age, that most of them cannot make their own decisions because they do not have the mental capacity to do so and thirdly because of the mental conditions they have, such as Dementia, Alzheimer’s Disease or Learning Difficulties. Also because the adults are not in their own environment they are vulnerable because they may not feel comfortable due to being in unfamiliar surroundings to what they are used too.

Within my own setting we have to ensure that we have the relevant and comprehensive policy in place and that it is followed by all staff in terms of safeguarding and protecting vulnerable adults. The policy must also be comprehensive enough that it covers staff who may be at risk from false claims being made against them. Also there has to be a policy in place where staff can feel confident that they can report any issue anonymously to their line manager. Each of these policies must also give a comprehensive reporting procedure as well.

The impact of the policy developments make it that it is the responsibility of statutory bodies, service providers and employees to protect vulnerable adults from abuse. It also makes it a requirement that all staff who apply for a job in the Health & Social Sector are suitable to work there and complete a DBS or CRB check that is either at the cost of the employer or potential employee. Another impact the policy developments have is that all staff have to be trained in safeguarding and protecting vulnerable adults and complete this as part of their induction training as set out by the CSSIW. Within Cardiff, staff undertake the POVA Level 2 training that explores this is so that they are able to be vigilant in spotting the signs of abuse and know what happens when it is reported to the local POVA team.

One of the biggest impacts policy development has in regards to the safeguarding and protection of vulnerable adults is that staff have to be vigilant about the way they act with residents. Staff are trained to a person-centred approach and if a resident is happy being called ‘love’, this can be perceived as abuse by someone else. Staff also have to be vigilant about following the correct procedures when it comes to moving and handling and how they care for a resident as if the policies and procedures are not followed then their actions can be reported as abuse. So these policy developments make staff constantly think about their own judgements and actions constantly.

Another impact that policy development has is it the POVA policy and any other policies that assist in safeguarding vulnerable adults is reviewed on a regular basis. In my setting these policies are usually reviewed on a 6 monthly or yearly basis. This is so that any developments nationally are implemented into the reviewed policy.

1.3 Explain the legislative framework for safeguarding vulnerable adults

There are many pieces of legislation out there that talk about safeguarding vulnerable adults. Prior to 2000 there was no such piece of legislation that gave responsibility for statutory services, such as Local Authority Social Services to investigate forms of abuse, but there were pieces of legislation that supported the protection of vulnerable adults to come forward. The Crime and Disorder Act (1998) acted as first-hand support for the protection of vulnerable adults and is the basis for the formation of partnerships between the LA’s and the police. The Human Rights Act (1998) explains the rights and freedom of individuals and the Disability Act (1995) sets out the protection for adults with disabilities. All these pieces of legislation played a part in the protection of vulnerable adults.

In 2000, the UK government set out to look at the agenda of Protection of Vulnerable Adults and gave out guidance to all LA’s called No secrets: Guidance on developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse. This laid out the responsibilities for LA’s to develop and organise a policy to protect vulnerable adults from abuse through a multi-agency approach, similar to the Child Protection Agenda. This guidance also gave LA’s the responsibility of setting up local multi-agency teams and set up the correct reporting procedures for any cause of concern to be reported. The guidance also set out that these local teams ensured that service providers had the relevant protection of vulnerable of adults’ policies and procedures in place and ensure that staff who work with vulnerable adults were trained to identify any signs or symptoms of abuse.

At the same time the Care Standards Act (2000) was implemented and set out the standards that all Social Care Services have to follow. It made the protection of vulnerable adults a priority and in Section 7 it stated that the provision of protecting vulnerable adults should be made. From this in 2004, the Protection of Vulnerable Adults (POVA) scheme was set up (Department of Health, 2009). Its intention was to not allow any individual work with vulnerable adults in the care sector if they have neglected, harmed or abused a vulnerable person.

The Mental Capacity Act (2005) was introduced to provide a statutory framework to empower and protect vulnerable people who are not able to make their own decisions. Within the Act there are 5 principles and these are: 1. a presumption of capacity – every adult has the right to make his or her own decisions and must be assumed to have capacity to do so unless it is proved otherwise; 2. the right for individuals to be supported to make their own decisions – people must be given all appropriate help before anyone concludes that they cannot make their own decisions; 3. individuals must retain the right to make what might be seen as eccentric or unwise decisions; 4. best interests – anything done for or on behalf of people without capacity must be in their best interests; and 5. least restrictive intervention – anything done for or on behalf of people without capacity should be the least restrictive of their basic rights and freedoms.

Another part of this act that is about the protection of vulnerable adults is the Deprivation of Liberties Safeguard (DoLs). They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. The safeguards should ensure that a care home, hospital or supported living arrangement only deprives someone of their liberty in a safe and correct way, and that this is only done when it is in the best interests of the person and there is no other way to look after them. A recent court decision in March 2014 has provided a definition of what is meant by the term ‘deprivation of liberty’. A deprivation of liberty occurs when ‘the person is under continuous supervision and control and is not free to leave, and the person lacks capacity to consent to these arrangements’. So this application for DoLs is necessary for all EMI residential care homes as residents lack capacity to leave the home and are lacking the understanding of identifying risks if left unattended.

Another major piece of legislative framework in regards to the protection of vulnerable adults was the introduction of the Criminal Record Bureau Checks now called the Disclosure and Barring Service. POVA teams needed a list of health and social care employees who have had a history of abusing vulnerable adults. These checks were implemented so that health and social care service providers were able to see if a potential employee was suitable for employment within their establishments. If employers are unable to wait for the CRB to come back then they can also use the ISA Adult First Check (previously known as the POVA list) that gives them access to a list that tells them if a potential employee is unsuitable to work with vulnerable adults.

1.4 Evaluate how serious case reviews or inquiries have influenced quality assurance, regulation and inspection relating to the safeguarding of vulnerable adults Case reviews or inquires have influenced quality assurance, regulation and inspection relating to the safeguarding of vulnerable adults because they have been used to introduce the right so that complaints procedures have to be implemented within health and social care settings. Within the National Minimum Standards (NMS) 16.1 states that: The registered person ensures that there is a simple, clear and accessible complaints procedure which includes the stages and timescales for the process, and that complaints are dealt with promptly and effectively And the outcome of that standard is so that the service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon.

The registered person needs to make the complaints procedure available to everyone and promote it in the service user brochure, the homes statement of purpose and is promoted throughout staff meetings, notice boards and resident meetings. It also sets out that the registered person has to respond to a complaint within 28 day (NMS 16.2). Registered managers also have to keep a written record of all complaints and copies of investigations (NMS 16.3)

Case reviews and inquiries can also influence quality assurance, regulation and inspection relating to the safeguarding of vulnerable adults because they can be used to establish best practice to prevent/reduce the risk of a similar incident happening again. They can also be used as training materials for staff to improve their practice and implement policies and procedures within a setting.

1.5 Explain the protocols and referral procedures when harm or abuse is alleged or suspected Within the National Minimum Standards for Care Homes, Standard 18’s outcome is that Service Users are protect from abuse. This standard sets out that the registered manager or person ensures that the service users are protected and safeguarded from all forms of abuse, be it from staff members, family or strangers. It also sets out that policies regarding safeguarding vulnerable adults are in place and adhered too (NMS 18.1). Registered managers or persons also to make certain that there are measures in position to respond to the suspicion of neglect and abuse (NMS 18.2) a

nd that they are reported immediately. In 2005, the Safeguarding

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My baby boomer parents gave me great financial advice. They taught me to budget and helped me open a checking account at 13.

• My parents gave me good financial advice while I was growing up.
• They helped shape how I think about and spend — or save — money today. 
• As baby boomers they had a different perspective than the parents of many of my other Gen Z friends.

As a Gen Zer in my early 20s, I'm starting my career and thinking about my future, and money is an important part of that. Many factors have influenced how I view and handle money, like my education, socioeconomic status, and being raised by baby boomers who are first- and second-generation immigrants. I've also realized that being raised by older parents has given me a different perspective than that of many of my peers.

There's so much personal finance advice out there, but as I settle into adult life, I rely more and more on the fundamentals my parents taught me. Though the economy has changed since they were young, my baby boomer parents' lessons of hard work and the importance of saving still ring true for me today living as an independent young adult.

They encouraged me to work hard

One of the most critical values my parents encouraged — and still do today — is to work hard. I started babysitting as my first job as soon as I could, went on to work part-time jobs in high school, and eventually got full-time jobs during my summer breaks.

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Aside from birthday and holiday gifts, the money I saved or spent was money that I worked for. When I went to university, my parents had saved for my tuition (which lasted me a while, thanks to being an only child ) and I also applied for scholarships at my school.

When I first started living on my own at 18, my parents would help me if I was ever in a pinch, but most of the money to pay rent and bills was that which I saved. Nothing was ever handed to me. This encouragement to learn how to manage what I earn and work hard is a value that extends not just to the number in my bank account but to my work ethic and career.

They taught me to save what I earned

It's undisputed that saving money is smart, and it's true that you can find this particular financial advice anywhere. But this is another one of the key money lessons my baby boomer parents taught me. It can't be overstated how easy it is to spend these days any time you walk out your door, and this is a fundamental practice, regardless of how obvious it may be.

Ever since I can remember, when I received money as a kid, my parents would encourage me to save it. I even saved up enough and bought our family dog with my own money when I was eight. This practice of saving and reflecting before spending shaped my perception of money as something valuable, finite, and worth safeguarding.

I learned from watching their relationship with money

Observing my parents' relationship with money and their reflectiveness when it came to spending throughout my childhood has also shaped my consumption patterns. For example, eating out at restaurants was a rarity growing up, an added expense saved for special occasions or travel — including fast food (though that may not have been entirely about money). It wasn't until I moved out that I realized how normalized dining out or picking up food is. But often, for my parents, it came down to the good old excuse, "We have this at home."

I also began formally managing my personal finances at a young age. I opened my first checking account when I was 13. I distinctly remember going to the branch with my mom and getting my first debit card. Going through this banking process at a young age gave me the independence to monitor how I was handling my money and learn how to navigate the basics of financial literacy as a teen.

Being economical often gets a bad rap, but I think it's one of the most valuable money habits my baby boomer parents instilled in me, especially given the cost of living today. Now that I'm older and have more expenses, my experience and relationship with money influenced by my baby boomer parents have hopefully set me up for success.

Watch: Why childcare has become so unaffordable

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