Safeguarding adults - Wales

The Care Act (2014) sets out the framework for local authorities to use (alongside health and social services)to protect adults considered at risk from abuse or neglect.Adult safeguarding involves protecting adults identified as having care and support needs and keeping themsafe from abuse or neglect when they find themselves unable to protect themselves. Those adults who find themselves in vulnerable circumstances can now expect that local services will work together to take steps to protect them, always keeping their well being in mind.

What constitutes abuse or neglect?

The Department of Health’s Care and Support Statutory Guidance was published in October 2014. Chapter 14 sets out what is meant by abuse or neglect, which can include:

• Physical abuse
• Domestic violence
• Sexual abuse
• Psychological abuse
• Financial or material abuse
• Modern slavery
• Discriminatory abuse
• Organisational abuse
• Neglect and acts of omission
• Self neglect.

The role of the healthcare professional

Healthcare professionals may be the first to be informed about safeguarding concerns, either directly by the patient, or by their relatives or carers. It can be challenging to determine when action is needed, and when to share information with others.

• All staff should be familiar with their internal safeguarding procedures for raising concerns. The police and local authority have safeguarding leads, and advice can be sought without revealing a patient’s personal details if there are doubts over whether a safeguarding referral is necessary.

Your duty of care

A duty of care includes respecting a patient’s wishes and protecting and respecting their rights. You may find it difficult to accept a patient’s choice if this involves them declining services or treatment, or acting against advice on how to manage their safety.

The GMC’s Consent guidance states that “You must respect a patient’s decision to refuse an investigation or treatment, even if you think their decision is wrong or irrational. You should explain your concerns clearly to the patient and outline the possible consequences of their decision.”

Where a patient’s safety is at risk, their right to make choices about their own safety has to be balanced with the rights of others to be safe. The GMC guidance Confidentiality sets out when information can be shared with others without a patient’s consent.

If a patient does not want information to be shared regarding their safety then it is important to consider whether there are risks to children, or other adults within the home, which would outweigh the patient’s request for information to remain confidential. If there is a risk of serious harm to others then information can be shared without consent, if there is a public interest in sharing the information to prevent a serious crime or to protect others from serious harm.

When considering disclosure to protect the patient the GMC guidance within Confidentiality states: “You should usually abide by a competent adult patient’s refusal to consent to disclosure, even if their decision leaves them,but nobody else, at risk of serious harm.”

Professionals must also be aware of the Mental Capacity Act (2005) when working with individuals who lack capacity to make decisions, ensuring they act in keeping with the principles set out in this Act.

What to do if you suspect abuse or neglect

Early sharing of any safeguarding concerns is encouraged, as the information held by an individual may only become significant in the context of concerns from other agencies. Follow your internal procedures for raising safeguarding concerns.

When sharing information:

• Try to obtain consent to share any information (unless this will put the patient or another person at greater risk of harm or is not practicable)
• Only share information without consent if it is proportionate to the risk involved
• Only share relevant information with those who need to know and share the information in a timely fashion
• Document the information that has been shared and the reasons for sharing
• Be aware of the Data Protection Act (1998) and the eight data protection principles.

Safeguarding Adults Boards

The Care Act (2014) requires local authorities to set up a Safeguarding Adults Board (SAB) in their area. The SAB must include the local authority, the NHS and the police and must meet regularly to discuss and act on any local safeguarding concerns. The Care Act (2014) makes clear that organisations and individuals must share relevant information with Safeguarding Adults Boards if requested. The information requested must be accessible to the person from whom it is requested and be proportionate to the needs of those for whom it is being provided.

Further information

• The Care Act (2014)
• Department of Health: Care and Support Statutory Guidance Issued under the Care Act 2014. October 2014
• Social Care Institute for Excellence: The Care Act: Safeguarding Adults
• Department of Health: Factsheet 7: The Care Act –
  Protecting adults from abuse or neglect Issued under the Care Act 2014