What is adult safeguarding?
Adult safeguarding means protecting an adult's right to live safely, free from abuse and neglect, while respecting their views, wishes and beliefs. It is not about taking control of people's lives. Adults with capacity can make choices others disagree with.
Every healthcare professional has a safeguarding role. You may be the only professional who sees the person alone, or the one who notices something does not fit: a pharmacist seeing early requests for a relative's opioids, a physiotherapist noticing bruising on a home visit, a paramedic seeing the state of a home, a nurse hearing a disclosure during personal care.
In England, the Care Act 2014 put adult safeguarding into law. Under section 42, the local authority must make enquiries, or ask others to, where it has reasonable cause to suspect that an adult has care and support needs, is experiencing or at risk of abuse or neglect, and because of those needs cannot protect themselves. You do not need to be sure all three apply before raising a concern. Your role is to recognise and report; the local authority decides what happens next.
What are the 10 types of abuse in adult safeguarding?
The Care and Support Statutory Guidance lists ten categories. The list is not exhaustive. Abuse can be a single act or a pattern, deliberate or the result of poor care, and can happen anywhere, including online. The person causing harm may be family, a partner, a paid carer, a professional, a stranger or another service user.
| Type | What it includes | Possible signs |
|---|---|---|
| Physical | Hitting, pushing, inappropriate restraint, misuse of medicines | Unexplained injuries, injuries at different stages of healing, explanations that do not fit |
| Domestic | Abuse by a partner or family member, including coercive control and so-called honour-based abuse | Fear of a partner, partner always present, isolation, repeated injuries |
| Sexual | Any sexual act the adult did not or could not consent to, including harassment | Distress, behaviour change, unexplained physical signs |
| Psychological | Threats, humiliation, intimidation, controlling or isolating someone | Withdrawal, anxiety, fear of a particular person |
| Financial or material | Theft, fraud, scams, pressure over wills or property, misuse of benefits | Unpaid bills, sudden money changes, a new 'friend' handling finances |
| Modern slavery | Forced labour, trafficking, domestic servitude | No access to own documents, appears controlled, lives at the workplace |
| Discriminatory | Harassment or unequal treatment because of a protected characteristic | Exclusion from services, abusive language, distress |
| Organisational | Poor practice or neglect within a service, from one-off incidents to ongoing ill-treatment | Rigid routines, lack of individual care, repeated incidents, poor staffing |
| Neglect and acts of omission | Ignoring care needs, withholding medicines, food or heating | Pressure ulcers, weight loss, poor hygiene, untreated conditions |
| Self-neglect | Not caring for one's own hygiene, health or surroundings, including hoarding | Very poor living conditions, refusing essential help, health deteriorating |
Some areas have specific duties. In England and Wales, regulated health and social care professionals must report known cases of female genital mutilation in girls under 18 to the police. NHS organisations have a Prevent duty, with concerns raised through your Prevent lead. The Domestic Abuse Act 2021 created a statutory definition of domestic abuse, and high-risk cases may go to a multi-agency risk assessment conference (MARAC).
What are the six principles of safeguarding?
| Principle | In practice |
|---|---|
| Empowerment | Support the person to make their own decisions; ask what outcome they want |
| Prevention | Act before harm occurs, for example supporting a carer under strain |
| Proportionality | Use the least intrusive response that fits the risk |
| Protection | Act promptly for people who cannot protect themselves |
| Partnership | Work with social care, GPs, police and communities, sharing information appropriately |
| Accountability | Keep clear records of decisions and who is responsible for each action |
Making Safeguarding Personal means safeguarding should be led by the person and focused on outcomes. Ask, where they are able to answer, 'What would you like to happen?' Safety is one part of wellbeing. A response that keeps someone physically safe but removes everything that matters to them may not be right.
How do you make an adult safeguarding referral?
Follow your local Safeguarding Adults Board procedures and your organisation's policy. The general sequence is below.
- Make the person safe: If there is immediate danger, call 999. Treat injuries. Consider whether it is safe for them to return home.
- Listen calmly: If someone discloses abuse, stay calm and take them seriously. Do not ask leading questions or investigate. Brief open questions to clarify are fine.
- Be honest about confidentiality: Never promise to keep a secret. Explain you may need to share information to keep them or others safe.
- Ask what they want: Find out the outcome they would like and record it.
- Preserve evidence: If a crime may have occurred, avoid disturbing evidence where possible and contact the police.
- Speak to your safeguarding lead: Discuss with the person in charge or your safeguarding team promptly. Do not delay if the risk is serious.
- Raise the concern: Contact the local authority adult social care team using the local route, often an online form or phone line. Include the person's details, what you saw or were told, their views, whether they consented, any capacity concerns, and immediate risks.
- Record it: Write a factual, dated, timed and signed note, including what the person said in their own words, and complete an incident report if local policy requires.
After a concern is raised, the local authority decides whether a section 42 enquiry is needed or whether another route fits better, such as a care needs or carer assessment, advocacy, MARAC or a care plan review. You may be asked to contribute information or attend meetings. If you do not hear back, follow up.
Do you need consent to make a safeguarding referral?
You should usually seek the person's consent and put their wishes at the centre. But consent is not always required. The Mental Capacity Act 2005 applies from age 16, presumes capacity, and is decision-specific. If you doubt capacity for the decision in question, assess it.
- The person lacks capacity to decide about the referral and sharing is in their best interests.
- Other people, including children or other adults at risk, may be in danger.
- A serious crime has been or may be committed.
- The person may be under coercion or undue influence.
- There is a serious risk to life, or another public interest reason.
- A member of staff or a service is the source of the risk.
In these situations you can raise a concern without consent, and you should record why. If an adult with capacity declines and no one else is at risk, their wishes should usually be respected. Still discuss with your safeguarding lead, give them information on where to get help, record your reasoning and keep things under review. You can also seek advice from the local authority without giving identifying details.
Worked example: self-neglect and a refusal of help
A district nurse, Hannah, visits Margaret to dress leg ulcers after a hospital stay. The house is cold with no working heating, there is little food, and stacked boxes block the stairs and back door. Margaret is clear and articulate and says she does not want social services 'interfering'. She has refused previous offers of help.
Patient declined referral. Has capacity. Dressings done. Will continue visits.
Margaret declined a referral today. I explained my concerns about the cold, food and the blocked exits being a fire risk. I assessed her capacity to decide about heating support: she understood the risks but could not explain how she would stay warm, and I am not confident she can weigh this up in practice, so I have recorded this and will reassess. She agreed to a home fire safety visit. I discussed with our safeguarding lead, who advised raising a concern with adult social care because of the serious risk; I told Margaret I was doing this and why. Her wish to stay at home is recorded. Review in two days.
Safeguarding Adults Reviews into deaths from self-neglect have often found that professionals accepted a refusal at face value without assessing capacity, sharing information or trying again. Respecting autonomy means persistent, skilled engagement, not withdrawal.
Looking after yourself and keeping your training current
Safeguarding work can be upsetting, particularly after a disclosure. Use supervision and your safeguarding team for support, and occupational health or staff wellbeing services if it affects you. If a concern is raised about your own practice or a service you work in, seek advice from your trade union or defence organisation.
The intercollegiate document on adult safeguarding describes the levels of competence expected for different roles. Check the level your organisation requires and keep your training up to date.
Our Safeguarding Adults course covers the Care Act framework, types and signs of abuse, the six principles, capacity and consent, responding to disclosures, raising concerns and record keeping, with a case study and reflection. It complements, but does not replace, the safeguarding training your employer requires.
Frequently asked questions
What are the 10 types of abuse under the Care Act?
The Care and Support Statutory Guidance lists physical abuse, domestic abuse, sexual abuse, psychological abuse, financial or material abuse, modern slavery, discriminatory abuse, organisational abuse, neglect and acts of omission, and self-neglect. The guidance makes clear the list is not exhaustive, so a concern that does not fit neatly into one category should still be raised.
What is the difference between a safeguarding concern and a section 42 enquiry?
A safeguarding concern is what you raise when you have reasonable cause to suspect an adult with care and support needs is experiencing or at risk of abuse or neglect. A section 42 enquiry is the statutory process the local authority starts if it decides all three Care Act criteria are met. Concerns that do not lead to an enquiry may be handled through other routes.
Can I make a safeguarding referral without the person's consent?
Yes, in some circumstances: if the person lacks capacity and it is in their best interests, if others are at risk, if a serious crime may be involved, if there is coercion, a serious risk to life, or a member of staff is the source of risk. Record your reasons and, where safe, tell the person what you are doing.
Who do I report adult safeguarding concerns to?
Discuss first with the person in charge or your organisation's safeguarding team, then raise the concern with the local authority adult social care team for the area where the person lives, using the local reporting route. In an emergency, call 999. Your organisation's safeguarding policy will set out the exact process.
Is self-neglect a safeguarding issue?
Yes. Self-neglect is one of the categories in the Care and Support Statutory Guidance. It does not always lead to a section 42 enquiry, but it can, especially where the risk is serious and the person may not be able to protect themselves. Assess capacity for specific decisions, build a relationship, address immediate risks and discuss with your safeguarding lead.
What should I do if someone discloses abuse to me?
Stay calm, listen, and reassure them they were right to tell you. Do not promise secrecy or ask leading questions. Ask what they would like to happen, make sure they are safe, and explain that you may need to share information. Then speak to your safeguarding lead promptly, raise a concern and record what was said in their own words.
What are the six principles of adult safeguarding?
Empowerment, prevention, proportionality, protection, partnership and accountability. They come from the Care and Support Statutory Guidance and help professionals check that their response is person-led, timely, the least intrusive option that fits the risk, coordinated with other agencies and clearly recorded.
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Sources and further reading
- Care Act 2014. legislation.gov.uk.
- Care and support statutory guidance. Department of Health and Social Care.
- Understanding what constitutes a safeguarding concern and how to support effective outcomes. Local Government Association and ADASS.
- Mental Capacity Act 2005 Code of Practice. Office of the Public Guardian.
- Adult safeguarding: roles and competencies for health care staff (intercollegiate document). Royal College of Nursing.
- The Caldicott Principles. National Data Guardian.
Practitioner Insight is an independent education provider. It is not affiliated with or endorsed by the GMC, MPTS, NMC, HCPC, GPhC or any NHS organisation, and this information is not legal advice. If you have been referred to a regulator, speak to your defence organisation, trade union or legal representative.
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