Disclosure and Raising a Concern

1. Using this Procedure

This is a multi-agency procedure, meaning it applies to all organisations in XXXXX.

It sets out how to recognise abuse, what to do if an adult discloses abuse, how to determine immediate action and preserve evidence, and how to raise a concern to the local authority.

2. Recognising Abuse and Neglect

The Care Act sets out 10 categories of abuse and neglect. For information about these categories, and examples of how the accompanying abuse or neglect may be experienced, see: The Care Act 2014, Categories of Abuse and Neglect.

3. Disclosure

What is a disclosure?

Put simply, a disclosure happens when:

1. The adult communicates that they have been (or are worried they may be) abused or neglected; or
2. Any other person reveals that they have seen an incident of abuse or neglect, or found evidence that indicates it may be, or is occurring.

A disclosure can be verbal, but can also be written (for example a text, email or letter).

A disclosure can relate to abuse that is happening now, may happen in the future or has happened in the past (historical).

Responding to a disclosure by the adult

Disclosing can be very traumatic for the adult, and often they will have spent some time thinking about whether or not to tell someone what has happened, is happening or what they are worried about.

One of the barriers to disclosing can be the fear that nothing will happen, that they will not be believed or that the abuse will get worse because they have told someone.

It is important that all of these potential fears are recognised and allayed by the response to a disclosure.

The lists below set out some good practice dos and don'ts when responding to a disclosure by the adult:

Do

• Take the disclosure seriously;
• Accept what they are saying;
• Listen carefully;
• Don't interrupt them;
• Try to remember the words used by the adult, and anything they want to happen next;
• Stay calm and avoid reactions such as shock, disbelief or anger;
• Ask questions to establish basic facts;
• Establish if the adult feels safe now, to identify if immediate action may be required;
• Establish any emotional support they may need after you leave;
• Talk about the safeguarding adults process and seek consent to make a referral;
• Explain what will happen next and when they can expect to hear from someone;
• Reassure them that they will be involved in any decisions;
• When talking about what will happen next, think about any specific communication needs they may have and how to make sure information is accessible.

Don't

• Question their motives for disclosing;
• Interview the person;
• Ask them to repeat the disclosure to someone else;
• Make promises about keeping the information confidential-explain how the information will be shared, who with and why;
• Speculate about the outcome of the safeguarding process.

Making a record of the disclosure

A written record of the disclosure must be made as a matter of urgency, as soon as possible after it is made.

Records should be made in line with the local recording requirements of the agency or professional to whom the disclosure was made.

Where relevant, all records should contain the following information:

1. The date, time and location that the disclosure was made;
2. Who made the disclosure;
3. The facts that have been provided;
4. The evidence that has been seen (including any injuries or witnesses);
5. The views and wishes of the adult.

If anyone else has additional information about the disclosure, or the abuse or neglect that may have taken place they should make their own record.

All records should be legible and signed and dated by the author.

The record of disclosure, and any supporting documentation should be stored securely in line with the requirements of the relevant agency.

Internal reporting

All practitioners should follow their organisation's internal procedures and processes to ensure that relevant line managers and Safeguarding leads are informed of the concerns raised and involved in any subsequent decision making about immediate action, preserving of evidence and raising the concern with the local authority or police.

4. Immediate Action and Preserving Physical Evidence

Immediate action

Following a disclosure, or whenever concerns are present, there should always be an immediate evaluation of risk to identify any urgent steps required to ensure the adult is in no pressing danger.

Unless there is a risk to life, the adult lacks capacity to make decisions of this nature, or there is a risk to others any immediate actions should take place in line with the views and wishes of the adult about how best to protect them from harm.

Examples of immediate action could include:

1. Calling 999 if a crime is in progress;
2. Calling 999 in a medical emergency;
3. Calling NHS 111 for medical advice;
4. Taking the adult to their GP or other health professional;
5. Supporting the adult to get home safely;
6. Arranging for someone to be with the adult so they are not alone;
7. Steps to manage the risk to others.

Where the adult has capacity, an immediate action could also be to support them to contact the police or local authority to report the concern themselves.

Regulated services

Regulated services include:

• Residential homes;
• Nursing homes;
• Domiciliary care providers (including those based in supported living and extra care schemes, and those provided in-house by the local authority or NHS Trust);
• Mental health hospitals;
• NHS Trust and independent hospitals;
• Hospices.

As soon as the regulated service is aware of the concerns, they are under a duty to take corrective action and protect the adult from harm as soon as possible. As such, they should not wait until they have raised a concern before making their own initial enquiries for this purpose.

The enquiries made by the regulated service at this time should be carried out in line with their internal procedures.

After taking any necessary immediate action, the regulated service should raise a concern to the local authority (as below), and notify them of the initial enquiry actions undertaken to protect the adult from further harm. They should also notify the Care Quality Commission.

Note: If the concern relates solely to a pressure ulcer, the service provider should request a clinical assessment is carried out by a clinician with experience in wound management (usually a nurse) to help determine whether a safeguarding concern should be raised. This is in line with Department of Health and Social Care guidance Pressure ulcers: how to safeguard adults.

Where it appears a criminal offence has taken place the regulated service should notify the police as well as raise the concern.

The body commissioning the service should also be notified, for example the Local Authority, Mental Health Trust or Integrated Care Board.

Allegations against staff members

In all services (regulated or otherwise) the provider may decide that it is appropriate to take immediate action by way of redistributing or even suspending the staff member in question.

At this stage all action against a staff member should be done on a 'without prejudice' basis, and in line with the HR procedures of the employer. 

Preserving physical evidence

It is important to preserve physical evidence when:

1. A crime may have been committed; or
2. The adult wishes to report any alleged abuse or neglect to the police.

Do not make assumptions about what evidence to preserve and how to preserve it. The police are the experts and have responsibility for determining this. As such, they should be contacted for guidance.

Depending on the nature of the concerns raised, the preservation of physical evidence could involve:

1. Not touching anything that you do not need to touch;
2. Not cleaning surfaces, carpets, door handles etc.;
3. Not washing clothing or bedding;
4. Not throwing anything away;
5. Limiting physical contact with the adult;
6. Discouraging the adult from washing/bathing;
7. Securing the area where the incident took place (not allowing anyone in).

5. Raising a Concern

Note: If the adult has died this section of the procedure does not apply. Instead, use the guidance set out in Section 6, If the Adult has Died.

Who should raise a concern

Safeguarding is everyone's responsibility.

Anyone who suspects, or knows that abuse or neglect is, or may be at risk of occurring must notify the local authority, using the relevant process set out below.

Never assume that another person or organisation will raise the concern, even if they tell you they will.

When to raise a concern

Concerns must be raised as soon as possible to ensure that the local authority is able to provide a timely and appropriate response.

There is an expectation in XXX (insert name of local authority) that safeguarding adult concerns are raised with the local authority within one working day of identification.

Amend accordingly to reflect local requirements

Concerns should be raised whenever there is a reasonable belief that first 2 criteria of the safeguarding duty apply:

1. The adult has need for Care and Support (regardless of whether these have been assessed or are being met by the local authority); and
2. They are experiencing, or at risk of experiencing abuse or neglect.

This is in accordance with guidance included within Understanding what constitutes a safeguarding concern and how to support effective outcomes (Local Government Association).

An adult is anyone aged 18 or above.

Before reporting the concern, consider the following checklist (not all will be possible / appropriate):

• Have you discussed your concerns with the adult?
• Have you sought consent from the adult to report a safeguarding concern?
• Have you discussed possible outcomes with the adult? Have you asked the adult what they would like to happen?
• Does the adult have the capacity to understand that a safeguarding concern will be raised – and what this process means?
• Have you thought about who you need to share the concern with immediately?

Consent

Adults

Unless one of the following applies, consent of the adult should always be sought before raising the concern:

1. Seeking consent will increase the level of risk posed to them (or a child or other vulnerable adult); or
2. Consent cannot practically be sought (for example, the referrer is being denied access to the adult or the adult cannot be located in a timely way); or
3. The adult lacks capacity to consent, and a decision has been made that raising a concern is in their best interests.

Note: A mental capacity assessment must be completed before reaching the conclusion that the adult lacks capacity to consent.

For guidance about assessing capacity see: The Mental Capacity Act 2005 Resource and Practice Toolkit.

Where consent has not been sought the reasons should be clearly recorded in line with recording requirements of the relevant agency.

Children

Consent does not need to be sought before raising a safeguarding concern about a child.

Consent not provided

If an adult with capacity has not provided their consent, further questions should be asked as necessary to determine whether or not their wishes should be overridden and a concern raised.

A concern should be raised without consent if:

1. 'Vital interests' are at stake;
2. The adult is being subjected to inhuman or degrading treatment which is having a serious impact on their wellbeing;
3. Other adults or children are at risk of being abused;
4. Staff or anyone else in a position of trust is implicated;
5. There are concerns that the decision to withhold consent has not been made freely, but as a result of undue influence or coercive control.

Note: 'Vital interests' generally apply to life or death situations and serious, immediate concerns for safety.

Where a decision has been made to raise a concern without the adult's consent the reason for doing so should be clearly recorded on the reporting form.

If consent is not given, and there is no reason to override the adult’s wishes, that is not the end of the matter. Consideration should still be given to ways in which the risk to the adult could be managed or mitigated, taking into account the impact of abuse or neglect on the adult’s wellbeing, including their 'vital interests' and the impact on others in the situation. This is recommendation four of Understanding what constitutes a safeguarding concern and how to support effective outcomes (Local Government Association).

How to raise a concern (Adults)

If you are concerned that an adult is in imminent danger from abuse or neglect, or that a criminal act has taken place you should contact the police by dialing 999.

Members of the public

Insert relevant local information about processes, including link to any online forms.

External professionals and organisations

External professionals and organisations are those outside of local authority adult social care.

Insert relevant local information about external processes for raising a concern, including link to any online forms.

Internal processes

Internal processes should only be used by local authority adult social care practitioners.

Insert relevant local information about internal processes for raising a concern, including link to any online forms.

How to raise a concern (Children)

Insert relevant local information about raising a concern about a child

If you are concerned that a child is in imminent danger from abuse or neglect, or that a criminal act has taken place you should contact the police by dialing 999.

Information that will be requested

In all cases, the following information should be provided, where relevant:

1. The nature of the concerns;
2. What has happened, or what might happen;
3. The evidence upon which concerns are based (including injuries);
4. Details of any disclosure made;
5. The views and wishes of the adult;
6. The names of any other witnesses;
7. Any immediate actions taken to reduce the risk of harm;
8. Any physical evidence that has been preserved;
9. Any previous incidents of concern;
10. Any risk of harm to other adults or to children;
11. Where the concern relates solely to a pressure ulcer, a copy of the clinical assessment and adult safeguarding decision guide;
12. Any other information deemed relevant by the referrer or the local authority.

A copy of any disclosure report or supporting documentary evidence should be sent securely to the local authority.

Recording

The person raising the concern should make a record of the concerns they have raised, and any advice given by the local authority about next steps. This should be made in line with the recording requirements of the relevant agency.

6. If the Adult has Died

If the adult's death may have been as a result of abuse and neglect and there is not already a safeguarding adult enquiry underway then a safeguarding concern should still be raised.

It is recognised that while the section 42 duty does not apply to an adult once they have died, there may be outstanding concerns in relation to risk to others and/or quality concerns related to a collective setting or service. There is a continued responsibility to ensure these are appropriately addressed in accordance with the Care Act and other relevant provisions.

6.1 Notification to the police

The police should be notified as a matter of priority if:

1. The death of the adult is suspected to have been potentially attributed to abuse or neglect; and/or
2. There is reason to suspect that a crime is likely to be committed i.e., other people are at risk.

6.2 Raising a concern(s) for others at risk

If the circumstances of the death mean that there are reasons to be concerned about risks to other adults, enquiries may need to be made to decide whether action needs to be taken to protect them. For example this will often be necessary following a death in an organisational setting where other adults are continuing to receive a service.

If this is the case, follow the guidance in Section 5, Raising a Concern.

6.3 Referral for a Section 44 Safeguarding Adults Review

If the criteria for a Section 44 Safeguarding Adults Review is met, a Safeguarding Adults Referral must be made.

See: Safeguarding Adults Reviews (SAR).

It is important to remember that a Section 44 Safeguarding Adults Review relates to how safeguarding partners have worked together to safeguard the adult and is not appropriate for single agency issues / failure.

6.4 Notification to the CQC

If there are concerns about how a provider has cared for the adult prior to their death a notification should be made to CQC via the CQC website.

The CQC has powers to bring a criminal prosecution against health and social care providers for failing to provide care and treatment in a safe way.

6.5 Notification to the appropriate Commissioning Team

If there are concerns about the quality of care delivered by the provider, the relevant Commissioning Team (Local Authority and / or Integrated Care Board) should be notified. The Commissioning Team can instigate the provider concern process and, if necessary, decommission the provider if appropriate improvements are not made.

6.6 Notification to the Coroner

Following a death, it is usually a doctor, or the police, who will decide whether a referral to the Coroner is required. When a death has been referred to the Coroner, the Coroner will make decisions regarding whether a police investigation should take place and whether a post-mortem is required.

6.7 Notification to Ofsted

The Working Together to Safeguard Children 2023 statutory guidance requires that local authorities should notify Ofsted of the death of any care leaver under the age of 25, where it is aware of their care leaver status. This is regardless of the circumstances of their death.

Notifications should be made via the Child Safeguarding Incident Notification System.