Care Certificate Standard 10 – Safeguarding Vulnerable Adults

In this article

After reading this Care Certificate Standard 10 – Safeguarding Vulnerable Adults, you should be able to:

Have greater understanding on the types of abuse that can occur
Have knowledge on the different legislation that applies to safeguarding
Understand how to record and report concerns.

The Care Certificate Standards detail what you must achieve and be assessed against to meet these learning outcomes.

If you have any concerns or queries, you should discuss these with your employer and/or assessor.

What is a vulnerable adult?

A vulnerable adult is classed as an individual who is aged 18 years or over and who, for any reason, is unable to take care of themselves or to protect themselves against any form of harm, abuse or exploitation. This can be either a temporary or a permanent state.

Although there is a link between an adult’s vulnerability and their ability to make decisions on their own behalf (i.e. to have capacity), it should never be assumed that all vulnerable adults lack capacity. On the other hand, just because an adult has the capacity to make their own decisions, it should never then be assumed that they are fully capable of taking care of themselves, as this may not be the case.

An adult’s vulnerability will vary depending on several factors and, when working with vulnerable adults, each individual’s needs should be considered on a unique basis, in line with a person-centred care approach to care and support.

Key facts and statistics

1 in every 42 adults over the age of 85, have required safeguarding enquiries.
475,560 concerns of abuse were raised during the 2019-2020 period.
In 2019 there were an estimated 778 deaths of homeless people in England and Wales.
Older females are identified as being most at risk, with neglect being the most common form of abuse.

What factors increase an adult’s vulnerability?

An adult will be considered as vulnerable due to one or more factors which affect their ability to care for themselves and to protect themselves against harm and exploitation.

These factors include:

Being elderly and frail: this may be due to physical disability, cognitive impairment, general ill health or advanced age.
Learning disabilities: although the severity of learning disabilities can vary greatly, those individuals whose learning disabilities are significant will be considered to be more vulnerable. A learning disability can also mean that an individual has other factors that make them vulnerable such as physical disabilities or sensory impairments.
Physical disabilities: the impact of a physical disability will determine the vulnerability of the adult in question. Most adults who have physical disabilities will not be considered vulnerable but those whose ability to effectively care for themselves will be classed as vulnerable due to their disability.
Mental illness: individuals who live with serious mental health conditions will be vulnerable due to the effects that mental illness can have. People who live with very serious conditions such as schizophrenia are more susceptible to abuse despite misconceptions that this form of mental illness makes them more likely to be a perpetrator than a victim of abuse and exploitation.
Dementia: the vulnerability of an individual with dementia will increase, as this is a progressive illness where the cognitive ability of the individual is subject to decline.
Substance misuse: any individual who misuses drugs and/or alcohol will be vulnerable due to the effects of the misuse. Individuals who abuse substances may also experience mental health difficulties, which can increase their level of vulnerability.
Lacking capacity: any individual who is unable to make decisions on their own behalf is classed as vulnerable due to the level of care and support that they need and because other people are wholly responsible for decisions about their life, making them more susceptible to abuse.
Long-term illness: individuals who live with long-term illness are more likely to need higher levels of care and support, which means that carrying out daily functions is something they may be unable to do alone. Being more reliant on others makes an individual with a long-term health condition more open to abuse.
Homelessness: any adult who is classed as homeless will also be considered as vulnerable due to the nature of their lifestyle where they are lacking access to fulfil their basic needs such as shelter, food and water.

What is safeguarding?

The Care Act 2014 defines safeguarding as “protecting an adult’s right to live in safety, free from abuse and neglect.” This means that in general terms, safeguarding aims to protect vulnerable adults (and children) from abuse and neglect in all circumstances.

Safeguarding involves putting processes into place to ensure that vulnerable people are not subject to harm, abuse or exploitation.

Safeguarding also means that individuals are adequately supported to access care and support where this is needed so that they are able to stay well and maintain a high quality of life. This is achieved by different organisations working successfully together to prevent and stop both the risks and experience of abuse or neglect.

Safeguarding aims to balance the right to be safe with the right of the individual to make informed choices and to have their well-being promoted at all times.

Who is responsible for safeguarding?

Safeguarding is the responsibility of everyone not just the people who are directly involved in working with vulnerable adults.

Safeguarding an individual means that they are protected from harm using appropriate measures. In terms of vulnerable adults, this is likely to mean checking for signs of abuse, such as that which is physical, emotional, sexual or financial. It may also mean ensuring that individuals are treated in a dignified and respectful manner, which enables them to retain independence and control over their own lives.

Duty of care

A duty of care is a moral or legal obligation to ensure the safety and well-being of others. This means that any organisation which provides care and support to vulnerable adults, must put the interests of the people who use those services first.

A further priority of the organisation is ensuring that individuals who are in their care are kept safe from harm, with prevention being preferable, in order to stop someone being harmed rather than reacting to it once it has already happened.

A duty of care should underpin everything that employees practise within their role, regardless of what that role is. A duty of care also underpins all Codes of Practice in a workplace so should influence practice on a day-to-day level. This also means that if there were an allegation of abuse or mistreatment, it would be ascertained in court if the employee’s duty of care had been exercised, as it is a legal requirement in all health and social care organisations.

The Care Act 2014

This Act sets out responsibility for the integration of care and support between local authorities and health authorities. Local authorities are responsible for safeguarding and they have a duty to promote well-being within local communities.

The Care Act maintains that local authorities must:

Lead a multi-agency local adult safeguarding system that seeks to prevent abuse and neglect and stop it quickly when it happens
Make enquiries, or request others to make them, when they think an adult with care and support needs may be at risk of abuse or neglect and they need to find out what action may be required
Establish a Safeguarding Adults Board, including the local authority, NHS and police, which will develop, share and implement a joint safeguarding strategy
Carry out Safeguarding Adults Reviews when someone with care and support needs dies as a result of neglect or abuse and there is a concern that the local authority or its partners could have done more to protect them
Arrange for an independent advocate to represent and support a person who is the subject of a safeguarding enquiry or review, if required.

safeguarding Vulnerable Adults in Health and Social Care

The Equality Act 2010

This Act came into force and replaced many previous Acts with the aim of making the rights of individuals easier to understand.

Acts that it replaced include:

The Disability Discrimination Act 1995 & 2005.
The Equal Pay Act 1970.
The Race Relations Act 1976.
The Equality Act 2006.
The Racial and Religious Hatred Act 2006.
The Sex Discrimination Act 1975.

The Equality Act 2010 aims to protect people or groups of people who have one or more ‘protected characteristic’. These protected characteristics are features of people’s lives upon which discrimination, in the UK, is now illegal.

The protected characteristics listed in the Act are:

Age.
Disability.
Sexual orientation.
Sex.
Gender reassignment.
Marriage and civil partnership.
Pregnancy and maternity.
Race.
Religion and belief.

The Carers Act 2004

Many individuals who are classed as vulnerable are likely to have someone who cares for them on a formal or informal basis. This Act aims to ensure that carers are aware of their rights when carrying out their caring responsibilities and that they have access to education, training, employment and leisure activities; none of which should be impacted by their role.

By doing this, the Act aims to acknowledge that carers are entitled to live their lives in as meaningful a way as anyone else and that they should not be subject to any form of exclusion because they are a carer.

The Act does not cover people who act as paid carers, such as those who might work for a health and social care organisation or those who act as volunteers. Instead, it protects the rights of people who act as carers in an unpaid capacity and this might include the individual’s family, friends or neighbours.

The Carers Act enables carers to maintain a high quality of life so that they are less likely to become exhausted, frustrated or unhappy about the role that they have taken on, meaning that they are less likely to subject an individual to abuse due to their own difficulties.

The Safeguarding Vulnerable Groups Act 2006

The aim of this Act is to help avoid harm or risk of harm by preventing people who are deemed unsuitable to work with vulnerable groups from gaining access to them by their role at work.

The overall principles of the Act are:

Those who are not suitable should be barred from working with both children and vulnerable adults.
Employers should be able to have an easy way of assessing whether or not someone is barred from working with children and vulnerable adults.
Checks of someone’s eligibility to work with children and vulnerable adults should not be one-offs but should be ongoing in order to identify those people who may have committed a crime since initially being assessed.

The Human Rights Act 1998

Human rights within the United Kingdom are protected by the Human Rights Act 1998, which means that if an individual believes that their human rights have been breached, they can take action against this in a court of law.

Examples of rights that are contained within the Act, known as ‘Articles’, are:

The right to freedom from torture and inhumane or degrading. treatment or punishment.
The right to liberty and security.
The right to freedom of thought, conscience and religion.
The right to freedom of expression.
The right of access to an education.

Vulnerable adults are equally protected by this Act but may be less aware of how it impacts them. This is why the use of an advocate may be necessary to enable vulnerable adults to exercise their rights successfully, if it is identified that they have been breached.

Safeguarding Vulnerable Adults Standard 10 Care Certificate

Safeguarding Vulnerable Adults Health and Social Care

The Mental Capacity Act 2005

This Act protects the rights of people aged 16 and over who may not be able to give consent to treatment and care or make decisions regarding any aspect of their care and support.

The Act is based on a set of key principles, which include:

An assumption that everyone is capable of making their own decisions, unless it is proven otherwise.
Individuals should be given as much support as possible when making decisions before anyone decides that they cannot make decisions on their own.
Anything done on behalf of the individual must be carried out with the individual’s best interests at heart.
Any decision made on behalf of someone who is unable to do this for themselves must be as free from restriction as possible.

Before an assessment of incapacity is made, all avenues of assistance must have been exhausted, and to be presumed incapable of decision-making, the following must apply:

The individual cannot understand information that is relevant to the decision.
The individual cannot retain information relevant to the decision.
The information cannot use or weigh up information.
The individual cannot, by any means, communicate the decision.

The Act helps to ensure that individuals are not subject to some form of abuse because they lack the capability to make their own decisions.

The Health and Social Care Act (2012)

Regulation 13 of this Act is intended to safeguard people who use health and social care services from being subject to any form of abuse or improper treatment whilst they receive care, treatment and support.

It specifies that care providers must have a zero-tolerance approach to abuse and discrimination including:

Neglect.
Subjecting people to degrading treatment.
Unnecessary or disproportionate restraint.
Deprivation of liberty.

It also specifies that any organisation which provides health and social care services must have robust procedures and processes in place to stop people who use their services from being abused by staff or anyone else who may be present, including other visitors. It also states that when any form of abuse occurs, is suspected or reported by a third party, this must be investigated immediately and any relevant information reported to the appropriate body.

Standard 10 Care Certificate Safeguarding Vulnerable Adults

Health and Social Care Safeguarding Vulnerable Adults

No Secrets (2002) and Public Interest Disclosure Act (1998)

No Secrets (2000)

No Secrets is a government White Paper, which gives guidance on how organisations can work together to protect adults who have been identified as ‘at risk’ from harm and/or abuse. It is also designed to address the need to give adults who have been identified as ‘at risk’ immediate protection and support.

Public Interest Disclosure Act (1998)

A whistle-blower is someone who informs on a person or organisation that is thought to be engaging in unlawful activities. This Act was designed to protect them from negative treatment or victimisation from their employers if they have made a disclosure about them. In order to be protected, the individual who is making the disclosure must have reasonable belief that the organisation in question is involved in some form of wrongdoing that is listed in the legislation, and the concern must have been raised in the correct way.

Who is most at risk of abuse?

Although it is possible for anyone to be a victim of harm or abuse, there are certain factors which are thought to contribute to someone’s risk, making it higher than normal.

These factors include:

Age.
Health.
Problems with substance abuse.
Disability.
Isolation.
Environment.

Some individuals may have more than one risk factor that makes them even more susceptible to abuse, although this is never inevitable.

Age

Elderly people lack the physical resources to defend themselves and, perhaps because of dementia or another condition, are not able to tell anyone what is happening maybe because they fear that no one will believe them, especially if their abuser is very manipulative.

Elderly people are also more likely to be subject to financial abuse if their abuser finds out that they have money or assets or that they can live with the elderly person without paying to do so.

Factors that may contribute to elderly people being abused include:

Living with their carer who is experiencing extreme caring-related stress.
Financial difficulties for live-in carers.
Being very frail.
Not understanding what is happening to them.
Fear of the repercussions of telling someone what is happening.
Being isolated, which can make abuse easier.
They may be unaware of their rights or not know how to complain about something.

Health

When someone has poor mental or physical health, their chances of being abused are substantially increased. Someone with poor physical health may not have the strength to stop abuse from happening or they may experience periods of unconsciousness where they become even more vulnerable.

Poor mental health may mean that the individual does not realise what is happening to them or if they experience learning disabilities as well, they may have been persuaded by their abuser that what is happening is normal and they have accepted this as the truth because they do not know any different. People in poor health may be subject to financial abuse without even realising it if they are too ill to check bank accounts and see that money has gone missing.

Problems with substance abuse

It is often mistakenly believed that someone who has substance abuse issues is more likely to be an abuser than to be abused themselves, but this is not always the case.

People who misuse substances are very vulnerable to abuse, often because of their lifestyle and their environment. For example, someone who has misuse problems may be abused by the person who sells them drugs, especially if they cannot pay them. Many people who experience substance abuse have no fixed abode and living on the streets or ‘sofa surfing’ where they go from one property to another makes them extremely vulnerable.

Substance abuse is often linked to low self-esteem and depression and people who experience these forms of mental illness will often not report abuse, simply accepting it as part of their life, sometimes, sadly, because it is what they think they deserve.

Disability

Being disabled can put extreme pressures on a family and this sometimes results in the person who is disabled being abused, perhaps because some family members see them as a burden or some are resentful of all the additional needs and attention that they require.

People who are disabled often report that they are treated like second-class citizens and any concerns that they raise are not taken seriously. If an abuser knows this then he or she is likely to take advantage of that, and abuse can take place in many ways.

Due to barriers to information, some disabled people may not know what their rights are and again, like with other groups of vulnerable individuals, this can mean that abuse goes unreported because the individual simply does not know what to do or who to tell.

Isolation

When an individual is isolated, their means of care and support are severely restricted, which can make them more vulnerable to harm and abuse. They may not have anyone to share their concerns with, but also they may come to harm, such as falling and no one will know this if they are not contacted by anyone on a regular basis due to their isolation.

Many people who are isolated also experience mental health issues, which can make the risk of abuse even higher. Someone, for example, who has depression and anxiety issues will often shut themselves away and become isolated very quickly. If their mental health condition means that their self-esteem and confidence are both low, this may result in them allowing the abuse to continue as they feel as though they have no one to turn to or that by asking for help, this will be seen as another weakness.

Environment

An environment refers to many aspects of a person’s current circumstances, for example their housing, their family, their community and their friends.

People who have experienced abuse themselves are more likely to go on to abuse others and this can mean that people who live in the same household as they do are put at risk of harm. Likewise, someone who lives in a household where someone has mental health issues or substance misuse problems may be more exposed to abuse; even the people who have the issues themselves are vulnerable.

Domestic abuse often takes place in an environment that is very volatile. The people involved in the relationship may try to control each other or one may be the passive recipient of abuse and feel unable to do anything about it. This might be because the abuser threatens to harm themselves if they do or that their emotional abuse is so powerful that the abused person believes that they deserve to be treated in this way.

The 6 principles of adult safeguarding

Safeguarding, in its most fundamental form, is important because it stops individuals from being harmed, abused or exploited.

The Care Act 2014 sets out several principles that should underpin the way in which employees work with vulnerable adults:

Empowerment: individuals are supported to make their own decisions as far as it is possible for them to do so. Individuals who are empowered are more likely to retain independence and are therefore less reliant on others and are less likely to be subject to abuse.
Prevention: this principle maintains the simple notion that it is better to take actions to prevent an incident occurring before any harm is caused.
Proportionality: this refers to how individuals should be enabled to take positive risks with the least restrictive response, as long as this maintains their safety. Employers should work in the best interests of the individual at all times and not become involved in their life when this is not necessary.
Protection: individuals should be given support and representation when they need it. This may mean that they work with an advocate to ensure that their rights are known and upheld.
Partnership: any organisation with which an individual works should work closely together to better ensure positive outcomes. The sharing of information should be in line with the individual’s needs, ensuring that anything pertaining to abuse is taken seriously and acted on so that the best outcome for the individual is possible.
Accountability: everyone who works with vulnerable adults should be aware of their own role and the part they play in safeguarding.

Types of abuse

Neglect (including self-neglect)

A passive form of abuse in which the perpetrator is responsible to provide care for someone, who is unable to care for oneself, but fails to provide adequate care to meet their needs. Neglect may include failing to provide sufficient supervision, nourishment, medical care or other needs.

Self-neglect occurs when individuals are unable to maintain their own personal hygiene or unable to access basic resources such as food, water and shelter.