Recording Abuse against Vulnerable Adults

Safeguarding vulnerable adults 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.

Given the overall concept of safeguarding, it is clear that anyone who works with vulnerable adults should be up to date in relation to safeguarding training, as this helps to ensure:

• Individuals are protected from abuse, maltreatment and exploitation.
• Individuals are protected from anything which may harm their health, both mental and physical.
• Individuals are empowered to make their own decisions and provide informed consent.
• Individuals have effective care.
• Individuals have their well-being promoted and have their wishes, views, feelings and beliefs taken into account.

Reporting Concerns

Once suspicions of abuse have been identified, the member of staff who will report these becomes known as the ‘alerter’ and it is vital that they are aware of who they should report concerns to.

In most cases, this will simply be their line manager, but in cases where the line manager may be implicated in the suspicion then the member of staff would alert either a more senior manager within their organisation or they may choose to report it to their local authority where it will be passed to the adult social services department.

The policy about who concerns should be reported to should be easily accessible to all members of staff who are responsible for knowing their content so that should such an occasion arise, there will be no unnecessary delay in passing information on. A delay may result in avoidable harm or may allow an abuser to continue abusing a vulnerable adult.

When to report a concern

A report about concerns relating to one or more individuals should be raised as soon as there is a suspicion that abuse is taking place against a vulnerable adult or will take place if an intervention is not made.

Also, a report should be made immediately once a disclosure has been made from an adult where they have shared information that they have been subject to abuse or they fear that they are going to be subjected to it at some point in the future.

In line with a person-centred approach, staff should know individuals well and therefore should be able to identify changes in their demeanour or their behaviour that may indicate that something about them has changed.

All members of staff should keep in mind that if there is any suspicion at all of abuse that they should speak up. It is better that they speak up and may be wrong about what is taking place than staying silent and therefore possibly facilitating an abuser to continue.

In emergency situations the member of staff must take action immediately to protect the safety and well-being of the individual. If the individual needs medical assistance then this should be summoned via a first aider or via the emergency services if the individual is badly injured and cannot be treated in the setting.

If the member of staff suspects or knows that injuries are not accidental then they should make other members of staff aware of this so that everyone can preserve any evidence in the event of a criminal offence that may follow at a later time.

Managers should take a decision to determine it the police need to be contacted and to start a safeguarding investigation immediately.

Your responsibilities

Everyone within a setting has safeguarding responsibilities and whilst some roles may have more responsibility than others, everyone must be fully aware of how to work with vulnerable adults in a way that ensures that they are safe. Therefore, responsibilities that apply to everyone include:

• Ensuring the ongoing safety of vulnerable adults.
• Promoting good practice within the organisation.
• Minimising potential risks.
• Being aware of the content of safeguarding policies and how they apply to own role.
• Knowing who to report concerns to.
• Knowing how to report concerns.
• Sharing information where this is necessary and appropriate.

Sharing information

When information is shared between professionals and other agencies, it better enables everyone involved to build a clearer picture of the individual’s life and therefore a better opportunity to assess the risks that are presented to them.

However, sharing information is not always appropriate, as to do so could put the individual at greater risk of harm. The times when sharing is appropriate include:

• When a family will benefit from additional support.
• When a family has requested additional support.
• When a court requires information to be shared.
• When another agency has permission for information to be shared.
• If there is concern that another member of their family or vulnerable adult is at risk of harm.
• If a crime has been committed or is about to be committed within a family (this includes possible acts of terrorism or radicalisation).

Not all information should be shared if this is not necessary and not all agencies and professionals involved will need to know all information. An informed decision about who to share with and what to share should be made by the people involved.

Staff should therefore ensure that they are aware of when information can be shared in a way that facilitates a positive outcome but remains within appropriate legislator frameworks, for example:

• They should remember that legislation such as the Data Protection Act is not a barrier to sharing information but acts as a guide to ensure that individuals are not put at risk from the sharing of personal data.
• Being open and honest with the individual (and their family where appropriate) about how and why their information may be shared.
• Consider the well-being and safety of the individual and anyone else who may be affected by the sharing of information.
• When another agency has permission for information to be shared.
• Consider the application of the Caldicott Principles when considering sharing information.
• Ensure a record is kept of a decision to share or not share information.

Information that is disclosed

When a decision has been taken to share information, the information that is then disclosed to one or more parties should be:

• Clear in terms of why it is being shared.
• Based on fact and not opinion or assumption.
• Relevant to the specific incident or others that are related.

When vulnerable adults lack capacity to consent to the sharing of information then the content of the Mental Capacity Act 2005 should be followed so that the individual’s best interests are at the centre of any decision that is made on their behalf.

Why do some people fail to report concerns?

Unfortunately, in some settings, some members of staff may fail to report concerns of abuse against a vulnerable adult, which means that individuals are put at risk of harm or at further risk of harm in instances where abuse is already taking place.

There are thought to be several reasons why staff may fail to report concerns, which include:

• Fear of losing their job.
• Fear of being ostracised by colleagues.
• Fear of not being believed.
• Being unwilling to breach personal ethics that are in contrast to duty of care.
• Being unsure how to report abuse.
• Fear of being the subject of a lawsuit.
• Personal experiences of the individual which have made them afraid of the individual’s family.
• Not having the time to collate information due to setting being understaffed.
• Fear of causing increased risk of harm to the individual.
• Fear of creating disruption within a family if the abuser is related to the individual.
• Not believing the abuse is serious enough to be reported.
• Believing that having no evidence means that abuse cannot be taken seriously.
• Insensitive response from organisation or related agencies in previous attempts to report abuse.
• Not wanting to believe that abuse is taking place.

What to do if your report isn’t taken seriously

Within some organisations, management systems may dictate that reports of abuse are not taken seriously; management may have developed a culture where they see such reports as being detrimental to their business and so they deter members of staff from speaking up.

In cases such as these, the member of staff will need to ensure that their concern is passed on to a higher authority even if they feel like their job may be at risk – as long as their concern is genuine then they will be protected by the Public Disclosure Act 1998.

Members of staff should initially report their concern about abuse to their local authority. At the same time, they should explain why they are reporting it as well, i.e. because it has not been taken seriously by their organisation. If the abuse concerns the local authority and the member of staff feels like they are somehow in collusion with their employer to hide instances of abuse, then they will need to report their concern elsewhere.

In this case, the concern should be raised with the Care Quality Commission (CQC) whose role is to regulate health and social care providers and who are obliged therefore to take the report seriously. At the point that the concern is reported, the member of staff should also explain to the CQC why it is that the concern has not been dealt with by either their organisation or the local authority.

How to report concerns about a professional

Reporting concerns about a professional will be dependent upon the professional’s role within their organisation. For example, if the professional is a care worker, then a report should be made in line with normal channels to the line manager of the member of staff who is making the report.

If the line manager were the subject of the concern then the report would be escalated to the manager of the organisation.

If the organisation’s manager and/or owner were the subject of the concern then the report would then be passed to the local authority where the adult’s social services department would then choose how to proceed.

In any of these cases it is vital that the member of staff gives the report the same importance as they would if concerns were about a non-professional. Information must reflect fact and not opinion and the reasons why the concern has been raised must be written down so that if the incident becomes a criminal investigation then information about why it came about originally is clear.

Recording concerns

Checking existing reports

Within a health and social care setting the care worker will be initially responsible for making a report to their line manager, after which, it will be the line manager’s responsibility, together with the organisation’s manager, to check if there are any existing reports relating to abuse of the individual in question.

If there is an existing report then its content may be used to corroborate allegations at a later time, such as if a criminal charge is brought against an abuser who has been previously convicted. An existing report can also be used to identify possible patterns of abuse from which the organisation may be able to learn more about how best to protect the individual from future abuse.

If an existing report does not exist then one will need to be made in relation to the incident that has recently taken place. The report will be essential in informing anyone who has access to it what has happened so that everyone involved will be able to work together to bring about the best outcome.

It should be kept in mind that in most cases, individuals and their families and carers may be given access to the information that a report contains, which means that the way in which it is put together should be within strict guidelines relating to this; individuals and others have the right to make formal complaints about reports which hold information about them.

How should key information be recorded?

The simple answer to this question is that the person making a referral should record as much information as they possibly can. Not everyone will have a lot of information to hand but this should not stop the person from reporting a concern because even with just small amounts of detail, action can still be taken that may prevent further harm from taking place.

Vital information should include:

• The details about the individual involved.
• Where the incidents are taking place.
• Known family members who may be involved.
• What exactly has been seen, heard or reported to the person making the referral.
• When the incident(s) has taken place.
• Any other relevant information.

If the person making the report does not have all of this detail, it does not matter and a report should still be made. It may turn out that other people have also recorded a cause for concern and the organisation taking the referrals may be able to use the information together as part of a larger investigation.

Information to be recorded from a disclosure

If information about potential abuse has been gathered from an overt or a covert disclosure then what needs to be recorded is very similar. However, it is important to also ensure that any information given by an individual is recorded in their own words, exactly as it was said at the time. The information should also contain details about what was happening at the time of the disclosure, where the disclosure took place and if there was anything happening prior to the disclosure that may be relevant.

If possible, particular details about when abuse has taken place should be recorded if this information has been given. For example, was it a one-off incident that took place in a public area or was it in the home of the individual or the home of the alleged abuser?

Other useful information to record includes when the alleged abuse took place, for example was it during the day, at night time, yesterday, a week ago or months ago? As well as this, an individual may disclose if they were alone with the alleged abuser or if they were with other people; any information like this should be noted as part of the report.

Individuals may mention that they have already told someone else about what happened and that person may or may not have taken action to make a report. Regardless of whether someone else has reported the information though, the person listening to the disclosure should always take action themselves because the more evidence that can be given about the incident, the more likely that the best outcome in terms of what to do in response can be achieved.

Any information that an individual gives should be of their own volition and the person who is hearing a disclosure should never press the individual for more information or ask them questions that could lead them to giving exaggerated or false information.

Body maps

A body map, such as the one below, is used to record information about any kind of physical injuries that an individual has sustained as a result of abuse. The map acts as a visual record and helps professionals and agencies to work together in determining whether or not there is a safeguarding concern.

Any person who completes a body map should keep in mind that it is not a replacement for a medical assessment and if there is any concern about the physical injuries that are recorded on the body map, the individual must be attended to by a medical professional.

Details that should be recorded on a body map include:

• Information about the person who noticed the injuries on the individual, when they noticed them and what their relationship is to the individual in question.
• Details of specific injuries – where they are, what they look like, their colour, shape, size and condition.
• Whether the injury seems to be healing or getting worse.
• Whether the individual is showing distress about the injury.
• Information about how the injury was sustained.
• Information about what an individual or someone else says about the injury.

Information on a body map, just like with a disclosure report form, should be factual and accurate and the information should be signed and dated by the person who has completed it.

Sites that are usually not accidents

The most common sites for injuries that have not been sustained by an accident include:

• Eyes.
• Ears.
• Cheeks.
• Mouth.
• Shoulders.
• Chest.
• Upper and inner arms.
• Stomach.
• Genitals.
• Front and back of thighs.
• Buttocks.
• Hands.
• Feet.

Bruises which occur in clusters are a common feature of abuse and these most often appear on arms, thighs and the body. They may be in the shape of an implement used to abuse an individual or may be in the shape of a hand or fingers if they have been grabbed.

Why does certain information need to be recorded?

Having a factual account of what has happened to an individual will better enable professionals who may be involved once the report has been forwarded to have a better idea of what is happening, or has happened, in the individual’s life and what might have brought about a disclosure of abuse that an vulnerable adult may have kept to themselves for a long time before they have finally been able to feel safe enough to tell someone about it.

If the recording of the disclosure results in court proceedings then the record of the disclosure may be the only actual piece of evidence that exists about the abuse that has taken place and this may then help to protect the vulnerable adult because they may be removed from their family and/or criminal proceedings may take place against the abuser.

Methods of recording

Any information that is written onto a disclosure form should be:

• Factual and not opinion based.
• Legible.
• Accurate.
• Signed and dated.

The person completing the form should remember that it may be used as evidence if the report results in a criminal trial.

Reviewing policies and procedures

If it is identified that an individual has been subject to abuse which may have been avoidable, then organisations must ensure that they learn lessons from what has happened, which may include reviewing their policies and procedures to make sure that they are still relevant and up to date in light of the incident. The reviewing of a policy also reflects that the organisation is taking responsibility for any failings but that they have learned from the failings and are actively working to prevent such failings from reoccurring again in the future.

The manager of the setting will be responsible for such a review but they are likely to work together with several other people in order to do this successfully. For example, they may review the policies and procedures with their staff to make sure that everyone has an equal say in how potential amendments should be made. This might be particularly pertinent for someone who was originally involved in identifying abuse.

Furthermore, the organisation’s manager may need to seek guidance from other agencies, particularly the local authority and/or the CQC, both of whom may have been involved in an investigation and therefore may be well placed to make pertinent recommendations about changes to be implemented in the future.

Once policies and procedures have been amended, the organisation is responsible for making sure that staff undergo any relevant identified training and that they are aware of what any changes are and how they impact the role that they carry out.

Management should set a date to check if the review is effective, preferably within six months of amendments to policies and procedures being made.