Disclosure and Raising a Concern

A disclosure happens when:

1. An 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).

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 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 an 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 any immediate action that 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.

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

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. Date, time and location of the incident;
2. Details of who made the disclosure;
3. State exactly what has been reported to you or what you saw, if you witnessed the incident (record the words used by the person making the disclosure);
4. If possible, state who was the perpetrator of the abuse or neglect;
5. Describe the appearance and behaviour of the adult;
6. Describe in detail any injuries observed (complete a body map if appropriate);
7. If the incident was reported to you, ask the person who witnessed the incident to make a written account and to date and sign the account;
8. Explain what action has been taken to address immediate risks.

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 author.

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

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 or has been committed;
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 to a place of safety;
6. Arranging for someone to be with 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.

What to do if you operate a regulated service

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. 

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).

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.

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 Gateshead that safeguarding adult concerns are raised with the local authority within one working day of identification.

In Gateshead, a Safeguarding Adult Concern must be raised whenever there is a reasonable cause to suspect 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).

The Gateshead Safeguarding Adults Board Concern Decision Making Tool provides additional guidance as to appropriate pathways for concerns about an adult in Gateshead. It is important that our practitioners understand the difference between statutory safeguarding, complaints, quality of care (concerns about a provider) and care / health management pathways. It can be found in the Practice Resources and Guidance (Local) section of the Contacts and Practice Resources area.

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

• Have you discussed your concerns with the adult? (see: Principles of Engagement within the Safeguarding Adults Process);
• Have you sought consent from the adult to report a safeguarding concern? (see below);
• Have you discussed possible outcomes with the adult? Have you asked the adult what they would like to happen? (see: The Skilled Conversation);
• Does the adult have the capacity to understand that a safeguarding concern will be raised – and what this process means? (see: The Mental Capacity Act 2005 Resource and Practice Toolkit);
• Have you thought about who you need to share the concern with immediately? (see: Section 4, Immediate Action and Preserving Physical Evidence).

Adults

Consent of the adult should always be sought before raising the concern, unless:

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: You should carry out a mental capacity assessment which is time and decision specific, this means that at the point you seek consent from the person to raise a concern you should decide if they have capacity to consent. This guidance will help you: Supporting People to Make Their Own Decisions.

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.

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

It is only appropriate to raise a concern 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. There are concerns that decision has not been made freely but been unduly influenced or subject to 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 a person declines safeguarding support that is not the end of the matter. Consideration should 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 person's wellbeing, including their 'vital interests' and the impact on others in the situation.

You can raise a safeguarding adult concern online or by telephone:

Online form: Raise an adult safeguarding concern online

Telephone: 0191 433 7033 (24 hours a day, 7 days a week)

See: Information required to raise a Safeguarding Adults Concern in Gateshead

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.