Overview and background

Introduction

This guidance document is to be used across Sussex to support professionals, partners, and providers to decide on whether to report a safeguarding concern for an adult with care and support needs (Care and Support (Eligibility Criteria) Regulations, 2014). It also helps differentiate between quality issues and safeguarding and provides alternative actions that can be considered.

This document should be used in conjunction with the Sussex Safeguarding Adults Policy and Procedures (Sussex Safeguarding Adults Boards, 2025) as well as each agency’s own safeguarding policies and procedures. It is not a substitute for agencies following their own internal incident policies and processes and responding to practice and performance issues with staff or following agency disciplinary procedures. Additionally, where concerns are categorised as ‘requires consultation’, it is important that staff consult initially with a manager or safeguarding lead in their own organisation, before consulting with the local authority Adult Social Care if further guidance is needed.

Please note, it is the responsibility of the referrer to use their professional judgement when making the decision to refer or not. This guidance and any consultation are not a substitute for the decision the referrer needs to make.

If there is professional disagreement regarding adult safeguarding decision-making, including the application of this guidance, please consult the Sussex Safeguarding Adults Escalation and Resolution Protocol.

Care Act 2014

Section 42 (1) and (2) of the Care Act 2014 outlines the criteria for raising a safeguarding concern and deciding whether it should lead to a safeguarding enquiry.

Section 42 (1): Whether there is ‘reasonable cause to suspect’ that an adult:

1. Has needs for care and support (whether the local authority is meeting any of those needs)
2. Is experiencing or is at risk of abuse or neglect, and
3. As a result of their needs is unable to protect themselves.

Section 42 (2):

1. Making (or causing to be made) whatever enquiries are necessary.
2. Deciding whether action is necessary – and if so what and by whom.

The Section 42 duty on the local authority exists from when a concern is received. This does not mean that all activity from that point will be reported under the duty to make enquiries (Section 42 (2) of the Care Act). It may turn out that the Section 42 (2) duty is not triggered because the concern does not meet all the Section 42 (1) criteria – points i. – iii. above.

The local authority is responsible for decision making as to whether to proceed with the duty to undertake enquiries under Section 42 (2) and retains the responsibility for overseeing a safeguarding enquiry. The framework that is used locally can be found in Section 2.3 of the Sussex Safeguarding Adults Policy and Procedures.

This guidance is informed by the frameworks produced by the Local Government Association (LGA) and the Association of Directors of Adult Social Services (ADASS). The frameworks support consistent multi-agency practice in relation to understanding, reporting, and recording of safeguarding concerns (LGA and ADASS, 2020) and whether a reported concern requires an enquiry under the Section 42 duty of the Care Act 2014 (LGA and ADASS, 2019).

Making Safeguarding Personal

The Care and Support Statutory Guidance that accompanies the Care Act 2014 requires adult safeguarding practice to be person-led and outcome-focused. It is vital to seek the views and desired outcomes of the adult or the adult's advocate and for these to be recorded. It is good practice to identify the adult’s feelings and the impact the abuse or neglect has had on them.

It is important to remember that consent is not essential when deciding whether safeguarding concerns should be raised, and for information to be shared about safeguarding risks. Please refer to Section 2.2.5 of the Sussex Safeguarding Adults Policy and Procedures and the Sussex SABs Information Sharing Guide and Protocol (Sussex Safeguarding Adults Boards, 2020) for more information on consent and empowerment of an adult when raising a safeguarding concern.

Quality and safeguarding

The expectation is effective, high-quality care and support for every adult. If the quality of a service is reduced, adults using the service may be placed at risk. However, these concerns could indicate poor practice and poor-quality care rather than abuse or neglect. This guidance contains examples of service provision issues frequently raised as safeguarding concerns that are quality issues and where alternative actions need to be considered in the first instance.

Section 14.9 of the Care and Support Statutory Guidance is clear that safeguarding is not a substitute for:

• The responsibility of providers to provide safe and high-quality care and support.
• Commissioners regularly assuring themselves of the safety and effectiveness of commissioned services.
• The Care Quality Commission (CQC) ensuring that regulated providers comply with the fundamental standards of care or by taking enforcement action.
• The core duties of the police to prevent and detect crime and protect life and property.

Quality issues in relation to registered providers should be reported to the Care Quality Commission (CQC) and, those related to commissioned health services, to the Surrey and Sussex Integrated Care Board (ICB) Quality Team via email to sxicb.qualityteam@nhs.net.

Quality issues that are reported to the CQC or ICB Quality Team about providers in Brighton & Hove should also be reported to the QualityMonitoringTeam@brighton-hove.gov.uk.

In East Sussex, if consultation is required in relation to quality or service contract monitoring, or decision-making regarding safeguarding or quality concerns, please contact the Council’s Health and Social Care Connect.

Please refer to Section 2.6 of the Sussex Safeguarding Adults Policy and Procedures or more information on safeguarding and quality of care.

Mental health and wellbeing

It is important to note that mental health and wellbeing concerns do not constitute abuse or neglect according to the Care Act 2014. Where there are mental health and/or wellbeing concerns, these should be reported to mental health services, in the first instance. Mental health services can refer to the local authority if, during the course of their response, care and support needs requiring assessment or review are identified, or abuse or neglect, including self-neglect, emerge.

Think Family

We know that children and adults rarely live in isolation, and as such, it’s important that when we are working with children or adults we take an approach which takes into consideration the whole family. This is known as a Think Family approach.

Think Family is an approach that can be used in many scenarios, but it’s particularly relevant in safeguarding work, where we want to understand the context in which abuse or neglect is occurring, as well as the support networks available to the individual. For more information, visit the West Sussex Safeguarding Adults Board information about Think Family.

Unpaid carers

When utilising this guidance it is important to consider the ways in which unpaid carers may be subject to abuse from those adults that they care for. This may be either intentional or unintentional, but in either case, unpaid carers may feel unable to protect themselves as a result of their complex relationship with the adult. When working with unpaid carers, always consider signposting them to Carers Support for advice, guidance, or a carers assessment.

Key considerations

Please note: This guidance is for support when assessing and managing risks, and only contains some examples. You should always consider the individual circumstances of each situation and use your professional judgement when deciding on the best course of action.

Questions to be considered for all potential safeguarding concerns:

• Does the person have care and support needs? For information about what constitutes care and support needs, see the explanatory note below.
• How long has the alleged abuse or neglect been occurring?
• What is the seriousness or impact on the individual?
• Are the incidents increasing in frequency and/or severity, or are there patterns of abuse?
• What is the person’s view in relation to the identified risks and actions they would like to be taken to address these risks?
• Has the person’s mental capacity been considered, and their ability to understand what has happened and how they wish to respond to the concern(s)?
• Does the person have any conditions or circumstances making them unable to protect themselves from suspected abuse or neglect? This might include physical or mental health needs, the impact of trauma, or cognitive impairments such as brain injury.
• Have there been any previous concerns about the person thought to be the cause of risk or are they are in a position of trust?
• Does the concern relate to family or friends in caring roles? If so, consider whether the risk of abuse or neglect may be connected to their caring role.
• Does the concern relate to the actions of other individuals? For example, issues such as anti-social behaviour or self-neglect may be caused by the impact of coercion, control, undue duress, or other forms of exploitation.
• Are there any other adults at risk?
• Are there children also at risk? If so, contact the relevant local authority Children’s Services department.

Responding to concerns

All incidents must be recorded and reported using the appropriate procedures but not all incidents will be safeguarding issues.

It is important to consider in the first instance whether someone is in immediate danger or has been the subject of a crime. Criminal acts must be reported to the police and/or emergency treatment should be sought where necessary. If it is not an emergency, please call Sussex Police on 101 or report online on the Sussex Police website.

You should always seek advice from your line manager and/or safeguarding lead if you have a concern. If in doubt or further consultation is required, contact the local authority Adult Social Care department:

• Brighton & Hove Adult Social Care
• East Sussex Adult Social Care
• West Sussex Adult Social Care

If a child is identified to be at risk of harm, contact your local Children’s Services department:

• Brighton & Hove Children's Services
• East Sussex Children's Services
• West Sussex Children's Services

Where there are repeated concerns raised, whether or not they individually constitute a safeguarding concern, it is important that the local authority adopts a ‘step back and look’ approach. This means being reflective and employing a professionally curious approach where repeated concerns are received about a person who is identified as having, or developing, care and support needs.

It is important to take the time to consider a holistic Think Family approach, considering any risk of harm to the person, any other people they live with (for example family members and/or carers/cared), or risk to others. It is also key that the person themselves or their representative are contacted in the process of information-gathering, triage, and decision-making, along with the referrer who has raised the concern.

Multi-agency working and risk management

When working with adults with care and support needs, and particularly those with multiple and compound needs, it is essential that you engage in multi-agency working. This means working collaboratively with staff from the involved agencies. This will ensure that everybody involved in an adult’s care is aware of, and understands, each other’s work and views so that the adult has the best experience of a co-ordinated approach.

This will help to ensure you are providing a high standard of care and will allow you to share your experience and expertise with other agencies, increasing the likelihood of positive outcomes for the adult. To engage in effective multi-agency working you should consider convening a multi-agency meeting and undertaking a multi-agency risk assessment. If, despite multi-agency operational responses being provided the risk is not felt to be reducing, escalation to your local Multi-Agency Risk Management (MARM) group may be indicated as the person remains at significant risk of harm.

• East Sussex SAB MARM Protocol
• West Sussex SAB MARM Protocol
• Brighton & Hove SAB MARM Framework

People in Positions of Trust (PiPoT)

The Care Act 2014 requires the local authority, its relevant partners and those providing care and support services to have clear policies in place for dealing with allegations or safeguarding concerns involving anyone working or volunteering in a position of trust. These policies should clearly distinguish between an allegation, a practice concern, a complaint, and a care quality issue. All staff should be familiar with these policies and aware of their responsibilities.

For detailed information in relation to PiPoT including when to report to local authority, please see Section 2.5 of the Sussex Safeguarding Adults Policy and Procedures which sets out employer responsibilities in this area and contact details across Sussex.

Categories of abuse and neglect

The Care Act 2014 has introduced the requirement to record additional categories of abuse such as Female Genital Mutilation, Modern Slavery, Self-Neglect, Honour Based Violence and Domestic Abuse. It should be noted that these categories may be seen within other categories of abuse.

Below is guidance for the ten categories of abuse and neglect identified in the Care Act 2014. These are followed by additional guidance on specific incidents where safeguarding concerns are frequently raised. These include pressure ulcers, falls, medication errors, incidents between adults in a service, and homelessness.

Prevent duty

Organisations named under the Prevent duty include schools, local authorities, police, the NHS, and prisons, are all specified authorities required to have "due regard to the need to prevent people from being drawn into terrorism". Professionals must recognise radicalisation as a safeguarding concern and follow the appropriate referral pathways. Concerns should be raised through internal safeguarding procedures, typically via the organisation’s Prevent Lead or Safeguarding Lead. If a risk is identified, a Prevent referral form should be completed and submitted to the Sussex Police Prevent team who will assess the concern and determine if multi-agency support is required. The Channel process is a confidential, voluntary programme that provides tailored interventions to support individuals at risk.

For information regarding Radicalisation, please see Section 2.10 and Section 3.1.22 of the Sussex Safeguarding Adults Policy and Procedures.