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https://trixcms.trixonline.co.uk/api/content/wynyy-kirklees

Learning from SAR/DHR

Learning Briefing Adult O.pdf

safeguarding adults review led by independent sar reviewer lorna warriner‘adult o’learning from sarbackgroundthe safeguarding adults review (sar) subgroup received a referral for adult o, a female in her 20’s who sadly passed away. adult o had been living at her family home and was cared for primarily by her mother.  adult o had complex health needs from birth, including cerebral palsy , scoliosis , blindness, epilepsy , quadriplegia  and she also had a profound learning disability. the sar subgroup reviewed records from the organisations who had worked with adult o and found that it met the criteria for a review to be conducted.safeguarding concerns•no transitional process from children services to adult services •awareness by some agencies mum had phobia of health professionals / hospital settings /dentists however no action was taken to support.•numerous missed appointments with dentist / hospital paediatric consultants / dietetics/ epilepsy clinic / home visits including gastrostomy tube  and nutritional feeds follow up•concerns around loss of weight when not attending school and poor personal care •epilepsy medication not collected - gp did not identify this for 12 months•adult o not registered to have annual learning disability health checks from the age of 14•occurring pressure sores with no evidence of support / advice to reduce risk provided to mum•mum requesting but then declining day care due costs with no further exploration of this •no safeguarding advice or concerns raised for suspected neglect / acts of omission •no mental capacity assessment or best interest decision completed •lack of multiagency information sharing and working together increased the risk of adult o’s health and social care needs not being metkey learningpartner agencies and local organisations are required to do the following: •review transitional policies and update and amend if required. •make reasonable adjustments to care pathways to ensure people with learning disabilities, autism or both, along with their carers can access highly personalised care and achieve equality of outcomes. •have an up to date and fit for purpose organisational ‘was not brought policy’.•increase their application and understanding around legal literacy to include raising  safeguarding adult concerns and deprivation of liberty safeguards.  •assess mental capacity regarding important life decisions and future care at the age of 16.  at 18 parental responsibility ceases therefore formal legal authority should be considered i.e. court appointed deputy or lasting power of attorney along with a mca and best interest meeting should take place, to make health and welfare decisions. 
good practice•as a child, adult o attended a special education school, which promoted reasonable access to health services and provided an easily accessible environment for them to be seen. •the consultant paediatrician made many attempts to engage professionals in the transition process in 2016 (when adult o was aged eighteen years old).•in august 2018, the gp followed up concerns that mum was not recognising signs of sepsis -  a face-to-face appointment with adult o and her mum was completed providing advice regarding catching and treating infection early, in the event that adult o became unwell. •dietician identified that there was an emerging theme of not being able to see adult o at home and contacted the gp to determine if they had any concerns.•a hospital learning disability matron visited her on the ward and made contact with several agencies to see who adult o was known to. the matron also referred to the community learning disability team •raising a section 42 safeguarding adult concern has been noted as a missed opportunity / learning point – we  would like to acknowledge that a section 42 was raised by a hospital trust due to concerns about her presenting physical condition on admission, sadly she passed a few days later.  kirklees safeguarding adult board response•the ksab commissioned an independent author to carry out the review •all agencies involved with adult o were required to submit a scoping document and chronology that encouraged early individual reflective learning. the chronologies and learning were then combined, and the author, chair and sar panel identified further areas that needed to be explored by all agencies involved.•a practitioner learning event was held which provided an opportunity for the practitioners who were involved with adult o and her family, to collaboratively reflect and identify learning in a safe and transparent space.  •this review was overseen by the kirklees safeguarding adults board (ksab) subgroup.•a combined multiagency action plan was put in place to address all concerns identified*glossary of terms usedwas not brought policy has a safeguarding focus and relates to patients who rely on others to take them to an appointment. safeguarding concern sometime referred to as a section 42 under the care act is the process to refer allegations of abuse and neglect of an adult at risk (someone with care and support needs)the act of neglect and acts of omission can be intentional or unintentional and relates to when a person at risk is reliant on another person to provide care. neglect and acts of omission can include ignoring a person’s medical needs, failure to provide care and support and withholding the necessities of life, such as medicationif you need to raise a safeguarding concern, contact kirklees community health and social care hub – call 0300 304 5555if any agency who was involved wishes to see copy of the report they are requested to contact ksab@kirklees.gov.uk 


Learning briefing Adult O.pdf

safeguarding adults review led by independent sar reviewer lorna warriner‘adult o’learning from sarbackgroundthe safeguarding adults review (sar) subgroup received a referral for adult o, a female in her 20’s who sadly passed away. adult o had been living at her family home and was cared for primarily by her mother.  adult o had complex health needs from birth, including cerebral palsy , scoliosis , blindness, epilepsy , quadriplegia  and she also had a profound learning disability. the sar subgroup reviewed records from the organisations who had worked with adult o and found that it met the criteria for a review to be conducted.safeguarding concerns•no transitional process from children services to adult services •awareness by some agencies mum had phobia of health professionals / hospital settings /dentists however no action was taken to support.•numerous missed appointments with dentist / hospital paediatric consultants / dietetics/ epilepsy clinic / home visits including gastrostomy tube  and nutritional feeds follow up•concerns around loss of weight when not attending school and poor personal care •epilepsy medication not collected - gp did not identify this for 12 months•adult o not registered to have annual learning disability health checks from the age of 14•occurring pressure sores with no evidence of support / advice to reduce risk provided to mum•mum requesting but then declining day care due costs with no further exploration of this •no safeguarding advice or concerns raised for suspected neglect / acts of omission •no mental capacity assessment or best interest decision completed •lack of multiagency information sharing and working together increased the risk of adult o’s health and social care needs not being metkey learning•adult o did not go through a formal transition process from children to adult services, which she should have had in accordance with the national institute for health and care excellence (nice) guideline [ng43] for ‘transition from children’s to adults’ services for young people using health or social care services’ (2016)•both child and adult services, all agencies involved did not have an effective ‘was not brought’ organisational policy, or they were still working under an organisational ‘did not attend policy.’•when adult o turned sixteen this would have been a time for agencies to assess her mental capacity regarding important life decisions and future care.  when adult o turned eighteen, her mum no longer had parental responsibility nor did she have a formal legal authority in the way of being a court appointed deputy  or lasting power of attorney, to make health and welfare decisions – a mca and best interest meeting should have taken place. •no consideration by the agencies that she may have been deprived of her liberty and required a court of protection, deprivation of liberty (copdol11) authorisation.
good practice•as a child, adult o attended a special education school, which promoted reasonable access to health services and provided an easily accessible environment for her to be seen. •the consultant paediatrician made many attempts to engage professionals in the transition process in 2016 (when adult o was aged eighteen years old).•in august 2018, the gp followed up concerns that mum was not recognising signs of sepsis -  a face-to-face appointment with adult o and her mum was completed providing advice regarding catching and treating infection early, in the event that adult o became unwell. •dietician identified that there was an emerging theme of not being able to see adult o at home and contacted the gp to determine if they had any concerns.•mum offered but declined carers assessment – no information provided where to seek support if required •a hospital learning disability matron visited her on the ward and made contact with several agencies to see who adult o was known to. the matron also referred to the community learning disability team •a section 42 safeguarding adult concern raised by hospital trust due to concerns about physical condition kirklees safeguarding adult board response•the ksab commissioned an independent author to carry out the review •all agencies involved with adult o were required to submit a scoping document and chronology that encouraged early individual reflective learning. the chronologies and learning were then combined, and the author, chair and sar panel identified further areas that needed to be explored by all agencies involved.•this review was overseen by the kirklees safeguarding adults board (ksab) subgroup.•a practitioner learning event was held which provided an opportunity for the practitioners who were involved with adult o and her family, to collaboratively reflect and identify learning in a safe and transparent space.  *glossary of terms usedwas not brought policy has a safeguarding focus and relates to patients who rely on others to take them to an appointment. please see further was not brought guidancesafeguarding concern sometime referred to as a section 42 under the care act is the process to refer allegations of abuse and neglect of an adult at risk (someone with care and support needs)the act of neglect and acts of omission can be intentional or unintentional and relates to when a person at risk is reliant on another person to provide care. neglect and acts of omission can include ignoring a person’s medical needs, failure to provide care and support and withholding the necessities of life, such as medicationif you need to raise a safeguarding concern contact kirklees community health and social care hub – call 0300 304 5555 or email gatewaytocare@kirklees.gov.uk if any agency who was involved wishes to see copy of the report they are requested to contact ksab@kirklees.gov.uk 


Video and Online Learning Resources.pdf

video and online learning resources  resource and area duration source mate crime     have we learned the lessons from steven hoskin's murder? 12.27 scie gemma: murdered by friends 29.59 bbc coercive control     walking on eggshells 16.55 womens aid/surrey police self-neglect and hoarding     keith's story: a personal and touching film about hoarding 13.34 birmingham safeguarding adults board self-neglect guidance 10.15 teeswide safeguarding adults board female genital mutilation     fgm: the uk's hidden crime 7.09 euronews modern slavery     break the chain: a short film about modern slavery in the uk 5.15 break the chain forced marriage     awareness of forced marriage-free online course   forced marriage unit nazir afzal part 1: forced marriage and honour killings 16.00 honour based violence awareness network radicalisation     prevent programme training-free online course   home office  


Learning briefing Domestic Abuse.pdf

‘domestic abuse’learning from sar/dhrwhat is domestic abuseunder section 9(4) of the domestic violence, crime and victims act 2004, a domestic homicide review (dhr) is a review of the circumstances in which the death of a person aged 16 or over has, or appears to have, resulted from domestic abuse.the domestic abuse act 2021 defines domestic abuse as behaviour between two people that are personally connected that consists of physical or sexual abuse; violent or threatening behaviour; controlling or coercive behaviour; economic abuse; psychological, emotional or other abuse.  it does not matter whether the behaviour consists of a single incident or a course of conduct. we define people who are ‘personally connected’ as: intimate partners, ex-partners, family members including siblings or individuals who share parental responsibility for a child. there is no requirement for the victim and perpetrator to live in the same household.professional curiosity •professional curiosity is the capacity and communication skill to explore and understand what is happening within a family rather than making assumptions or accepting things at face value.•professional curiosity can require practitioners to think ‘outside the box’, beyond their usual professional role, and consider families’ circumstances holistically.  curious professionals engage with individuals and families through visits, conversations, observations and asking relevant questions to gather historical and current information. •it is important to understand the context of language, if someone advises that a partner/ family member is becoming more aggressive – what do they mean by this, is this physical abuse/ verbal or emotional abuse.  all of which are definitions of domestic abuse, and any interventions need to have this risk in mind and respond appropriately to it.  domestic abuse and dementia / cognitive declineeven in previously healthy relationships, a person living with dementia can begin to use abusive behaviour.  in situations where the perpetrator has dementia, the risk of harm can significantly increase, particularly if the victim-survivor is their primary carer. providing intimate care means close physical contact, making it harder for victim-survivors to keep themselves safe. sometimes signs of domestic abuse are either overlooked, or seen as a one-off incident, rather than a pattern of coercive behaviour. there is also a tendency to treat the abuse as unintentional harm or neglect, thanks to a general assumption that families and partners always act with compassion towards the older person. yet the reality is often far from the idealised picture we have of care and support in later life. when an individual is experiencing cognitive decline there is a risk that domestic abuse may not be suspected because of the vulnerability of the perpetrator. whilst it may feel uncomfortable referring people diagnosed with dementia to agencies stating they are a perpetrator of domestic abuse; it is important to share this information to reduce risks.  multiagency working is key and sharing information to all parties involved is critical in keeping victims safe, this includes domiciliary care providers.  
responding to domestic abuse•domestic abuse is a crime if you're a victim of domestic abuse, or know someone who is, and there's an emergency that's ongoing or life is in danger, call 999 now.•consideration of section 42 duty – if the victim has care and support needs as defined in the care act 2014 and domestic abuse is suspected then a referral should be made to adult social care to raise a safeguarding concern.  a safeguarding response may then be initiated, and a multiagency meeting may be convened where risks should be shared and responded to, it is imperative risks are shared with care providers.  professionals can raise a safeguarding concern to adult social care - report abuse or neglect of an adult at risk | kirklees council•all safeguarding concerns will be considered in line with making safeguarding personal in reaching effective outcomes in line with the person's own wishes.  •unpaid carers require a carers assessment – when working with people consideration should be made as to who is caring for who, and a carers assessment offered.  it may be that both victim and perpetrator care for each other so both should be offered a carers assessment.  •referral to specialist services – the pennine domestic abuse partnership is a registered charity that provides high quality specialist support, advice, information and safe accommodation to anyone effected by or experiencing domestic abuse.•multiagency working is the most effective way to approach the issue at both an operational and strategic level – anyone can call a multi-agency meeting to share concerns about a family.kirklees community partnership board responsewhen someone dies as a result of domestic abuse, a domestic homicide review should be carried out to:•establish what lessons are to be learned from the domestic homicide regarding the way in which local professionals and organisations work individually and together to safeguard victims.•identify clearly what those lessons are both within and between agencies, how and within what timescales they will be acted on, and what is expected to change as a result.•apply these lessons to service responses including changes to policies and procedures as appropriate.•prevent domestic violence homicide and improve service responses for all domestic violence victims and their children through improved intra and inter-agency working.central to a dhr is improving our understanding of domestic abuse and how our services respond to victims and children.  understanding how disclosures and/or other evidence of domestic abuse were recognised and responded to will support us to improve our co-ordinated multi-agency approach so domestic abuse can be identified and responded to effectively at the earliest opportunity.further resourceskirklees council - domestic abusewelcome to pennine domestic abuse partnership – pdapkirklees domestic abuse strategyadvice about domestic abuse | police.uk (www.police.uk)contacts and practice resources (trixonline.co.uk) – section 7hidden harms - domestic abuse in older people – youtubeprofessional curiosity film


The Learning Disability Mortality Review (LeDeR) programme was set up by NHS England to improve the health and social care of people with learning disabilities. It is coordinated by Bristol University but managed locally by each authority.
If a person with a learning disability (aged 4 years or over) dies the LeDeR programme should be notified so that a review can be carried out and any learning identified.
In each case the reviewer will look at the health needs of the individual and the care they were getting, as well as whether annual health checks were being carried out, the right services were being accessed, medication was being reviewed, and reasonable adjustments were being made.
The programme also provides support to local areas to take forward any lessons learned in the reviews to make improvements to service provision.
For more information and to make an online referral, see: <a href="https://leder.nhs.uk/report" target="_blank" rel="noopener">Report the death of someone with a learning disability or an autistic person</a>.

Learning Disability Mortality Review (LeDeR)

Homepage

This is a joint multi-agency procedure, meaning it applies to all partner organisations in West Yorkshire, North Yorkshire and City of York.
It applies to any professional or organisation involved in any aspect of the Safeguarding Adults Review process, from referral right through to reviewing recommendations.
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<div class="panel-heading">Remember</div>
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Check the&nbsp;<a href="/resources/contacts-and-practice-resources">Contacts and Practice Resources</a> area for any supplementary guidance or processes you are required to follow. This can be accessed from the big button below or the main Contents List.
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Using this Procedure

What is a Safeguarding Adults Review (SAR)?

Any agency or professional may refer a case that they consider meets the criteria for either a mandatory or discretionary SAR to be carried out as outlined above.
<h4>Bradford</h4>
Email: &nbsp;<a href="mailto:BSAB@bradford.gov.uk" target="_blank" rel="noopener">BSAB@bradford.gov.uk</a> or Call: 01274 432736
<h4>Calderdale</h4>
<a href="https://safeguarding.calderdale.gov.uk/wp-content/uploads/2019/11/SAR-consideration-request-form.docx" target="_blank" rel="noopener">Safeguarding Adults Review (SAR) - Calderdale SAB Case Consideration Request Form</a>
<h4>City of York</h4>
<a href="https://www.safeguardingadultsyork.org.uk/safeguarding-adult-reviews" target="_blank" rel="noopener">Safeguarding Adult Reviews</a>
<h4>Kirklees</h4>
<a href="https://my.kirklees.gov.uk/en/service/Adult_social_care___Safeguarding_Adults_Review_referral_form" target="_blank" rel="noopener">Safeguarding Adults Review referral</a>
<h4>North Yorkshire</h4>
<a href="https://safeguardingadults.co.uk/learning-research/nysab-learning/sar-policy/sar-referral/" target="_blank" rel="noopener">NYSAB - Make a SAR referral</a>
<h4>Wakefield</h4>
<a href="https://www.wakefield.gov.uk/adult-social-care/safeguarding-adults-from-abuse/safeguarding-adults-reviews/" target="_blank" rel="noopener">Safeguarding Adults Review (SAR) Referral Form</a>

Making a referral

Remember: It is the sole responsibility of the Safeguarding Adults Board (SAB) to decide whether the conditions for carrying out any kind of Safeguarding Adults Review (SAR) have been met and to arrange for a SAR to be carried out.
All referrals should be reviewed by the Safeguarding Adults Board (SAB) to ensure that the conditions for carrying out a Safeguarding Adults Review (SAR) have been met. Decisions should be made in line with local processes and requirements.
The Chair of the SAB is ultimately responsible for making any final decision.

Referral decisions

The decision to accept (or not to accept) the referral should be clearly recorded in line with local recording requirements.

Recording the decision

Once a referral is accepted the SAB should appoint an appropriate individual to carry out the SAR.
The individual must have appropriate skills and experience which should include:
<ol style="list-style-type: lower-alpha;">
<li>Strong leadership and ability to motivate others;</li>
<li>Expert facilitation skills and ability to handle multiple perspectives and potentially sensitive and complex group dynamics;</li>
<li>Collaborative problem-solving experience and knowledge of participative approaches;</li>
<li>Good analytic skills and ability to manage qualitative data;</li>
<li>Safeguarding knowledge.</li>
</ol>
There will also be a need to address the budgetary requirements for undertaking the SAR.
Decisions about who should carry out the SAR should be made in line with local processes and requirements.
The referrer should be notified of the decision made.

Referral accepted

In the event of a SAR referral being rejected, the rationale should be clearly recorded in line with local recording requirements.
The referrer should be notified of the decision made.
If the referrer is dissatisfied with the decision, they can discuss their concerns with the SAB or make a formal complaint.

Referral rejected

Carrying out a SAR

Remember: It is the responsibility of the Safeguarding Adults Board to determine what process each SAR should follow.
The approach should be proportionate to the scale of the abuse or neglect that has occurred, the impact on the person and the level of complexity in the issues to be examined during the review.
The focus must be on what needs to happen to achieve understanding, remedial action and, very often, answers for families and friends of people who have died or been seriously abused or neglected.

The SAR process

The SAR should be completed within a reasonable period of time and in any event within six months of initiation, unless there are good reasons for a longer time period.

The SAR timescale

In all cases
The SAR Panel should ensure that all relevant persons are involved.
For example:
<ol style="list-style-type: lower-alpha;">
<li>Professionals involved with the adult;</li>
<li>Organisations involved with the adult;</li>
<li>Family members;</li>
<li>Carer's (informal and paid).</li>
</ol>
In some cases, it may be deemed necessary to also involve the person who caused (or is suspected of causing) the abuse or neglect.
If the adult is alive
If the adult is still alive, they should be consulted on the level of their involvement. They can decline to be involved.

Who must be involved

If the SAB or individual carrying out the SAR requests a person or organisation supply information to support the process, they have a duty to comply with that request under s45 of the Care Act.
All information sharing should be carried out with regard to the Caldicott Principles, Data Protection legislation and local information sharing policies.

The duty to provide information

A Safeguarding Adults Review (SAR) is a review carried out to evaluate the practice of agencies involved with an adult (or adults) at risk, so that lessons can be learned, and practices improved.
Section 44 of the Care Act 2014 requires the Safeguarding Adults Board (SAB) to conduct a Safeguarding Adults Review (SAR) when the duty to do applies (a mandatory SAR) and permits them to arrange one in other circumstances (a Discretionary SAR). These are both explained in section 3 below.
The purpose of a SAR is not to proportion blame but to identify learning and decide how to apply this to future cases. The SAR should also be used to identify good practice.

Overview

If the adult is alive there is a statutory duty on the local authority to ensure they receive the support they need to enable them to understand and/or participate in the SAR process.
If they are already in receipt of advocacy support under Section 67 of The Care Act, The Mental Capacity Act 2005, or the Mental Health Act 1983 it is appropriate to establish whether the existing advocate is able to provide this support.
Otherwise, the duty to appoint an advocate under Section 68 of the Care Act must be considered.
For further information about the duty to appoint an independent advocate see:&nbsp;<a href="https://www.proceduresonline.com/resources/careact/p_duty_indep_adv.html" target="_blank" rel="noopener">The Duty to Provide an Independent Advocate</a>.

Advocacy and Support

Several SARs have identified discrimination as either leading to or being a feature of the abuse that subsequently led to the death of an adult at risk. The Safeguarding Adult Review (SAR) should therefore seek to establish any role that protected characteristics or discrimination may have had in both the abuse or neglect and the safeguarding response itself.
For further information see: <a href="https://www.local.gov.uk/publications/discriminatory-abuse-briefing-practitioners#discriminatory-abuse-in-safeguarding-adults-reviews-and-serious-case-reviews" target="_blank" rel="noopener">Discriminatory abuse in Safeguarding Adults Reviews and Serious Case Reviews (part of LGA briefing)</a>.

Discriminatory abuse and protected characteristics

Following the Safeguarding Adults Review (SAR) a report must be provided to the Safeguarding Adults Board (SAB).
The report should set out:
<ol style="list-style-type: lower-alpha;">
<li>How the SAR was carried out;</li>
<li>The conclusions reached;</li>
<li>Learning identified;</li>
<li>Recommendations and actions for the SAB.</li>
</ol>
The report should:
<ol style="list-style-type: lower-alpha;">
<li>Provide a sound analysis of what happened, why, and what action needs to be taken to prevent a reoccurrence, where possible;</li>
<li>Be written in plain English;</li>
<li>Contain findings of practical value to organisations and professionals.</li>
</ol>
Remember: The purpose of a SAR is not to proportion blame but to identify learning and decide how to apply this to future cases.

The SAR Report

Learning should be shared in line with local processes and requirements, and with regard to the circumstances of each report.

Sharing findings and learning

All recommendations from the SAR report must be considered by the Safeguarding Adults Board (SAB).
If the unlikely event that the SAB decides not to carry out a recommendation, the reasons for doing so must be clearly recorded in line with local recording requirements.

Recommendations from the SAR

Any actions to be carried out should be recorded in an Action Plan. It should be clear which individual representative of the relevant agency/organisation is responsible for carrying out each action and in what timeframe. This individual will be accountable to the SAB for implementation of the actions allocated to them.
The Chair of the SAB is responsible for reviewing the Action Plan and monitoring progress of the actions.

Action Plans

The following information from each Safeguarding Adults Review (SAR) must be recorded in the annual SAB Report:
<ol style="list-style-type: lower-alpha;">
<li>The findings of the SAR;</li>
<li>What actions have been taken (or will be taken) in relation to those findings;</li>
<li>Where a recommendation has not been implemented, the reason/s for that decision.</li>
</ol>
Annual reports can be access using the links below:
<h4>Bradford</h4>
<a href="https://www.saferbradford.co.uk/learning-resources/learning-reviews/" target="_blank" rel="noopener">Learning from Practice</a>
<h4>Calderdale</h4>
<a href="https://safeguarding.calderdale.gov.uk/the-organisations/safeguarding-adults-board/" target="_blank" rel="noopener">Calderdale Safeguarding Adults Board</a>
<h4>City of York</h4>
<a href="https://www.safeguardingadultsyork.org.uk/safeguarding-adult-reviews" target="_blank" rel="noopener">Safeguarding Adult Reviews</a>
<h4>Kirklees</h4>
<a href="https://www.kirklees.gov.uk/beta/adult-social-care-providers/kirklees-safeguarding-adults-board.aspx" target="_blank" rel="noopener">Kirklees Safeguarding Adults Board (KSAB)</a>
<h4>North Yorkshire</h4>
<a href="https://safeguardingadults.co.uk/about-us/annual-reports/" target="_blank" rel="noopener">NYSAB Annual Reports</a>
<h4>Wakefield</h4>
<a href="https://www.wakefield.gov.uk/adult-social-care/safeguarding-adults-from-abuse/safeguarding-adults-partnership-board/" target="_blank" rel="noopener">Safeguarding adults from abuse</a>

Annual SAB Reports

When instigating a Safeguarding Adults Review (SAR), the Safeguarding Adults Board (SAB) should establish if any other relevant investigations are/will be taking place in parallel to the SAR. For example, a:
<ol style="list-style-type: lower-alpha;">
<li>Child Safeguarding Practice Review (CSPR) (previously known as a Serious Case Review);</li>
<li>Domestic Homicide Review;</li>
<li>Criminal investigation;</li>
<li>Coroner's Inquest/Enquiry.</li>
</ol>
The SAB should make contact with the Chair of any parallel process to agree on how best to avoid duplication for the adult (if they are alive), families, professionals, and organisations. This should include how to share relevant information in a timely way, in line with Data Protection legislation and local information sharing policy.

Links with Other Reviews

Safeguarding Adult Boards (SABs) can experience frustration if a Safeguarding Adult Review (SAR) process takes a long time to complete or doesn&rsquo;t produce learning that is useful.&nbsp;
Developed by SCIE, the Safeguarding Adult Reviews in Rapid Time (SARiRT) process and related tools supports a timely and proportionate approach to SARs, helping them to be turned around more quickly and for final reports to be shorter and better focused on systems learning.
For further information see: <a href="https://www.scie.org.uk/safeguarding/adults/reviews/in-rapid-time" target="_blank" rel="noopener">Safeguarding Adult Reviews in Rapid Time (SARiRT)</a>.

Safeguarding Adult Reviews in Rapid Time (SARiRT)

<a href="https://www.scie.org.uk/safeguarding/adults/reviews/quality-markers/" target="_blank" rel="noopener">SCIE: Safeguarding Adult Review Quality Markers</a>
<a href="https://www.local.gov.uk/publications/analysis-safeguarding-adult-reviews-april-2017-march-2019" target="_blank" rel="noopener">LGA: Analysis of Safeguarding Adult Reviews</a>

Further information for SAB’s

The Safeguarding Adults Board
The following are the sole responsibility of the Safeguarding Adult Board:
<ol style="list-style-type: lower-alpha;">
<li>Deciding whether there is a duty to conduct a SAR; and</li>
<li>If so, deciding the manner most appropriate and proportionate to carry it out; and</li>
<li>Making the necessary arrangements.</li>
</ol>
If the Safeguarding Adults Board decides there is no duty to conduct a SAR; they must decide whether there is still a value to carrying out a SAR. If there is, they must decide the most appropriate and proportionate manner to do so and make the necessary arrangements.
Note: The decision about whether a SAR should be carried out, and how best to do so lies solely with the Safeguarding Adults Board and cannot be made by any other organisation.
All other organisations and individuals
All organisations and individuals should be aware of the circumstances in which SAR referral must be made, and take the necessary steps to make a referral when those circumstances apply. If this is unclear, a referral should be made for the SAB to decide upon.
Where a decision is made to carry out a SAR (either mandatory or discretionary), any organisation or individual asked to co-operate with or contribute to the process must do so.

Responsibilities of different organisations

All SARs are subject to the six key principles that underpin all adult safeguarding work:
<ol>
<li>Empowerment;</li>
<li>Prevention;</li>
<li>Proportionality;</li>
<li>Protection;</li>
<li>Partnership;</li>
<li>Accountability.</li>
</ol>
For more information about these principles, see: <a href="https://www.scie.org.uk/safeguarding/adults/introduction/six-principles/" target="_blank" rel="noopener">Six Key Principles that should underpin all Adult Safeguarding Work</a>.
The following principles should also be applied:
<ol style="list-style-type: lower-alpha;">
<li>There should be a culture of continuous learning and improvement across organisations that work together to safeguard and promote the Wellbeing of adults, identifying opportunities to draw on what works and promote good practice;</li>
<li>The approach taken to reviews should be proportionate according to the scale and level of complexity of the issues being examined;</li>
<li>Reviews of serious cases should be led by individuals who are independent of the case under review and of the organisations whose actions are being reviewed;</li>
<li>Professionals should be involved fully in reviews and invited to contribute their perspectives without fear of being blamed;</li>
<li>Families should be invited to contribute to reviews. They should understand how they are going to be involved and their expectations should be managed appropriately and sensitively.</li>
</ol>

Principles of SAR

If the adult is still alive all of the overarching aims, duties, and principles of adult safeguarding apply.
See:&nbsp;<a href="/chapter/overarching-aims-duties-and-principles">Overarching Aims, Duties and Principles Procedure</a>.

Principles if the adult is still alive

The SAR criteria

A mandatory SAR is a SAR that must be carried out because the duties set out in sections 44 (1), (2) and (3) of the Care Act 2014 apply:
<ol style="list-style-type: lower-alpha;">
<li>There is a reasonable course for concern about how the SAB, its members or other persons involved worked together to safeguard the adult; and</li>
<li>The adult has died, and it is known or suspected that the death resulted from abuse or neglect; or</li>
<li>The adult is alive, but it is known or suspected that they have experienced serious abuse or neglect.</li>
</ol>
Note: It is irrelevant whether or not the adult is known to the local authority, or whether or not they are being provided with support or services to meet their care and support needs.
With regard to c. above, indicators that this condition is met could include:
<ul>
<li>The adult would have been likely to have died but for an intervention;</li>
<li>The adult has suffered permanent harm;</li>
<li>The adult has reduced capacity or quality of life (whether because of physical or psychological side effects) as a result of the abuse or neglect.</li>
</ul>

Mandatory SAR’s

A discretionary SAR is a SAR that is carried out when the absolute duty to do so (set out above) does not apply. Under Section 44 (4) of the Care Act SABs are able to arrange for a discretionary SAR to be carried out in any other situation involving an adult in its area with needs for care and support where it believes that there will be value in doing so. This may be where a case can provide useful insights into the way organisations are working together to prevent and reduce abuse and neglect, and can include exploring examples of good practice that can be applied to future cases.

Discretionary SAR’s

SAR referrals

The Safeguarding Adults Board has developed local guidance to support safeguarding where self-neglect and/or hoarding is a factor. It should be read alongside this section of the procedure.
See: <a href="/resources/contacts-and-practice-resources">Contacts and Practice Resources</a>.

Local Guidance

Self-neglect can broadly be defined as one or more of the following:
<table title="self-neglect defined">
<tbody>
<tr>
<td>Lack of self-care</td>
<td>This includes neglect of personal hygiene, nutrition and hydration, or health, to an extent that may endanger safety or wellbeing.</td>
</tr>
<tr>
<td>Lack of environment care</td>
<td>This includes situations that may lead to domestic squalor or elevated levels of risk in the domestic environment (e.g., health or fire risks caused by <a href="/chapter/hoarding">hoarding</a>).</td>
</tr>
<tr>
<td>Refusal of assistance to alleviate issues</td>
<td>This might include, for example, refusal of care services in either their home or a care environment or of health assessments or interventions, even if previously agreed, which could potentially improve self-care or the home environment.</td>
</tr>
</tbody>
</table>

What is Self-neglect?

Self-neglect can be a result of a range of factors and understanding the fundamental causes is essential for addressing the concerns effectively. Some causes of Self-Neglect can include:
<ul>
<li>Mental health issues such as depression, anxiety or diagnosed schizophrenia and psychosis;</li>
<li>Cognitive impairments such as dementia, intellectual disabilities, or traumatic brain injury;</li>
<li>Physical health issues such as chronic illness; mobility issues or substance misuse;</li>
<li>Social isolation; or</li>
<li>Trauma.</li>
</ul>
Self-neglect may be intentional or unintentional, brief or prolonged, and can occur as repeated or isolated incidents.

Causes of self-neglect

Given the complex and diverse nature of self-neglect, responses by a range of organisations are likely to be more effective than a single agency response with reference to housing providers.
It is important to recognise that assessments of self-neglect are grounded in, and influenced by, personal, social, and cultural values and people working with the adult should always reflect on how their own values might affect their judgement.
Finding the right balance between respecting the adult's autonomy and meeting the duty to protect their wellbeing can be challenging. It may involve building up a rapport with the adult to come to a better understanding about whether self-neglect are matters for adult safeguarding or any other kind of intervention.
As there are many causes of self-neglect, it is helpful to try and determine when the self-neglect began as this can help explain why it is happening.
Self-neglect should not be seen simply as a lifestyle choice or the way someone prefers to live. Professionals still have a duty of care to understand why those decisions are being made and explore how to support someone who is self-neglecting and unwilling to engage with help. This involves building a relationship with the person and requires multi-agency collaboration, rather than decisions being made by a single individual or service.
If a person self-neglects because they are unable to care for themselves due to, for example a physical disability, then the most appropriate course of action may be a full assessment of needs and a care and support plan.
Some people self-neglect because of trauma, loss, or bereavement. A person may have been neglected or abused, may be experiencing domestic abuse, or may have had significant loss in their life. This trauma or loss may have affected their self-esteem, self-worth, and ability to self-care. Support from mental health services or a full needs assessment may be helpful to consider all aspects of the person's wellbeing.
It is important to ensure that the adult is not being abused, coerced or harassed into making decisions resulting in self-neglect. There could be a range of reasons why someone can self-neglect, it is important not to make assumptions. Professional Curiosity is particularly helpful in these situations. See <a href="/chapter/professional-curiosity">Professional Curiosity</a>.

Responding to Self-neglect and Hoarding

Crucial to all decision making is a robust risk assessment, preferably multi-agency that includes the views of the adult and their informal networks of support.
The risk assessment might cover:
<ol style="list-style-type: lower-alpha;">
<li>Capacity and consent;</li>
<li>Indications of mental health issues;</li>
<li>The level of risk to the persons physical health;</li>
<li>The level of risk to their overall wellbeing;</li>
<li>Effects on other people's health and wellbeing;</li>
<li>Serious risk of fire;</li>
<li>Serious environmental risk e.g. destruction or partial destruction of accommodation.</li>
</ol>
The&nbsp;Clutter Image Ratings (CIR) may also be a helpful decision-making tool. It is a rising pictorial scale of nine photographs showing clutter in three rooms &ndash; living room, bedroom and kitchen. See <a href="https://hoardingdisordersuk.org/research-and-resources/clutter-image-ratings/" target="_blank" rel="noopener">Clutter Image Ratings (CIR)</a>.

Risk Assessment

If the adult has a carer, it is important to consider their ability to meet the needs of the adult and rule out any neglect or acts of omission. It could be that the carer has unintentionally neglected the caring role because they are no longer able to cope.
Carers can also neglect themselves due to the stresses and demands of their caring responsibilities. It is important to consider whether a carers assessment may be required. Under the Care Act 2014 a carer is eligible for an assessment of their needs regardless of how many hours a week they provide care. See: <a href="https://careact.trixonline.co.uk/chapter/legal-requirements-of-a-carers-assessment" target="_blank" rel="noopener">Legal Requirements of a Carers Assessment</a>.

Carers

The Environmental Health Service (EHS) has a range of powers to intervene where a property is in a condition that is prejudicial to health, or where the premise is materially affecting neighbouring premises.
In addition, where properties are verminous or pose a statutory nuisance, the EHS will take a leading role in case managing the necessary investigations and determining the most effective means of intervention.
Where the adult is residing in conditions that pose a threat only to their own welfare the powers available to the EHS may have limited or no effect.

Environment Health Service Intervention

Self-neglect becomes a safeguarding issue when an adult is at risk of significant harm or there is a risk of harm to their health, safety, or wellbeing due to their inability or unwillingness to care for themselves.
An update to the Care Act statutory guidance in March 2016 gave detail as to when self-neglect should be considered safeguarding:
"It should be noted that self-neglect may not prompt a section 42 enquiry. An assessment should be made on a case-by-case basis. A decision on whether a response is required under safeguarding will depend on the adult's ability to protect themselves by controlling their own behaviour. There may come a point when they are no longer able to do this, without external support."
Signs that Self-Neglect may be a safeguarding concern are:
<ol style="list-style-type: lower-alpha;">
<li>When it is apparent that a person has poor personal hygiene, such as unkempt appearance, body odour and/or wearing unwashed clothing consistently;</li>
<li>Where there is a decline in health because of non-engagement with essential treatment, for example declining medication, refusing pressure ulcer treatment;</li>
<li>Their living environment is unclean, such as accumulation of rubbish, clutter, dirt or signs of pests or insects, which may also lead to fire risk or risk to others;</li>
<li>Unsafe living conditions to include a lack of running water, heat and or electricity;</li>
<li>Evidence of malnutrition or dehydration, lack of food in the home and weight loss.</li>
</ol>

When is Self-neglect a Safeguarding Issue?

The National Network of Safeguarding Adults Boards (NNSAB) website provides lots of useful information about safeguarding, including sharing best practice. The following is a list of common themes from Safeguarding Adult Reviews of deaths due to self-neglect: &nbsp;
<ol style="list-style-type: lower-alpha;">
<li>Refusal of help;</li>
<li>Inadequate or delayed risk assessments;</li>
<li>Lack of Multi-Agency Coordination;</li>
<li>Failure to Escalate Concerns.</li>
</ol>

Summary of Deaths from Safeguarding Adult Reviews (SARs)

The purpose of SARs is outlined in the statutory guidance as to &lsquo;promote effective learning and improvement action to prevent future deaths or serious harm occurring again&rsquo;.
Some identified areas of improvement for services in relation to self-neglect are:
<ol style="list-style-type: lower-alpha;">
<li>Earlier, coordinated risk assessments;</li>
<li>Enhanced multi-agency collaboration;</li>
<li>Better use of mental health resources:</li>
<li>Proactive escalation of concerns;</li>
<li>Involvement of advocacy services.</li>
</ol>
For further information see: <a href="https://nationalnetwork.org.uk/about_us.html" target="_blank" rel="noopener">National Network for Chairs of Adult Safeguarding Boards</a>.

Learning from SARs

Hoarding involves the acquisition of items with an associated inability to discard things that have little or no value (in the opinions of others) to the point where it interferes with use of living space or activities of daily living. The types of items which are hoarded may include household items such as newspapers, books, letters, clothes, containers or household supplies. Some people also hoard animals or data. The Mind website provides further information on types of hoarding, see: <a href="https://www.mind.org.uk/information-support/types-of-mental-health-problems/hoarding/about-hoarding/#OtherTypesOfHoarding" target="_blank" rel="noopener">Hoarding</a>.
Hoarding should not be seen simply as a lifestyle choice or the way someone prefers to live. Even if the adult has the mental capacity and is declining support, professionals should still try to engage with the person and explore ways in which they can support.
Hoarding is recognised as a mental health issue called Hoarding Disorder. When hoarding becomes unmanageable, it can lead to the home becoming chaotic and make living areas hard to access. Everyday life can become more challenging for the person because normal use of space is prevented. For example, activities such as cooking, cleaning, moving through the house and sleeping become restricted because of the lack of space. It could also potentially put the adult and others at risk from fire. The adult may also be at a greater risk of Self-Neglect. See <a href="/chapter/self-neglect">Self-Neglect</a>.
Sometimes the adult is aware that there is an issue, however a strong attachment to their items and feelings of embarrassment or guilt may prevent them from removing them or accepting support. Hoarding can also lead to difficult relationships with family members, neighbours and the close community due to the impact it may have on them. This can include environmental issues such as vermin. See: <a href="https://www.nhs.uk/mental-health/conditions/hoarding-disorder/" target="_blank" rel="noopener">Hoarding Disorder (NHS)</a>.

Understanding Hoarding

Multiple underlying factors can lead to Hoarding Disorder, such as:
<table title="underlying factors">
<tbody>
<tr>
<td>Environmental factors</td>
<td>Growing up where resources are limited, or growing up in a household where hoarding is normalised can be contributing factors in current hoarding behaviours. People who have experienced abuse or neglect as a child may develop hoarding behaviours to create comfort and stability.</td>
</tr>
<tr>
<td>Trauma and life changes</td>
<td>Hoarding can become a coping mechanism following trauma, loss, or following major life events often leading to feelings of anxiety and depression. There can be a temporary feeling of comfort and security whilst collecting and keeping items.</td>
</tr>
<tr>
<td>Other health conditions</td>
<td>Obsessive-compulsive disorder (OCD) is often linked to hoarding behaviours due to the repetitive collection of items which can reduce anxiety providing temporary relief at the time. In addition, the fear of losing items, or discarding items is considered obsessive in nature. Depression, dementia, substance addiction, brain injury, psychotic disorders (such as schizophrenia) or mobility problems could also be symptoms of why an adult may begin hoarding.</td>
</tr>
</tbody>
</table>

Causes of Hoarding Disorder

It is essential to consider an adult&rsquo;s decision-making ability in relation to their tendency to collect and hoard items. This will involve considering the adults understanding of the impact hoarding has on their lives, whether they can weigh up different options and are able to communicate their choices.
When a person&rsquo;s hoarding poses a serious risk to their health and safety, intervention will be required. With the exception of statutory requirements, any intervention or action proposed must be with the customer&rsquo;s consent. In extreme cases of hoarding behaviour, the very nature of the environment should lead professionals to question whether the customer has capacity to consent to the proposed action or intervention and trigger a capacity assessment. The Mental Capacity Act Code of Practice states that people may question a person&rsquo;s capacity to make a specific decision if the person&rsquo;s behaviour or circumstances cause doubt as to whether they have capacity to make a decision. Extreme hoarding behaviour could meet this criterion and if so, a mental capacity assessment should take place.
In particularly challenging and complex cases, it may be necessary for the local authority to refer to the Court of Protection. Any referral to the Court of Protection should be discussed with legal services and the relevant service manager.
If a court is required to review a case involving mental capacity and hoarding, they will consider an adult&rsquo;s ability to manage their belongings as well as make informed choices about their living spaces. The aim of the court is to decide what is in the adult&rsquo;s best interest to remain safe whilst also respecting their independence.
See: <a href="https://www.39essex.com/information-hub/case/local-authority-v-x-0" target="_blank" rel="noopener">39 Essex Chambers summary of case A Local Authority v X</a>
<a href="https://mca-adults.trixonline.co.uk/contents/contents" target="_blank" rel="noopener">Mental Capacity Act 2005 Resource and Practice Toolkit</a>.

Mental Capacity and Hoarding

Although hoarding is not a category of abuse Under section 42 of the Care Act 2014, hoarding can be an aspect of self-neglect. According to the Care Act statutory guidance, a decision on whether a response is required under safeguarding will depend on the adult&rsquo;s ability to protect themselves by controlling their own behaviour. There may come a point when they are no longer able to do this, without external support. When deciding if intervention is required, a case-by-case approach needs to be taken to identify if there is a risk to the adult&rsquo;s safety and welfare. During initial enquiries it is essential that agencies involved share information with the local authority to ensure a coordinated approach whilst considering the wishes and feelings of the adult. The duty applies regardless of mental capacity.
<div class="panel panel-info">
<div class="panel-heading">Need to know</div>
<div class="panel-body">
Some people living with a hoarding disorder can present themselves well to the outside world hiding their condition from others.
</div>
</div>

Hoarding Disorder and Safeguarding

The following table contains actions which should be considered when supporting a person who hoards.
<table title="How to support a person with hoarding behaviours"><caption>Caption: How to support a person with hoarding behaviours</caption>
<thead>
<tr>
<th scope="col">Action</th>
<th scope="col">Considerations</th>
</tr>
</thead>
<tbody>
<tr>
<td>
Multi-agency approach
</td>
<td>
A multi-agency approach is crucial when working with individuals with a hoarding disorder, particularly housing providers. Identify the most appropriate professional to take the lead. Utilise the skills of each profession. Ensure good communication with the multi-agency team. Multi-agency meetings with a clear agenda, action plan and timescales. Professionals/services who will have a role in supporting adults who hoard:
<ul>
<li>Housing providers;</li>
<li>Local council;</li>
<li>Social workers;</li>
<li>Occupational therapists;</li>
<li>Mental health practitioners;</li>
<li>Fire service;</li>
<li>GP;</li>
<li><a href="#environment-health-service-intervention">Environmental health service</a>.</li>
</ul>
Also consider what local community services are available in your area.
</td>
</tr>
<tr>
<td>
Build a trusting relationship
</td>
<td>
Be patient, it may take time. Be open and honest about your concerns. Ensure the adult does not feel judged. Be careful about your use of language. The adult may not see their belongings as &lsquo;clutter&rsquo;. Use language the adult is comfortable with. Ensure the adult is involved in any decisions and is happy with the pace. Find out what is important to the adult.
</td>
</tr>
<tr>
<td>
Involve family/carers
</td>
<td>
Gather information from the people who know the adult best. Involve the family/carers in the assessment/risk assessment (respecting the adult&rsquo;s wishes, feelings and boundaries). Help to educate family/carers about hoarding offering support and signposting to resources.
</td>
</tr>
<tr>
<td>
Consider the role of carers
</td>
<td>
If the adult has a carer, it is important to consider their ability to meet the needs of the adult and rule out any neglect or acts of omission. The carer may have unintentionally neglected the caring role because they are no longer able to cope. Carers are also at risk of neglecting their own needs due to the stresses and demands of their caring responsibilities and may also need some support.
</td>
</tr>
<tr>
<td>
Assessment of needs
</td>
<td>
The adult may be unable to care for themselves due to, for example a physical disability, therefore the most appropriate course of action may be a full assessment of needs and a care and support plan.
</td>
</tr>
<tr>
<td>
Risk assessment
</td>
<td>
This might cover:
Mental capacity and consent.
Use a multi-agency approach.
Identify the environmental hazards and risks such as fire.
Ensure the views and wishes of the adult are included.
Consider the adult&rsquo;s formal and informal support networks.
Identify the impact of the risks on the adult&rsquo;s physical health and overall wellbeing.
Consider the impact that making changing in the adult&rsquo;s home may also have on them.
Consider the impact of any mental health and/or physical health needs the adult may have.
Use tools such as the Clutter Image Rating (CIR) to help to assess the scale of the hoarding. See: <a href="https://hoardingdisordersuk.org/clutter-image-ratings/" target="_blank" rel="noopener">Clutter Image Ratings</a>.
</td>
</tr>
<tr>
<td>
Consider the impact on others
</td>
<td>
Discuss the adult&rsquo;s relationships with neighbours and the wider community. Hoarding can result in unpleasant odour, pests, and/or fire hazards which can sometimes impact on neighbouring properties. Hoarding can be considered anti-social behaviour under the Anti-Social Behaviour, Crime and Policing Act 2014 and where there is a landlord they may need to consider their duties under the Act.
</td>
</tr>
</tbody>
</table>

Addressing Hoarding

The Environmental Health Service (EHS) has a range of powers to intervene where a property is in a condition that is prejudicial to health, or where the premise is materially affecting neighbouring premises.
In addition, where properties are verminous or pose a statutory nuisance, the EHS will take a leading role in case managing the necessary investigations and determining the most effective means of intervention. Where the adult is residing in conditions that pose a threat only to their own welfare the powers available to the EHS may have limited or no effect.
In cases involving persistent hoarding the powers may only temporarily address and/or contain the problem. It must therefore be recognised that utilising powers under public health legislation in isolation may not be the most effective use of resources.
<div class="panel panel-info">
<div class="panel-heading">Need to know</div>
<div class="panel-body">
Hoarding UK is a UK-based charity that supports people affected by hoarding behaviour. They offer a helpline, support groups, and one-to-one sessions. They also provide training for professionals, run awareness campaigns, and advocate for policy changes. Additionally, they produce educational resources and participate in research to better understand and address hoarding disorder. Their goal is to improve lives and reduce stigma around hoarding. See: <a href="https://hoardinguk.org/" target="_blank" rel="noopener">Hoarding UK</a>.
</div>
</div>

Environment Health Service intervention

The National Network of Safeguarding Adults Boards (NNSAB) website provides lots of useful information about safeguarding, including sharing best practice. The following is a list of common themes from Safeguarding Adult Reviews of deaths due to hoarding:
<ol style="list-style-type: lower-alpha;">
<li>Lack of understanding of hoarding behaviours;</li>
<li>Inadequate risk assessments;</li>
<li>Failure to engage multi-agency working;</li>
<li>Delayed intervention;</li>
<li>Insufficient training for professionals;</li>
<li>Inconsistent follow-up and monitoring;</li>
<li>Limited availability of support services;</li>
<li>Failure to address underlying mental health issues;</li>
<li>Poor communication with the adult;</li>
<li>Overlooking family dynamics.</li>
</ol>
For further information see: <a href="https://nationalnetwork.org.uk/about_us.html" target="_blank" rel="noopener">National Network for Chairs of Adult Safeguarding Boards</a>.

Summary of Learning from Safeguarding Adult Reviews

Safeguarding Adults Core Procedures

Safeguarding Adults Practice Guidance

Learning and Improvement

Bradford

Calderdale

City of York

Kirklees

North Yorkshire

Wakefield

Contacts and Practice Resources by Area

Safeguarding Adults Bradford

Calderdale Safeguarding Adults Board

Safeguarding Adults York

Kirklees Safeguarding Adults Board

North Yorkshire Safeguarding Adults Board

Wakefield and District Safeguarding Adults Board

Safeguarding Adults Board Websites

The Care Act 2014 Resource

The Mental Capacity Act 2005 Resource and Practice Toolkit

Technology is an integral part of life for many people and impacts how we learn, interact with others, work and communicate. Online devices such as mobile/smart phones, laptops, computers, tablets and games consoles offer many benefits, and when used safely can help to improve a person&rsquo;s well-being and independence. Some of the benefits include:
<ol style="list-style-type: lower-alpha;">
<li>Opportunities for social interaction;</li>
<li>Information can be provided in an accessible way;</li>
<li>Online shopping, banking, and paying bills can help to maintain independence with managing finances;</li>
<li>Online advice and learning;</li>
<li>Telecare/care lines and use of apps by care providers can support the provision of care and support;</li>
<li>Being able to monitor the safety of loved ones with the use of ring doorbells and tracking devices.</li>
</ol>
The internet can also pose risks for us all. It is important that education and support to use the internet safely is provided to the adult with care and support needs where required. The adult may be a victim or a perpetrator of abuse online.
Sometimes abuse can be amplified online because of the reach that social networking sites have and the perceived anonymity that the internet can give people.
E-Safety is the generic term that refers to raising awareness about how everybody can protect themselves when using digital technology.

Introduction

The Online Safety Act 2023 introduced new criminal offences including:
<ol style="list-style-type: lower-alpha;">
<li>Sending a message with information the sender knows to be false with the intention of causing non-trivial psychological or physical harm to a likely audience without reasonable excuse;</li>
<li>Sending a message with a threat of death, serious injury, rape or serious financial loss where the sender intends the recipient to fear that threat will be carried out (or is reckless as to whether the recipient has such fear);</li>
<li>Sending or showing an electronic communication with flashing images with the intention to cause harm to an adult with epilepsy;</li>
<li>Communicating, publishing or showing material capable (and with the intention) of encouraging or assisting the serious self-harm of another, even if the sender cannot identify the recipients and even if the self-harm does not occur;</li>
<li>Intentionally sending or giving images of any person&rsquo;s genitals to another person with the intention to cause the recipient alarm, distress or humiliation, or for the purposes of sexual gratification whilst reckless as to whether the recipient will be caused alarm, distress or humiliation;</li>
<li>Four offences in relation to intentional sharing or threatening to share intimate images without consent, which do not necessarily require proof that the sender intended to cause alarm, distress or humiliation. This replaces the previous offences relating to so-called &lsquo;revenge porn&rsquo; where there was a requirement for an intention to cause distress.</li>
</ol>

The Internet and the Law

<a href="https://www.mencap.org.uk/advice-and-support/bullying-and-discrimination/stay-safe" target="_blank" rel="noopener">Mencap: Staying safe</a>
<a href="https://www.ageuk.org.uk/information-advice/work-learning/technology-internet/internet-security/" target="_blank" rel="noopener">Age Concern: Staying safe online</a>
<a href="https://www.samaritans.org/about-samaritans/research-policy/internet-suicide/internet-safety-practitioners/" target="_blank" rel="noopener">Samaritans: The internet and suicide</a>
Relevant Court Judgements
<a href="https://www.39essex.com/information-hub/case/re-capacity-social-media-and-internet-use-best-interests-re-bcapacity-social" target="_blank" rel="noopener">Re A (Capacity: Social Media and Internet Use: Best Interests); Re B(Capacity: Social Media: Care and Contact)</a>
<a href="https://www.39essex.com/information-hub/case/c-capacity-access-internet-and-social-media" target="_blank" rel="noopener">C (Capacity to Access the Internet and Social Media)</a>

Further Information

Types of Online Abuse

Internet abuse may also include cyberbullying or online bullying. It may also be referred to as trolling. This is when an adult is tormented, threatened, harassed, humiliated, embarrassed or otherwise targeted by another person using the internet and/or mobile devices. It is possible for one victim to be bullied by many perpetrators.
For further information, please refer to the <a href="https://www.nationalbullyinghelpline.co.uk/cyberbullying.html" target="_blank" rel="noopener">National Bullying Helpline website</a>.

Cyberbullying

Examples of sexual abuse and exploitation online are:
<ol style="list-style-type: lower-alpha;">
<li>Sharing and production of abusive images;</li>
<li>Being victim to revenge porn (when a previously taken video or photograph, which was taken with or without consent, is shared online);</li>
<li>Being forced to take part in or watch pornographic content;</li>
<li>Grooming.</li>
</ol>
Sexually coerced extortion or 'sextortion' is a type of blackmail where someone tries to use intimate, naked or sexual photos or videos of children and young people to make them do things they don't want to do. Sometimes, these photos or videos are taken without their knowledge, and the person uses these to blackmail the adult and force them to pay money or do something against their will.
Image based sexual abuse is when someone takes, shares or threatens to share sexually explicit images or videos of an adult without their knowledge, consent or capacity to consent and with the aim of causing them distress. This can also include digitally altered images. Image based sexual abuse is a broad term and covers many different abusive behaviours.
Image based sexual abuse is a criminal offence. Online and offline sexual abuse has the same impact no matter how the abuse took place. Victims of this type of abuse can experience further abuse or be retraumatised when abuse is recorded, uploaded and shared by others online.
Image based sexual abuse can involve the following:
<table class="plain" title="image based sexual abuse">
<tbody>
<tr>
<td>Deepfakes</td>
<td>Deepfakes are digitally altered images, videos or audio. An individual may use Artificial Intelligence (AI) technology to create or transform an image of someone into a sexually explicit image or video. It may also be called synthetic sexual content, deepfake porn, fake porn or morphing.</td>
</tr>
<tr>
<td>Downblousing</td>
<td>Where an image is taken down someone&rsquo;s top without their consent, is detailed in CPS guidance. See: <a href="https://www.cps.gov.uk/cps/news/illegal-sexual-behaviour-online-including-sharing-and-threatening-share-intimate-images" target="_blank" rel="noopener">Guidance from the CPS</a>.</td>
</tr>
<tr>
<td>Revenge Porn/Intimate Image Abuse/ Non-Consensual Pornography/Sexting/Sextortion/Webcam Blackmail</td>
<td>This is when someone shares or threatens to share intimate images or videos of the adult. They may do this online or via social media sites, such as subscription website or porn sites. They may also share or threaten to share them with friends, family members or others. For further information, see: <a href="https://revengepornhelpline.org.uk/" target="_blank" rel="noopener">Revenge Porn Helpline</a> <a href="https://stopncii.org/" target="_blank" rel="noopener">Stop NCII</a> <a href="https://www.iwf.org.uk/resources/sextortion/" target="_blank" rel="noopener">Internet Watch Foundation</a></td>
</tr>
<tr>
<td>Upskirting</td>
<td>When someone takes a photograph underneath the adult&rsquo;s clothing without their permission. This is often done to view the adult&rsquo;s genitals or buttocks, with or without underwear, for sexual gratification (sexual arousal or pleasure) and/or to cause the adult fear, alarm or humiliation. Upskirting became an offence in England and Wales in 2019 under&nbsp;<a href="https://www.legislation.gov.uk/ukpga/2019/2/enacted" target="_blank" rel="noopener">Voyeurism (Offences) Act 2019</a>.</td>
</tr>
</tbody>
</table>

Sexual abuse and exploitation

Grooming is when someone builds a relationship, trust and emotional connection with an adult whether online or in person so they can manipulate, exploit and abuse them. The perpetrator may:
<ol style="list-style-type: lower-alpha;">
<li>Be dominant and persistent or may hide their identity and present as another, such as an authority figure, romantic figure or mentor;</li>
<li>Use financial tactics such as gift giving or may give the adult attention and support;</li>
<li>Encourage the adult to move conversations to platforms that use end to end encryption which means only the sender and recipient can see the content of the message. This makes it more difficult to protect the adult;</li>
<li>Isolate the adult from their friends, family, carers and services, leading to dependence on the perpetrator;</li>
<li>Use blackmail to make an adult feel guilt and shame or introduce the idea of 'secrets' to control, frighten and intimidate.</li>
</ol>
It is important to remember that the adult may not understand that they have been groomed. They may have complicated feelings, like loyalty, admiration, love, as well as fear, distress and confusion around their interaction with the with the perpetrator(s).

Grooming

Stalking and harassment is&nbsp;fixated, obsessive, unwanted and repeated behaviour that makes the adult feel pestered and harassed. It includes behaviour that happens two or more times, directed at or towards the adult by another individual, which causes alarm, distress and there could be a fear violence. It can occur both online and offline.
For details on how to report stalking and harassment, see: <a href="https://www.gov.uk/report-stalker" target="_blank" rel="noopener">Report a stalker</a>.
For support for victims of stalking, see: <a href="https://www.paladinservice.co.uk/" target="_blank" rel="noopener">Paladin National Stalking Advocacy Service</a>.

Stalking and harassment

Scams/fraud are the most likely crime perpetrated through the internet. They can involve financial abuse and/ or learning private information from the adult. They usually involve some sort of deception.
Types of online scams/fraud include:
<table class="plain" title="online scams/fraud">
<tbody>
<tr>
<td>Romance scams</td>
<td>This includes using dating websites, social networks and chat rooms to deceive the adult into giving personal details or money. Romance scammers do not target a specific gender, sexuality, race or age. It may using fake profiles and some scammers will impersonate celebrities to attract victims.&nbsp;</td>
</tr>
<tr>
<td>Free Trials/Offers, Health Scams, Repair Scams, Competition and/or Shopping Scams</td>
<td>Scammers will make the adult believe they have won a prize, get them to pay for an item that does not exist or offer a sub-standard service or product or link an adult into a service or product that they have inadvertently signed up for.</td>
</tr>
<tr>
<td>Identity Theft</td>
<td>Examples of identity theft include, taking an adult&rsquo;s name and information to open new bank accounts, apply for a passport or apply for benefits.</td>
</tr>
<tr>
<td>Mandate Fraud</td>
<td>Fraudsters will pose as a service or organisation used by the adult and ask them to change the bank transfer details that payments are made to in order to obtain the money. </td>
</tr>
<tr>
<td>Pharming</td>
<td>Pharming is when hackers redirect traffic from a genuine website to another, such as a fake ecommerce or banking site. This is a difficult scam to protect people from as although the adult may have entered the right address to bring them to a particular site, it sends them to a fake one to try to get information.</td>
</tr>
<tr>
<td>Phishing</td>
<td>A common trick sending a fake email pretending to be from a bank or another organisation of trust such as HMRC or PayPal. This email will ask the adult to visit a website and log in with account details. The site looks just like the genuine website but is really a fake site set up by criminals to get details.</td>
</tr>
</tbody>
</table>
For further information, see <a href="https://www.friendsagainstscams.org.uk/" target="_blank" rel="noopener">Friends Against Scams</a>.
Scams, fraud or cybercrime can be reported to Action Fraud which is the UK&rsquo;s national reporting centre. See: <a href="https://www.actionfraud.police.uk/" target="_blank" rel="noopener">Action Fraud: National Cyber Crime Reporting Centre</a>.

Scams and fraud

Social networking and dating sites
Social networking sites and dating sites are often used by perpetrators as an easy way to access adults, children and young people for sexual abuse. In addition, radical and extremist groups may use social networking to engage adults in exposure to harmful content, extremist ideologies or to promote gang related violence; this is similar to the grooming process and exploits the same vulnerabilities.
Addiction Issues
Social media platforms are designed to be addictive with features like notifications, likes, and scrolling endlessly through feeds. The adult may find themselves spending excessive amounts of time on these platforms, which can lead to neglect of self-care, their home and in-person relationships.
Health and the internet
People can gain support from the internet and be a part of specific communities for their disability or health condition which can be invaluable in providing support and learning. However, there are risks that adults with certain conditions are targeted via the internet to cause harm to themselves or others.
The internet has been used to physically harm people with epilepsy hence the inclusion of this in the Online Safety Act 2023.
Social media can negatively impact on the adult&rsquo;s self-esteem and how they view themselves.
The internet can be triggering for some adults and it can be hard to restrict or filter out content which may cause harm.
Examples include:
<ol style="list-style-type: lower-alpha;">
<li>Eating disorders &ndash; which have been linked to social media use due to the increasing importance of self-image particularly in young people. It can define how an adult perceives they should look, influence their poor eating habits and thought processes. It can also reinforce and normalise an eating disorder;</li>
<li>Self-harming behaviours and suicide - self-harming sites can encourage and support adults to harm themselves;</li>
<li>Depression and anxiety &ndash; consistently viewing or reading about negative events could impact on wellbeing and sleep patterns.</li>
</ol>
Artificial intelligence (AI)
AI now plays a part in sexual abuse and exploitation as it has the ability to generate material that is partially or entirely computer-generated. They are usually produced using software which converts a text description into an image. This technology is developing rapidly, the images created can now be very realistic, and recent examples are difficult to differentiate from unaltered photographs.
Character AI is a chatbot which is designed to provide human-like responses and can be customised to be based on real people or fictional characters. For further information about the safety considerations of Character AI, see: <a href="https://www.internetmatters.org/advice/apps-and-platforms/entertainment/character-ai/" target="_blank" rel="noopener">Internet Matters, What is Character AI? What parents need to know</a>. Although the information is directed towards use by children, the same concerns could apply to adults.

Other considerations

The same safeguarding principles will apply regardless of whether the abuse has occurred online or offline. See: <a href="/chapter/disclosure-and-raising-a-concern">Disclosure and Raising a Concern</a>.
It is important that any evidence is preserved so screen shots, screen records and/or videos should be saved. Chronologies are also important to build up evidence of contacts made.
Harmful content can be reported online. See: <a href="https://reportharmfulcontent.com/report/" target="_blank" rel="noopener">Report Harmful Content</a>.
It may be useful to consider the following when assessing the risk to the adult:
<ol style="list-style-type: lower-alpha;">
<li>How much time the adult spends online;</li>
<li>Which social media sites are being used by the adult;</li>
<li>The adult&rsquo;s understanding of the implications of their actions;</li>
<li>The adult&rsquo;s understanding of consent;</li>
<li>Support available to the adult to keep themselves safe online e.g. use of educational material, being shown how to manage privacy settings;</li>
<li>Who the adult is connecting with online and whether they are aware that someone they are connecting with may not be who they say they are;</li>
<li>Whether the adult understands that social media could be shared more widely, including with people the adult does not know, without them knowing or being able to stop it;</li>
<li>Understanding of the kinds of online activities which would be illegal, inappropriate, or break the site&rsquo;s terms &amp; conditions;</li>
<li>Whether the adult is aware of their online rights and know where to go for help if they needed it;</li>
<li>What support has been offered if the adult is receiving provider services e.g. risk assessments, tool kits;</li>
<li>Mental Capacity Act assessments may need to be in place if the adult is not deemed to be able to use any part of the internet safely to both protect them and/or others with regards to internet use.</li>
</ol>

Action to be Taken

The experience of the adult at risk
<img src="https://trixcms.trixonline.co.uk/api/assets/wynyy/10101fc2-b4dd-40b6-83cc-76ad13fe60df/experience.png" alt="Experience" />
The procedures to deliver this 
<img src="https://trixcms.trixonline.co.uk/api/assets/wynyy/82030ab6-4710-4d57-891c-972939cbb4e3/deliver.png" alt="Deliver" />

The Experience of the Adult at Risk

The time taken to respond to a safeguarding concern(s) will depend on a range of factors, including the wishes and needs of the adult at risk, as well as the nature, seriousness and complexity of the concern(s).
Note: The timescales described within these procedures are not intended as performance indicators, however provide useful targets for practice that are achievable in many cases. The timescales need to reflect:
<ul>
<li>All other investigations such as NHS Serious Incidents (SI);</li>
<li>The investigation that takes priority &ndash; this needs to be agreed on a case by case basis.</li>
</ul>

Section 42 Flowchart Summary and Timescales

Flowcharts to support Stage 2: Responding to the Concern / Information Gathering

Safeguarding Concern Received by the Local Authority/ Multi-Agency Safeguarding Hub (MASH)

The following case studies are all taken from the <a href="https://www.gov.uk/government/publications/care-act-statutory-guidance/care-and-support-statutory-guidance" target="_blank" rel="noopener">Care Act Statutory Guidance</a>.

Care Act Statutory Guidance Case Studies

Two brothers with mild learning disabilities lived in their family home, where they had remained following the death of their parents some time previously. Large amounts of rubbish had accumulated both in the garden and inside the house, with cleanliness and self-neglect also an issue. They had been targeted by fraudsters, resulting in criminal investigation and conviction of those responsible, but the brothers had refused subsequent services from adult social care and their case had been closed.
They had, however, had a good relationship with their social worker, and as concerns about their health and wellbeing continued it was decided that the social worker would maintain contact, calling in every couple of weeks to see how they were, and offer any help needed, on their terms. After almost a year, through the gradual building of trust and understanding, the brothers asked to be considered for supported housing; with the social worker's help they improved the state of their house enough to sell it, and moved to a living environment in which practical support could be provided.

Making Safeguarding Personal

This case study highlights the need for local authorities not to underestimate the potential impact of financial abuse:
Mrs B is an 88 year old woman with dementia who was admitted to a care home from hospital following a fall. Mrs B appointed her only daughter G, to act for her under a Lasting Power of Attorney in relation to her property and financial affairs.
Mrs B's former home was sold and she became liable to pay the full fees of her care home. Mrs B's daughter failed to pay the fees and arrears built up, until the home made a referral to the local authority, which in turn alerted the Office of the Public Guardian (OPG).
The OPG carried out an investigation and discovered that G was not providing her mother with any money for clothing or toiletries, which were being provided by the home from its own stocks. A visit and discussion with Mrs B revealed that she was unable to participate in any activities or outings arranged by the home, which she dearly wished to do. Her room was bare of any personal effects and she had limited stocks of underwear and nightwear.
The Police were alerted and interviewed G, who admitted using the proceeds of the mother's house for her own benefit. The OPG applied to the Court of Protection for suspension of the power of attorney and the appointment of a deputy, who was able to seek recovery of funds and ensure Mrs B's needs were met.

Financial Abuse

This case study demonstrates how anyone can become aware of information suggesting that abuse and neglect is occurring:
Mr A is in his 40s, and lives in a housing association flat, with little family contact. His mental health is relatively stable, following a previous period of hospitalisation and he has visits from a mental health support worker.
He rarely goes out, but he allows people into his accommodation because of his loneliness. The police were alerted by Mr A's neighbours to several domestic disturbances. His accommodation had been targeted by a number of local people and he had become subjected to verbal, financial and physical abuse. Although Mr A initially insisted they were his friends, he did indicate he was frightened; he attended a case conference with representatives from adult social care, mental health services and the police, from which emerged a plan to strengthen his own self-protective ability as well as to deal with the present abuse.
Mr A has made different arrangements for managing his money so that he does not accumulate large sums at home. A community-based visiting service has been engaged to keep him company through visits to his home, and with time his support worker aims to help get involved in social activities that will bring more positive contacts to allay the loneliness that Mr A sees as his main challenge.

Spotting signs of abuse and neglect

This case study shows how carers can be abused by the adult they are caring for, and how to support them when this happens:
Mrs D lives with her husband, B. B has a long term brain injury which affects his mood, behaviour and his ability to manage close family relationships. This has often led to him shouting and hitting out at his wife, who is also his main informal carer. Mrs D told a professional who was involved in supporting her that she was becoming increasingly frightened by B's physical and verbal outbursts and at times feared for her personal safety.
Other family members were unaware of the extent of the harm and that Mrs D was exhausted and considering leaving the situation. The local authority became involved.
The situation presented significant personal risk to Mrs D but there was also a risk of fragmenting relationships if the local authority staff were not sensitive to the needs of the whole family. The practitioner, under supervision from her social work manager invested time in meeting with Mrs D to explore her preferences around managing her safety and how information about the situation would be communicated with the wider family and with B. This presented dilemmas around balancing the local authority's duty of care towards Mrs D with her wishes to remain in the situation with B. Placing emphasis on the latter inevitably meant that Mrs D would not be entirely free from the risk of harm but allowed the practitioner to explore help and support options which would enable Mrs D to manage and sustain her safety at a level which was acceptable to her.
The practitioner received regular supervision to allow time to reflect on the support being offered and to ensure that it was 'person centred'. The outcome for Mrs D was that she was able to continue to care for B by working in partnership with the local authority. The practitioner offered advice about how to safely access help in an emergency and helped her to develop strategies to manage her own safety &ndash; this included staff building rapport with B, building on his strengths and desire to participate in social activities outside the family home. The effect of this was that some of the trigger points of him being at home with his wife for sustained periods during the day were reduced because he was there less.
Mrs D also had a number of pre-existing support avenues, including counselling and a good relationship with her son and her friends. The situation will be reviewed regularly with Mrs D but for the time being she feels much more able to manage.

Carers and Safeguarding

This case study demonstrates how agencies should work together to prevent abuse and neglect from occurring/reoccurring:
Miss P's mental health social worker became concerned when she had received reports that 2 of Miss P's associates were visiting more regularly and sometimes staying over at her flat. Miss P was being coerced into prostitution and reportedly being physically assaulted by one of the men visiting her flat. There was also concern that she was being financially exploited. Miss P's lack of understanding of how to protect herself when living alone was exacerbated by her mental health needs and consequent inability to set safe boundaries with the people she was associating with.
The social worker recognised that the most appropriate way to enable Miss P to manage the risk of harm was to involve Miss P's family, which she agreed to, and other professionals to develop and coordinate a plan which would enable her to continue living independently but provide a safety net for when the risk of harm became heightened. Guided initially by Miss P's wish for the 2 men to stay away from her, the social worker initiated a planning meeting between supportive family members and other professionals such as the police, domestic violence workers, support workers and housing officers. Although Miss P herself felt unable to attend the planning meeting, her social worker ensured that her views were included and helped guide the plan. The meeting allowed family and professionals to work in partnership, to openly share information about the risks and to plan what support Miss P needed to safely maintain her independence.
Tasks were divided between the police, family members and specialist support workers. The social worker had a role in ensuring that the plan was coordinated properly and that Miss P was fully aware of everyone's role. Miss P's family were crucial to the success of the plan as they had always supported her and were able to advocate for her needs.
They also had a trusting relationship with her and were able to notify the police and other professionals if they thought that the risk to Miss P was increasing. The police played an active role in monitoring and preventing criminal activity towards Miss P and ensured that they kept all of the other professionals and family up to date with what was happening. Miss P is working with a domestic violence specialist to help her develop personal strategies to keep safer and her support worker is helping her to build resilience through community support and activities.

Multi-Agency Safeguarding Role

These case studies shows how agencies can work together to provide a co-ordinated response during a criminal investigation:
<h4>Case study 1: Miss Y</h4>
Miss Y is a young woman with a learning disability with limited support from her family and was not engaged with health and social care services. Miss Y was befriended by an individual who took her to parties where she was given drugs and alcohol and forced to have sex with different men. Sometimes she would be given money or gifts in return for having sex with the men.
Miss Y disclosed this to a social worker and it was discovered that there were a number of young people and vulnerable adults who were being sexually exploited by multiple perpetrators. Miss Y lacked mental capacity in order to be able to consent to having sex, as well as in relation to her accommodation, finances or personal safety.
The perpetrators sought out Miss Y and others because of their perceived vulnerability &ndash; whether that was because of their isolated situation and social circumstances coupled with age, disability, mental illness, or their previous history as a victim of abuse. The process to safeguard Miss Y involved a coordinated response between the police, social care, health and voluntary and community sector organisations.
This included the police investigating the perpetrators for rape, sexual assault, trafficking and drug offences. The Court of Protection and Deprivation of Liberty Safeguards were also used initially to safeguard Miss Y.
<h4>Case Study 2: Mr P</h4>
Mr P has mild learning disabilities. The safeguarding concern was financial and other abuse and neglect by his brother, with whom he lived. His support worker had noticed that Mr P had begun to appear agitated and anxious, that he looked increasingly unkempt and that he was often without money; then he suddenly stopped attending his day centre.
When the support worker and the safeguarding officer followed up, Mr P told them that at times he was not allowed out at all by his brother and was confined to his bedroom. He was only allowed to use the bathroom when his brother said he could, and often didn't get enough to eat. He was also very worried because his bank card no longer worked, and he had no money, so couldn't buy food for himself.
Mr P consented to move to temporary accommodation, and a case conference was held, which he attended with an advocate. At his request a move to a supported living flat was arranged and his belongings were retrieved from his brother's property. His bank account had been emptied by his brother, so he has made new arrangements for his money.
The police are investigating both the financial abuse and the harm Mr P suffered at his brother's hands. He has begun to talk about his experiences and is gradually regaining his confidence.

Criminal offences and safeguarding

This case study demonstrates how a Safeguarding Plan can be used to develop an adult's capacity to protect themselves from harm:
Mr A is 24 and has autism and a mild learning disability. He is a very friendly and sociable young man, who is prone to waving and talking to most people he comes across and who sees everyone as a potential friend. However, he struggles to read the intentions of others and is easily led astray and manipulated.
He lives next door to a pub, where he knows the staff and the regulars. He also lives close to his GP and is able to access his most frequently visited places. He does, however, like to walk into town to talk to people he meets out and about. On such occasions he has been repeatedly tricked into stealing items from a newsagent by a group of teenagers and given large amounts of money away to strangers he strikes up conversations with. Due to his previous experiences, Mr A was identified during a needs assessment as being at risk of abuse and neglect and a safeguarding enquiry was triggered.
The council found that, although Mr A was not currently experiencing abuse or neglect, he remained highly vulnerable to abuse due to his being well-known in his area as someone as easy to manipulate.
To assure his safety in the future, a safeguarding plan was agreed between Mr A and a social worker. This focused on developing his social skills and understanding of relationships and boundaries and the social worker worked with Mr A to consider various support options such as having a buddy or circle of support.
The social worker put Mr A in touch with an autism social group which provided sessions on skills for staying safe. As the group was based in town, Mr A's plan also included a support worker to accompany him. After the first 5 sessions Mr A was able to attend himself but continued to meet with his support worker on a monthly basis as part of the risk management strategy set out in his safeguarding plan.

Safeguarding Plans

Stage 1: Reporting a concern

Case Study 1: Mr R
Mr R, a 58-year-old man, has faced severe issues with hoarding that have compromised his safety and well-being. His small apartment is packed with items accumulated over years, creating unsafe living conditions. These behaviours stem from unresolved trauma and contribute to his worsening depression and anxiety, resulting in isolation and neglect of self-care.
Mr R&rsquo;s mental capacity was assessed. He was unable to understand the risks associated with his environment, such as fire hazards and restricted emergency access and therefore lacked mental capacity in relation to this decision. A best interest decision was made to address the concerns with a social worker taking the lead in coordinating a comprehensive Care Act 2014 assessment and support plan.
The social worker's role involved building trust with Mr R, a key challenge due to his mistrust and resistance to intervention. Through consistent, empathetic communication, his anxiety around change reduced. The social worker collaborated with housing, mental health professionals and decluttering specialists to create a plan that respected Mr R&rsquo;s autonomy while ensuring his safety.
Regular home visits took place with gradual decluttering sessions which were supervised to avoid overwhelming Mr R, and the professionals involved had regular multi-agency meetings to share information, update on progress and agree actions. The social worker also engaged community resources to foster a sense of connection, aiming to break the cycle of isolation. By overcoming these challenges with a patient, step-by-step approach, Mr R was supported to reclaim his living space and improve his quality of life.
Case Study 2: Mrs H
Mrs H was an older woman living alone, who was hoarding household items, including food and rubbish. Neighbours raised concerns due to the smell from her home. Mrs H had significant health problems, including malnutrition and untreated medical conditions. Her living conditions posed serious risks of falls and fire hazards.
Despite several attempts by social services to complete welfare checks, interventions were delayed. Tragically, Mrs H was later found deceased in her home, with the volume of hoarded items contributing to her inability to escape in an emergency.
This case highlights the need for timely and effective risk assessments. Collaboration between social services, healthcare providers, mental health professionals, and housing services are also key in addressing complex needs. Earlier involvement of mental health services could have supported Mrs H in managing her hoarding behaviour and health issues.
Effective communication, empathy and a non-judgemental approach may have helped to build trust with Mrs H. Involving family members and carers where available can provide additional support and help to understand the adult. Regular risk assessment reviews and close monitoring of the adult&rsquo;s well-being are also essential.
Immediate action should be taken if safeguarding concerns arise. A proactive safeguarding approach could have prevented delays in Mrs H&rsquo;s case.

Hoarding

Case Study 1: Ms E
Ms E, who lived alone, was at risk of severe complications due to malnutrition and dehydration. Her self-neglect was linked to untreated depression following the death of her partner. Ms E received visits from community nurses and mental health services, but they were initially working in isolation. Due to the high level of risk to Ms E, the duty to make enquiries under Section 42 of the Care Act was triggered.
A co-ordinated multi-agency approach was implemented, coordinated by the social worker assigned to Ms E&rsquo;s case. The social worker conducted a thorough assessment of Ms E&rsquo;s living conditions and health needs and tried to understand what and who were important to Ms E in relation to her care. The social worker coordinated regular multi-agency meetings with healthcare providers, mental health services, and community organisations sharing information and formulating actions plans which were communicated with Ms E. She advocated for Ms E&rsquo;s needs, ensuring her voice was heard in the planning of her care, and identified and addressed risks to Ms E&rsquo;s health and safety.
Ms E talked about being overwhelmed by having too many professional visits, so a lead professional was agreed, and visits were coordinated to suit Ms E. Ms E began to engage in accepting support and services at her pace, initially agreeing to take nutritional supplements and a small package of care. Eventually, Ms E accepted support for her depression.
Working within the framework of the Care Act 2014, the social worker promoted Ms E&rsquo;s well-being and took a personalised approach. The effective multi-agency working and information sharing ensured that all relevant services were coordinated with a clear plan of support for Ms E.
Case Study 2: Mr M
Mr M, in his 70s, lives in an upper-floor council flat, and had hoarded over many years: his own possessions, items inherited from his family home, and materials he had collected from skips and building sites in case they came in useful. The material was piled from floor to ceiling in every room, and Mr M lived in a burrow tunnelled through the middle, with no lighting or heating, apart from a gas stove. Finally, after years of hiding in privacy, Mr M had realised that work being carried out on the building would lead to his living conditions being discovered. Mr M himself recounted how hard it had been for him to invite access to his home, how ashamed and scared he was, and how important his hoard was to him, having learnt as a child of the war never to waste anything.
Through working closely together, Mr M, his support worker and experienced contractors have been able gradually to remove from his flat a very large volume of hoarded material and bring improvements to his home environment. It has taken time and patience, courage and faith, and a strong relationship based on trust. The worker has not judged Mr M, and has worked at his pace, positively affirming his progress. Both Mr M and his support worker acknowledge his low self-esteem, and have connected with his doctor and mental health services. The worker has recognised the need to replace what Mr M is giving up, and has encouraged activities that reflect his interests. Mr M has valued the worker's honesty, kindness and sensitivity, his ability to listen and the respect and reciprocity within their relationship.

Positive outcomes for those who self-neglect

At the age of 72 years, Ms W, although registered disabled, was an active member in her community often seen helping at community events and visiting the local shops and swimming pool. Ms W had a fall in her home which left her lacking in confidence and fearful that she would fall again. As the winter approached, Ms W spent more time alone at home only venturing to the corner shop to buy groceries. As time passed her house came in disrepair and unhygienic as local youths began throw rubbish, including dog faeces into her front garden.
Within a 5 month period Ms W made 7 complaints to the police about anti-social behaviour in her local area, and on 2 occasions was the victim of criminal damage to the front of her house, where her wheelchair accessibility ramp has been painted by graffiti. The police made a referral to social services. As a result, Ms W was placed on a waiting list for a support service.
Four weeks after she was last seen Ms W committed suicide. A Safeguarding Adults Review (SAR) was convened according to the local policy that stated 'the purpose of an&nbsp;SAR&nbsp;is not to reinvestigate or to apportion blame, but to establish whether there are lessons to be learnt from the circumstances of the case about the way in which local professionals and agencies work together to safeguard vulnerable adults. The published report and recommendations which followed demonstrated the lessons from this case. The resultant action plan included:
<ul>
<li>Strengthened relationships and information sharing between police officers, health and the local authority;</li>
<li>Clear lines of reporting and joint working arrangements with the community safety partnerships;</li>
<li>A robust multi-agency training plan;</li>
<li>A targeted community programme to address anti-social behaviour;</li>
<li>The development of a 'people's panel' as a sub group to the Safeguarding Adults Board which includes people who access services, carers and voluntary groups;</li>
<li>The development of a 'stay safe' programme involving local shops where adults at risk of abuse may report their concerns to a trusted member if their community.</li>
</ul>

Safeguarding Adult Reviews (SAR's)

Further case studies can be found in the LGA/ADASS guidance:&nbsp;<a href="https://www.local.gov.uk/sites/default/files/documents/25.168_Understanding_what_constitutes_a_safeguarding_07.1.pdf" target="_blank" rel="noopener">Understanding what constitutes a safeguarding concern and how to support effective outcomes</a>.
This includes a case study based on the&nbsp;<a href="http://www.iowsab.org.uk/wp-content/uploads/2019/01/2880-IoW-SAB-Howard-SAR-FINAL-FOR-PUBLICATION.pdf" target="_blank" rel="noopener">Howard case</a>.

Further Case Studies

Stage 2: Responding to the concern / information gathering

Stage 3: Safeguarding Response

Stage 4: Outcomes and closure (including plan and review)

Flowcharts to Support Stage 1: Reporting a Concern

Flowchart A: Deciding if you need to raise a safeguarding concern to the local authority / Multi-Agency Safeguarding Hub (MASH)

Flowchart B: Managing Safeguarding Concerns Flowchart

Flowchart C: Key questions when deciding whether to report a safeguarding concern

Mate crime is the inappropriate befriending of an adult by another person or persons with the intention of abusing and/or exploiting them.
Exploitation can include, but is not limited to:
<ol style="list-style-type: lower-alpha;">
<li>Forced labour (modern slavery);</li>
<li>Coercion into spending money or giving away possessions (financial or material abuse);</li>
<li>Coercion into prostitution or other sexual acts (sexual abuse);</li>
<li>Coercion to commit criminal offences e.g. buying/selling drugs, shoplifting;</li>
<li>Coercion into County Lines activity.</li>
</ol>
For further information and guidance about coercion, see: <a href="/chapter/controlling-and-coercive-behaviour">Coercive and Controlling Behaviour</a>.
In the early stages of mate crime, the person will usually behave in ways that build rapport and trust with the adult, homing in on the material and/or emotional things that the adult in question genuinely needs or desires. For example, buying them gifts, spending quality time with them, giving them drugs or alcohol.
Once befriended, the person can use a range of abusive or harmful behaviour towards the adult, either to abuse / neglect them, or to ensure their compliance with exploitation. For example:
<ol style="list-style-type: lower-alpha;">
<li>Threats of harm;</li>
<li>Saying things to create feelings of worthlessness or dependency;</li>
<li>Actual physical assault or restraint;</li>
<li>Withholding of medication or possessions important to the adult;</li>
<li>Covert or overt use of drugs or alcohol.</li>
</ol>
The person may continue to display the original &lsquo;positive&rsquo; behaviours alongside those behaviours that abuse and exploit the adult, to maintain the charade of friendship.
The abuse or exploitation often happens in private and the 'relationship' may appear on the face of it to be genuine to both the adult and their networks of support.
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<div class="panel-heading">Need to know</div>
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In extreme cases, mate crime can lead to cuckooing (also known as forced home invasion). Cuckooing occurs when the person that has befriended the adult takes over their property, and uses it to grow or distribute drugs, or as a base for other illegal activities such as prostitution. The adult is often manipulated or forced to become involved in the illegal activity against their will.
For further information see: <a href="cuckooing-forced-home-invasion">Cuckooing (Forced Home Invasion)</a>.
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What is Mate Crime?

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A hate crime is defined as "Any criminal offence which is perceived by the victim or any other person, to be motivated by hostility or prejudice based on a person's race or perceived race; religion or perceived religion; sexual orientation or perceived sexual orientation; disability or perceived disability and any crime motivated by hostility or prejudice against a person who is transgender or perceived to be transgender."
Depending on the motivation of the person befriending the adult, and the type of behaviour taking place, mate crime could also be a hate crime.
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Is Mate Crime a Hate Crime?

Those adults most at risk of mate crime are usually socially isolated or living on their own. This is clearly intentional on the part of the person befriending them, as it reduces the likelihood that the exploitation will be challenged by others.
This does not mean that adults who live with others or in a family environment are not at risk. Social media platforms provide a gateway to these adults that can also be exploited to befriend them online in the same way as befriending in person.&nbsp;