Safeguarding Adults Part 2: Alerter’s Guidance

Our Commitment

As people that have worked to develop and adopt the multi-agency procedures and guidance relating to the protection of adults in Devon we agree that we will work to the following principles:

  • Everyone has the right to live his or her life free from violence, fear and abuse.
  • All adults have the right to be protected from harm and exploitation.
  • All adults have the right to independence, which involves a degree of risk.

Procedures for Recording and Reporting Abuse


Who is a Vulnerable Adult?

The definition in ‘No Secrets’ (March 2000) describes a vulnerable adult as being someone who is aged 18 or over and “who is or may be in need of community care services by reason of mental or other disability; age or illness; and who is or may be unable to take care of him or herself, or unable to protect him or herself against significant harm or exploitation”.

‘Safeguarding Adults’ (ADSS October 2005) proposes that we need to ensure protection procedures are inclusive and enable any adult to receive an appropriate response. For those not fitting the criteria of a vulnerable adult as defined above, it will normally be possible to direct them to another organisation or agency that will be able to offer advice and/or support.

The new language of ‘Safeguarding Adults’ has been adopted in this and other guidance and publicity.

1. What is abuse?

Abuse is defined in Devon’s and Torbay’s policy and guidance as follows:

Abuse is a violation of an individual’s human and civil rights by another person or persons.

Abuse of a person often includes behaviour that is abusive in one or more of the categories outlined on the following pages. In particular, the majority of people who are experiencing abuse of any kind will also be experiencing psychological abuse.

Anyone can be an abuser.

General indicators of an abusive relationship often include the misuse of power by one person over another and are most likely to be found in situations where one person has power over another. For example, where one person is dependent on another for their physical care or due to power relationships in society, (such as, between a professional worker and a service user, a man and a woman or a person of the dominant race/culture and a person of an ethnic minority).

Abuse may consist of a single act or repeated acts. It may be physical, verbal or psychological, it may be an act of neglect or an omission to act or it may occur when a vulnerable person is persuaded to enter into a financial or sexual transaction to which he or she had not consented or cannot consent. Abuse can occur in any relationship and may result in significant harm to – or exploitation of – the person subjected to it.

It is essential to be alert to signals or non-verbal communication or challenging behaviour, and to be aware this could indicate unacceptable practice that is being deliberately hidden or denied.

There are different forms of abuse, as described on the following pages.

(Each type of abuse described starts on a fresh page for ease of use.)

  1. Psychological abuse
  2. Physical abuse
  3. Sexual abuse
  4. Neglect
  5. Discriminatory abuse
  6. Financial abuse
  7. Institutional abuse

1.1 Psychological Abuse

This may include:

  • Emotional abuse.
  • Threats of harm or abandonment.
  • Deprivation of contact.
  • Humiliation.
  • Blaming.
  • Controlling.
  • Intimidation.
  • Coercion.
  • Harassment.
  • Verbal abuse/excessive criticism.
  • Isolation or withdrawal from services or support networks.
    Note: Psychological abuse will usually occur in conjunction with other forms of abuse.
    Signs that psychological abuse may be taking place could include:
  • Difficulty gaining access to the adult on their own or the adult gaining opportunities to contact you.
  • The adult not getting access to medical care or appointments with other agencies.
  • Low self-esteem.
  • Lack of confidence and anxiety.
  • Increased levels of confusion.
  • Increased urinary or faecal incontinence.
  • Sleep disturbance.
  • The person feeling/acting as if they are being watched all of the time.
  • Decreased ability to communicate.
  • Communication that sounds like things that the perpetrator would say or language being used that is not usual for the service user.
  • Deference/submission to the perpetrator.

1.2 Physical Abuse

Physical abuse may include:

  • Hitting.
  • Slapping.
  • Pushing.
  • Kicking.
  • Misuse of medication.
  • Restraint or inappropriate sanctions.

Signs that physical abuse may be taking place can be:

  • Injuries that are consistent with physical abuse.
  • Injuries that are the shape of objects.
  • Presence of several injuries of a variety of ages.
  • Injuries that have not received medical attention.
  • A person being taken to many different places to receive medical attention.
  • Skin infections.
  • Dehydration.
  • Unexplained weight changes or medication being lost.
  • Behaviour that indicates that the person is afraid of the perpetrator.
  • Change of behaviour or avoiding the perpetrator.

1.3 Sexual Abuse

Sexual abuse may include:

  • Rape and sexual assault to which the vulnerable adult has not consented, could not consent, or was pressurised into consenting.
  • Non-contact sexual abuse could include being forced or coerced to be photographed or videoed to allow others to look at their body.
  • Any sexual activity involving staff will be regarded as contrary to professional standards and hence abusive.

Signs that sexual abuse may be taking place:

  • Sexually transmitted diseases or pregnancy.
  • Tears or bruises in genital/anal areas.
  • Soreness when sitting.
  • Signs that someone is trying to take control of their body image, for example, anorexia, bulimia or self-harm.
  • Sexualised behaviour.

The signs that a person may be experiencing sexual abuse and psychological abuse are often very similar. This is due to the emotional impact of sexual abuse on a person’s sense of identity and to the degree of manipulation that a perpetrator may carry out in “grooming” a victim.

1.4 Neglect

Neglect can include:

  • Ignoring medical or physical care needs.
  • Failure to provide access to appropriate health, social care or educational services.
  • The withholding of the necessities of life, such as medication, adequate nutrition and heating.

Signs that neglect may be occurring:

  • Malnutrition.
  • Rapid or continuous weight loss.
  • Not having access to necessary physical aides.
  • Inadequate or inappropriate clothing.
  • Untreated medical problems e.g. pressure ulcers
  • Dirty clothing/bedding.
  • Lack of personal care.

1.5 Discriminatory Abuse

  • Discriminatory abuse may include:
  • Racist slurs.
  • Sexist slurs.
  • Slurs or harassment on the basis of a disability.
  • Slurs or harassment on the basis of sexual preference.
  • Age discrimination is also a form of abuse.

Signs that discrimination may be taking place include:

  • A person overly concerned about race, sexual preference and the like.
  • A person tries to be more like others.
  • A person reacts angrily if any attention is paid to race, sex and the like.
  • A carer is overly critical/anxious about these areas.
  • Disparaging remarks made.
  • A person is made to dress differently.

1.6 Financial Abuse

Financial abuse may include:

  • Theft.
  • Fraud.
  • Exploitation.
  • Pressure concerning wills, property, inheritance or financial transactions.
  • The misuse or misappropriation of property, possessions or benefits by someone who has been trusted to handle their finances or who has assumed control of their finances by default.

Signs that financial abuse may be occurring include:

  • Sudden loss of assets.
  • Unusual or inappropriate financial transactions.
  • Visitors whose visits always coincide with the day a person’s benefits are cashed.
  • Insufficient food in the house.
  • Bills not being paid.
  • A person who is managing the finances being overly concerned with money.
  • A sense that the person is being tolerated in the house due to the income they bring in; sometimes with that person not included in the activities the rest of the family enjoys.

If the vulnerable person is asking for someone in authority to take on his or her financial affairs, establish whether this should be someone in the local authority, for example, Home Care or another professional.

Acquire the appropriate forms, either appointee forms from the Department of Work and Pensions or Court of Protection forms from the Public Guardianship office.

1.7 Institutional abuse

Institutional abuse may include:

  • Times for rising and going to bed are set to suit staff and shift changeovers and do not take account of personal need or preference
  • No choice of meal time, or venue in which to eat meals or of menu
  • Wearing other people’s clothes
  • Set times for drinks that are inflexible
  • Set times for being taken to the toilet or having a bath (to suit staff)
  • Call bells not answered during staff breaks
  • Lack of appropriate equipment, particularly for moving and handling
  • Failure to use moving and handling equipment as per care plan
  • Communal use of resident’s money e.g. for the home mini bus
  • Resident’s challenging behaviour used as an excuse for responding in a particular way

Institutional abuse refers to any care activity that is delivered in a way that suits the needs of the organisation and the staff rather than the needs of the service users. This type of abuse can vary in seriousness from poor practice which needs to be addressed with the provider, through to dangerous and abusive practice which needs to be addressed through the multi agency adult protection policy.

2. Responding to Disclosure

Some incidents of abuse only come to light because the abused person discloses the information himself or herself.

The abused person may not understand that they are being abused and so not realise the significance of what they are telling you. Some disclosures happen many years after the abuse. There may be good reasons for this for example the person they were afraid of has left the setting.  Therefore, any delay in an individual reporting an incident should not cast doubt on its truthfulness.

When someone discloses to you, remember you are not investigating. Do:

  • Stay calm and try not to show shock.
  • Listen very carefully.
  • Be sympathetic.
  • Be aware of the possibility that medical evidence might be needed.
  • Tell the person that:
  • They did a good/right thing in telling you.
  • You are treating the information seriously.
  • It was not their fault.
  • Explain that you must tell your Line Manager and, with their consent, the manager will contact Adult Services, Health and/or Police. The manager will, in specific circumstances, contact Adult & Community Services or Torbay Care Trust without their consent but their wishes will be made clear throughout.
  • If a referral is made but the vulnerable adult is reluctant to continue with an investigation, record this and bring this to the attention of the Safeguarding Adults Co-ordinator. This will enable a discussion of how best to support and protect the vulnerable adult. However, a professional case discussion will still need to take place and should be recorded appropriately.

Do not:

  • Press the person for more details.
  • Promise to keep secrets (you can never keep this kind of information confidential).
  • Pass on the information to anyone other than those with a legitimate “need to know”, such as your Line Manager.
  • Make promises you cannot keep (such as, “I will never let this happen to you again”).
  • Contact the alleged abuser.
  • Be judgmental (for example, “Why didn’t you run away?”).
  • Gossip about abuse.
  • Stop someone when they are telling you what has happened to them, as they may never tell you again.

You must

  • Make a note of what the person actually said, using his or her own words and phrases.
  • Describe the circumstance in which the disclosure came about.
  • Note the setting and anyone else who was there at the time.
  • When there are cuts, bruises or other marks on the skin use a body map (see following pages) to indicate their location, noting the colour of any bruising.
  • Make sure the information you write is factual. You may wish to indicate your own opinion or a third party’s information. If you do, ensure the separation is made very clear.
  • Use a pen or biro with black ink so that the report can be photocopied. Try to keep your writing clear.
  • Sign and date the report, noting the time and location.

Be aware that your report may be needed later as part of a legal action or disciplinary procedure.

3. Alerting

3.1 Introduction

Safeguarding vulnerable adults is everyone’s business. Everyone could be an alerter.

Alerting or raising a concern about abuse involves:

  • Recognising if a person is a vulnerable adult.
  • Recognising signs and signals of adult abuse.
  • Responding to disclosures.
  • Acting, when necessary, to protect an adult and preserve evidence.
  • Reporting a concern, disclosure or allegation.

3.2 Definitions

A concern of abuse is where someone suspects that a person(s) is/are being abused. A disclosure of abuse is where someone states that they are being abused.

3.3 Responsibilities

As an alerter, you are not asked to prove that information is true. You are being asked to log your concerns or disclosures made to you and then report them to Adult Services, Health or Police. The Police have the responsibility for establishing whether or not a criminal offence has been committed.

It is the responsibility of the relevant statutory authority to then instigate the Safeguarding Adults process, and you will receive information about this.

These procedures are written to ensure that the response to any abusive situation is at an appropriate level, co-ordinated and happens in the least intrusive way for the vulnerable adult.

3.4 Immediate Action

(see flow chart)

If a vulnerable adult is in a violent situation and feels in immediate danger, call the Police on 999. If the vulnerable adult is injured, call for an ambulance.

In some circumstances, the alleged abuser may also need support and possibly immediate services to make the situation safe for both parties. In these cases, we may well need to call for support to manage these arrangements, such as another worker.


  • Do not start investigating the incidents yourself.
  • Do not talk to the alleged abuser about the incident even if they contact you and never give them any information about the abused person, especially not the abused person’s whereabouts.
  • At this stage, do not discuss what has happened with carers or relatives of the abused person.  

Following any abusive incident, remember four basic rules:

  1. Ensure safety – look after the victim and keep them safe. Protect other possible vulnerable adults. If the perpetrator is also a service user, support them but also consider any possible further risk.
  2. Contact your Manager/or named person immediately and tell them what has happened. Discuss with them whether the incident, allegation or disclosure is to be reported to the Police for investigation.
  3. Preserve evidence – see Section 5 of this guidance: Preserving and Protecting Evidence.
  4. Hand write a report of what happened in the order it happened as soon as you practically can – use anything to write the report on and keep it safe. Sign and date the report.

Where the situation does not present as an emergency but you are informing Adult & Community Services/Torbay Care Trust, the Police or Health, be prepared to give as much of the following information as you can:

  • Name(s) by which the person is known, date of birth, address, language spoken and method of communication, racial origin and current whereabouts of the vulnerable adult.
  • Your name and your involvement.
  • What happened, where and when?
  • Details of the alleged abuser, such as name, date of birth, address, language spoken/method of communication, current whereabouts and his/her relationship to the person being referred
  • Whether there are any other people, including any children, who may be at risk.
  • Details of other agencies involved with the vulnerable adult.
  • Awareness of the person being referred, carers and alleged abuser to your making this referral. It is also important to pass on how the abused person feels about you making this referral.
  • The likely movements of the person being referred and the alleged abuser within the next 24 hours.

Note: You may not have all of this information but give all the information you do have when making a referral.

Note: Where possible, the opinion of the abused person should always be sought when deciding whether to inform Adult & Community Services/Torbay Care Trust or the Police. There may be circumstances where you need to overrule their wishes. This would normally be the decision of your Line Manager.

Do not give information to people making enquiries but refer them to the named individual in your organisation or the Responsible Manager. Should you suspect that your Line Manager or Senior Manager could be involved in the abuse, contact the Police and/or Adult & Community Services/Torbay Care Trust directly.

You may be invited to co-operate with any investigation. This may include:

  • Providing a statement.
  • Attending strategy meetings and case conferences.
  • Contributing towards the plans for the vulnerable adult’s care and/or protection – depending upon the level of your involvement with the individual.

3.5 What Happens to the Referral?

It is vital to acknowledge the importance that recognising and reporting adult abuse plays in the overall protection of vulnerable adults.

Once a referral has been made to the relevant statutory agency, that agency will acknowledge the referral, and offer a brief explanation of the follow-up process.

3.6 Confidential Alerters

If your Line Manager or his or her Manager is the abuser or is colluding in the abuse, you may need to find someone you can trust outside your immediate agency e.g. Safeguarding Adults Team, Adult & Community Services/Torbay Care Trust; CQC or the Police.

The service user’s interest is paramount and the common law “duty of care” requires that each employee has a responsibility to:

  • Draw attention to any matter they consider to be damaging to the interests of a service user, carer or colleague.
  • Put forward suggestions that may improve a service.
  • Correct any statutory omissions.
  • Prevent malpractice.

Confidential alerters will always be:

  • Treated seriously.
  • Treated confidentially where relevant.
  • Treated with a fair and equitable manner.
  • Kept informed of action taken and its outcome.

Confidential alerters should be aware of the ‘whistle blowing ‘ policy in their own workplace, or can contact Public Concern at Work.

3.7 Support for Alerters – The Public Interest Disclosure Act 1998

People have in the past been put off from disclosing their concerns about possible neglect or abuse because of having worries about their duty of confidentiality and/or the consequences of speaking out.

The Public Interest Disclosure Act 1998 seeks to protect genuine disclosures of such acts.

No confidentiality clause in an employment contract can be used to prevent anyone from disclosing genuine concerns about abuse or abusive practice to an appropriate person. Additionally, any person being treated detrimentally at work because of making an appropriate disclosure may be able to claim compensation at an Employment Tribunal.

For further information see:

The Public Interest Disclosure Act (PIDA)

Public Concern at Work is an independent authority on whistle blowing and can offer advice and support.

Contact them by:
Phone: 0207 4046609
Post: PCAW
Suite 301
16 Baldwin Gardens London

4. Body Maps

These body maps may be copied as required.

Please note on the body map any bruising, scars, injuries, red marks or the like, giving as much detail as possible under the prevailing circumstances as to size, colour and so on.

Only complete these if the injuries are clearly visible or shown to you freely.

4.1 Front and Back Views – Female

Details of service user:


Completed by

4.2 Front and Back Views – Male

Details of service user:


Completed by

4.3 Front and Side Views – Head

Details of service user:


Completed by

5. Preserving or Protecting Evidence

Note: In traumatic situations, it may not be possible to follow this guidance exactly. Do the best you can.

Your first responsibility is the safety and welfare of the abused person, but immediate action may be necessary to preserve or protect evidence.

Your action may be vital in any future proceedings and the success or failure of any investigation may depend upon what you do or not do in the time whilst you are waiting for the Police to arrive.

5.1 Incidents of Physical and/or Sexual Assault

Following allegations of physical and/or sexual assault, consideration will be given to organising, with the abused adult’s consent, a medical examination. Any examination will ideally be carried out by a Forensic Medical Examiner who will be contacted by the Police.

  • If the abused person has a physical injury and it is appropriate for you to examine it, always obtain their consent first.
  • Only touch what you have to. Wherever possible, leave things as they are.
  • Strongly advise the abused person not to wash or remove clothing.
  • Preserve the abused person’s clothing and footwear, do not wash or wipe them. Handle them as little as possible.
  • Preserve anything that is used to comfort the abused person, for example, a blanket.
  • Do not clean up, do not wash anything or in any way remove fibres, blood and the like.
  • Try not to touch items/weapons. If you have to, as before keep handling to a minimum. Put them in a clean dry place until the Police collect them.
  • The room should be secured and no-one allowed to enter unless necessary to support you, the abused person and/or the alleged perpetrator, until the Police arrive.
  • If the alleged perpetrator is also a service user, a separate member of staff needs to be assigned to them.

5.2 Incidents of Theft/Financial Abuse

With the person’s consent, secure all receipts, bankbooks, bank statements, benefit books and the like.

5.3 Methods of Preservation

  • For most items use clean paper, a clean paper bag or a clean envelope. Do not lick the envelope to seal it.
  • For liquids, use a clean glass.
  • Do not handle items unless really necessary to move and make safe.

Safeguarding Adults Process

Reporting concerns of abuse or neglect which are received or noticed within a partner organisation. Any immediate protection needs are addressed. Adult & Community Services complete SS29 Alert form.

Placing information about that concern into a multi-agency context by logging a referral with Care Direct at ‘My Devon’.

Deciding whether the ‘Safeguarding Adults’ procedures are appropriate to address the concern.

Safeguarding strategy meeting
Formulating a multi-agency plan for assessing the risk and addressing any immediate protection needs. This will include co-ordinating the collection of information about abuse or neglect that has occurred or might occur. It will decide if an investigation is needed and if so, who will be responsible.

Safeguarding conference
This would usually follow the safeguarding strategy meeting. The adult concerned must be invited and enabled to attend. The Safeguarding Plan will be formulated here using the information gathered.

Safeguarding plan
Co-ordinating a multi-agency response to the risk of abuse that has been identified in order to protect the individual or individuals at risk.

The review of that plan.

Recording and monitoring
Recording and monitoring the ‘Safeguarding Adults’ process and its outcomes. Adult and Community Services complete SS30 outcomes form.

Good Practice

Based within the community care assessment time frame

Maximum time frame
AlertImmediate action to safeguard anyone at immediate risk
ReferralWithin the same working day
DecisionBy the end of the working day following the one on which the safeguarding referral was made
Safeguarding Strategy MeetingWithin five working days
Safeguarding AssessmentWithin four weeks of the safeguarding referral
Safeguarding Conference }
Safeguarding Action Plan }
Within four weeks of the safeguarding assessment being completed
ReviewWithin six months for first review and thereafter yearly until the case is closed to Adult Protection/Safeguarding Adults

From ‘Safeguarding Adults’ standard 9

ADSS Protocol for inter-authority Investigation of Vulnerable Adult Abuse

This agreement was ratified by the ADSS on 20th February 2004 and is intended for adoption by all Local Authorities and Adult Protection Committees.

1. Introduction

These arrangements recognise the increased risk to vulnerable adults whose care arrangements are complicated by cross boundary considerations. These may arise, for instance, where funding/commissioning responsibility lies with one authority and where concerns about potential abuse and/or exploitation subsequently arise in another. This would apply where the individual lives or otherwise receives services in another local authority area.

2. Aims

This protocol aims to clarify the responsibilities and actions to be taken by local authorities with respect to people who live in one area, but for whom some responsibility remains with the area from which they originated.

This protocol should be read in conjunction with Section 3.8 of ‘No Secrets’ (DoH 2000) and LAC (93) Ordinary Residence – Which identifies these responsibilities in term of:

  • The authority where the abuse occurred in respect of the monitoring and review of services and overall responsibility for Safeguarding Adults;
  • The registered body in fulfilling its regulatory function with regard to regulated establishments; and
  • The placing authority’s continuing duty of care to the abused person.

3. Principles

  • The authority where the abuse occurs will have overall responsibility for co-ordinating the adult protection arrangements (and, for the purposes of this protocol, be referred to as the host authority)
  • The placing authority (i.e. the authority with funding/commissioning responsibility) will have a continuing duty of carer to the vulnerable adult.
  • The placing authority should ensure that the provider, in service specifications, has arrangements in place for protecting vulnerable adults and for managing concerns, which in turn link with local policy and procedures set out by the host authority.
  • The placing authority will provide any necessary support and information to the host authority in order for a prompt and thorough investigation to take place.
  • The host authority will make provision in service contracts, which refer to this protocol, outlining the responsibilities of the provider to notify the host authority of any safeguarding adults concern.

4. Responsibilities of the Host Authorities

  • The authority where the abuse occurred should always take the initial lead on referral. This may include taking immediate action to protect the adult, if appropriate, and arranging an early discussion with the police if a criminal offence may have been committed.
  • The host authority will also co-ordinate initial information gathering, background checks and ensure a prompt notification to the placing authority and other relevant agencies.
  • It is the responsibility of the host authority to co-ordinate any investigation of institutional abuse. If the alleged abuse took place in a residential or nursing home, other people could potentially be at risk and enquiries should be carried out with this in mind.
  • The Care Quality Commission should always be included in investigations involving regulated care providers and enquiries should make reference to national guidance regarding arrangements for the protection of vulnerable adults.
  • There will be instances where allegations relate to one individual only and in these cases it may be appropriate to negotiate with the placing authority undertaking certain aspects of the investigation. However the host authority should retain the overall co-ordinating role throughout the investigation.

5. Responsibilities of Placing Authorities

  • The placing authority will be responsible for providing support to the vulnerable adult and planning their future care needs.
  • The placing authority should nominate a link person for liaison purposes during the investigation. They will be invited to attend any Safeguarding Adults strategy meeting and/or may be required to submit a written report.

6. Responsibilities of Provider Agencies

  • Provider agencies should have in place suitable safeguarding adults procedures to prevent and respond to abuse which link with the local inter-agency policy and procedures set out by the host authority.
  • Providers should ensure that any allegation or complaint about abuse is brought promptly to the attention of Social Services, the Police and/or the Care Quality Commission in accordance with local inter-agency policies and procedures.
  • Provider agencies will have responsibilities under the Care Standards Act 2000 to notify their local CQC area office of any allegations of abuse or any other significant incidents.
  • Provider agencies who have services registered in more than one local authority will defer to the CQC area office relevant to the area in which abuse took place.

Working with:

The Police

The early involvement of the police may have benefits, in particular:

  • It will help ensure that evidence is not lost or contaminated
  • Early referral or consultation with the police will enable them to establish whether a criminal act has been committed and this will give them the opportunity of determining if and at what stage, they need to become involved
  • A higher standard of proof is required in criminal proceedings than in disciplinary or regulatory proceedings (where the test is the balance of probability)
  • Police officers have considerable skill in investigating and interviewing and their early involvement may prevent the abused adult being interviewed unnecessarily on subsequent occasions
  • Police investigations should proceed alongside those dealing with health and social care issues
  • In addition, the Police can provide information to vulnerable people to help them to protect themselves

The Care Quality Commission (CQC)

The Care Quality Commission will:
  • Ensure inspection reports are available on their website:
  • Inform Social Services when information is received that one or more service users may be or are at risk of abuse or neglect within registered establishments or their own homes
  • Work jointly with other agencies where service users require a response under these procedures
  • Attend Strategy meetings in respect of regulated services
  • Keep other agencies informed of any relevant enforcement action taken by the Commission on any regulated service
  • Where a potential breech of Regulation(s) has occurred, undertake appropriate inspection activity
  • Pursue statutory action where appropriate

The Coroner

  • All sudden and/or suspicious deaths will be reported to the coroner
  • It is the duty of every citizen to share information with the Coroner if they believe it is relevant
  • Any health or social care worker involved in a safeguarding adults investigation whereby a vulnerable adult dies or has died, has a duty to share information from the investigation with the Coroner. This should be agreed through the Chair of the Safeguarding meetings, or with the responsible manager for their agency.
  • If the Coroner or a coroner’s officer is the first to raise a possible safeguarding adults concern, they will contact the relevant Adult and Community Services Team by phoning Care Direct (0845 1551 007) and request a safeguarding adults investigation.

Supporting people

  • ‘Supporting People’ is a housing support initiative that contracts with landlords and service providers for housing related support services. It covers every adult client group in addition to other vulnerable groups not necessarily in receipt of any other community care service.
  • The supporting people team monitor the contracts against the quality standards, one of which is specific to abuse of vulnerable adults. The team may become aware of safeguarding adults issues through their routine monitoring or through health and social care colleagues.
  • In the event of a safeguarding adults alert, the supporting people team should be invited to attend a safeguarding adults strategy meeting, and should be copied in to the minutes and decisions.
  • The direct care provider would not normally be invited to the first strategy meeting unless there is good reason to do so. This is because they may be the alleged abuser or be close to that person, or have failed to address previous complaints.

South West Adult Placement Scheme (SWAPS)

  • SWAPS is registered with the Care Quality Commission. It is an umbrella organisation which recruits and monitors people to look after adults in their own homes.
  • The recruitment procedures include an enhanced CRB (Criminal Records Bureau) check for the main carer, training and ongoing monitoring and support.
  • As with Supporting People, any safeguarding adults alert made to health or social services should lead to a SWAPS representative being invited to contribute to the information gathering stage and to any strategy meeting that is held. Again, it is not usual to invite the direct care provider to the first strategy meeting for the reasons given above.

What are my duties as a Responsible Manager?

(Refer to this information regarding a responsible manager)

As the Responsible Manager you are responsible for the overall co-ordination and management of a safeguarding adults case and chairing any meetings that may be necessary.

You should delegate the task of assessment/investigation to an appropriately trained and experienced staff member who will report back to you. This person will be referred to as the investigating officer. You will need to be available to provide support, supervision and advice to the investigating officer and ensure that they have the resources necessary to carry out their task. (Resources include time, clerical support and another person with whom to share the task of interviewing).

If you are the RM managing the case you are responsible for:

  • Seeing that there is a completed alert form on the file. Adult Protection Alert/Referral Form
  • Ensuring that steps are taken to keep the vulnerable adult safe while initial inquiries are made.
  • You will need to decide from the information available from the initial inquiries if the vulnerable adult is at continuing risk of significant harm. These initial checks with other agencies and departments will also be necessary to determine whether there are other vulnerable adults or children who may be at risk.        It is important that any contracts or visits by care managers, social workers, health staff or regulatory staff do not alert possible perpetrators to the issues of concern unless this is unavoidable.
  • Consulting the police if there is a possibility that a criminal offence has been committed. Any emergency action to protect the vulnerable adult may alert the alleged perpetrator resulting in evidence being removed or altered. Hence the police may wish to be involved in any emergency action to preserve forensic evidence or documentation.
  • In the event of the death of a vulnerable adult where safeguarding adults concerns already exist or are raised around the time of death, you should ensure that the coroner’s office is informed of the adult protection issues as a matter of urgency, if the police have not already done so. The coroner will make arrangements for any investigations considered necessary.
  • If abuse is alleged against a staff member who is providing ongoing care or support to vulnerable adults it will be necessary to consider, prior to any planning meeting, if action needs to be taken to reduce any further risk that this staff member might pose to any vulnerable adults. This may also serve to protect the staff member from further allegations being made against them. You should inform the service’s manager as soon as possible about the issues to enable them to take appropriate action to protect all the vulnerable adults within their service. If it is possible they are implicated in the abuse issues, protective actions will need to take this into account.
  • Arranging an appropriate planning process within 5 days or as soon as practicably possible. The planning process will need to involve all appropriate professionals, agencies, services and departments and any other person who has information essential to the case.
  • A formal planning meeting will allow a full discussion of actions already taken and allow for future planning. Where the allegations involve a staff member from any organisation or agency providing services, a senior representative of the service should be invited to the meeting unless they are implicated in the abuse allegations. If, in exceptional circumstances, the service provider has not already been made aware of the allegations of abuse, you will need to ensure that a decision is taken, during the meeting, about informing the service provider of the issues that need to be investigated/assessed.
  • Liaising with the contracts service, where appropriate, regarding the status of the contract and deciding with them whether any action is needed in relation to the contract, either before or after the investigation has taken place.
  • Ensuring that, where appropriate, placing authorities are informed of safeguarding adult concerns in a care setting which might affect their clients. This will enable them to be involved in meetings and assessments as necessary.
  • Ensuring that a complete record of all contacts, meetings; phone calls, interviews and decisions are kept in the closed/restricted part of the client’s file.
  • Ensuring that there is a record of the decisions taken as a result of a formal planning meeting and/or recording the outcome of initial post alert consultations.
  • Ensuring that any assessment/investigation carried out with or without the support of other agencies is fully recorded and that there is a written summary of the findings on which to base decisions.
  • Chairing the Safeguarding Adults conference and ensuring that full support is available for any vulnerable adults attending the conference. This is a major responsibility and the RM should have appropriate training and support to undertake the task.
  • Ensuring that the minute-taker is appropriately trained and skilled at this task. They should be identified in advance of the meeting and be updated regarding the case and possible issues that are likely to arise.
  • Ensuring that appropriate pre-conference support has been provided to the vulnerable adult and/or his/her representatives in the case conference. You have the authority, in consultation with the vulnerable adult and other representatives, to restrict or exclude attendance of people at the conference if they are likely to prevent a full and proper discussion. This should be clearly recorded in Safeguarding Adults conference notes.
  • Ensuring that decisions taken at a Safeguarding Adults conference or other review meetings are minuted including decisions concerning:
    • The vulnerable adult(s) or children;
    • The person responsible;
    • The service setting/agency;
      As the chair of the planning meeting or case conference, you should take responsibility for checking that the employer has made the referral to POVA.
    • If the Care Quality Commission (CQC) who will take responsibility for following this up with the employer.
    • The chair of the meeting should also liaise with the employer to ascertain what decision POVA made regarding the referral.
    • This information should then be recorded in the adult protection papers for the client(s) who was the subject(s) of the safeguarding adult case(s). See further guidance page 56.

Guide for Employee Relations Staff

  • You receive a call or letter from a manager saying that an allegation or complaint has been made about a member of staff. At this point it is important to ascertain if the subject of the complaint is a ‘vulnerable adult’ in terms of the Safeguarding Adults/Adult Protection policy and guidance.
  • If they do fit these criteria, remind the manager that they have a responsibility to consider using the Safeguarding Adults/Adult Protection process. They can seek advice from other colleagues or from the Safeguarding Adults/Adult Protection Team if unsure.
    • The next step is to consider if the staff member needs to be sent home. There are occasional situations where people can be moved to non client contact settings, but sending them home usually protects them as well as the vulnerable adult.
    • The safeguarding adults process should have been initiated by the manager and must fit in with your timescales i.e. a strategy meeting within 5 working days from the staff member being sent home.
    • The strategy meeting should include police where relevant, care manager, CQC (Care Quality Commission), ER (Employee Relations), any other key players with a contribution to make (see Safeguarding Adults Guidance for more detail). It should be chaired by a Safeguarding Adults Officer or by another manager.
    • The Safeguarding Strategy meeting will look at the whole picture, including the possibility of any other vulnerable adults being at risk; the need for a police investigation; the need for more information etc. The meeting will decide what type of investigation, if any, needs to take place. Police investigations take precedence over all others. Work needs to be done with the police to enable joint interviews with HR where possible, to avoid interviewing vulnerable adults twice.
    • Where there is no police interview and the issue is dealt with under the disciplinary process, there are two things that may assist your staff. One is to enlist the support of a trained investigator, and two for ER advisors to get a place on the Safeguarding Adults Investigator’s training.

The main reasons for using the Safeguarding Adults/Adult Protection process are:

  1. To ensure the needs of the vulnerable adult are given high priority
  2. To ensure that the broader picture is looked at i.e. is anyone else at risk, or may they have been?
  3. To ensure that police involvement is considered from the beginning and the contamination of evidence is minimised. If evidence has been contaminated, the case will have difficulty getting to court.
  4. It can run in conjunction with the disciplinary process but requires close liaison between the different agencies, particularly where the police are investigating an alleged crime.
  5. To consider the future of the staff member, if guilty, in terms of protecting vulnerable adults e.g. POVA list application.

Safeguarding Adults Incidents And / Or Allegations Concerning Employers Of Devon County Council


What are my responsibilities – as an employer?

Employer is used as a generic term and includes all key personnel involved in the management of the service.

  • You will ensure that your service has its own safeguarding procedures that are complementary to the multi-agency safeguarding protocols.
  • You are responsible for ensuring that all service users are safeguarded from abuse.
  • All allegations and incidents of abuse are followed up promptly and actions recorded.
  • You should use the measures available to you through your internal staff disciplinary procedures to ensure the safety of all service users pending investigation/assessment of the concerns.
  • The paramount consideration must be to protect vulnerable adults in your care. However, it is important to ensure that any action taken in accordance with internal staff disciplinary procedures is compliant with best practice in employment legislation and the Human Rights Act 1998.
  • If a home or organisation has a Devon or Torbay contract, have the contracts team been consulted? Is any action required, regarding the contract, prior to any investigation being carried out? Contract actions need to be agreed and recorded at the strategy meeting. E.g. temporary suspension of placements – see contract guidance note.

    It needs to be agreed at the strategy meeting who will be responsible for:
    • Informing the home of any actions taken which affects their contract.
    • Alerting care management teams, via the e-mail system of any issues which may affect the use of any service.

Either with or without a strategy meeting, the RM must ensure that there is a full record of the consultation/planning stage. This might include:

  • Which agencies were consulted and or represented at the strategy meeting.
  • That any investigation/assessment is agreed together with timescales. Co-ordination of the investigation/assessment should be allocated to an investigating officer from the social services agency and any named representatives from other departments or agencies.
  • That there is a record of the terms of reference for the investigation/assessment.
  • That it is clear who will be involved in all aspects of the investigation/assessment.
  • That consideration has been given to the possibility of likelihood that issues of abuse may concern other vulnerable adults or children.
  • If criminal matters are suspected what kind of investigation will be carried out? Ensure that there is a record of concurrent and consecutive actions to be taken by agencies other than the police.
  • Any care management, contracting or regulatory action to protect the vulnerable adult(s) or children is recorded.
  • Any decision to take no further action is agreed and recorded. Record who will feed back to the referrer.
  • Any disagreement with decisions taken should be recorded in the minutes of the meeting and discussed by the RM with senior managers as a matter of urgency.
  • For further information – see ACAS Code of Practice on disciplinary and grievance procedures

Chairing Safeguarding Adult’s meetings

The Chair will usually be the Responsible Manager of the Lead Agency (see the policy for further information on the Responsible Manager role). The Chair is responsible for ensuring the Safeguarding Adults meeting is arranged, taking into account any particular access or communication needs. Chairing Skills courses and packs are available; please contact the Safeguarding Adults Team training co-ordinator, in Adult and Community Services, regarding training.

As part of their role, the Chair is responsible for:

  • Arranging meetings in accordance with Safeguarding Adults Guidance
  • Ensuring a minute taker is appointed and briefed about their role.
  • Ensuring information sharing and confidentiality protocol is adhered to
  • Establishing an agenda for meetings.
  • Facilitating the full participation of everyone at the meeting.
  • Ensuring Safeguarding plans are produced, based on risk assessments.
  • Ensuring attendance sheets are fully completed and minutes are circulated appropriately.
  • Checking and signing minutes prior to circulation.
  • Promoting the involvement of vulnerable adults and their carers (where appropriate) in Safeguarding meetings.
  • Responding to requests for amendments to minutes
  • Requesting reports (signed and dated where possible) to be used as part of the meeting
  • That SS29 and SS30 forms are completed by the appropriate person

The Safeguarding Adults/Adult Protection Officer in Devon (different practice applies to Torbay Care Trust) will chair Safeguarding Strategy meetings where:

  • A registered provider is involved
  • More than one person is at risk
  • CQC have concerns about the provider
  • There are previous concerns
  • It may be a service used by several teams
  • It is likely to have a high profile

Minute Taking

Minutes of meetings should provide a reflection of the meeting as a whole and accurately record what was discussed, the stated opinions of others and what the outcomes are in terms of actions, roles and responsibilities – (safeguarding plan). They do not necessarily need to be word for word. Minutes are the responsibility of the Chair and therefore the minute taker and Chair need to work closely together.

Below are some guidance notes to consider when taking minutes as part of the Safeguarding Adults/Adult Protection process.

  • Minutes should be written in the past tense
  • The full names of those involved in the meeting and those discussed should be used –
    Please also see Record Keeping and Confidentiality Guidance Notes.
  • Where possible, written reports should be provided for the meeting and if agreed by the Chair, attached as a copy to the minutes, thus saving the need for a further written précis of the reports.
  • The Safeguarding Adults minutes template should be used and the type of meeting must be clear eg strategy meeting.
  • The meeting Chair should spend some preparation time with the minute taker prior to the meeting to familiarise them with the issues/agenda and any specific requirements for that meeting.
  • The minute taker may want to sit next to the Chair.
  • The minute taker should be able to request clarification, if required, during the meeting.
  • Minutes should be sent to the Chair of the meeting to check and amend, (if required) before circulation. The Chair also needs to sign the minutes once agreed, before circulation.
  • Circulation of minutes is the responsibility of the chair. An attendance sheet should be completed and all those attending and giving apologies should receive a copy unless agreed otherwise at the meeting.
  • Password protect all minutes circulated by e-mail and mark any posted minutes as confidential, (see DCC corporate policy guidance).
  • Aim to have minutes typed and circulated within 14 days of the meeting.
  • Requests for amendments to minutes following circulation must be addressed to the Chair.

For a copy of the minutes template, please contact the Safeguarding Adults Team Administrator on 01392 383131.

Agenda – Safeguarding Strategy Meeting

Agenda – Safeguarding Conference

Case Discussions and Safeguarding Strategy Meeting Guidance

Case Discussion

Where there is a concern being expressed by one or more agency(s), which falls short of an allegation or disclosure being made, a Case Discussion must take place. This would normally take place between the key worker (care manager, CPN etc) and their line manager. Main points to consider include:

  • Is the person currently safe?
  • Is the person aware they are subject of an alert?
  • Is there a need for protective action, either on a voluntary basis or through the courts?
  • Is it likely to happen again?
  • Is there enough information? It may be necessary to check with other agencies, and clarify the information given with the alert. Check the facts are correct.

This must be recorded in the case file.

Where an allegation or disclosure of abuse has been made, a Safeguarding Strategy Meeting may be called. This decision will be based on information/evidence available.

A Safeguarding Strategy Meeting is recommended where:

  • Several different agencies have similar concerns
  • A crime may have occurred
  • Other legal or regulatory action may be needed
  • Paid staff are implicated
  • Other people may be at risk
  • The degree of harm or distress experienced by the adult is significant
  • There is significant level of risk to the adult and/or others

The Safeguarding Adults/Adult Protection Officer in Devon (different practice applies to Torbay Care Trust) will chair Safeguarding Strategy meetings where:

  • A registered provider is involved
  • More than one person is at risk
  • CQC have concerns about the provider
  • There are previous concerns
  • It may be a service used by several teams
  • It is likely to have a high profile
Strategy Meeting

A strategy meeting is an inter-agency forum to plan the process of the investigation. Service users and their carers will not normally be invited to Strategy Meetings.

The first Strategy Meeting must take place as soon as possible and definitely within five working days of the initial alert or case discussion.

The Strategy Meetings will be chaired by a senior practitioner (preferably suitably trained). A Strategy Meeting will consider the following:

It is expected that all participants will contribute some information to the Strategy Meeting(s).

Reports to Strategy Meetings

Wherever possible, these should be in writing even if it is only a list of bullet points to back up an oral statement. This should be written by the person who is regarded as the key worker in the case e.g. care manager, community nurse. Reports should always be requested from people invited but unable to attend. Wherever possible, reports should be sent to the Chair before the day of the meeting.

A list of issues that need to be covered in a report:

  • Details of the initial alert.
  • Outline of this and any other previous related allegations/concerns.
  • A pen-picture of the vulnerable adult(s) and their circumstances.
  • An assessment of the vulnerable adult(s) in terms of consent, capacity and/or other legal issues, including a risk assessment.
  • Any other relevant information including date of birth, address, who they live with.
Strategy Meeting Attendees

The following list is a guide to who should be invited to attend the Strategy Meetings. You should only invite those people who are relevant to the case.

The Alerter would not normally be invited to attend – a written record of their concerns or observations should be presented to the meeting.

Even when the meeting is set up by phone, a written invitation should be sent as confirmation. This should request a written report from anyone who is unable to attend.

It is important to note that when someone from a non-statutory service (e.g. voluntary organisations, independent care provider) is invited, it may be necessary to hold the meeting in two parts. This is particularly important where the Police are present – the information sharing protocol does not allow them to share confidential information outside the statutory services of the NHS, the Local Authority and the Care Quality Commission.

  • Managers from investigating agencies.
  • Police Supervisor/Officer(s).
  • Social worker.
  • Investigating social worker.
  • Social Work Team Manager.
  • Community Nurse.
  • Community Psychiatric Nurse.
  • Home Care Manager.
  • Environmental Health Officer.
  • Health Visitor.
  • Care Quality Commission
  • Human Resources.
  • Housing Officer.
  • Occupational Therapist.
  • Probation Officer.
  • Senior Health/Social Services Manager.
  • Any voluntary agency known to be involved.    NB Statutory agencies may not be able to share all information with voluntary agencies and the meeting may need two distinct parts.
  • General Practitioner.
  • Legal Practitioner/s.
  • Procurement and contract team.
Strategy Meeting Issues

Issues that must be considered during any Strategy Meeting include:

  • The wishes of the vulnerable adult
  • Are there any doubts surrounding the vulnerable adult’s mental capacity? If so, what are they and who has raised them?
  • Is an assessment needed concerning the vulnerable adult’s mental capacity in this situation? If so, who will arrange it and who will carry it out?
  • Do you need to make a referral to the IMCA service?
  • Have/will/can they give permission to involve agencies other than those represented at the meeting or in the discussions?
  • How can the vulnerable adult’s family or carers be involved if the vulnerable adult wants this? This includes such matters as:
    • Who should be interviewed?
    • When is the best time for the interviews?
    • Will their involvement alert the alleged perpetrator and threaten the safety of the vulnerable adult and/or the collection of evidence?
    • Where is the best place for the interviews?
    • Does their current level of distress affect their involvement, and if so how?
    • Should they be present at any of the meetings or are there more appropriate ways for them to contribute to the decision making?
    • Support groups.
    • Social work support.
    • Carer representation.
  • Is there a need to break confidentiality?
  • Who is going to lead and therefore co-ordinate the investigations?
  • Is the allocated key worker/care manager to take part in the investigation or will they have a support role only?
  • Who will take responsibility for keeping the vulnerable adult, alerter, carers and so on informed of events?
  • Have issues of gender, race, culture, language, communication been considered? Is an interpreter or signer needed?
  • What practical assistance would facilitate the vulnerable adult’s involvement? This includes:
    • Transport to medical appointments or interviews.
    • Assistance with child care arrangements.
    • Fully accessible interview venues.
    • Is the giving of video evidence appropriate?
  • How can information about the vulnerable adult and the alleged incident(s) best be gathered?
  • Are criminal proceedings a possible outcome?
    • Is there a need for co-ordinated interviews to avoid repeat interviewing?
    • Is there a need for a formal interview to take place with the involvement and under the direction of the Police?
  • Is there a need for the vulnerable adult/perpetrator to undergo a medical examination? Who will carry out the examination(s) and what will be the necessary arrangements?
  • Is it possible that there are other abused people?
  • Are there children potentially at risk? Does a referral need to be made to Safeguarding Children?
  • When, how and by whom is the alleged perpetrator to be informed about the allegations?
  • Is the alleged perpetrator in need of community care services?
    • Will they need social work support?
    • Will they need an Appropriate Adult for Police interviews?
    • If they are in need of community care services, a separate Safeguarding Conference must be arranged specifically to consider their needs.
  • Who will support the vulnerable adult after the investigation?
  • Action plan
  • Date, time and venue for the Safeguarding Conference.

Other Procedures That May Be Relevant


Safeguarding Adults Investigation Process

“A properly co-ordinated joint investigation will achieve more than a series of separate investigations. It will ensure that evidence is shared, repeat interviewing is avoided and will cause less distress for the person who may have suffered abuse ‘However, no individual agency’s statutory responsibility can be delegated to another. Each agency must act in accordance with its duty when it is satisfied that the action is appropriate. Joint investigation there may be but the shared information flowing from that must be constantly evaluated and reviewed by each agency.”

“No Secrets” (page 29)

Proceeding to an investigation

If an investigation is required then the terms of reference for the investigation/assessment must be jointly agreed at the strategy meeting. This meeting will decide the scope and nature of the investigation and agree who will lead the process.

If the alleged perpetrator is a member of staff, human resource advisors should be consulted. They should be informed of the progress of the investigation and where appropriate could be involved in the investigation, provided their involvement does not compromise any criminal investigation.

If a criminal act is suspected then the police investigation will take precedence. It is however, important to ensure that the protection of the vulnerable adult(s) is not unduly delayed by their investigation. Agreement will be required regarding actions to be taken by others while the police investigation is being carried out. Police action may be supported by care management, health or regulatory staff but if this is not the case, liaison over the progress of the police investigation should be carried out by the investigating officer.

When the police investigation has been completed other investigations may then be required. Where possible, joint interviews with police should be conducted with vulnerable victims and witnesses to avoid delays and duplication of investigation activities.

Discussions with other professionals will be required to ensure that appropriate support is made available to the vulnerable adult(s) taking into account their cognitive ability, comprehension and communication needs.

The purpose of an investigation is:
  • To establish matters of fact about one or more incident(s) in which abuse is alleged or concerns have been raised.
  • To assess the support and protection needs of the vulnerable adult(s).
  • To determine who was responsible and/or culpable and what action should be recommended in relation to them.
  • To review the management of the setting/service and any improvements required or sanctions to be recommended.
Who is responsible for what?

Investigations will always be led by one of the statutory agencies. In planning the investigation it should be clear which agency/individual is taking responsibility for each strand. Interviews with vulnerable victims or vulnerable witnesses should be carried out with the support of appropriate social or health care staff regardless of who has the lead responsibility for the investigation. The Adult and Community Services, Devon or Torbay Care Trust will take responsibility for overall co-ordination as part of the Safeguarding Adults strategy meeting.

  • If the police are not involved the social services agency will take responsibility for A and B above, i.e. for finding out what happened and for taking action to protect the person.
  • If the police are involved they will be fully responsible for any criminal investigation.
  • Where the alleged abuse has taken place in a regulated service and formal statements are required under the Care Standards Act 2000, the regulatory authorities will take lead responsibility for ensuring that the investigation is conducted within the requirements of the Act.
  • Where the alleged abuse has taken place in a non-regulated service but one which is contracted, e.g. supporting people, day care or work opportunity service, the social services agency should take the lead but be supported by other appropriate professionals. All interviews will be formally recorded.

Different agencies may take a lead in relation to perpetrators depending on their position and relationship to the client

  • Family members who are carers may be assessed in terms of their own needs for support as an alternative to sanctions being taken.
  • Other service users will warrant a parallel assessment by the social services agency with possible input from health, police probation, or other agencies.
  • Staff members may require coordinated input by police, personnel, professional bodies, unions or legal services.
  • Employees, service proprietors or managers are more likely to face disciplinary action or actions under the Care Standards Act 2000 or in relation to their professional bodies.
  • Members of the public who abuse will probably be subject to police investigation. They may also be subject to action by housing authorities, race equality units etc. As they are outside the service or professional frameworks, action through civil or criminal courts may be considered.

Where an individual has potentially committed a criminal act they may be investigated by the police with a view to prosecution and this may take place in parallel with, and not instead of, these other actions.

The co-ordination role involves sharing information for these different arenas, planning any agreed joint interviews to avoid repeated and distressing rehearsal of the facts, and drawing up a timetable, which acknowledges the different time frames involved in taking these disparate forms of action.

Following the allocation of the case by the designated senior officer the investigating officer should start the formal investigation process within 48 hours, in conjunction with the other professionals. A timetable should be drawn up indicating the order in which tasks will be undertaken.

What are my responsibilities as the Investigating Officer?

The investigating officer assigned to co-ordinate the assessment and/or the investigation will be responsible for:

  • Ensuring that an appropriate alert/referral form has been completed by the professional receiving the initial information.
  • Ensuring the safety of the vulnerable adult(s) in liaison with the Responsible Manager (RM)
  • Ensuring that the wider issues of communication, language, culture, religion and gender are taken into account when planning investigation/assessment.
  • Ensuring that a complete record of contacts, meetings, phone calls, interviews and decisions is made and kept in the client’s file.
  • Carrying out an assessment/investigation with other agencies where appropriate and writing a summary of the findings to aid decision-making.
  • Carrying out any other actions identified through the planning, investigation and assessment process.
A range of investigative actions

These might include any or all of the following:

  • Joint visits with other agencies/departments (i.e. police, contracts staff, regulatory authorities). The designated senior officer will support the investigating officer to plan this action or it will be agreed during the formal planning meeting;
  • Examination of documentary evidence such as files, accident and incident reports, daily logs, accounts, medical records etc;
  • Interviews with witnesses and/or complainants and others who are able to set the scene;
  • In cases of suspected sexual or physical abuse, a medical assessment should be made available to the individual. In cases where a person cannot give their consent or where consent is questionable, a responsible medical practitioner will have to make a judgment about whether such an examination (either for medical and/or evidential reasons) is likely to be in the person’s best interests.

The legislative issues relating to Safeguarding Adults is complex and conflicting with the need to balance the issues of autonomy, individual rights and protection. The Law Commission has addressed these concerns in a series of consultative documents culminating in Law Commission Report No. 231 (March 1995) as the basis for law reform. A report “Making Decisions” (October 1999) outlines the government’s approach to incapacity and provides a new legislative framework for substitute decision making.  In April 2005 The Mental Capacity Act 2005 received Royal Assent, this will address a wide range of concerns for people who lack capacity when it is implemented in April 2007.

Managers are advised to seek specific individual advice from their legal advisors and/or the local police. The responsible managers may seek the support of an independent legal advocate

to protect the interests of the vulnerable person where these may run counter to those of the host or purchasing authorities or provider services.

Investigation/Assessment Checklist

The role of the investigating officer is central to the safeguarding adults process. If you are asked to be an investigating officer for a case you should have an understanding of the multi- agency safeguarding adults policy and protocols and be appropriately trained and experienced to undertake the task. The AIMS for Adult Protection Guide (Pavilion Publishing) contains extensive checklists to support the investigative process. These can be copied and used to record information or to remind the investigator, in detail, of the issues that may need to be considered.

A summary of your responsibilities includes:

Completing, as necessary, the alert form and ensuring that it has been input onto the appropriate database.

  • Liaising with the relevant manager if emergency action is required to protect the vulnerable adult(s) or children.
  • Keeping a complete record of contacts, meetings, interviews, phone calls and any decisions taken and issues considered to be placed in the closed section of the client’s file.
  • Recording decisions taken as a result of meetings or consultations with other professionals or service providers.
  • Carrying out an assessment/investigation with other agencies, where appropriate, and writing a summary of the findings that will support decision making.

This checklist may assist you to consider specific issues involved in investigation and assessment of cases of abuse or suspected abuse:

  1. Do you have clear terms of reference for the investigation/assessment?
  2. Consider both the detective and protective aspects of the investigation
  3. Who will support you in the investigation/assessment process? You may carry out some tasks alone (checking through reports or files), but during all interviews and meetings you should have the support of another person. This person can be from:- police, health, regulatory authorities, voluntary organisation (e.g. Mencap or Age Concern, Racial Equality Council etc.), a funding authority representative or a colleague from your own team. Please consider the cultural religious and gender issues and seek appropriate support.
  4. The 4 main strands of the investigation are:-
    • To establish matters of fact.
    • To assess what is needed to make and keep the vulnerable adult safe and to assist them to recover from any trauma.
    • To consider any action which may be taken against the alleged perpetrator.
    • To evaluate the services response to the case.
  5. Map out your investigation
    • What do you need to find out?
    • Who might have this information?
    • What legal powers do you have or need?
    • Check out all necessary documentation.
    • Do you need a psychological, psychiatric or speech therapy assessment of any of the vulnerable adults, prior to carrying out any interviews?
    • Interview people, in the appropriate environment, taking into account any need for an independent advocate and/or any language, communication, gender or race issues.
    • Plan interviews with your colleague prior to commencing the interview.
    • Take statements and record interviews; (training in conducting interviews is essential).
    • Collate the evidence.
  6. Evaluate the evidence obtained:
    • Medical or forensic evidence.
    • Background reports, service records and previous histories.
    • Witness statements from formal/joint interviews.
    • Assess individuals’ capacity and witness skills.
    • Circumstantial evidence.
    • Assess the extent and seriousness of the abuse and the effect it has had on the vulnerable adult and others in their network.
      The evaluation of each piece of evidence should assist in:
    • Proving the allegation.
    • Supporting the allegation.
    • Being neutral
    • Throwing doubt on the allegation
    • Actively disproving the allegation.
  7. You should now be ready to compile your report to enable decisions to be made. Your report does not have to be long or complicated, just clear and to the point, describing what your investigations/assessments have covered and reviewing the evidence in a dispassionate way. If you have worked closely with other professionals, the report can be written jointly and at the very least agreed as correct.
Compiling a report following investigation

At the end of the investigation, the investigating officer should compile a short report summarising all the information. Those involved may be asked to contribute to one or more sections of the report drawing on their personal or professional knowledge, judgment and/or on specific injuries carried out as part of the investigation.

The report should cover the following points:

  • Details of the initial alert and of the incident or concern which triggered the referral.
  • Outline of any previous related incidents or allegations.
  • A pen picture of the vulnerable adult’s circumstances.
  • An assessment of the vulnerable adult’s capacity in relation to consent and other legal issues.
  • A sketch of the person’s network and social supports.
  • Any issue of discrimination identified.
  • Information about the person alleged responsible for the abuse.
  • A brief account of the investigation process and the input of other agencies.
  • An evaluation of the evidence.
  • An assessment of how serious the abuse has been and whether there is a risk of it escalating or being repeated.
  • Recommendations about future action to support the person and/or manage any ongoing risk.
  • Conclusions about culpability and responsibility for the abuse or harm.
  • Other actions to be taken.
  • Recommendations about when and in what circumstances the case should be revisited.

The completed report should be passed to the responsible officer for decision making. The report will be available to inform the safeguarding conference. It will be marked ‘Confidential’. If a safeguarding conference is not held the information, the outcome and the recommendations for future care planning and monitoring will be shared at a review meeting. In cases where the employer is considering disciplinary action or referral to POVA, the Responsible Manager will make a copy of the report, or a summary, available to the employer.

Guidance on Interviewing

Planning and Conducting the Interview(s) – Context

Interviewers must have received relevant training. It will be decided at the Strategy Meeting level:

  • Who will be interviewed?
  • When they will be interviewed.
  • Who will conduct the interview?

If there is a possibility of criminal proceedings, it is important that repeat interviews are avoided as evidence may become contaminated.

Conducting interviews is an integral part of the investigation of suspected or actual abuse.

The information and evidence gathered during the course of an interview may be required in criminal and/or civil proceedings.

It is therefore imperative that any interview conducted complies with the legal and procedural requirements to ensure its integrity.

Failure to comply may render information or evidence obtained during that and future interviews inadmissible.

For these reasons, interviews must only be conducted by those who have received the appropriate training.

The ‘interview strategy’ will be decided upon at the Strategy Meeting.


Joint Police Interviews – Police and Criminal Evidence Act 1984 (PACE)

PACE provides a comprehensive code for the arrest, detention and interviewing of people suspected of crime. What follows here is only a summary of some of the salient provisions about interviewing, as they may apply where vulnerable adults are accused of, or the victims of, crime. Those using this guide should refer to the actual provisions of PACE for full details of what is required.

Code C

Annexed to PACE are four Codes of Practice. Of these, Code C deals with the detention, treatment and questioning of persons in custody by Police officers. It applies whether or not the person has been arrested for an offence, and it also applies to people who have been removed to a Police Station as a place of safety under Sections 135 or 136 of the Mental Health Act 1983.

All the provisions of the Code apply to vulnerable adults as they do to anyone else, but there are additional protections for people who have mental, sensory or physical difficulties, are drunk or drugged, cannot understand written or spoken English, or are under 17 (but juveniles are outside the scope of this Guide).

Code C provides that people in custody should:

  • Be dealt with expeditiously.
  • Have their time in custody accurately recorded.
  • Be informed of their rights (to have someone informed of their arrest, to consult privately with a solicitor, and consult the Codes).
  • Have their property looked after.
  • Not be held incommunicado.
  • Be held in decent conditions (heat, cleanliness, toilet facilities, and food).

It is the responsibility of the Police – usually the Custody Officer – to consider whether a person may be mentally disordered, have a learning disability, or be unable to understand the questions to be put to him or her. Where that is the case, an appropriate adult must be called to participate in the interview. If there is any doubt about the detainee’s capacity, an appropriate adult should be called.

Appropriate Adult

For an adult detainee with mental health issues or a learning disability, an “appropriate adult” may be:

  • A relative, guardian or other person responsible for his or her care or custody.
  • A person who has experience of dealing with mentally disordered or mentally handicapped people, but is not a Police Officer or employed by the Police, such as an Approved Social Worker or a Specialist Social Worker. 1
  • Failing either of the above, some other responsible adult aged 18 years or over who is not a Police Officer or employed by the Police.

Note:      An adult with experience may be better than an inexperienced relative, but the wishes of the person detained must be taken into account. If they say that a particular person should or should not be with them, then those wishes should be respected if practicable.

A solicitor who is acting in that capacity may not be an appropriate adult. The detainee must be allowed to see a solicitor in private, that is without the appropriate adult, if they so wish.

1 Note that the person does not have to be a qualified Social Worker so long as they have the relevant experience

Duties of the Appropriate Adult (AA)


  • To attend the Police Station and establish the grounds of detention and the whereabouts of the detained person.
  • To ensure, where the person has been detained under the Mental Health Act, that an ASW and a Registered Medical Practitioner are called to interview and examine him or her, and make suitable arrangements for their treatment and care. Once this has happened, the person should be released.
  • To hear the detainee being informed of their rights.
  • To consider whether legal advice is required, and if so, that it is obtained.
  • If the detainee cannot read (for whatever reason), to help with any documentation. The AA may sign to signify the person’s consent, so long as it is genuine.
  • To check the record of what has happened to any property of the detainee that has been removed, and the reasons for removing it.
  • To ensure that the arrested person has had one other person (or up to two alternatives) informed of his or her whereabouts.
  • To complain (if necessary) about any aspect of the detainee’s treatment since arrest. Any complaint should be recorded and referred to a senior officer.
  • To consider the detainee’s physical condition, including requirements for medication, and whether a Police Surgeon should be called.  Medication should generally be administered under the personal supervision of a Police Surgeon.
At Police Interviews
  • To be present when a caution 2 is given (and if not, it should be repeated in their presence) and to ensure that the interviewee understands it and that it is recorded.
  • To advise the interviewee during the interview and to consider whether the interview is being conducted properly and fairly, without being oppressive, and that proper breaks are taken.
  • If required, to aid communication with the interviewee. People who are deaf or have a speaking disability should have an interpreter.
  • To receive any notice of charge on behalf of a mentally disordered person.
  • To attend intimate 3 or strip searches4, or ensure that any other person that the person being searched wants to be there, can attend.
2 The caution should be in this form: “You do not have to say anything. But it may harm your defence if you do not mention when questioned something you later rely on in court. Anything you do say may be given in evidence.”
3 An intimate search is a physical examination of a body orifice other than the mouth.
4 A strip search involves the removal of more than just the outer layer of clothing.
Planning and Conducting the Interview(s)

Note: If there is a possibility of criminal proceedings the Police will direct any disclosure interviews(s).

Because of the dual nature of safeguarding adults investigations, a social worker should always be present at the interview. There are two procedures, one for victims and one for suspects (even when suspects are themselves vulnerable).

Practice Guidelines for All Interviews not Involving the Police

Planning the Interview

Interviewers must have received appropriate training.

The interview needs to be planned and a record made of the plan. Before the interview, you need to think about:

  • The Person
    • The vulnerable adult’s right to self-determination. They must be consulted at every stage.
    • The available options should be put to the adult for consideration.
    • Know something about the person’s history.
    • Check if the person has a sensory impairment (if this is not already known).
    • Establish if spoken English is their first language.
    • Establish if the person can communicate without specific assistance.
    • Always watch for signs of discomfort or distress.
  • Preparing the Person
    Note: Preparing does not mean coaching, that is, telling someone what to say.
    • The vulnerable adult should be told the purpose of the interview.
    • The interviewer(s) should introduce themselves and colleague(s) fully and clearly.
    • State who you are and where you are from.
    • Show your identity card.
    • Speak clearly.
    • Be honest and up-front – abused people have spoken about “feeling tricked” as Investigating Officers have engaged in general conversation and then suddenly gone into very direct questioning about alleged abuse (Pritchard, J. 1999).
    • Explain the boundaries of confidentiality. This should be done at the outset of any investigation.
    • The issue of confidentiality should be borne in mind throughout an interview as the person may disclose incidents of abuse other than those being investigated.
    • They should know who will be present at the interview.
    • They should be taken to the interview venue if it is in an unfamiliar setting.
  • Communication
    • It is essential to gain an understanding of how the person communicates.
    • It may be appropriate for the interview to be facilitated by someone who knows the person well.
    • It should not be assumed that a family member, carer would be the most appropriate person to facilitate the meeting. It can be distressing and embarrassing to discuss details of the abuse that has occurred with family members and/or carers present.
    • The investigating officer(s) would need to be satisfied that the facilitator was not involved directly with the situation.
    • Establish if there is a need for translation/interpretation/ communication boards/a sign language interpreter/Makaton. If so, who will be responsible for organising these things?
    • In some instances, a speech and language therapist may be able to assist in assessment/communication.
    • Someone will need to take responsibility for organising transport for the vulnerable adult.
    • The building needs to be accessible.
    • The room needs to be comfortable.
    • An interview room may not always be the most appropriate setting. If it has been decided that audio/visual recording will be used, this will take precedence.
    • Responsibility needs to be taken for checking any equipment to be used.
    • If the vulnerable adult has sensory impairment(s) adjustable lighting and a loop system may be necessary.
    • The position of the seating should allow direct eye contact to be made between all those present at the interview.
The Interview(s)

General Issues

  • It must be decided in advance, amongst all participants, how long the interview will last and how many breaks there will be.
  • Always interview in private.
  • Create an atmosphere in which the person can relax.
  • Always proceed at the person’s pace.
  • The more clearly the account is seen to be in the person’s words the more compelling and reliable it will be – do not put words into the person’s mouth.
  • Notice non-verbal signals such as facial expressions, gestures, body language, fidgeting, tense posture, and poor eye contact.
Preparing Yourself
  • Be respectful towards the person.
  • Speak in a clear, neutral tone of voice.
  • Logic and reasoning may not always work.
  • Always speak directly to the person and not to the interpreter/supporter or advocate who may be present.
  • Remember the person may have low self-confidence and poor self-esteem.
  • Ensure a non-judgmental attitude.
Listening to the Person
  • Be aware of similar themes.
  • Look for repetition of words or phrases.
  • The information may be disjointed.
  • Repeat the person’s answers to aid recall and to allow them to confirm (or correct) their initial response.
Interviewing Skills
  • Speak to the person as an adult.
  • Ensure you have the person’s attention.
  • Use their/your name.
  • Speak slowly and clearly.
  • Use short sentences.
  • Avoid abstract ideas.
  • Avoid comparative/either/or questions.
  • Break interview into small slots.
  • Do not ask more than one question at a time.
  • Do not incorporate more than one idea per question.
  • Use statements.
  • Avoid jargon.
  • Do not ask open-ended questions.
  • Summarise what has been understood.
  • Do not ask ‘why’ questions, ask instead who, what, where, when.
  • Stick to the issues.
  • Give one piece of information at a time.
After the Interview(s)

It is important that the vulnerable adult is supported throughout the investigation and interview stages. However, it is essential that they be supported after the investigation. The most appropriate person to provide support should be decided at the Strategy Meeting or Case Conference (needs an identified individual to do this).

It is essential that the vulnerable adult is involved as much as possible in the subsequent decision making process.

If the investigation leads to criminal proceedings the vulnerable adult will need to be informed at each stage as to what will happen next.

The vulnerable adult will still need support even if there is no further action in terms of the perpetrator.

Whatever the outcome of the investigation, the vulnerable adult’s wishes must be taken into account.

The vulnerable adult may experience feelings of:

  • Powerlessness.
  • Self-blame.
  • Guilt.
  • Fear.
  • Depression.
  • Low self-esteem.
  • Anger.
  • An inability to trust.

The Safeguarding Adults Plan must address the issue of ongoing support.

The Safeguarding Conference


The decision to call Safeguarding Conferences is usually taken at Strategy Meetings. Occasionally a Safeguarding Conference may take place without a Strategy Meeting being held.

The Safeguarding Conference enables inter-agency, multi-disciplinary discussions to clarify the following:

  • The details of the case.
  • Legal intervention.
  • Different professionals’ roles and responsibilities.
  • Development of a Safeguarding Plan.
  • Individual responsibilities for actioning the recommendations.
  • Reviewing and monitoring the case.
The Procedure

Safeguarding Conferences will normally be held within 20 working days from the initial alert but this may depend upon decisions taken at Strategy Meetings.

  • Appropriate location.
  • Arrange for suitably experienced person to chair.
  • Communication needs of all those attending.
  • The vulnerable adult’s needs – for example, an interpreter, transport or an advocate need careful planning.
Information to the Vulnerable Adult and Other Relevant People

Inform the vulnerable adult:

  • Exactly what the meeting is about.
  • Who is going to be at the meeting?
  • What will be discussed – the agenda.
  • They have a right to speak.
  • They can sit where they choose.
  • They can have a break at any time.
  • They can have support and legal advice.
  • They can bring an advocate.
  • They can send an advocate on their behalf if they do not want to attend the meeting.
Who is Invited
  • The vulnerable adult and/or their representative advocate.
  • The investigating officers.
  • Adult & Community Services Practice Manager
  • GP.
  • Local Authority solicitor (who would need the investigator’s report in advance).
  • Any other appropriate or useful agencies.
The Conference Process
  • Everyone attending states his or her name, agency and what their involvement is in the case.
  • The investigating officer(s) must give a report outlining the details of the case and the action taken to date.
  • Representatives from other agencies will inform the conference of their previous involvement with the individual or case and of any action being undertaken or planned.
  • Availability of statutory powers of intervention must be discussed.
  • A protection plan should be agreed stating the responsibility of each agency.
  • The protection plan should be completed (if possible) at the conference, signed by all involved and a photocopy given to all those attending.
  • Where a mental health need is identified, the Safeguarding Adults plan should be incorporated into a Care Programme Approach (CPA).
  • If appropriate, arrangements for reviewing progress must be made
  • If it is decided that a protection plan is not necessary, or that no further action is to be taken, the reasons why must be detailed in the minutes.

A detailed set of minutes must be taken at the Case Conference. The Chair will be responsible for ensuring a dedicated minute taker is present.

The Chair, will ensure that minutes are sent to all those who were invited to attend the conference within 10 working days.

Any questions or clarification about the content of the minutes must be made to the Chair of the meeting within five working days of receipt. Only the Chair can agree any changes to the content of the minutes.

The minutes of the Case Conference are confidential and should only be distributed to those agency members who attended or were invited to attend the conference. They must not be reproduced without permission of the Chair.

Ideally the Chair should ensure the minutes are produced in a manner that makes them understandable to the service user or nominated person for example Braille, large print, total communication and so on.

An adult protection outcomes form (SS30) will be completed by the Chair after the Conference detailing the safeguarding plan or reasons for no further action.

The role of the vulnerable adult

The following steps should be followed

The protection of the vulnerable adult is paramount at the Case Conference. The rights of other parties will be respected.

The vulnerable adult should always be invited to attend.

If the vulnerable adult agrees, their carer(s) can be invited. If the vulnerable adult is unable to give consent, the Chair will make this decision.

When an allegation of abuse has been made against a service user a separate Case Conference should be held but with the same Chair.

Only invite those people who are relevant to the individual or case, or who can be helpful in formulating the protection/care plan.

Sharing Reports

The investigating officers should share any reports they have written with the relevant individuals, prior to the conference.

This will:

  • Encourage an open atmosphere at the Case Conference.
  • Reduce areas of conflict at the Case Conference.
Safeguarding Plans

These should be specific and detailed. They should be agreed in Safeguarding Conferences but more detail can be added after the Conference.

Include objectives of the plan:

  • What are you going to try to achieve?
  • List the people involved and their responsibilities and tasks.
  • How to monitor and review the plan.
Long-Term Work

Reviewing and monitoring should be ongoing. The Plan should be reviewed every six months. Refer to the Guidance for more information about Safeguarding Adults reviews.

Remember to keep the service user’s wishes central to the process.

Safeguarding Review Meetings

  • The Safeguarding Plan must be reviewed within 6 months from the date it was produced. In practice a review tends to happen much sooner than this, and may be more than one meeting
  • The Review should be managed in the same way as Strategy Meetings and Safeguarding Conferences, by the Responsible Manager.
  • The purpose of the review is to:
    • assess the current level of risk to the vulnerable person.
    • to look at the continued necessity and appropriateness of the Safeguarding Plan.
    • to decide whether work needs to continue under the Safeguarding Adults process or if the case can return to normal procedures (e.g. CPA, care management).
    • to revise the Safeguarding Plan as appropriate.

All participating agencies will be consulted and written reports may be requested The views and wishes of the vulnerable person will always be sought

The Responsible Manager will ensure a full record of the meeting is made and shared with the participants

The Review outcome will be one or more of the following:

  • a revised safeguarding plan
  • agreed monitoring and reporting arrangements
  • the identification of any weaknesses in the process and recommendations for improvement sent to the Safeguarding Adults Coordinator
  • the identification of any strategic policy issues
  • no further action under Safeguarding Adults procedures
  • Responsible Manager always completes a SS30 outcomes form when a process is concluded

Record Keeping

Practice Guidance

All records should be:


Records should be made as soon as possible.


If mistakes in information have been recorded, they are unlikely to be questioned by a new worker. The inaccurate information will be perpetuated inadvertently.

At times, information may be gathered in a stressful situation. However, every effort must be made to ensure accuracy. It may be advisable to check the information recorded at a later date.


It is essential to record the nature and the source of the information.

  • What is said and by whom.
  • What was observed and by whom.

Hearsay and third party information must be clearly recorded as such.


All records should be non-judgmental and non-discriminatory. It may be a useful guide to record information with an assumption that the person you are writing about will read it.

The importance of good record keeping is essential for all agencies and not just Local Authorities.

“Good record keeping is essential for Local Authorities so that when they are challenged – as is increasingly likely – they are able to demonstrate that decisions were not taken unlawfully or with maladministration…Defensive record keeping can easily become poor record keeping…This renders decision making opaque and difficult to defend against challenge.” (Mandelstam, M., 1998, page 163)

From a legal perspective, the Human Rights Act 1998, which came into effect 1st October 2000, brings into English law a distinct and different approach to thinking about rights, responsibilities and remedies. Additionally, courts appear increasingly willing to hold Local Authorities, and individual practitioners, to legal account. In the light of this, it is important to keep detailed records.

Record keeping is an integral part of the professional practice and should assist the process. It is not separate from the process and not an optional extra to be fitted in if time and circumstances allow.

Practitioners must be aware of the Human Rights articles and if they feel that they are possibly contravening any Human Rights article, they must refer to this in written records, including a justification.

For more information regarding the Human Rights Act, refer to the “Code of Practice”.


Whenever a complaint or allegation of abuse is made all agencies should keep clear and accurate records and each agency should identify procedures for incorporating all relevant agency and vulnerable adult’s records into a file to record all actions taken. In the case of providers of services these should be available to the commissioners of services and to the Care Quality Commission.

When Should Information be recorded?
  • Records must be kept from the time that a concern, allegation or disclosure is made.
  • Each entry must be dated and timed.
  • The name of the person recording the information must be written in full. Do not use initials.
What to Record
  • All entries must provide factual information, for example, times, dates, names of people contacted.
  • Avoid expressions of opinion (remember that the person you are writing about may have the right to read what you have said).
  • All contact with the vulnerable adult and alleged perpetrator must be recorded.
  • Record the exact words the vulnerable adult and alleged perpetrator used.
  • Use body maps to illustrate any physical injuries.
  • All consultation with a Manager and/or Senior Manager must be recorded.
  • When contacting other agencies the questions asked and information received must be recorded.
  • If a decision is made not to contact the Police, the details of why this decision was made and on whose authority it was made must be recorded.
  • All telephone calls, those received and made in relation to the abuse, must be recorded even if there was no reply to outgoing calls.
  • Those who attend Safeguarding Strategy Meetings must be named.
  • The decisions taken at all meetings must be recorded.
  • It is essential to demonstrate how an assessment of risk, responsibility, rights, autonomy and protection of the vulnerable adult was undertaken.
  • If no investigation is to take place, the reasons why and on whose authority this decision was taken must be recorded.
How to Record Information
  • All records should be typed.
  • If this is not possible, they must be written in black ink.
  • Any alteration to records must be made by drawing a single line through the word(s).
  • Correction fluid must not be used.
Other Documentation
  • Any rough notes made during the investigation must be kept with the record.
  • Minutes from Safeguarding Strategy Meetings must be kept with the record.
  • Minutes from the Case Conference must be kept with the record.
  • All Safeguarding plans and reviews must be kept with the record.
  • Records should not breach a person’s legal rights
  • All agencies should identify arrangements, consistent with principles of fairness, for making records available to those affected by and subject to the investigation. (See “No Secrets” – Section 6.17.)
Service User as Perpetrator
  • If the alleged perpetrator is a service user then information about his/her involvement in an Safeguarding Adults investigation, including the outcome of the investigation, should be included on his/her case records. (See “No Secrets” – Section 6.18.)
Storing of Information
  • All records must be stored in accordance with your own agency’s policies with regard to the Data Protection Act 1998.
Standards of Recording
  • Best practice in recording is based on key principles of partnership, openness and accuracy. Effective recording is part of the total service to the user.



Adult Protection Data Monitoring Forms – Guidance Notes


Devon County Council is required to supply performance monitoring data on the Protection of Vulnerable Adults to central government on a regular basis. The Management Information Team, which is part of Performance Review based at County Hall, is responsible for collecting and reporting the data.

The following forms, which should be completed by responsible managers whenever an Adult Protection alert or referral is received, are required to provide the necessary information for monitoring performance.

Form SS29 – Adult Protection Alert/Referral Form

This should be completed by the responsible manager for all Adult Protection alerts or referrals received. The form should be completed and e-mailed to the Management Information Team Mailbox within 5 working days of receiving the alert/referral ( ).

Form SS30 (revised June 2006) – Adult Protection Monitoring Form

If an Adult Protection alert/referral proceeds to investigation, then form SS30 should be completed by the responsible manager and e-mailed to the Management Information Team ( ) mailbox within 3 working days of the Adult Protection Case Closure.

These two forms are e-forms. This means that the forms are Word document templates which should be completed on the computer, saved as a Word .doc file and e-mailed to the Management Information Team. The manager who completes the form should also keep a copy of the form and save it as a .doc file for your reference. Guidance is given in this document as to completion of the forms but should any difficulties arise, please contact Pam Mealing or Deborah Bingham in the Management Information Team, Room AG08, County Hall Annexe (phone 01392 382333 or e-mail )

Guidance on completing form SS29 Adult Protection Alert/Referral Form

To be completed for each Adult Protection alert/referral received.

Part 1: Vulnerable Adult’s Details

Alert/Referral DateEnter date alert/referral received as dd/mm/yyyy
Vulnerable Adult’s NameType in name as Title First Name Family Name
CareFirst No:Enter Client’s ID Number as recorded on CareFirst
Date of Birth:Enter vulnerable adult’s date of birth as dd/mm/yyyy
Age (dropdown list)Select appropriate age range from dropdown list
Gender (dropdown list)Select gender from dropdown list
Vulnerable Adult’s usual address/postcode/telephone:Type in address, postcode and telephone number
GP’s or Surgery NameType either the GP’s Name or the surgery name and address
Vulnerable Adult’s ethnic origin (dropdown list –Select the appropriate ethnic origin
see appendix 1 for choices)from the dropdown list
Client Group (dropdown list – see appendix 1 for choices)Select appropriate primary client group from dropdown list
Has a referral been made for this person in the last year as a victim of abuse (only include Adult Protection Referrals)Select “Yes” or “No” from dropdown list
Is the person known to any other agenciesSelect “Yes” or “No” from dropdown list
Vulnerable Adult’s current place of residence (dropdown list – see Appendix 1 for choicesSelect appropriate type of residence from dropdown list
Is the vulnerable adult from another Local Authority areaSelect “Yes” or “No” from dropdown list

Part 2: Source of Alert/Referral

Select the appropriate source of alert/referral from the dropdown list. Contents of dropdown list:

  • Self (vulnerable adult)
  • Main Family Carer
  • Vulnerable Adult’s Family
  • Neighbour/Friend
  • Member of Public
  • Paid Carer
  • Housing
  • Service Provider
  • Voluntary Agency/Volunteer
  • Other Service User
  • GP
  • Hospital
  • PCT
  • Independent Health Care Provider (non NHS)
  • CQC
  • Social Services
  • Police
  • Prison/Probation
  • Counselling/Therapy
  • Customer Services
  • Not Known
  • Other

If “other” is selected, please type in brief details.

Part 3: Information about Alleged Perpetrator

Name of alleged perpetratorType in alleged perpetrator’s name as Title First Name Family Name
Is the alleged perpetrator a current or previous Social Services clientSelect “Yes” or “No” from dropdown list
If Yes, please give CareFirst numberEnter alleged perpetrator’s CareFirst Client ID
Alleged Perpetrator’s gender (dropdown list)Select gender from dropdown list
Alleged Perpetrator’s age (dropdown list)Select appropriate age range from dropdown list
Alleged Perpetrator’s ethnic origin (dropdown list – see appendix 1 for choices)Select the appropriate ethnic origin from the dropdown list
Has a referral been made for this person in the last year as an alleged perpetratorSelect “Yes” or “No” from dropdown list
Does the alleged perpetrator live with the vulnerable adultSelect “Yes” or “No” from dropdown list
Relationship of alleged perpetrator to vulnerable adult (dropdown list – see appendix 1 for choices)Select appropriate relationship from dropdown list

Part 4: Incidents Details and Referral Outcome

Type of alleged abuse: Each type of abuse on the form has a “check-box” to the right of it. Click on the check-box for each type of abuse that applies. If you click on more than one type of abuse then you should also click on the “multiple abuse” box.

Location of abuse (dropdown list – see Appendix 1 for choices)Select appropriate location from dropdown list
If other, please specifyIf you select “other” please give brief details
If Sheltered or Supported, is the property regulated by Supporting PeopleSelect “Yes” or “No” from dropdown list
Team responsible for referralType in the appropriate Team Code
Practice ManagerType in the name of the responsible manager
Did this referral proceed to an investigationSelect “Yes” or “No” from dropdown list

If the referral did not proceed to an investigation, then Part 5 should be completed

If the referral did proceed to an investigation, then omit Part 5 and complete Part 6. In this case, Adult Protection Monitoring Form SS30 (revised June 2006) should be completed as the case progresses and e-mailed to the Management Information Team mailbox once the Adult Protection case is closed.

Part 5: Decision not to refer for investigation

If a decision has been made not to refer an alleged Adult Protection incident for an investigation, then Part 5 should be completed as follows:

Type in a brief reason for not referring for a planning/strategy meeting and investigation

Has the referrer been informed of the decision not to investigateSelect “Yes” or “No” from dropdown list
If no, please give brief reasonType in brief reasons for not informing referrer
Date referral closedEnter date referral closed as recorded on CareFirst (dd/mm/yyyy)
Outcome authorised byType in name of responsible manager

If the referral is not to proceed to investigation, go to the end of the form:

Form completed by:Type the name of the person who completed the form
Date completed:Type the date the form was completed (dd/mm/yyyy)

Once the form is completed, save it as a Word .doc file with an appropriate name and then e- mail a copy of this file to the Management Information Team Mailbox. Keep an electronic copy of the form for you records.

The form should be completed and e-mailed to the Management Information Team within 5 working days of the receipt of the Alert/Referral.

Part 6: Information about Investigation

If the Adult Protection Alert/Referral is to proceed to an Investigation, this part of the form should be completed

Has the vulnerable adult agreed to investigation proceedingSelect “Yes” or “No” from dropdown list
Has the vulnerable adult agreed to participate in the investigationSelect “Yes” or “No” from dropdown list
Name of investigation workerType the name of the worker
Telephone numberType the worker’s phone number

Complete the details at the end of the form as regards the person completing the form and the date the form was completed.

Once the form is completed, save it as a Word .doc file with an appropriate name and then e- mail a copy of this file to the Management Information Team Mailbox. Keep an electronic copy of the form for you records.

The form should be completed and e-mailed to the Management Information Team within 5 working days of the receipt of the Alert/Referral.

In this case, where the Adult Protection Alert/Referral proceeds to investigation, the Adult Protection Monitoring Form SS30 (revised June 2006) should be completed as the investigation progresses and should be e-mailed to the Management Information Team mailbox once the Adult Protection case has been closed.

Guidance on completing form SS30 Adult Protection Monitoring Form

(revised June 2006)

This form should be completed for every Adult Protection Alert/Referral which proceeds to an investigation.

Part 1: Vulnerable Adult’s Details

Referral DateEnter date alert/referral received as dd/mm/yyyy
Vulnerable Adult’s NameType in name as Title First Name Family Name
CareFirst No:Enter Client’s ID Number as recorded on CareFirst
Date of Birth:Enter vulnerable adult’s date of birth as dd/mm/yyyy
Gender (dropdown list)Select gender from dropdown list
Vulnerable Adult’s ethnic origin (dropdown list – see appendix 1 for choices)Select the appropriate ethnic origin from the dropdown list
Client Group (dropdown list – see appendix 1 for choices)Select appropriate primary client group from dropdown list

Part 2: Referral Details

An Adult Protection Alert/Referral Form (SS29) should already have been completed for this referral. All the details for Part 1 above should be available from this form. The minimum input for part 1 of this form is the Vulnerable Person’s CareFirst ID and the date of the referral.

Part 3: Organisations involved in the Investigation

A list of the organisations who may have been involved in the investigation is given in Part 3 of the form. They each have a “check-box” to the right of them. Select whichever organisation(s) you require by clicking on the appropriate check-box(es). If “other” is selected, please type brief details of the organisation type.

Part 4: Consent

Has the client been deemed to have the capacity to consent to the investigationSelect “Yes” or “No” from dropdown list
If yes, did the client agree to the investigation proceedingSelect “Yes” or “No” from dropdown list
Did the client agree to participate in the investigationSelect “Yes” or “No” from dropdown list
If no, has the client refused to proceed beforeSelect “Yes” or “No” from dropdown list

Part 5: Investigation outcome

This consists of a dropdown list:

  • Concerns substantiated
  • Partly substantiated
  • Concerns not substantiated
  • Inconclusive

Select the appropriate outcome from the dropdown list

Part 6: Outcome for Client/Protection Plan

A list of possible outcomes for the vulnerable adult is given in Part 6. A “check-box” appears to the right of each outcome. To select the appropriate outcome(s) for the client, click on the appropriate check-box(es). If “other” is selected, please type brief details.

Part 7: Was Protection Plan accepted by the vulnerable adult

Select “Yes” or “No” from dropdown list

Part 8: Outcomes for Alleged Perpetrator/Organisation/Service

A list of possible outcomes for the alleged perpetrator is given in Part 7. A “check-box” appears to the right of each outcome. To select the appropriate outcome(s) for the alleged perpetrator/organisation/service, click on the appropriate check-box(es). If “other” is selected, please type brief details.

Part 9: Strategy Meetings and Case Conferences

Please keep a count of the number and types of meeting/conferences/reviews which take place for each case and complete Part 9 as follows:

Number of Adult Protection Strategy MeetingsEnter the number of AP Strategy Meetings connected with this case
Was there a strategy meeting held within 5 days of the alert-referral (target)Select “Yes” or “No” from dropdown list
Number of AP Case conferencesEnter the number of AP case conferences connected with this case
Number of AP ReviewsEnter the number of AP reviews connected with this case
Was there a review held within 6 months of the initial meeting (target)Select “Yes” or “No” from dropdown list
Number of Serious concerns about an Establishment Meetings/Concerns about Serial Abuse MeetingsEnter the number of such meetings connected with this case

Part 10: Date of Final Adult Protection Review

Type in the date that the last Adult Protection Review was held before the AP case was closed (dd/mm/yyyy). If this is not applicable, click the check-box

Part 11: Date Adult Protection Case Closed

Type in the date that the Adult Protection case was closed (dd/mm/yyyy)

Once the form as been completed, type in the name of the person who completed the form and the date the form was completed.

Adult Protection Monitoring Form SS30 (revised June 2006) should be completed as the investigation progresses and should be e-mailed to the Management Information Team mailbox within 3 working days of closure of the Adult Protection case.


Contents of drop-down lists on form SS29 (June 2006)

Vulnerable Adult’s age


Ethnic Origin

White BritishBlack AfricanOther Mixed ethnic origin
White IrishBlack CaribbeanChinese
Other WhiteOther BlackOther Ethnic origin
IndianWhite and Black AfricanDeclined to answer
PakistaniWhite and Black Caribbean 
BangladeshiWhite and Asian 
Other AsianWhite and Chinese 

Client Group

Physical DisabilitySubstance Misuse
Frailty/Temp IllnessHIV/AIDS
Sensory ImpairmentOther Vulnerable People
Mental Health
Older Person Mental Health
Learning Disability

Vulnerable Adult’s Current Place of Residence

Own HomeParents/Relatives HomeNot Known
Residential HomeAdult Placement SchemeOther
Nursing HomeRespite Home 
Supported HousingHomeless 

Alleged Perpetrator’s Age


Relationship of Alleged Perpetrator to Vulnerable Adult

Other Family MemberPaid Carer
Main CarerProfessional (nurse, GP, etc)
Neighbour/FriendOther Vulnerable Adult
Volunteer/BefrienderNot Known
Other Service User

Location of Abuse

Vulnerable Adult’s HomeSheltered Accommodation
Vulnerable Adult’s Relative’s HomeExtra Care Sheltered Accomm
Residential HomeSupported Accommodation Other
Respite HomeDay Centre/Service
Nursing HomePublic Place
Alleged Perpetrator’s HomeAdult Placement Scheme
HospitalCollege/Adult Education/Work
Other health settingNot Known


Proposed Performance Indicators for Adult Protection

Total number of AP referrals during year (by gender, age, ethnicity and Locality)

AP Referrals by client group (County, Locality, PCT)

AP Referrals by type of abuse (County, Locality, PCT)

AP Referrals by location of abuse

AP Referrals by perpetrator

AP Referrals by source of referral

No of AP Referrals from each PCT (6)

No of domestic violence cases

By age range per 1000 population

Learning disabilities AP Referrals

Outcomes for vulnerable adult

Outcomes for alleged perpetrator

Previous referrals for vulnerable adult/perpetrator/service provider

Strategy meeting/case conferences/reviews/serious concerns meeting

Timescales for above meetings

Case conclusions

In every situation it will be assumed that a person can make their own decisions unless it is proved that they are unable to do so. There will be a presumption against lack of capacity.

The Law Commission proposed three definitions to ascertain whether a person lacks capacity.

  • A person is without capacity if, at the time that a decision needs to be taken, he or she is unable by reason of mental disability to make a decision on the matter in question; or unable to communicate a decision on that matter because he or she is unconscious or for other reason.”
  • Mental disability is “any disability or disorder of the mind or brain, whether permanent or temporary, which results in an impairment or disturbance of mental functioning.”
  • A person is to be regarded as unable to make a decision by reason of mental disability if the disability is such that, at the time when the decision needs to be made, the person is “unable to understand or retain the information relevant to the decision, or unable to make a decision based on that information.”

Law Commission, pages 32-48, 1995

Issues of capacity and consent are central both in deciding whether an act or transaction was abusive and in deciding to what extent the adult can, and should, be asked to take decisions about how best to deal with the situation.

During the investigation process, it is essential that you are certain that the vulnerable adult fully understands the nature of the concerns and the choices facing them.

In cases in which the investigating officer(s) feel that the adult is unable to give informed consent, it will be necessary to commission a multi-disciplinary assessment. Consideration should be given to calling a speech therapist.

Capacity should be assessed in relation to the specific activity or issue that is being considered.

It should not be assumed that capacity or lack of capacity in respect to one area equates directly to another situation. For example, the ability to consent to medical treatment may not mean that an adult is able to give their consent to sexual activity. This approach to the assessment of capacity can be regarded as a “functional approach”.

This approach focuses on the decision itself and the capability of the person concerned to understand, at the time it is made, the nature of the decision required and its implications. This approach is very specific and avoids generalisations that may involve unnecessary intrusions into the affairs of the person.

An assessment in respect of capacity should:

  • Relate to the timing and nature of a particular situation, such as a particular treatment or decision.
  • Be undertaken by a person with expertise relevant to the vulnerable adult’s situation.
  • This person should consult other relevant people who know the vulnerable adult
  • Consider whether the vulnerable adult is able to understand and retain the information relevant to the decision to be made.
  • Consider whether the vulnerable adult is able to make a decision based on that information.
  • Be fully recorded in the case file.

Circumstances where the vulnerable adult is considered to lack capacity might include those:

  • Where the vulnerable adult does not know that they have a decision to make.
  • Where the vulnerable adult does not understand the choices available or the consequences of those choices.
  • Where the vulnerable adult cannot communicate their decision. However, in these and other circumstances they can only be deemed incapable of making a decision where every reasonable effort has been made to assist their understanding of the situation and the communication of their wishes. This will include arranging an advocate and/or interpreter where necessary and possible.
  • It is important to start from the assumption that the vulnerable adult is trying to find some way of communicating their wishes rather than that they cannot do so.
  • There may be situations where the vulnerable adult seems able, in terms of their knowledge and understanding, to make their own decisions. However, they may be subject to undue pressure to support a particular course of action, perhaps pressure from, or fear of, a professional or relative.
  • See guidance on the Mental Capacity Act 2005

Workers will need to determine whether the vulnerable adult is making the decision of their own free will or whether they are being subjected to coercion or intimidation.

If it is believed that the vulnerable adult is exposed to intimidation or coercion, efforts should be made to offer the adult “distance” from the situation in order to facilitate decision making.

Situations where the vulnerable adult does have capacity.

If it is decided that the vulnerable adult does have capacity, has taken an informed decision and so is placing him or herself at risk, staff should consult with:

  • The vulnerable adult themselves.
  • Their carer – with the person’s consent.
  • Their community supports.
  • Any other relevant agency, service or individual to ensure that the vulnerable adult understands the risk that they are taking and the choices available to them to remove or reduce the risk.
  • If you cannot offer the vulnerable adult anything better than the situation they are enduring, they may well choose to remain in an abusive situation.
Situations where the vulnerable adult does not have capacity.

If it is decided that the vulnerable adult does not have capacity then staff should act in the best interests of the vulnerable adult, and do, what is necessary to promote health or wellbeing or prevent deterioration.

Note:    An adult can only be compulsorily removed from an abusive situation through the use of either the National Assistance Act 1948 or the Mental Health Act 1983. Both of these pieces of legislation involve what may be regarded as sanctions against the vulnerable adult not the alleged perpetrator. Seek advice from your agency or organisation’s legal section/department in relation to compulsory removal.

Where appropriate, consultation with or appointment of a legal or other independent advocate may help make the best decisions on the person’s behalf.

Independent Mental Capacity Advocates (IMCA)

It is a mandatory requirement of the Mental Capacity Act (2005) that adults who lack capacity have the services of an IMCA case worker when: i) they are without family and friends (although there are exceptions to this – see local guidance), and ii) are faced with a decision about serious medical treatment or a change in accommodation.

The new regulations to the MCA (October 2006) also give Local Authorities and the NHS the power to instruct IMCAs in certain cases of accommodation reviews and safeguarding adults cases. It would be unlawful not to consider the exercise of these powers to instruct IMCAs for accommodation reviews and safeguarding adults where the qualifying criteria are met.

Devon Adult and Community Services and Torbay Care Trust have jointly commissioned an IMCA service to cover both authorities from April 2007. Full information can be found on the Mental Capacity Act page of the Devon website ( ), the Living Options website ( ) and Age Concern Devon website ( )

Medical Examinations

Based on case law, the capacity to give informed consent to medical treatment has been defined as containing three essential stages:

  • The ability to comprehend and remember information about treatment.
  • Believing the information.
  • Balancing the information and arriving at a decision.
  • An adult will be assessed as having capacity if they are able to:
  • Understand what the treatment is.
  • Understand why the treatment is being proposed.
  • Understand the nature of the proposed treatment.
  • Understand the benefits and risks of the treatment.
  • Balance the information and arrive at a decision.

Confidentiality Guidance

The Government Guidance Document, “No Secrets”, recognises that there are circumstances in which it will be necessary to share confidential information.

  • Information will only be shared on a “need-to-know basis” when it is in the best interest of the service user.
  • Confidentiality must never be confused with secrecy.
  • Informed consent should be obtained but, if this is not possible and others are at risk, it may be necessary to override this requirement.
  • It is inappropriate for agencies to give assurances of absolute confidentiality in cases where there are concerns about abuse, particularly in situations when other people may be at risk.

(“No Secrets” – Section 5.6)

Decisions about who needs to know and what needs to be known should be taken on a case- by-case basis.

(“No Secrets” – Section 5.7)

“No Secrets” states that the principles of confidentiality designed to protect the management interests of an organisation must never be allowed to conflict with those designed to promote the interest of the service user. “If it appears to an employee or person in a similar role that such confidentiality rules may be operating against the interests of the adults then a duty arises to make full disclosure in the public interest”.

(“No Secrets” – Section 5.8)

In certain circumstances it will be necessary to exchange or disclose personal information, which will need to be done in accordance with the Data Protection Act 1998 where this applies.

(“No Secrets” – Section 5.9)


Decisions about sharing information need to be taken on a case-by-case basis. Therefore, before you share information you need to ask yourself the following questions:

  • Do I have the permission of the vulnerable adult to disclose personal information?

If not:

  • Do I have the legal power to disclose this information?
  • Is there a duty to protect the wider public interest; are other people at risk?
  • Am I proposing to share information with due regard to both common and statute law?
  • Do I have the correct level of seniority to disclose this information?

The sharing of information must always be discussed with a senior manager and/or Legal Services Advisor.

All decisions made in terms of withholding or sharing information must be recorded.

Service User as Perpetrator

If it is assessed that the service user continues to pose a threat to other service users then this should be included in any information that is passed on to service providers.

(“No Secrets” – Section 6.18)

Practice Guidelines

While papers and records belong to the agency, the information belongs to the vulnerable adult. The views and wishes of the vulnerable adult will normally be respected when sharing the information they give.

There will be circumstances when a duty to protect the wider public will outweigh the responsibility to any one individual.

Decisions to share information about the vulnerable adult must be made by the agency and not any member of staff acting on their own.

Agencies should ensure they have clear guidelines for when the duty to protect the wider public outweighs their responsibility to protect the vulnerable adult’s right to confidentiality.

Staff must never confuse confidentiality with secrecy.

Information given to an individual member of staff, or agency representative, belongs to the agency, not that member of staff.

The vulnerable adult, and when relevant their carers, must be advised why and with whom information will be shared.

Information must be shared on a need-to-know basis only.

Information will be shared only for the purpose of providing care or for the protection of the vulnerable adult.

Information given to an agency must only be used for the purpose for which it was intended.

If confidentiality is broken, who decided and why the decision was taken should be recorded on the file.

All exchange or disclosure of personal information needs to be in accordance with the Data Protection Act 1998, where this applies.

(“No Secrets” – Section 5.9)

Safeguarding Adults Meeting Minutes and Confidentiality

Q I’ve had a request from a third party under the Freedom of Information Act asking to see the minutes of a strategy meeting about one of my clients. Do I have to share them?

A Probably not. The minutes will contain personal information about the client. Access to personal information by a third party is a qualified exemption under FOI and must be dealt with in accordance with the Data Protection Act. These minutes are confidential so releasing them may breach Principle One of the Data Protection Act – ‘Information must be processed fairly and lawfully’. This means that you may only share the minutes if the vulnerable adult they are about gives written permission for this to happen (and is able to understand any implications of this). You must also take into account whether the vulnerable adult is likely to be caused any unnecessary or unjustified distress or damage. It would be good practice to consult those who were present at the meeting for permission for any information identifying them to be disclosed.

The golden rule is to consult either the Freedom of Information or Data Protection Act coordinators in Adult & Community Services if you ever have a request of this nature. They will ensure the request is logged and dealt with in accordance with the FOI Act and will provide access to expertise when difficult issues arise.


Case Law – Maddock V Devon County Council

(13 AUGUST 2003) (QBD)

M was a single mother. Social Services had been involved in the upbringing of her son, A, almost since his birth. A’s name had been placed on the child protection register under the category of emotional abuse. He spent much of his childhood in the care of foster parents. In 1996, when A was 14, M started work, employed by the council through its social services department, as an enabler in a Unit supporting people with physical and/or sensory disabilities and mental health issues. A year later, M obtained a place on a course leading to a Diploma in Social Work.

When the council became aware of M’s acceptance on the course it raised its’ concerns with the university about M’s suitability to qualify to become a social worker. In particular, the council was concerned that M had refused to accept any responsibility for the considerable signs of disturbance which A had exhibited during his childhood. A report containing information from M’s family social work files was sent to the university under cover of letter. As a result of the council’s disclosure, the university removed M from the course after conducting its own inquiry and giving M an opportunity to put her case.

M sued the council, claiming damages for breach of confidentiality, negligent misstatements which she said gave an unfair and misleading impression of her parenting skills and her fitness to be a social worker, and infringement of her article 8 rights under the European Convention. She alleged that as result of the council’s disclosures she was removed from the course and so deprived of the chance of earning a living as a social worker.

The council accepted that there was an obligation of confidentiality in respect of the files but argued that the disclosure of the information was necessary in the public interest.

The court held that the report and letters sent to the university by the council were neither negligent nor unfair. In making its disclosure to the university, the council owed a duty of care to M to ensure the accuracy of the matters disclosed. It was just and reasonable to impose such a duty on the council given that it was aware that the university might act on the information disclosed to it and that the result could well be M’s exclusion from her course.

There was no reason why a public duty to make a disclosure should be inconsistent with a private duty to the subject of the disclosure to ensure the accuracy of the matters disclosed. The fact that the report on M’s involvement with social services which was sent to the university was not negligent or unfair was irrelevant to whether the council had breached its duty of confidence to M. It was no defence to a breach of confidence claim that the information disclosed was true.

The court’s analysis of the duty of confidentiality owed was that the primary obligation lay on the council to decide whether or not to make the disclosure and there was no requirement for it to obtain a ruling from the court before doing so. In this case, the council’s disclosure was not a disproportionate reaction to the perceived problem. It was proper for the council to draw the university’s attention to its concerns so that the university could make its own decision. It was a matter of public interest that unsuitable persons should not become social workers. The council had properly considered whether to make disclosure of the information and there was no breach of confidence in making the disclosures contained in the report and its cover letter. It followed that there was no infringement of M’s rights under article 8 of the Convention.

The court added that, in general, as a matter of good practice, before making a disclosure in a case such as this, a party in the council’s position should inform the subject of the disclosure of that intention in enough time to enable that person to seek an injunction from the courts. A failure to do so, however, even if it did breach good practice, did not of itself create a breach of the duty of confidence.