All health and social care professionals have a responsibility to protect people from harm, abuse and neglect. It’s part of your role to act when you’re concerned about a patient or carer’s safety. Here, you can find information on spotting the signs of abuse or neglect, what to do if you suspect abuse or neglect, and where to get support for yourself.
If you or someone else are experiencing, or at risk of, abuse or neglect read our information on how to get help. If you or someone else is in immediate danger, call 999.
This page has been created following the guidance outlined in the Domestic Abuse and Life Limiting Illness (DALLI) toolkit. It is about safeguarding adults. Visit the NSPCC for more information about safeguarding children.
This information is for health and social care professionals. You can use our My Learning form to reflect on how this page has helped with your continuing professional development. Download the form.
Key points
- It’s everyone’s responsibility to speak up if you have concerns about a patient or carer’s safety – do not assume someone else will do it.
- Call 999 if you or the person is in immediate danger.
- If the person is not in immediate danger, and it’s safe to do so, speak to them about your concerns.
- Raise your concerns to your line manager or safeguarding lead and clearly document all your actions.
- Follow your organisation’s safeguarding policy.
- Be aware of different types of abuse and signs someone is being abused.
- Be aware how having a terminal illness can make people more vulnerable to abuse and neglect.
- Be familiar with mental capacity and how this may affect a person’s ability to consent for their situation to be shared.
- Involve the person you’re concerned about in decisions.
Why are people with a terminal illness more at risk of abuse and neglect?
People living with a terminal illness are more at risk of abuse and neglect because they may:
- be frail or physically weak
- be less able to communicate what they want or need
- be isolated from other people, places or social settings
- be dependent on others for care
- spend a long time at home with a carer.
Having a terminal illness can also change relationships, especially with those who help to care for them. Changes to relationships can make existing abuse or neglect worse.
Who is more at risk of abuse or neglect?
Some people with a terminal illness who are more at risk of abuse are:
- women
- people with lots of care and support needs
- people who have difficulty communicating
- people who have cognitive impairments, such as dementia.
What does safeguarding mean?
Safeguarding means doing something to reduce the risk of abuse and neglect.
Safeguarding in palliative care includes:
- preventing and stopping abuse or neglect where possible
- supporting patients and carers to make choices and have control over their lives
- providing information on the different types of abuse and how to report concerns.
As a health and social care professional, you have a responsibility to speak up about any concerns you have. If it’s safe to do so, you should also speak to the person involved about your concerns and include them in decisions.
Types of abuse and neglect
Abuse and neglect can happen in any setting, including homes, care homes, hospices and hospitals. It can be intentional or unintentional and may involve multiple people. A relationship might become abusive or neglectful over time. For example, if someone’s ability to care for someone changes and they become neglectful.
Read more about the different types of abuse and neglect on page 11 of the DALLI toolkit.
Signs of abuse and neglect
Being able to recognise the signs of abuse and neglect helps to protect patients and prevent harm in palliative care. Warning signs that someone might be being abused include:
Changes in behaviour
The person may:
- become quieter, angrier or more withdrawn
- not want to speak openly, even though they are capable
- become more tearful or depressed
- be unusually friendly or happy or say nothing’s wrong.
Physical changes or medication errors
The person may:
- look untidy or unclean – for example, having dirty fingernails or bad hygiene
- have unexplained bruises, wounds or injuries which are not being treated
- have the same injuries happening more than once
- offer stories or explanations for physical injuries that do not make sense
- have medication errors or missing medications.
Changes to their home, care environment, social activities or finances
The person may:
- have a colder or more untidy home than usual
- not want to be left by themselves or alone with a particular person
- be more isolated from family and friends than usual
- have less money than usual or not have access to their own money.
What should you do if you suspect abuse or neglect
It’s everyone’s responsibility to speak up if you spot signs of abuse - do not assume another professional will do something. You should always follow your own organisation’s safeguarding policy if you suspect abuse or neglect. But here are some steps that may help.
Flow chart showing some steps you could follow if you suspect abuse or neglect.
Step 1 – Ask opening questions
Ask general questions to see how the person is or explore any issues at home. For example, “How are things at home?” Speak to the person in private. See How to ask questions about abuse and neglect below.
Step 2 – Follow up with further questions
Find out more about the situation. Ask open questions and give the person time to respond. For example, “Tell me more about…” See How to ask questions about abuse and neglect below.
Step 3 – Find out if you, the person, or someone else is in immediate danger
Call 999 if you suspect someone is in immediate danger.
Step 4 – Assess whether anyone involved is a child or an adult at risk
A child or adult at risk is someone who cannot protect themselves agsinst abuse and neglect. Assess whether the person involved can protect themselves. This might mean considering if they have mental capacity (see below), or if they have additional care and support needs.
Follow the safeguarding policy for your organisation and the policy for sharing information about patients. Most organisations will have a place to log safeguarding concerns. Ask your manager if you do not know how to do this, or do not know where to find the safeguarding policy.
If you have concerns that a child may be at risk of harm, escalate this in line with your organisation’s safeguarding policy.
Step 5 – Refer to your organisation’s safeguarding team for a risk assessment
Your organisation’s safeguarding team can help you with a risk assessment, further advice and support.
Consent and confidentiality
When talking to someone you are concerned about, there are a few things to keep in mind. If you are unsure how to approach a situation, speak to your manager or safeguarding lead.
- Tell the person that you may need to tell your manager or safeguarding lead and explain how they will be involved. This puts the person in control of what they tell you.
- Ask the person what they would like to happen next, including any support they would like. It’s important to explain what’s possible. If you’re not sure, you could tell them you can find more information for them.
- Ask if they consent for you to share their information with other relevant professionals or organisations.
- Explain that by law, you may have to share some information. For example, when children are involved, or if the person is in danger.
Mental capacity and consent
Sometimes, patients cannot make decisions for themselves because of their condition or symptoms. This is called lacking mental capacity.
If a patient lacks mental capacity, they might not be able to make decisions about their own situation or give consent for you to share their information. In these cases, decisions will be made for them. If you think a patient might not have mental capacity, talk to your line manager or safeguarding lead.
How to ask questions about abuse and neglect
Asking questions can help you to find out if someone is being abused or neglected. When asking questions, remember to:
- be compassionate
- speak to the person in private
- plan enough time to speak to them properly, so you will not be interrupted
- consider whether they need support communicating in different ways
- use a professional interpreter if needed - do not ask a friend of family member to interpret.
Opening questions
Some questions you could start with include:
- How are things at home?
- You seem worried about something. Is there anything you’d like to talk about?
- What do I need to know to support you?
Further questions
You can gently find out more with open questions like:
- How safe do you feel?
- Tell me more about…
- What happens if you challenge the behaviour?
- Who do you trust?
- What’s important to you at this time?
You do not need to cover everything in one conversation. Building a relationship with the person through smaller conversations can make them feel more comfortable and able to tell you about their concerns.
How to support someone who has disclosed abuse or neglect
It can be hard to know how to support someone if they’ve told you about abuse or neglect. The main things to do are:
- thank them for telling you
- let them know that you believe them, they’re being listened to and it’s OK to feel how they do
- make a note of what the person says, including when and where they said the abuse happened
- try to use the specific language and words they used.
As soon as it’s appropriate, record or escalate what you’ve been told according to your safeguarding policy. This might be by:
- telling your line manager
- referring to the local authorities
- referring to the police.
Why someone may not tell you about abuse or neglect
It’s important to understand there are lots of reasons why someone might not want to disclose abuse or leave an abusive or neglectful situation. These can include:
- fear of the abuser
- dependence on the person
- fear of what might happen next
- not thinking the person’s behaviour counts as abuse
- having bad experiences with disclosing things in the past.
The person may also feel embarrassed, ashamed, scared or guilty. And these emotions can stop them from telling others.
Some groups of people may find it harder to speak up about abuse or seek help, like people with disabilities, learning disabilities or communication difficulties.
If you still have concerns about someone
Even if someone does not tell you about abuse or neglect, you might still have concerns. Try not to challenge the person on their answers. The person should have the choice about what information they share. In general, a person is more likely to disclose concerns to you when they are ready and feel that they can trust you.
If you are still concerned about someone’s safety and wellbeing, think about the signs that you have seen. Discuss your concerns with your manager or the wider care team. And keep a record of when you’ve spotted these signs.
Getting support for yourself
Discussing a safeguarding concern, being involved in a safeguarding case, or listening to a patient’s experience can be hard. As a healthcare professional, it’s important to remember to look after your own wellbeing, and the wellbeing of your colleagues.
Here are some things you can do to look after yourself.
- Speak to your safeguarding lead or team. They will be able to offer guidance and support.
- Use supervision with your manager or clinical supervisor to talk about safeguarding concerns and cases.
- Check if your employer offers an Employee Assistance Programme. This might offer confidential counselling and emotional support.
- Reach out to a professional body that offers advice about safeguarding concerns. This could be the General Medical Council or the Nursing and Midwifery Council.
Abuse and neglect can happen to anyone. If you, or a colleague are experiencing or have experienced abuse or neglect before, being involved in a safeguarding concern might be especially hard. Speak to your line manager or safeguarding lead for support.