Posted: September 1st, 2023

Health and social care essay

Safeguarding vulnerable adults: exploring
the challenges to best practice across
multi-agency settings
Emma Stevens
Abstract
Purpose – The purpose of this paper is to highlight contemporary issues in achieving best practice in
safeguarding adults across multi-agency settings.
Design/methodology/approach – The paper is an empirical exploration, reviewing a range of relevant
literature and recent policy to present evidence suggesting that there continue to be challenges in
achieving best practice in multi-agency approaches to safeguarding. The literature review was
undertaken using the following databases: Cumulative Index of Nursing and Allied Health Literature
(CINAHL), Cochrane, PsycINFO and Medline. The inclusion criteria included being peer-reviewed and
published between 2004 and 2012. The key words used were: ‘‘safeguarding adults’’ and ‘‘abuse’’.
Further literature was found through adopting a ‘‘snowballing’’ technique, in which additional sources
were found from the reference lists used in the initial articles.
Findings – Although guidance such as No Secrets from the Department of Health, in 2000, emphasises
the importance of a multi-agency approach, this continues to be problematic and presents challenges.
In practice, differing professionals may not fully understand each other’s roles and responsibilities and
both thresholds and scope of adult abuse are still not universally agreed. Legislation could be used
positively to mandate the multi-agency approach to adult safeguarding, supported by local
Safeguarding Adults Boards and local policies can be used to provide guidance and clarity for
practitioners. Further empirical investigation into supporting the multi-agency approach is required.
Originality/value – The paper fulfils the need for discussion on the complexities and challenges that
continue to present in multi-agency responses to adult safeguarding practice.
Keywords Adult protection, Best practice, Social services, United Kingdom, Safeguarding adults,
Vulnerable adults, Adult abuse, Multi-agency, Empowerment, Risk management
Paper type Literature review
Introduction
This article explores some of the challenges associated with achieving best practice
across multi-agency settings for safeguarding vulnerable adults. A systematic review was
undertaken in order to identify some of the key issues that require further empirical
investigation.
The literature review was undertaken using the following databases: Cumulative Index of
Nursing and Allied Health Literature (CINAHL), Cochrane, PsycINFO and Medline. The
inclusion criteria included being peer-reviewed and published between 2004 and 2012. The
key words used were: ‘‘safeguarding adults’’ and ‘‘abuse’’. CINAHL was used to obtain
research relating to nursing and social work. Cochrane offered a source of up to date, reliable
research and PsychINFO was used as a resource of peer-reviewed literature in the
behavioural sciences and mental health. Medline was used to source general health care and
nursing research. Further literature was found through adopting a ‘‘snowballing’’ technique in
which additional sources were found from the reference lists used in the initial articles.
A range of literature sources were utilised, including government policy and guidance as well
as empirical research papers.
DOI 10.1108/14668201311313596 VOL. 15 NO. 2 2013, pp. 85-95, Q Emerald Group Publishing Limited, ISSN 1466-8203 j THE JOURNAL OF ADULT PROTECTION j PAGE 85
Emma Stevens is based
within Adult Services,
City Health Care
Partnership CIC, Hull, UK.
From the literature, several themes emerged. First, researchers highlight concerns over
different professionals and agencies holding inconsistent interpretations of the scope and
threshold of adult abuse and the implications of labelling adults as ‘‘vulnerable’’. In practice,
there are dilemmas between balancing the need to empower service-users whilst minimising
risk, with these issues being made even more complex by considerations of mental capacity.
In addition, past systematic failures to protect adults offers insight into the challenges of
achieving best practice across multi-agency settings.
All agencies need a clear understanding of their role in safeguarding adults (Perkins et al.,
2007), regardless of whether this is in a proactive or reactive role. Effective information
sharing continues to be problematic as not only do demands of the Data Protection Act 1998
need to be considered, but relevant agencies need access to appropriate information in a
timely manner because features of effective inter-agency working could be undermined by
poor information sharing (Reid et al., 2009). In previous cases, poor communication between
agencies has been cited as a major contributory factor to failures in maintaining the
safeguarding of vulnerable adults. For example, the serious case review of Stephen Hoskin,
noted various warnings and missed opportunities for intervention. It was revealed that
adequate information was available across partnership agencies regarding Steven and his
circumstances; however a failure to share this information contributed to his unnecessary
death (Flynn, 2007).
Empowerment of service-users is fundamental to safeguarding practice, however Allen and
Brodzinski (2009) recognise that public sector organisations are operating in a risk-averse
environment in which this need for empowerment is balanced against reducing risks to the
safety of service-users. Therefore, practitioners have day-to-day dilemmas of how far to
empower a service-user without intervening in risk-taking behaviours whilst working in a
society and culture where there is aversion to risk.
The multi-agency process of safeguarding vulnerable adults continues to pose challenges,
despite agencies improving their commitment to partnership working. Practitioners are still
unclear over rolesand responsibilities within adult safeguarding and although the Department
of Health interim report on Winterbourne View Hospital outlined a government objective to
‘‘clarify roles and responsibilities across the system whilst ensuring better integration’’
(Department of Health, 2012, p. 9), it remains to be seen whether greater clarity will be
achieved.
The vulnerable adult and difficulties in defining abuse
Abuse may be intentional or unintentional and cause harm temporarily or over a period of
time, involving a single act or repeated acts. No Secrets guidance defines abuse as;
‘‘a violation of an individual’s human and civil rights by another person or persons’’
(Department of Health, 2000b, p. 9).
The No Secrets (Department of Health, 2000b) definition of abuse is broad enough to
encompass a wide-range of actions or inactions, however using this as the threshold for
determining abuse may be problematic as certain circumstances may be open to subjective
interpretation or debate as to whether the human rights of a vulnerable adult have been
violated. For example, article 3 of the Human Rights Act 1998 is the right not to be subjected to
torture or to inhuman or degrading treatment or punishment. Addo and Grief (1998) argue that
as terms such as ‘‘degrading treatment’’ are not clearly defined or absolute, alternative
interpretations may ensue. Different professionals may interpret these terms inconsistently
and without the government issuing a further definition or clarification over these terms, the
threshold may remain unclear.
No Secrets (Department of Health, 2000b) went on to identify six core categories of abuse –
physical, sexual, psychological, neglect and/or acts of omission, discriminatory and financial
abuse (Department of Health, 2000b). Importantly the report also identified the potential for
institutional abuse. This can range from isolated incidents of poor care and professional
practice through to acts of ill-treatment and neglect, or ignoring an individual’s needs and
wishes in order to maintain the smooth delivery of services. Self-neglect was not considered
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within the remit of No Secrets (Department of Health, 2000b), yet this continues to pose
challenges for practitioners who want to ensure the safety of vulnerable adults who selfneglect. In the future, this may be recognised nationally as a form of abuse.
Brown (2010) states that the concept of ‘‘vulnerability’’ is important. Use of the term
‘‘vulnerable adult’’ can be criticised as applying this label may increase the likelihood of it
becoming a self-fulfilling prophecy. For example, these individuals may be treated as unable
to make decisions and thus become disempowered by practitioners labelling them as
‘‘vulnerable’’. Hollomotz (2011) also argues that the social construction of ‘‘vulnerability’’
contributes to its creation and Williams (2011) suggests that the review of No Secrets
(Department of Health, 2009) makes firm suggestions that the term ‘‘vulnerable adult’’should
be replaced with the term ‘‘adult at risk’’, focusing attention on the risk as opposed to the
vulnerability. This review also preferred the use of the term ‘‘safeguarding adults’’ to
‘‘protection’’ as it is a better reflection of the wider policy agenda and aligns with legislation
such as the Safeguarding Vulnerable Groups Act, 2006 (Williams, 2011). However, by
omitting the term ‘‘vulnerable’’, there is the danger for the scope to be widened to cover all
adults, and not the specific adults defined in No Secrets (Department of Health, 2000b).
Therefore, there may continue to be confusion over whom safeguarding adults is related to
and without national legislation, thresholds and scope of adult safeguarding work are still
interpreted differently across local regions.
Whilst everyone has the potential to experience abuse (Straughair, 2011), there are some
people that may be at particular risk of abuse as a consequence of their social circumstances
or medical condition (Department of Health, 2000b; Safeguarding Vulnerable Groups Act,
2006) and thus increasing the likelihood of abuse in these groups. For example, adults with a
learning disability are four times more likely to experience sexual abuse than those without a
disability (Mencap, 2012). Choi et al. (2009) identified neglect as the most common type of
abuse occurring in the elderly population and Action on Elder Abuse (2004) found that a third
of its contacts related to psychological abuse. Due to financial abuse often being very well
hidden and undetected, existing research is likely to underestimate the scale of financial
abuse experienced by elderly people, with 70 per cent being perpetrated by a family member
(Crosby et al., 2008). Therefore, further research into this is recommended. As many
vulnerable adults with capacity may be unlikely to consent to interventions when a family
member is alleged as the financial abuser, research could offer insight into strategies to
prevent this form of abuse.
Individual practitioners should reflect on the multi-agency response to a vulnerable adult
who is being abused and share this learning across professions. Issues over mental
capacity and balancing risk and empowerment are paramount and require additional
consideration and investigation within the context of personalisation.
Personalisation, risk and empowerment for service-users
The government has pointed to three key concepts involved in adult safeguarding: protection,
justice and empowerment (Minister of State, 2010). In practice, there are professional
dilemmas of balancing the empowerment of service-users to make decisions and intervening
(or not) when they make choices that may seem unwise. Individuals retain the right to make
poor decisions and these choices do not indicate a lack of capacity; therefore multi-agency
partnerships need to balance elements of risk with empowering service-users. The
review of No Secrets (Department of Health, 2009) criticised adult safeguarding work for
generally disempowering service-users and failing to involve them in the decision-making
process. Current research fails to adequately explore the dilemmas of balancing risk with
empowerment across multi-agency settings and this will remain a challenge in practice until
further empirical evidence is obtained. It would be beneficial for researchers to consider the
practitioner’s decision-making process when determining how empowerment and risk are
balanced.
Involving service-users in the decision-making process is an important aspect of the recent
policy development of personalisation (first outlined by HM Government, 2007), which aims to
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give service-users increased control and choice over their social care. This has led to some
service-users now receiving a personal budget, which includes an option of a managed
budget or the preferred choice of a direct payment (Department of Health, 2010). Both
personalisation and safeguarding share principles of promoting independence and control
and they should work together in an integrated way to both support and empower (Carr, 2011).
Personalisation is at the heart of transforming care and support for people with learning
disabilities or autism and behaviour which challenges (Department of Health, 2012). With
personal budgets now being a reality, service-users are empowered to employ anyone they
choose to provide their care services, resulting in additional concerns about safeguarding
vulnerable adults.
In order to protect vulnerable adults, No Secrets (Department of Health, 2000b)
recommended implementing multi-agency protection of vulnerable adult procedures,
which have subsequently been established in England in Wales. The government aims for a
better sharing of information between the state and organisations (Home Office, 2012) and
therefore introduced the Protection of Freedoms Act 2012, which came into effect in
September 2012. This merged the services of the Independent Safeguarding Authority and
Criminal Records Bureau into a new organisation called the Disclosure and Barring Service
(DBS). The DBS became operational in December 2012 and performs a duty in ensuring only
suitable people continue to work with children and vulnerable adults. Organisations have a
duty to ensure that they do not knowingly engage a barred person in a regulated activity (such
as work with vulnerable adults), although the definition for ‘‘regulated activity’’ has changed
since the introduction of the Protection of Freedoms Act.
Under the personalisation agenda, service-users may decide to employ a friend, neighbour
or family member to provide personal care, and this carer may not have been subjected to
the same DBS (formerly CRB clearances) as agency-employed carers. Although CRB and
DBS clearances do not guarantee staff integrity, they are a useful mechanism to ensure
many abusers do not gain access to vulnerable adults. Service-users who have been
empowered to make choices over their personal care may find that the people
delivering their care may have previous convictions for abuse, without the safeguard of
the DBS.
Alongside the personalisation agenda, practitioners must consider issues of mental
capacity, working from the assumption that (until proven otherwise) all service-users have
capacity to make decisions over who provides their care. The Mental Capacity Act 2005
influences everyone who is involved in the care, treatment and support of people aged over
16 who live in England and Wales and who lack capacity to make some or all decisions for
themselves (Social Care Institute for Excellence, 2011a).
Mental capacity and the Mental Capacity Act 2005
Mental capacity is at the heart of safeguarding (Social Care Institute for Excellence, 2011b).
However, prior to the implementation of the Mental Capacity Act, practitioners within both
health and social care were unclear as to what their responsibilities were in relation to
providing care and treatment to people who lacked capacity, which sometimes led to poor
practice or neglect (Williamson, 2007).
A criticism of multi-agency work involving mental capacity is that many practitioners are still
unclear who completes capacity assessments and who determines best interests (Social
Care Institute for Excellence, 2011b). It is therefore vital that professional roles and
responsibilities are clear. Capacity is both time and issue specific and practitioners must take
into account fluctuating capacity. Every practitioner has the potential to assess capacity
(using the two-stage test) and these assessments should be done in real-time, remain time
and issue specific and the outcomes must be documented.
The Mental Capacity Act relates to people aged over 16, but there are limitations on its use for
those aged 16-17. For example, they cannot make a lasting power of attorney, or make an
advance decision to refuse medical treatment. Chico and Hagger (2011) also argue that the
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Mental Capacity Act’s failure to extend to mature minors (or Fraser competent young people)
under the age of 16 is a missed opportunity, as they may also benefit from this legislation.
Lasseter et al. (2011) imply that the implementation of the Mental Capacity Act may have had
an impact on recent research completed in care homes. They argue that people who lack
capacity have been excluded from research trials and therefore their voices are ignored in
findings. Despite criticisms, the Mental Capacity Act (if used correctly) has the ability to both
empower and minimise risk for vulnerable members of society.
Systematic failures: failed service-users and professional accountability
The publication of No Secrets (Department of Health, 2000b) was instigated following
the autumn of 1994, in which a leaked council report to journalist Pring (2005) revealed that
people with learning disabilities had been abused at Longcare homes in Buckinghamshire.
Despite arrests and prosecutions of staff at Longcare Homes, the GP for the homes avoided
prosecution and until recently has been practicing in the London area (Disability News
Service, 2012). The General Medical Council has been criticised for failing to conduct an
investigation into the care provided by Dr X at Longcare (Disability News Service, 2012).
As the GP avoided prosecution and was not subject to a GMC investigation, questions are
raised within multi-agency practice over the equity of this. Whilst unregistered front-line staff
from Longcare were investigated and successfully prosecuted, the GP, a registered health
professional, was allowed to continue in practice without further investigation.
The death of Fiona Pilkington led to an investigation (Independent Police Complaints
Commission (IPCC), 2009) where it was found that the police failed to act on evidence of
abuse of a vulnerable adult. The investigation’s findings reinforced that all agencies must
work together to protect vulnerable adults. The police are responsible when crimes are
alleged and each agency performs its own role in safeguarding vulnerable adults.
Similarly, the outcome of the serious case review into Steven Hoskin found that agencies
were not communicating well between themselves (Flynn, 2007). Between August 2005 and
June 2006 the police had 12 contacts with him and Steven informed social services that he
was being taken advantage of, later cancelling his community care support. Each agency
focused on their particular issue and failed to identify Steven as a vulnerable adult in need of
protection, resulting in his death. Although no individual practitioner is accountable for
Steven’s death, if all the practitioners had shared their knowledge this may have been a
preventable death.
After systematic failures within Mid-Staffordshire NHS Foundation Trust a more recent inquiry
was commissioned and led by Francis (2010). The inquiry found that staff had neglected
patients, leaving them unwashed and unfed; also failing to take sufficient care over the dignity
of patients. In the period 2005-2008, between 400 and 1,200 more people died at the MidStaffordshire NHS Foundation Trust than at other hospital trust within this period. The Francis
(2010) report found that there was an organisational culture influenced by bullying, a targetdriven culture and acceptance of poor behaviours, which was compounded by understaffed
wards. Vulnerable adults may become even more prone to abuse when poor organisational
culture remains unchallenged. Organisational culture is a contributory factor to institutional
abuse and further empirical exploration into the effects of organisational culture will enhance
the multi-agency approach to safeguarding adults. A specific aspect of organisational culture
that requires further empirical study is the confidence of different professionals to whistle-blow
is necessary; as it if often when organisational cultures go wrong that abuse of vulnerable
adults ensues.
Unfortunately further systematic professional failures have been substantiated, some as a
result of whistle-blowing. In 2011, the case of Winterbourne View was exposed by the
Panorama programme (BBC, 2010), and this highlighted that 11 years on from No Secrets
(Department of Health, 2000b), service-users with learning disabilities were still being
systematically abused and despite the multi-agency approach, they were not being
protected. Following the documentary, in 2012 11 staff members were convicted of offences
including abuse and wilful neglect. In 2012, Panorama also aired some hidden filming from
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footage taken within a care home rated as ‘‘excellent’’ by the Care Quality Commission,
which showed an elderly woman with dementia being abused by carers (BBC, 2012).
Investigative journalism such as this highlights that despite monitoring by organisations
such as the Care Quality Commission, systematic failures remain prevalent within the care
system.
In addition, Mencap, the national learning disability charity have undertaken some recent
research as a follow-up to their earlier report Death by Indifference (Mencap, 2007) which
highlighted how institutional discrimination has resulted in failures to protect vulnerable
adults. Since the initial report in 2007, Mencap have highlighted how there have been
74 additional deaths of people with learning disabilities in NHS care.
It therefore appears that members of society’s most vulnerable groups are still not being
protected despite the publication of No Secrets (Department of Health, 2000b) and
subsequent adult safeguarding policy and formation of multi-agency partnerships. Some
safeguarding issues are deeply embedded in abusive professional practices and therefore it
is important that only suitable and competent people are allowed to enter jobs with vulnerable
adults. The evidence suggests that many failed service-users may have received a better
level and quality of care and support if effective partnerships were in place. McKeough (2009)
suggests that successful adult protection relies on effective inter-agency working, including
the sharing of information, timely interventions and effective decision making. However, the
failed service-users discussed above, indicate that in practice, these continue to cause
challenges.
The challenges to achieving best practice strategically and in practice within
multi-agency settings
According to Williams (2011), partnership working between agencies involved in adult
protection became part of the national policy agenda during the 1990s, in part as a result of
scandals and inquiries (Perkins et al., 2007).
In England, No Secrets (Department of Health, 2000b) provided guidance on the coordination of responses to the abuse of vulnerable adults. No Secrets sets out principles for
inter-agency participation (Department of Health, 2000b, para 4.3) and provides guidance on
the co-ordination of responses to the abuse of vulnerable adults, however Williams (2011)
notes that it focused on multi-agency working through defining roles and responsibilities of
individual agencies, including protocols for information sharing. This did not include a
statutory requirement for different agencies to work together (Pinkney et al., 2008).
Single-agency investigations into alleged abuse fail to conform to adult protection guidance.
Practitioners working within a multi-agency setting will aid safeguarding work through the
sharing of specialist knowledge, adopting a transparent investigation process, and balancing
the interests of the service-user and the employee (West, 2006). The lead agency is identified
as local authority social services, and partner organisations include health, social care,
housing service providers, the police, service-user groups and support organisations.
It is local adult safeguarding boards consisting of representatives from stakeholders that
facilitate joint-working in adult protection (Spencer-Lane, 2011). Their responsibilities are to
ensure that multi-agency policies and procedures are in place; they conduct serious case
reviews and commission training and information. Currently, adult safeguarding boards are
not required under statutory law, although they are briefly mentioned in statutory guidance
(Department of Health 2000b, para 3.4).
In May 2012, the Queen’s Speech announced the publication of the Care and Support Bill to
establish the first legislative framework for safeguarding adults in England, including
legislating for Safeguarding Adults Boards. Across agencies, the consistency of safeguarding
adults work may be impeded by the present issue that there is no legislative requirement for
Safeguarding Adults Boards. It is anticipated that in future, the statutory basis will ensure that
the boards are better equipped both to prevent abuse and to respond when abuse occurs
(Department of Health, 2012). However, this will also require the development of local policies
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to support service-users and practitioners in safeguarding practice. If safeguarding
vulnerable adults is given a statutory basis, potential implications may include more
effective inter-agency co-operation (Reid et al., 2009) and ensuring the accountability of
agencies (Braye et al., 2010, cited in Social Care Institute for Excellence, 2011a).
Dugmore (2002) acknowledges that as No Secrets (Department of Health, 2000b) was only
issued as guidance it was not considered a priority, although some inter-agency policies
were developed. The lack of statutory authority to the guidance has resulted in variable
implementation and impact (Parsons, 2006; Cambridge and Parkes, 2006). The voluntary
sector performs an essential contribution to the safeguarding agenda, and whilst commitment
and engagement is evident in many areas, there continue to be missed opportunities for multiagency work through engaging voluntary and charitable organisations. Encouraging
practitioners from the voluntary sector to be represented on Safeguarding Adults Boards, in
addition to facilitating the membership of service-users would widen the expertise available to
the strategic and operational levels of adult safeguarding practice.
In 2005, the Association of Directors of Adult Social Services published the National
Framework for Safeguarding Adults. This is implemented at a local level, and comprises of
11 standards for good practice in safeguarding adults. It also makes a distinct change in
language from ‘‘vulnerable adult’’ as used in No Secrets (Department of Health, 2000b) to
‘‘safeguarding adults’’. This is an important publication for multi-agency work in safeguarding
vulnerable adults, however its implementation is not currently supported by parliamentary
legislation, failing to give it the legislative significance of, for example, the Children’s Act 1989.
Perkins et al. (2007) report that Department of Health research reinforces that barriers to
partnership working include a lack of clarity over professional roles, inadequate sharing of
information and delays in making decisions. The No Secrets review (Department of Health,
2009) recommends multi-agency training for staff in order to facilitate better multi-agency
work. This has the advantage of encouraging consistency across professions and
emphasises the collaborative approach required for the effective safeguarding of adults
(Davies and Jenkins, 2004). In multi-agency practice, there may be a lack of trust between
different professionals (Harbottle, 2007), and multi-agency training can assist in clarifying
professional roles and accountabilities. Although practitioners are more likely to learn from
incidents where they take responsibility, this also has the potential to lead to more defensive
practice dependant on what they conclude (Department of Health, 2000a). The benefits of
multi-agency training and the impact of inter-professional learning require further empirical
investigation to assess the potential to improve outcomes for vulnerable adults.
In order to support effective policies and practices pertaining to safeguarding vulnerable
adults, it is essential for service providers to display effective leadership. This includes
promoting an organisational culture that prevents abuse and ensuring that all staff are
confident and have the skills to act quickly if concerns are identified (Department of Health,
2012). The current government aims to establish a significant and enduring culture shift which
includes zero-tolerance of abuse and neglect at every level of the health and social care
system (Department of Health, 2012). It is internal management systems that provide the infrastructure and support to front-line practitioners delivering services and support to vulnerable
adults. Service-providers must be accountable in their governance arrangements and they
need to focus on developing good systems of quality assurance and improving outcomes for
all service-users.
The interim report on Winterbourne View hospital acknowledged that effective local
partnerships and sharing resources were essential in working to improve outcomes for
vulnerable adults (Department of Health, 2012). This includes effective partnership
engagement across health and social care and between child and adult services to ensure
a seamless transition for people moving across these services. The serious case review into
the hospital concluded that ‘‘the multi-agency approach was ineffective’’ (Flynn, 2012, p. 144)
and the poor responses of various agencies failed to protect service-users. This indicates that
consistently effective multi-agency work to safeguard vulnerable adults may continue to bring
challenges at both a strategic and practitioner level.
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Conclusion
This article has explored some current challenges in achieving effective multi-agency
practice in the field of safeguarding vulnerable adults. The principle of empowerment of
service-users is fundamental to safeguarding practice, however with empowerment, may
come the increased possibility of risk. Many organisational cultures emphasise a risk-averse
attitude, and therefore it is important for future research to consider how to balance the need to
protect people with genuinely empowering them to make choices and decisions, that may at
times seem unwise.
In order to protect society’s most vulnerable adults, a multi-agency approach is essential.
Serious case reviews have cited poor communication between agencies as a contributory
factor in the failure to protect vulnerable adults (Flynn, 2007; IPCC, 2009). There are many
lessons to be learnt from previous systematic failures where service-users have not been
protected. These lessons highlight that achieving best practice through a partnership
approach involves many factors, including safeguarding systems being thorough,
transparent and timely in order to maintain the safety of those at risk of abuse (Williams,
2011) and all agencies adopting clear and timely communication (McKeough, 2009).
Professionals may remain unclear over their own roles and responsibilities (Williamson,
2007) and therefore clarification over these may assist in improving multi-agency responses.
The abuse of vulnerable adults continues to be reported (Francis, 2010; Mencap, 2007,
2012; BBC, 2010; IPCC, 2009), however without legislation to mandate the multi-agency
approach to adult safeguarding there may be more cases of adults who will not be
protected.
The 2009 review of No Secrets may lead to future legislation to prevent abuse of adults
(McNally, 2009; Spencer-Lane, 2010), alternatively both documents may be replaced
(Collins, 2010). Policy and legislative frameworks are essential in empowering and
protecting service-users as well as empowering practitioners involved in the safeguarding of
adults. The government notes that ‘‘strengthening adult safeguarding arrangements is a key
priority for this Government’’ (Department of Health, 2012, p. 34). However, the Interim report
about Winterbourne View notes that legislation is only one part of the solution; all
practitioners working within health and social care must reinforce that abuse is
unacceptable and everyone has a responsibility to prevent and report abuse (Department
of Health, 2012).
Straughair (2011) argues that safeguarding procedures should aim to identify abuse as early
as possible to prevent further episodes and therefore protect vulnerable adults, It remains
challenging to practitioners who determine when is the most appropriate time to make an
intervention. Although abuse may be identified early, often interventions occur after abuse is
experienced, making safeguarding vulnerable adults a reactive service. Preventative work
should be an important remit for local safeguarding partnerships, despite it not always being
high on the safeguarding agenda (Social Care Institute for Excellence, 2011a), and in
practice, the resources may not be there to carry out this essential function.
Safeguarding means protecting vulnerable adults from harm, however it is also about
empowering them to make their own decisions and if there is an intervention, this must be
using the least restrictive option within multi-agency practice. This article has provided a
review of some of the relevant literature relating to the multi-agency approach of
safeguarding practice and has highlighted a number of contemporary issues within the field
of adult safeguarding requiring further empirical investigation.
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Further reading
ADASS (2005), Safeguarding Adults: A National Framework of Standards for Good Practice and
Outcomes in Adult Protection Work, Association of Directors of Adult Social Services, London.
About the author
Emma Stevens is a Safeguarding Adults Practitioner, Adult Services, City Health Care
Partnership CIC, Hull, UK. Emma Stevens can be contacted at: emma.stevens@chcphull.
nhs.uk
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