8.3 Safeguarding Vulnerable Adults & Children

Safeguarding Vulnerable Adults & Children

Safeguarding means protecting an individual’s health, wellbeing, and human rights, enabling them to live free from harm, abuse, and neglect. For registered nurses in the UK, safeguarding is both a statutory requirement and a fundamental duty under The NMC Code (2018). Nurses occupy a privileged position of trust and must act decisively to protect vulnerable children, young people, and adults at risk.

Safeguarding Adults (Care Act 2014)

In England, the Care Act 2014 provides the legal framework for adult safeguarding. It defines an "adult at risk" as an individual aged 18 or over who:

1. Has needs for care and support (whether or not the local authority is meeting any of those needs),
2. Is experiencing, or is at risk of, abuse or neglect, and
3. As a result of those care and support needs, is unable to protect themselves against the abuse or neglect or the risk of it.

The 6 Principles of Adult Safeguarding

The Care Act 2014 outlines six core principles that must guide all adult safeguarding practice:

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Recognized Categories of Adult Abuse

The Care Act 2014 statutory guidance recognizes ten distinct categories of adult abuse:

1. Physical Abuse: Assault, hitting, slapping, inappropriate restraint, or misuse of medication.
2. Sexual Abuse: Non-consensual sexual contact, sexual exposure, or exploitation.
3. Psychological / Emotional Abuse: Threats, humiliation, intimidation, verbal harassment, or isolation.
4. Financial or Material Abuse: Theft, fraud, coercion regarding financial affairs, wills, or property.
5. Neglect and Acts of Omission: Failure to provide basic medical, physical, or emotional care, nutrition, hydration, or medication.
6. Discriminatory Abuse: Harassment or slurs based on race, gender, disability, age, sexual orientation, or religion.
7. Organizational / Institutional Abuse: Poor care practices, rigid routines, or systemic neglect across a care setting or hospital unit.
8. Self-Neglect: Failure to attend to personal hygiene, health, or environment, including hoarding behavior.
9. Domestic Violence and Abuse: Controlling, coercive, or threatening behavior between intimate partners or family members.
10. Modern Slavery: Human trafficking, forced labor, domestic servitude, or debt bondage.

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Safeguarding Children (Children Acts 1989 & 2004)

Safeguarding children applies to any individual under the age of 18. Key legislation includes:

• The Children Act 1989: Establishes the core principle that the welfare of the child is paramount. Under Section 47, local authorities have a statutory duty to investigate when there is reasonable cause to suspect a child is suffering, or likely to suffer, significant harm.
• The Children Act 2004: Created under the Every Child Matters framework, establishing Section 11 duties requiring NHS organizations to ensure their functions are discharged with regard to safeguarding children.
• Working Together to Safeguard Children (2023): Statutory multi-agency guidance defining joint working standards between health, police, and social care.

Categories of Child Abuse & Exploitation

• Physical Abuse: Causing physical harm or non-accidental injury.
• Emotional Abuse: Persistent emotional ill-treatment causing severe adverse impacts on development.
• Sexual Abuse: Involving a child in sexual activity, online grooming, or exploitation.
• Neglect: Persistent failure to meet a child's basic physical, psychological, nutritional, or medical needs.
• Child Sexual Exploitation (CSE) & Child Criminal Exploitation (CCE / County Lines): Coercion of children into criminal activity or sexual acts in exchange for gifts, money, or protection.

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Recognizing Indicators and Handling Disclosures

Nurses must recognize both physical signs (unexplained injuries, burns, pressure injuries) and behavioral indicators (withdrawn demeanor, fear of specific caregivers, sudden financial changes).

Protocol for Managing a Direct Disclosure

1. Listen Actively: Maintain a calm, supportive posture. Allow the individual to speak at their own pace without asking leading questions.
2. Reassure: Confirm that they were right to share the information and that it is not their fault.
3. Do NOT Promise Absolute Confidentiality: Explain clearly that to keep them safe, information must be shared with the safeguarding team.
4. Document Verbatim: Record exact words used by the victim, date, time, physical observations, and signatures immediately.
5. Report Promptly: Inform the unit Safeguarding Lead, Named Nurse for Safeguarding, or Social Services.

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Multi-Agency Working and MASH

Effective safeguarding depends upon rapid information sharing across institutional boundaries.

Multi-Agency Safeguarding Hub (MASH)

A MASH is a co-located, multi-disciplinary team comprising professionals from:

• NHS Healthcare Services (Designated/Named Nurses and Doctors)
• Police Services
• Local Authority Social Care (Adult and Children Services)
• Education and Probation Services

MASH enables rapid information sharing, holistic risk assessment, and coordinated safeguarding interventions without delay.

The Prevent Strategy

Under the Counter-Terrorism and Security Act 2015, healthcare workers have a statutory Duty under the UK Government’s Prevent strategy. Nurses must recognize indicators of radicalization and vulnerable individuals being drawn into terrorism, referring concerns through local channel safeguarding pathways.