The Care Quality Commission (CQC) defines safeguarding as “protecting a citizen’s health, wellbeing, and human rights and enabling them to live free from harm, abuse and neglect”. Safeguarding procedures are about risk management rather than blame, and are an integral part of providing high-quality health care. The purpose of a safeguarding referral is to establish whether abuse or neglect has occurred or is likely to occur, and to determine what action is needed to stop or prevent harm.

Who is being protected?

Safeguarding processes are there to protect:

• children and young people
• vulnerable adults, such as those receiving care, people with physical, sensory and mental impairments, and those with learning disabilities.

All health care staff, whether they work in a hospital, a care home, in general practice, or in providing community care, have a responsibility to safeguard children and vulnerable adults.

What are they being protected from?

The Care Act 2014 lists ten types of abuse that safeguarding is designed to protect children and vulnerable adults from:

• physical abuse
• domestic violence or abuse
• sexual abuse
• psychological or emotional abuse
• financial or material abuse
• modern slavery
• discriminatory abuse
• organisational or institutional abuse
• neglect or acts of omission
• self-neglect.

Safeguarding is not about punishing individual members of nursing staff, however, the outcomes from safeguarding may impact someone’s ability to practise.

The UK’s four nations – England, Northern Ireland, Scotland, and Wales – each have their own safeguarding systems and laws to help protect children and vulnerable adults from abuse and neglect, although they are all based on similar principles.

Each nation has a framework of legislation, guidance, and practice to identify children and vulnerable adults who are at risk of harm, take action to protect them and prevent further abuse occurring:

• England - Children Act 1989/2004 and Care Act 2014 for adults
• Northern Ireland - Children (Northern Ireland) Order 1995 and specific adult protection policies. A new Adult Protection Bill is under consultation.
• Scotland - Children and Young People (Scotland) Act 2014 and the Adult Support and Protection (Scotland) Act 2007.
• Wales - Social Services and Well-being (Wales) Act 2014.

When a local authority safeguarding team receives a safeguarding referral, they follow a structured process to decide what level of response is needed to keep someone safe. The detail varies slightly between children’s services and adult services, but the core stages are similar.

1. The referral is logged and basic details are checked.
2. A safeguarding officer or social worker reviews the referral to decide whether it meets the threshold for statutory action, whether a crime may have occurred, and whether anyone is in immediate danger and needs urgent action.
3. The safeguarding team then gathers further information around the safeguarding issue. Health or care professionals, social workers, and the police may be contacted to share information. Information sharing is lawful when safeguarding is involved. Any staff involved are expected to cooperate and may be asked to provide a statement.
4. The safeguarding team decides what action is needed. It may be that no further action is required, or that additional support may be provided, or if the threshold for statutory action is met, a formal investigation is carried out.
5. If a formal investigation is initiated, this may include further discussion with the person at risk, health or care professionals, social workers, the police, and partner agencies.
6. If a risk is confirmed, a safeguarding or protection plan is developed, and actions agreed. The outcome from this discussion may involve a police investigation or employer investigation. However, referrers may not always be told the outcome (due to confidentiality).
7. The case is only closed when the safeguarding outcomes are achieved.

Safeguarding law places clear statutory duties on health care professionals to identify risk, share information, report concerns, and cooperate with safeguarding enquiries. Failure to do so can have legal, professional, and organisational consequences.

You may:

• have to report concerns about others or deficiencies in their care (see the NMC code and our duty of candour guidance). Making a safeguarding referral in good faith is a protected disclosure.
• have concerns raised by others about your practice (be the alleged perpetrator)
• be the employer of an alleged perpetrator
• be a health care professional required to engage with safeguarding processes, for example, to give information, or be responsible for investigating safeguarding concerns.

As soon as you are made aware that a safeguarding referral has been made about you:

• Inform your manager/employer, if they are not already aware. Your employer should have a safeguarding policy that includes agreed ways of working, how to meet the standards of quality and safety, how to comply with legislation and best practices, and reporting responsibilities and procedures. Check the policy for guidance on the next steps, which may include temporary suspension or restricted duties.
• Keep meticulous records. Document your own version of events as soon as possible while they are fresh in your mind. This should be a factual, objective account of your actions and decisions.
• Maintain confidentiality, other than with your manager/employer. Do not discuss details with colleagues or the person involved to avoid compromising any investigation.
• Engage with the process by cooperating with any investigation. If you are asked to provide a written statement as part of an investigation, please see our statement writing guidance.
• Contact us if you are referred to the NMC and/or DBS/DS as a result of the safeguarding, or you require further support or advice

The Local Authority investigates the safeguarding concern itself. A regulatory body, such as the CQC, may be asked to investigate whether the care setting and provider systems kept people safe.

The regulatory body becomes involved when a safeguarding issue suggests that:

• people are at risk of abuse or neglect because the care provided is unsafe
• there are systemic failings (for example, poor staffing, weak leadership or lack of training)
• the provider may be breaching the Health and Social Care Act 2008 (Regulated Activities) Regulations.

The regulatory body is more likely to act if:

• there are multiple safeguarding incidents, not just one-off events
• the same type of abuse or neglect keeps happening
• previous actions or warnings have not led to improvement.

If you are involved in an investigation by a regulatory body, please contact us.

If you are involved in a work-related safeguarding incident, please contact us. Note that for tailored advice and support you must have been in the correct category of membership at the time of the incident.

If you are involved in a safeguarding issue that is not work-related, you could access our free legal helpline. You may also benefit from Counselling. If this results in a workplace investigation, please see our investigations guidance.

If you are referred to the NMC and/or DBS/DS as a result of safeguarding, please see our NMC and/or DBS guidance, and contact us for legal support.

If you are considering self-referring to the NMC as a result of a safeguarding incident, please see our NMC self-referral guidance.

If you have to attend an interview under caution by a regulatory body, such as the CQC, please see our guidance on interviews, and contact us for support.