The statutory guidance on the Care Act ([42]) (DH [81], paras. 14.17–14.33) describes different forms of abuse and neglect: physical, sexual, psychological, discriminatory, domestic and financial, as well as organizational abuse and modern slavery (Box 5.18). Further adult safeguarding concerns include female genital mutilation, forced marriage, honour‐based violence, hate crime, human trafficking, sexual exploitation and mate crime (Box 5.19) (Gov.uk n.d., [110], [111]).

Within the child safeguarding arena, there are four identified types of abuse and neglect: physical, psychological, sexual and neglect (DfE [65]) (Box 5.20). The London Child Protection Procedures (London Safeguarding Children Board [154]) provide guidance in relation to safeguarding children in specific circumstances, including children with disabilities and those with fabricated or induced illness (Box 5.21).

As abuse usually occurs in secret, it is not possible to accurately state the number of people who are abused in the UK. Abused individuals may not know that they are being abused, or may be too frightened or ashamed to tell others what they are experiencing. Further, ‘observers’ of abuse may not recognize the signs of abuse and therefore fail to identify and report it.

Nonetheless, there are a number of sources of data that can be drawn upon to provide a sketch of the level of abuse, for example, government (Figure 5.18), social services and charities such as the NSPCC (Figure 5.19). It is accepted that actual levels of abuse and neglect are higher than the number of reported incidents.

People are usually abused by someone they know, for example a spouse, parent or other family member, as well as friends, neighbours, professionals and volunteers. This is not to say that strangers cannot be the perpetrators of abuse. Neglect, by definition, can only be carried out by someone who has a personal or professional relationship with the neglected person. Extra‐familial threats can arise in educational, work or healthcare establishments; from within peer groups; or from the wider community (including online). Thus, nursing assessments must include an awareness and understanding of the context in which a child or adult exists to enable them to prevent and manage safeguarding risks.

Safeguarding aims to protect people from harm and abuse while concurrently promoting individual (and thereby societal) wellbeing so that everybody can live a healthy life to their fullest potential.

Government and healthcare guidance includes safeguarding principles that underscore the need for relevant systems to be developed and applied in a robust and appropriate manner. When nurses adhere to the principles outlined below, they can provide an appropriate and personalized approach to safeguarding.

The Care Act ([42]) and statutory guidance (DH [81]) define six key principles that underpin all adult safeguarding work. These are the prevention of abuse and neglect, the empowerment and protection of people, the delivery of accountable and proportionate safeguarding responses, and partnership work with other agencies (Table 5.22). These principles are embraced by the nursing profession, which clearly states that safeguarding is a core component of the nursing role:

The Royal College of Nursing more specifically states that nurses must take both individual and collective responsibility to safeguard others:

The concept ‘making safeguarding personal’ (MSP) (LGA [152]) is an important approach to adult safeguarding that encourages all staff to take personal responsibility for safeguarding patients and their families. This approach was implemented to end a culture of passing safeguarding concerns and responsibilities to others. Thus, MSP encourages staff to see themselves as key to both raising concerns and to implementing appropriate safeguarding responses. Nurses need to have conversations with patients that enhance patient involvement, choice and control as well as improving quality of life, wellbeing and safety. MSP frames people as experts in their own lives and supports staff to work alongside them to enable them to reach a better resolution of their circumstances and recovery.

While it is parents and carers who have primary care for their children, local authorities, working with partner organizations and agencies, have specific duties to safeguard and promote the welfare of all children in their area. Local authorities have statutory responsibility for adults in their area. Local authorities can only do their job effectively if there is appropriate partnership work between health, social care and other key support agencies. Co‐operation between agencies is important to reduce the risk of cases slipping through the safeguarding system and stopping abuse at an early stage or preventing it from happening in the first place.

In order for organizations, agencies and practitioners to collaborate effectively, it is vital that nurses working with adults, children and families understand the role they should play and the roles of other practitioners (Box 5.22). Nurses should be aware of, and comply with, the published arrangements set out by their local safeguarding partners.

A different form of partnership working is with the families or carers of patients. Families and carers have a wealth of information and knowledge about the person that they care for and support. As well as raising concerns, families and carers are able to support safeguarding enquiries through sharing important information. If a family member or carer speaks up about abuse or neglect, it is essential that they are listened to and appropriate enquiries are made. Families and carers can identify and mitigate risks as well as advocate for patients. Staff should also be vigilant to recognize the signs of carer stress and potential unintentional neglect; staff must address these directly with carers and discuss key agencies that can provide support.

Section 44 of the Care Act ([42]) stipulates that local authorities must conduct a safeguarding adults review (SAR) when an adult in its area with care and support needs has experienced significant harm from, or dies as a result of, abuse or neglect (whether known or suspected) and when there is a concern that partner agencies could have worked more effectively to protect the adult. The purposes of a SAR are to identify lessons to be learned from the case, to apply those lessons to future cases, and to improve how agencies work both independently and together to safeguard adults at risk. Nurses may be asked to contribute to a SAR by providing evidence and/or to participate in learning events following a SAR so that lessons learned can be embedded in health and social care practice.

A thematic review of 27 SARs completed in London identified key lessons (Braye and Preston‐Shoot [35]) (Figure 5.20). These included the need to consider risk assessment as a process (rather than a one‐off event) that is carried out in a person‐centred manner. Thus, nurses need to engage with the person at risk (and others in their system as appropriate) to elicit the history of any concerns and the person's wishes and views about these concerns and needs, bearing in mind that these may differ from the nurse's own view. Moreover, the review identified a need for services to more proficiently assess mental capacity, and, where this is deemed to be lacking, to engage in best interests decision making that incorporates the family's and/or carer's information. Furthermore, the review identified that staff need to report their concerns about services providing substandard care.

The NSPCC ([214]) examined a series of safeguarding children reviews and reported a number of consistent errors, including overreliance on parental reporting and a reluctance to challenge parents’ views, a failure to flag up missed appointments, uncertainty about how to escalate safeguarding concerns, and inadequate information sharing.

People have the right to expect that information shared with a nurse will be treated as confidential. However, nurses must make it clear to patients at the beginning of conversations that when they are concerned about the patient's (or another person's) welfare, they have a professional duty to share the information with someone who is in a position to take action, for example a line manager. When a nurse is concerned about safety it is important to discuss with the patient the rationale for sharing information, and how and with whom that information will be shared. Furthermore, the nurse must explain to the patient that they will record their views and wishes about what they want to happen so that these can be taken into account in so far as is possible. There may be times when it is unsafe for a nurse to share their safeguarding concerns with a patient – for example, when the nurse suspects that the patient may feel compelled to tell the alleged perpetrator due to high levels of control and coercion.

Sharing the right patient information at the right time with the right professionals is a fundamental part of safeguarding practice. Nurses can be ambivalent about sharing patient information within and between organizations for fear of breaching confidentiality or data protection guidance. However, sharing information in relation to day‐to‐day safeguarding practice is covered within common‐law duty of confidentiality, Crime and Disorder Act ([54]), the Human Rights Act ([137]), the Care Act ([42]) and the General Data Protection Regulation (GDPR) ([103]) (Box 5.23). It is important to record on the patient's notes the decision to share, or not, information and the reasons for this decision.

Some legislation pertinent to safeguarding is only applicable to individual parts of the UK. It is important that nurses familiarize themselves with legislation, guidance and policy that is applicable in the country where they work. Acts of Parliament and guidance that form the legal framework for safeguarding adults are detailed in Box 5.24.