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Since the murder of Steven Hoskin, there have been considerable changes in the way that agencies in Cornwall operate. In order to prevent further tragedies on such a scale, a protocol was agreed by the agencies about when an alert should be triggered (Cornwall and Isles of Scilly Safeguarding Adults Board, 2008). This paper describes the process and implications of the protocol from the perspective of Devon and Cornwall Police, South Western Ambulance Service Trust and Cornwall and Isles of Scilly Primary Care Trust. The protocol has improved and encouraged information sharing within and between agencies, which will help to identify and reduce the risks to vulnerable adults.

The purpose of this paper is to evaluate key organisational processes in managing “safeguarding” in relation to the independent sector, the local authority delivery arm for care.

The methods employed were a telephone survey (one in five random sample of all residential and domiciliary providers in a local authority area) and follow up focus groups (n=2) of local authority staff and independent sector domiciliary and residential providers, in an action research framework. The survey was developed through expert members of a multi‐agency Project Reference Group.

Three survey domains (on “information”, “training” and “support and advice”) indicated high satisfaction, but “experience of investigations'” low rating raised questions for further exploration and were followed up in detail in the focus groups selected from providers with experience of safeguarding alerts. A number of issues were raised for local policy and for safeguarding more broadly.

The paper only assesses one local authority area. A more balanced systems approach is needed to manage safeguarding.

The involvement of the independent sector in safeguarding is under‐researched and the development of processes that encourage a research culture and a systems approach are exemplified.

Financial abuse of people with dementia is of rising concern to family carers, the voluntary sector and professionals. Little is known about preventative and early response practice among community services staff. The purpose of this paper is to investigate voluntary sector staff's views of the risks of managing money when a person has a dementia and explore ways that individuals may be protected from the risks of financial abuse.

An online survey of staff of local Alzheimer's Society groups across England was conducted in 2011 and was completed by 86 respondents. Open-ended responses supplemented survey questions. Statistical analysis and content analysis identified emergent findings.

Most respondents said their people with dementia experienced problems with money management, with almost half the respondents reporting encountering cases of financial abuse over the past year. Most were alert to warning signs and vulnerabilities and offered suggestions relevant to practice and policy about prevention and risk minimization.

Adult safeguarding practitioners are likely to encounter money management uncertainties and concerns about exploitation of people with dementia. They may be contacted by community-based support staff from the voluntary sector about individual queries but could ensure that such practitioners are engaged in local training and networking activities to promote their skills and confidence.

As with other forms of elder abuse, professionals need to be aware of risks of financial abuse and be able to suggest effective yet acceptable preventive measures and ways to reduce risks of harm and loss. Further publicity about adult safeguarding services may be needed among local community support services.

There have been few studies investigating the views of people working with people with dementia in the community about adult safeguarding.

This paper seeks to reconcile society's need to apply strong sanctions to parents who are responsible for the murder of a disabled adult while also recognising the stresses present in their lives.

The paper reviews six cases in which seven disabled adults were killed by a parent in the UK between 1999 and 2009.

The review found that these were no ordinary crimes and nor were they motivated by malice, but occurred against a backdrop of significant mental illness and distress. In addition, two of the parents killed themselves as well as their adult child and another attempted suicide. The explanations offered in court to account for the murders included a combination of caregiver stress and mercy killing and the courts struggled to find a consistent approach.

The review is limited to cases reported in the press and only considers information in the public domain. The portrayal of the issues in the media is integral to the study. The cases reported in this paper are a sub‐set of a larger sample of children and adults murdered by caregivers during this period.

The paper compares and contrasts some features of these high‐profile cases, commenting on the way they were addressed in the courts and making recommendations as to how the backdrop of significant mental ill‐health could be taken into account in the way families are offered support with a view to preventing further tragedies.

The purpose of this paper is to consider the role of the Mental Health Act (MHA) 1983 in safeguarding adults at risk of abuse and neglect. The author has undertaken a thematic review of Safeguarding Adults Reviews (SARs) commissioned in England and Adult Practice Reviews (APRs) commissioned in Wales where the MHA 1983 was a central aspect to the review.

Reviews were included based on specific determinants, following analysis of SARs, APRs and executive summaries. This should not affect the credibility of the research, as themes were identified in conjunction with analysis of literature regarding use of the MHA in the context of adult safeguarding. Consequently, this review has been underpinned by evidence-based research in the area of study.

The interaction between statutes, such as the MHA 1983 and Care Act 2014, signify challenges to professionals, with variable application of mental health legislation in practice.

Lack of a complete national repository for review reports means that it is likely that the data set analysis is incomplete. It was noted that limitations to this research include the fact that Safeguarding Adults Boards in England may not publish SAR reports or may choose to publish an executive summary or practice brief instead of the full SAR report, therefore limiting the scope of disseminating learning from SARs, as this is difficult to achieve where the full report has not been published. The author aimed to mitigate this by undertaking comprehensive searches of Local Authority and SAB websites, in addition to submitting Information requests to ensure that this research encompassed as many relevant review reports as possible.

This is an important and timely topic for debate, given that the UK Government is proposing reform of the MHA 1983. In addition, existing thematic reviews of SARS tend to be generalised, rather than specifically focused on the MHA.

This paper seeks to report some of the findings from an evaluation of adult safeguarding in one English local authority. The evaluation was commissioned in the context of concern regarding the number of safeguarding investigations that resulted in inconclusive outcomes.

All adult social care teams in the local authority were asked to complete a short pro forma about the five most recent adult safeguarding alerts that they had managed to completion. Data collected included: characteristics of the alleged victim and alleged perpetrator; details of the professionals involved; whether or not a safeguarding plan meeting/case conference was held; and the outcome of any investigation. Respondents were also asked to comment on factors that they perceived to have helped or hindered the investigation.

Findings suggest that a significant number of variables influence the likelihood of cases resulting in a conclusive outcome. These variables included not only the characteristics of alleged victims, but also elements of safeguarding practice – including inter‐agency co‐operation, social workers' pre‐existing knowledge of the alleged victim, and the convening of safeguarding plan meetings. A failure to actively involve alleged victims in the safeguarding process was also noted.

This is a relatively small sample from a single local authority.

This is the first study to provide qualitative evidence about the factors which influence the success or otherwise of adult safeguarding practice. The findings are likely to be of value to professionals working in adult safeguarding who are seeking to understand “what works” in managing investigations following safeguarding alerts.

People with an intellectual disability are much more likely to be sexually violated and the violation is less likely to be reported. Despite this being high-lighted at least 3 decades ago and improvements in both safeguarding and national reporting processes, under-reporting remains a problem. This paper explored under-reporting alongside prevention possibilities using safeguarding alerts raised in a Community Learning Disability Team within a UK NHS trust.

Using a combination of authentic but anonymised case vignettes and descriptive data drawn from the safeguarding team, under-reporting was examined through the lens of an ecological model. Safeguarding alerts raised in a particular year were compared with the number expected if all (estimated) cases of abuse were disclosed and reported.

Only 4.4 per cent of expected abuse cases were reported to the team, which is lower than the reporting level the authors had expected from the literature. There is evidence in the literature of the under-reporting of sexual assault for all kinds of people. Arguably, the implications of under-reporting for PwID are even more traumatic.

Constraints included the lack of standardisation in data collection within the statutory services that report to the Birmingham Safeguarding Adults Board. One key recommendation is that the national provider of data for the NHS in the UK requires more complex and standardised audit information that would allow each local authority to benchmark their practice against a higher protection standard. Another recommendation is that compliance to quality standards sits within a comprehensive strategy.

This paper explored the extent to which the previously documented under-reporting concern remains an issue. Certainly eye-balling safeguarding compliance data in the NHS organisation we worked in led us to a concern that reporting might be even lower than implied in the literature. This together with a renewed spot-light on sexual violence (e.g, NHS England, 2018) led us to decide that it was timely to re-examine the problem.

The purpose of this paper is to clarify the relationship between safeguarding adults training, staff knowledge and confidence.

A total of 647 responses from a cross sectional postal sample survey of the health and social care sector in Cornwall, were analysed.

Differences in knowledge and confidence around safeguarding were observed between staff groups and agencies. Training contributed to an approximately 20 per cent increase in knowledge and a ceiling effect was noted. Confidence linked knowledge and action. More confident staff offered more sophisticated responses regarding improving safeguarding processes.

Low response rates and the specific context limit generalisability. Knowledge and confidence measures were simplistic. Further research is needed on the mechanism of action by which safeguarding adults training is effective.

Safeguarding adults training and a targeted approach to the analysis of learning needs should be debated in the context of training transfer. Training should be evaluated to ascertain its effectiveness.

This is the first major multi‐agency UK survey of its kind. Findings provide a baseline for further research.

The purpose of this paper is to look at safeguarding documentation in relation to 50 adult safeguarding files for the period April 2010 to March 2011. This was followed up with semi-structured interviews with a small number of Designated Officers whose role it is to screen referrals and coordinate investigations. Findings from the research were used to redesign regional adult safeguarding documentation to ensure Designated Officers have access to the information necessary to assist them in reaching decisions. Designated and Investigating Officer training was also updated to reflect learning from the research thereby reducing the potential for variation in practice.

A file tool was developed which examined the recorded information in safeguarding documentation contained within 50 service user files. The review tool looked at the personal characteristics of the vulnerable adult, the nature of the alleged abuse and the decisions/outcomes reached by staff acting as safeguarding Designated Officers. A semi-structured interview schedule asked Designated Offices to comment on the training and understanding of the process as well as the factors they believed were central to the decision making process. Their responses were compared to data obtained from the file review.

A key finding in the research was that while factors such as type of abuse, the vulnerable adults’ consent to cooperate with proceedings, identity of the referrer, etc. did influence decisions taken there was a lack of clarity on the part of Designated Officers in relation to their roles and responsibilities and of the process to be followed.

The research was limited to one Health & Social Care Trust area and had a small sample size (n=50).

The findings of the research led to a revamping of existing safeguarding documentation which had failed to keep pace with developments and was no longer fit for purpose. Adult safeguarding training courses within the Trust were redesigned to bring greater focus to the role and responsibilities of designated and Investigating Officers and the stages in the safeguarding process. Adult Safeguarding leads were established within programmes of care and professional support mechanisms put in place for staff engaged in this area of work.

Better trained and supported staff alongside more efficient safeguarding systems should lead to better outcomes in the protection of vulnerable people from abuse and harm.

The research built on existing albeit limited research into what potentially influences staff involved in critical decision-making processes within adult safeguarding.

Serious Case Reviews (SCRs, now Safeguarding Adults Reviews (SARs)) may be held at local level in England when a vulnerable adult dies or is harmed, and abuse or neglect is suspected, and there is cause for concern about multi-agency safeguarding practice. There has been no analysis of SCRs focussing on pressure ulcers. The purpose of this paper is to present findings from a documentary analysis of SCRs/SARs to investigate what recommendations are made about pressure ulcer prevention and treatment in a care home setting in the context of safeguarding. This analysis is presented in cognisance of the prevalence and risks of pressure ulcers among care home residents; and debates about the interface of care quality and safeguarding systems.

Identification of SCRs and SARs from England where the person who died or who was harmed had a pressure ulcer or its synonym. Narrative and textual analysis of documents summarising the reports was used to explore the Reviews’ observations and recommendations. The main themes were identified.

The authors located 18 relevant SCRs and 1 SAR covering pressure ulcer care in a care home setting. Most of these inquiries into practice, service communications and the events leading up to the death or harm of care home residents with pressure ulcers observed that there were failings in the care home, but also in the wider health and care systems. Overall, the reports reveal specific failings in multi-agency communication and in quality of care. Pressure ulcers featured in several SCRs, but it is problems and inadequacies with care and treatment that moved them to the safeguarding arena. The value of examining pressure ulcers as a key line of inquiry is that they are “visible” in the system, with consensus about what they are, how to measure them and what constitutes optimal care and treatment. In the new Care Act 2014 context they may continue to feature in safeguarding enquiries and investigations as they may be possible symptoms of system failures.

Reviews vary in content, structure and accessibility making it hard to compare their approach, findings and recommendations. There are risks in drawing too many conclusions from the corpus of Reviews since these are not published in full and contexts have subsequently changed. However, this is the first analysis of these documents to take pressure ulcers as the focus and it offers valuable insights into care home practices amid other systems and professional activity.

This analysis highlights that it is not inevitably poor quality care in a care home that gives rise to pressure ulcers among residents. Several SCRs note problems in wider communications with healthcare providers and their engagement. Nonetheless, poor care quality and negligence were reported in some cases. Various policies have commented on the potential overlap between the raising of concerns about poor quality care and about safeguarding. These were highlighted prior to the Care Act 2014 although current policy views problems with pressure ulcers more as care quality and clinical concerns.

The value of this documentary analysis is that it rests on real case examples and scrutiny at local level. Future research could consider the findings of SARs, similar documents from the rest of the UK, and international perspectives.

The value of having a set of documents about adult safeguarding is that they lend themselves to analysis and comparison. This first analysis to focus on pressure ulcers addresses wider considerations related to safeguarding policy and practice.