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The purpose of this paper is to review the reasons underlying the slow rate of progress towards developing a comprehensive policy underpinning for adult safeguarding in England and proposes long-term solutions.

This paper uses a model of policy change to argue that adult safeguarding has been over-reliant on case histories to define its policy problems and influence its politics, while making insufficient progress on data collection and analysis. It uses examples from the parallel discipline of public health to explore four challenges, or “problems”, relevant to the further development of the knowledge base underpinning adult safeguarding policy.

Four recommendations emerge for closing the adult safeguarding “knowledge gap”, including the development of a national research strategy for adult safeguarding. In a fifth recommendation the paper also proposes a clearer recognition of the contribution that local public health professionals can make to local adult safeguarding policy making and programme development.

The first four recommendations of this paper would serve as the basis for developing a national research strategy for adult safeguarding. The fifth would strengthen the contribution of local public health departments to safeguarding adults boards.

The author is unaware of the existence of any other review of the limitations of the adult safeguarding knowledge base as a foundation for policy making, or which proposes strategic solutions. The work is valuable for its practical proposals.

The purpose of this paper is to critically review the context of adult protection in Ireland with a focus on older people. The paper traces advances and current limitations in policy, regulation, practice and legislation.

A review of historical and current contexts in adult safeguarding in Ireland is presented with consideration of key public reviews and commentaries related to care provision, governance and the legislative status of adults at risk.

While Ireland’s journey to provide adult safeguarding responses for older people has progressed since 2002, there remain many gaps. Further work needs to be addressed urgently to enable a comprehensive alignment of fit-for-purpose, responsive legislation, practice and policy to meet the complex and diverse needs of an increasing ageing population who may require safeguarding support. This includes fostering robust inter-sectorial collaboration, safeguarding legislation and cultural change related to human rights approaches.

The paper is a discussion on the context of adults safeguarding in relation to practice, policy and legislation.

Identifies the need for significant reform in the Irish system of health service. Argues for an overarching, inter-sectorial approach to addressing adult safeguarding, which focuses on prevention as well as early intervention.

The paper offers a review of the current diverse elements comprising current adult safeguarding and older people in Ireland and integrates legislative, regulatory, policy and practice realities. Challenges are illustrated within the context of reactive rather than proactive safeguarding agendas which are linked to public scandals and debates. The paper argues for a more integrated and robust inter-sectorial approach to safeguarding underpinned by adult safeguarding legislation and an overarching governance structure.

The purpose of this paper is to outline and critique the current model of adult safeguarding in Northern Ireland (NI).

The paper offers a critical analysis of adult safeguarding, legislation, policy and practice. Insights are offered from the Regional Adult Safeguarding Officer for NI, and available research evidence is cited.

Distinct features of Northern Irish society have shaped its adult safeguarding policy and practice in ways which differ from those in England, Scotland and Wales. The strengths and limitations of the legal and policy framework, and practice systems are discussed.

The paper offers the viewpoint of the authors, which may not be representative.

The potential advantages and challenges of the Northern Irish safeguarding systems are presented, and potential future developments are highlighted.

Changes have been highlighted in the way adult safeguarding has been conceptualised. An emphasis on prevention and early intervention activities, with a key role envisaged for community, voluntary and faith sector organisations, have been noted.

This paper provides an accessible overview of adult safeguarding in NI, which to date has been lacking from the literature.

The paper aims to appraise professional practice in safeguarding vulnerable adults. It will examine the mechanisms in place and discuss how future policy will affect multi‐agency working in this field.

The paper examines recent consultations, policy development, inspectorate reports and legal guidance surrounding the issue of safeguarding adults in England and Wales, and suggests ways in which inter‐agency working can be strengthened.

Safeguarding systems need to be timely, rigorous and transparent to increase levels of public confidence and to ensure that the people who are at most risk of being abused are safe when accessing public services. The concept of safeguarding adults is increasingly being integrated into government policy and there are many successful examples of safeguarding partnership working in England and Wales. However, there are also substantial barriers that hinder organisations from working together effectively, such as different cultures, practices and ideologies.

The paper explores the fact that there needs to be clarification of roles and responsibilities and integration of processes, and acceptance of true multi‐agency working. There is a danger that instead of providing extra protection for adults at risk, multiple routes will result in a lack of co‐ordination.

Local Safeguarding Adults Board (SAB) policies, procedures, guidance and related documents on self-neglect were gathered and analysed, to map what approaches are being taken across England. This paper aims to identify areas of divergence to highlight innovations or challenges faced by SABs.

Self-neglect documents were identified by searching SAB websites. Data were extracted into a framework enabling synthesis and comparison between documents.

This paper reports on how English SAB documentation defines self-neglect, treats executive capacity, lays out pathways for self-neglect cases, advises on refusal of service input and multi-agency coordination and draws on theories or tools. Greater coherence in understanding self-neglect has developed since it was brought within safeguarding in 2014; however, variation remains regarding scope, referral pathways and threshold criteria.

This review was limited to published SAB documentation at one point in time and could not consider either the wider context of safeguarding guidance and training or implementation in practice.

This review provides an overview of how SABs are interpreting national guidance and guiding practitioners. The trends and areas of uncertainty identified offer a resource for informed research and policy-making.

To the best of the author’s knowledge, this is the first systematic survey of SAB self-neglect policies, procedures and guidance since self-neglect was included under safeguarding.

The purpose of this paper is to identify and encourage good practice in adult safeguarding by housing providers, despite their unclear and largely unregulated role in this area.

Literature search on policy and research on the role of housing in adult safeguarding. Good practice search, drawn from No Secrets consultation responses and more recently, from other housing providers.

Despite the current weak incentives for housing providers to engage in adult safeguarding, some have done so effectively, overcoming barriers to joint working.

This is not a comprehensive study of all good practice in this area; much will exist “unsung” and unrecognised.

Increase housing providers' involvement in adult safeguarding.

The paper is of value, as there is a dearth of literature on the role and potential of housing and adult safeguarding.

The safeguarding and protection components of the Social Services and Well-being (Wales) Act 2014 offers the culmination of four years consultation in England and Wales by the Law Commission and many years of evolving policy and practice with a view to protecting adults from harm. The purpose of this paper is to offer both scrutiny and challenge for Wales’ policy makers and practitioners alike.

The paper is a critical analysis of both current responses and forthcoming changes.

The paper proposes that Wales has failed to implement previous recommendations in relation to institutional abuse. Currently in Wales, there are individuals employed in safeguarding lead roles who have no social care qualification. This apparent “loophole” has not to date been highlighted to date by either of the regulatory bodies within Wales (CSSIW/CCfW).

The paper offers a viewpoint but leaves some questions unanswered.

The Williams Review in April 2014 is set to change the local authority landscape in Wales. There is scope for developing the function of adult safeguarding.

Wales’ failure to recognize institutionalized abuse as a distinct category may have had impacted on its ability to respond to abuse in nursing and care as well hospital settings.

The failure to recognize institutional abuse is not the only safeguarding anomaly within Wales’ arrangements for protecting those are risk of abuse. This paper describes gaps in the NHS and of professional accountability.

The issue of forced marriage is typically located within debates on violence against women, immigration control and cultural difference and is rarely considered in relation to adults with learning disabilities. The purpose of this paper is to argue that this is an issue which needs to be addressed by Safeguarding Adult Boards.

This paper draws upon original research undertaken by the author in conjunction with the Ann Craft Trust, a voluntary sector organisation which supports statutory, independent and voluntary sector organisations across the UK to protect adults at risk. The project sought to establish the extent to which the issue of forced marriage of people with learning disabilities is recognised, understood and acted upon by Boards.

Although many Boards are aware of national policy guidelines, very few had incorporated these guidelines into their local practice. There were two key consequences of this. First, Boards were failing to monitor cases of forced marriage and were unable to plan preventative services. Second, frontline workers were not given necessary training and so were unable to develop effective skills of knowledge. The need for both better recognition of and improved responses to the problem of forced marriage of people with learning disabilities is highlighted, as is the need for the safeguarding workforce to be supported by more effective strategic planning and better training.

This paper draws upon original research which examined how Safeguarding Adult Boards are responding to the issue of forced marriage of people with learning disabilities – a problem currently very much under-represented in existing research and practice literature.

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.

The purpose of this paper is to compare the stringency of different types of public financing institutions' safeguard mechanisms in the financing of large dams in developing countries. It seeks to do so by examining: the institutional strategies and policies currently in place in a set of key public financing institutions; and project‐level case studies of dams financed by these institutions and the stringency with which existing policies are applied by the key financing institutions. It aims then to cite the key factors determining why the “safeguard‐performance” between these types of financing institutions differs and what the implications are for leaders working to effect improvements in these areas.

The study compares the safeguard mechanisms of two types of financing institutions by applying a set of benchmark criteria to both existing strategy and policy documents and to the actual application of those policies at the project level, through correspondence, interviews, and site visits.

The study argues that leaders may make a difference on improving the sustainability performance gap in the financing of large dams – with more difficulty in those cases where the current gap is mainly to be explained by “systemic” factors; and arguably with more ease in cases where the current gap is caused mostly by other factors.

The study leads to the above findings for the case of public financing institutions and large infrastructure projects (with a focus on dams). To make for greater generalisability of the findings, future research should complement this work by focusing on private financing institutions and on the financing of other types of projects.

Large infrastructure projects have massive social and environmental impacts, and public financial institutions have a large stake in determining the sustainability (or otherwise) of these projects. The paper seeks to help make large infrastructure investments more sustainable by providing guidance to leaders as to where and how sustainability aspects could best be integrated in financing decisions for these projects.

The value added lies in helping leaders define where sustainability efforts in large infrastructure finance are warranted – and where, conversely, they represent largely wasted efforts.