Annexes and footnotes to accompany British Sign Language videos
Updated 4 July 2023
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Ministerial foreword
1 Vulnerability Knowledge and Practice Programme. 2022. Domestic Homicide Project Spotlight Briefing #4: Carers (www.vkpp.org.uk).
2 Next steps to put People at the Heart of Care (GOV.UK).
Executive summary
3 Public Health England. 2015. Disability and Domestic Abuse: Risk, impacts and response Domestic Abuse Act 2021(GOV.UK); Home Office. 2022. Domestic Abuse: Statutory Guidance;
SCIE. 2015. Adult safeguarding practice questions (www.scie.org.uk).
4 SafeLives. 2017. Disabled Survivors Too.pdf (safelives.org.uk);
SafeLives. 2016. Safe Later Lives - Older people and domestic abuse.pdf (safelives.org.uk).
5 Vulnerability Knowledge and Practice Programme. 2022. Domestic Homicide Project Spotlight Briefing #4: Carers (www.vkpp.org.uk).
Chapter 1: Introduction
6 Domestic Abuse Bill. 2021. Hansard. UK Parliament.
Chapter 2: Current context
7 DHSC. 2021. People at the Heart of Care: adult social care reform white paper. (GOV.UK).
8 Adult Social Care Activity and Finance Report, England, 2021-22. (digital.nhs.uk);
Community Care Statistics, Social Services Activity, England - 2015-16. (digital.nhs.uk).
9 Nicky Stanley, Christine Anne Barter, Nicola Farrelly, Claire Houghton, Leah McCabe, Franziska Meinck, Helen Richardson Foster, Sarah Shorrock. 2021. Innovation, Collaboration and Adaptation: The UK Response to Domestic Abuse under Covid-19 (clok.uclan.ac.uk);Corinne Peek-Asa, Anne Wallis, Karisa Harland, Kristen Beyer, Penny Dickey, Audrey Saftlas. 2011. Rural disparity in domestic violence prevalence and access to resources. J Womens Health (www.ncbi.nlm.nih.gov).
10 Based on NHS Digital Short and Long-term Support (SALT) data, available at Adult Social Care Activity and Finance Report (digital.nhs.uk).
11 NHS Digital. 2021. Adult Social Care Activity and Finance Report: Detailed Analysis, England 2020- 21 (digital.nhs.uk).
12 Adult social care charging reform: further details. 2022. (GOV.UK).
14 The Care Act 2014 section 10(9) defines a carer as an adult who provides or intends to provide care for another adult, but also states that if the care is provided under or by virtue of a contract or on a voluntary basis, then the adult should not be considered as a carer. However, section 10(9) states that “An adult is not regarded as a carer if the adult provides or intends to provide care – under or by virtue of a contract, or as voluntary work” s.10(10) states that in a case where the local authority considers that the relationship between the adult needing care and the adult providing or intending to provide care is such that it would be appropriate for the latter to be regarded as a carer, that adult is to be regarded as such (and subsection (9) is therefore to be ignored in that case).
15 Unpaid carers may also be family members. Unpaid carers provide care for the person on an unpaid basis due to the person having a long-term condition.
16 Care Quality Commission. 2022. Personal care (cqc.org.uk).
17 More information about who CQC regulates can be found at Care Quality Commission. 2022. Personal care (cqc.org.uk).
18 Office for National Statistics. Unpaid care, England and Wales (ons.gov.uk).
19 DHSC modelling for 2022/23 based on Projections of Adult Social Care Demand and Expenditure 2018 to 2038 (www.lse.ac.uk).
20 NHS Digital. 2020. Health Survey for England 2019 (digital.nhs.uk).
21 ONS. 2020. Domestic abuse prevalence and victim characteristics (ons.gov.uk);
SafeLives. 2015. Insights Idva National Dataset 2013-14. Bristol: SafeLives.
22 Jane Monckton-Smith. 2018. Intimate Partner Femicide Timeline. In: UN Day Opposing Violence against Women Seminar and launch of the Femicide Watch 2018, Dublin.
23 See Public Health England. 2015. Disability and Domestic Abuse: Risk, impacts and response
Domestic Abuse Act 2021 (GOV.UK); SafeLives. 2017. Disabled Survivors Too.pdf (safelives.org.uk); SafeLives. 2016. Safe Later Lives - Older people and domestic abuse.pdf (safelives.org.uk); Home Office. 2022. Domestic Abuse: Statutory Guidance;SCIE. Adult safeguarding practice questions (www.scie.org.uk).
24 See SafeLives. 2017. Disabled Survivors Too.pdf (safelives.org.uk); SafeLives. 2016. Safe Later Lives - Older people and domestic abuse.pdf (safelives.org.uk); SCIE. Adult safeguarding practice questions (www.scie.org.uk).
25 Janet Anand, Brian Taylor, Lorna Montgomery, Onder Bakircioglu, Colin Harper, John Devaney, Anne Lazenbatt, Katherine Pearson, Kathryn Mackay and Denis Nejbir. 2014. A Review of the Adult Safeguarding Framework in Northern Ireland, the UK, Ireland and Internationally.Commissioner of Older People Northern Ireland (dickinsonlaw.psu.edu).
26 Davidson, Phil Rossall and Sarah Hart. 2015. Financial Abuse Evidence Review. Age UK Research.
27 SCIE. Mental Capacity Act. Best interests principle (www.scie.org.uk).
28 Home Office. 2022. Domestic Abuse: Statutory Guidance; SafeLives. 2017. Disabled Survivors Too (safelives.org.uk).
29 Safeguarding Adult Reviews (SAR’s) – Swindon Safeguarding Partnership (safeguardingpartnership.swindon.gov.uk).
30 Pseudonyms have been used in all case studies in order to protect the anonymity and confidentiality of the individuals concerned.
31 NHS Digital. 2022. Safeguarding Adults (digital.nhs.uk).
32 Local Government Association – MSP is a sector-led initiative which aims to develop an outcomes focus to safeguarding work, and a range of responses to support people to improve or resolve their circumstances.
33 Care and support statutory guidance – 1.27 The role of the Principal Social Worker in care and support (GOV.UK).
34 NHS England. What are integrated care systems? (www.england.nhs.uk).
35 For more information on SABs access SCIE’s guidance on Roles and Duties of Safeguarding Adult Boards.
36 Disclosure and Barring Service - GOV.UK (www.gov.uk).
37 A Multi-Agency Risk Assessment Conference (MARAC) is a non-statutory process that brings together statutory and voluntary agencies to jointly support adult and child victims of domestic abuse who are at a high risk of serious harm or homicide, and to disrupt and divert the behaviour of perpetrator(s).
38 A Multi-Agency Safeguarding Hub (MASH) is one way of co-ordinating activity around safeguarding referrals, assessments and joined-up responses. Other local areas may call multi-agency safeguarding structures something different. These bring together expert professionals from a range of services that have contact with children, young people, adults and families, making the best possible use of their combined knowledge and information to safeguarding children who are at risk of harm or neglect.
39 The Domestic Abuse Stalking and Harassment (DASH) risk assessment is one of the tools that professionals can use to help identify the level of risk an individual is facing and to tailor their support accordingly. The DASH risk tool is not a definitive assessment of risk but provides for the identification and assessment of risk based on structured professional judgement.
41 Introduction to Intelligence. Pre-read (college.police.uk).
Chapter 3: Leadership and accountability
42 Skills for Care. 2022. Summary of domiciliary care services (skillsforcare.org.uk).
43 ADASS Autumn Survey Report. 2022. (mcusercontent.com).
44 National Audit Office. 2021. The adult social care market in England (nao.org.uk).
45 ‘By and for’ services are specialist services that are led, designed and delivered by and for the users and communities they aim to serve (for example, survivors from ethnic minority backgrounds, deaf and disabled victims and LGBT victims).
46 Domestic Abuse Commissioner. 2022. A Patchwork of Provision (domesticabusecommissioner.uk).
47 Tackling violence against women and girls strategy. 2021. (GOV.UK).
48 Tackling Domestic Abuse Plan. 2022. (GOV.UK).
49 Victims Funding Strategy. 2022. (publishing.service.gov.uk).
50 SCIE. Safeguarding Adult Reviews (SARs) In Rapid Time. 2023. (www.scie.org.uk).
51 SCIE. Safeguarding adults. (www.scie.org.uk).
52 Care Quality Commission. 2022. Key questions and quality statements. (cqc.org.uk).
53 National Network for Chairs of Adult Safeguarding Boards. www.nationalnetwork.org.uk
54 Local Government Association. National Escalation Protocol for Issues from Safeguarding Adults Reviews from Safeguarding Adult Boards. (www.local.gov.uk).
55 Safeguarding Adult Review Quality Markers are a tool used to support people involved in commissioning and conducting SARs. (www.scie.org.uk).
56 Local Government Association. Analysis of Safeguarding Adult Reviews: April 2017 - March 2019. (www.local.gov.uk).
Chapter 4: Effectiveness of the local response to abuse and neglect in the home
57 Domestic Abuse Commissioner. 2022. A Patchwork of Provision (domesticabusecommissioner.uk).
58 NHS Digital. Adult Social Care Activity and Finance Report, England, 2021-22 (digital.nhs.uk).
59 Carers UK. State of Caring 2022 (carersuk.org).
60 Carers UK. 2021. Evidence review for adult social care reform (publishing.service.gov.uk).
Carers UK. State of Caring 2022 (carersuk.org).
61 NHS Digital. Personal Social Services Survey of Adult Carers in England, 2021-22 (digital.nhs.uk). ‘SACE is representative of adult carers known to their local authority rather than all carers in England’.
62 CPEC. 2020. Supporting carers following the implementation of the Care Act 2014: eligibility, support and prevention (www.lse.ac.uk).
63 Carers UK. State of Caring 2022 (carersuk.org).
64 Public Health England. 2021. Caring as a social determinant of health (publishing.service.gov.uk).
65 Research in Practice. Supporting evidence-informed practice (www.researchinpractice.org.uk).
66 Pseudonyms have been used in all case studies in order to protect the anonymity and confidentiality of the individuals concerned.
67 Camden Safeguarding Adults Partnership Board. 2015. Serious Case Review in respect of ZZ (www.camden.gov.uk).
68 Ministry of Justice. 2022. Achieving Best Evidence in Criminal Proceedings (publishing.service.gov.uk).
69 Draft MCA Code of Practice: summary - GOV.UK (www.gov.uk).
70 University of Bristol. 2022. Mental Capacity, Self-Neglect, and Adult Safeguarding Practices: Evidence Synthesis and Agenda for Change (www.bristol.ac.uk).
71 Pseudonyms have been used in all case studies in order to protect the anonymity and confidentiality of the individuals concerned.
72 London Borough of Barnet. 2022. Financial Abuse and Safeguarding: NCL SAB workshop findings report, Fiona Bateman (barnet.moderngov.co.uk).
73 Andy Myhill and Katrin Hohl. 2019. The “Golden Thread”: Coercive Control and Risk Assessment for Domestic Violence, Journal of Interpersonal Violence, Volume 34, Issue 21-22 pages 4477-4497 (pubmed.ncbi.nlm.nih.gov).
74 Home Office, NPCC, College of Policing. 2021. Vulnerability Knowledge and Practice Programme (VKPP): Domestic Homicides and Suspected Victim Suicides During the Covid-19 Pandemic 2020-2021 (assets.publishing.service.gov.uk).
75 Domestic Abuse Protection Notices / Orders factsheet. 2022. (GOV.UK).
Chapter 5: Research, evidence and Learning
76 Madeleine O’Keeffe, Amy Hills, Melanie Doyle, Claudine McCreadie, Shaun Scholes, Rebecca Constantine, Anthea Tinker, Jill Manthorpe, Simon Biggs and Bob Erens. 2007. UK Study of Abuse and Neglect of Older People Prevalence Survey Report (www.researchgate.net).
77 Claudia Cooper, Amber Selwood and Gill Livingston. 2008. The prevalence of elder abuse and neglect: a systematic review. Age and Ageing, 37(2), pages151-160 (academic.oup.com).
78 ONS. 2022. Domestic abuse prevalence and victim characteristics (ons.gov.uk).
79 NHS Digital. 2022. Safeguarding Adults (digital.nhs.uk).
80 Introduction and Key Points - NDRS (digital.nhs.uk); SAC Introduction and Key Points - NDRS (digital.nhs.uk).
81 Standing Together Against Domestic Abuse. MARAC (www.standingtogether.org.uk).
82 SafeLives. MARAC data 2021-2022 England and Wales (safelives.org.uk).
83 Unpublished data is not reconciled and is subject to change. Data is not available for the following police forces for the time period: Greater Manchester, Kent, Staffordshire, West Midlands and Wiltshire.
84 The total number of offences a defendant is prosecuted for (principal offences plus non-principal offences). There is only detailed prosecution and conviction data for all offences.
85 Ministry of Justice. 2022. Outcomes by Offence 2017 to 2021: Pivot Table Analytical Tool for England and Wales (GOV.UK).
86 Andrew Hutchison Biza Stenfert Kroese. 2015. A review of literature exploring the possible causes of abuse and neglect in adult residential care. The Journal of Adult Protection. Volume 17, Issue 4 pages 216 to 233.
87 Also see Catherine Hawes. 2003. Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America - PubMed (nih.gov) www.ncbi.nlm.nih.gov)).
88 Also see Kateřina Ivanová. 2009. Elder Abuse and Mistreatment in Residential Settings. (researchgate.net).
89 Also see Wenche Malmedal, Astrid Kilvik, Gunn Steinsheim, Anja Botngård. 2020. A literature review of survey instruments used to measure staff‐to‐resident elder abuse in residential care settings (openlibrary.wiley.com).Britt-Inger Saveman, Sture Åström, Gösta Bucht and Astrid Norberg. 2008. Elder Abuse in Residential Settings in Sweden: Journal of Elder Abuse & Neglect: Volume 10, No 1-2 (tandfonline.com).
90 Adult safeguarding policy and law - Research Portal, King’s College, London (kcl.ac.uk).
92 Vulnerability Knowledge and Practice Programme. 2022. Domestic Homicide Project Spotlight Briefing #4: Carers (www.vkpp.org.uk).
93 The VKPP’s analysis is of a total of 470 domestic-abuse related deaths recorded between 1st April 2020 and 31st March 2022. Of these, 79 victims (17%, over one in six) were either cared-for by the suspect of were the carer of the suspect. In the year ending March 2022, there were a total of 134 domestic homicides. Homicide in England and Wales - Office for National Statistics (ons.gov.uk).
94 Home Office. 2022. Key findings from analysis of domestic homicide reviews: October 2020 to September 2021 (GOV.UK).
Chapter 6: Conclusion
95 Care Quality Commission. 2022. Key questions and quality statements. (cqc.org.uk).
96 Research in Practice. Supporting evidence-informed practice (www.researchinpractice.org.uk).
Annex A – Methodology
The evidence presented in the review includes a combination of findings from stakeholder engagement and a review of the existing literature and data (such as the Crime Survey for England and Wales and published social care statistics). This evidence sought to shed light on the prevalence, experiences of, and responses to abuse towards adults in their own homes by people providing their care.
Stakeholder engagement
The review team sought to generate evidence representing a broad group of stakeholders and the specific needs of different cohorts, such as older people, and deaf and disabled people. In total, the review team engaged with 127 individuals, representing over 40 organisations and stakeholder groups via roundtable discussions, workshops and one-to-one interviews.
The review team engaged cross-government policy teams within the Home Office, Department of Health and Social Care, Ministry of Justice, Department for Work and Pensions, Department for Levelling Up, Housing and Communities, and the Cabinet Office. Evidence was also collected from experts by experience, including: representatives from the violence against women and girls and domestic abuse sector, the deaf and disability sector, organisations representing and working with older people with care and support needs and, experts involved in delivery of the existing criminal and safeguarding system including local authorities and social work professionals, police, academics, and the Crown Prosecution Service.
A total of seven stakeholder workshops and roundtable discussions were held with thematic stakeholder groups, attended by seventy-seven stakeholder participants. Fifty one-to-one interviews with stakeholder representatives as summarised in the table below. Workshops and roundtables were held virtually and included frontline professionals including social workers, police officers, care workers and advocates and ‘by and for’ organisations. Separate sessions were held with police and criminal justice partners, and academics. The disability and older people organisations (specialist and ‘by and for’) were represented in roundtables to provide the voice of victims and survivors.
Table 1: Summary of one-to-one interviews with stakeholder representatives
| Stakeholder | Number of interviews |
|---|---|
| Academic experts | 9 |
| Disability sector | 8 |
| Health and social care | 10 |
| Housing sector | 7 |
| Other (such as other government departments and local government representatives) | 9 |
| Police and criminal justice | 7 |
| Total | 50 |
The review team aimed to hear the views of victims and survivors through expert sector organisations. Discussion guides were developed and agreed alongside these expert sector organisations, prioritising the wellbeing of the interviewees, and avoiding re-traumatisation.
In addition to targeted stakeholder engagement, the review team maintained an open mailbox, receiving correspondence from over 130 organisations.
Limitations
Throughout the report the review team discussed the particularly hidden nature of the abuse that people with care and support needs may be suffering at the hands of the people providing their care and the complex nature of this abuse type. This review does not aim to be an exhaustive analysis of this type of harm, but it rather aims to shed a light on the complexity and key issues present when dealing with this type of abuse. Therefore, the report may not cover all issues related to harm in the context of victims with care and support needs exhaustively. The review focuses on the key themes that arose from stakeholder engagement and existing literature. The review recognises that further research should be undertaken to better understand and tackle this type of harm as set out in Chapter 5.
While extensive stakeholder engagement was undertaken as outlined above, findings cannot be viewed as representative of all views and experiences across England.
Use of quotes and case studies
To illustrate evidence which came to light in the process of carrying out this review, the report contains case studies. The review summarises findings from stakeholder roundtables, workshops, and one-to-one interviews, and quotes have been used to reflect some of the common themes. All quotes and case studies have been anonymised so personally identifiable information has been removed. Permission has been obtained from all relevant stakeholders to include anonymised quotes within the review. Quotes reflect what the review team heard from stakeholder representatives, and therefore express personal and professional perspectives.
Annex B – Acronyms
| CQC | Care Quality Commission |
|---|---|
| AFH | Adult family homicides |
| ADASS | Association of Directors of Adult Social Services |
| APCC | Association of Police and Crime Commissioners |
| CSEW | Crime Survey for England and Wales |
| DfE | Department for Education |
| DHSC | Department for Health and Social Care |
| DLUHC | Department for Levelling Up, Housing and Communities |
| DWP | Department for Work and Pensions |
| DBS | Disclosure and Barring Service |
| DA Act | Domestic Abuse Act 2021 |
| DAPO | Domestic Abuse Protection Orders |
| DARA | Domestic Abuse Risk Assessment |
| DASH | Domestic Abuse, Stalking and Harassment |
| DHR | Domestic Homicide Reviews |
| DVPO | Domestic Violence Protection Orders |
| HSE | Health Survey for England |
| ICB | Integrated Care Board |
| IPH | Intimate partner homicides |
| MHA | Mental Health Act |
| MOJ | Ministry of Justice |
| MARAC | Multi-Agency Risk Assessment Conferences |
| MASH | Multi-Agency Safeguarding Hubs |
| NIHR | National Institute for Health and Care Research |
| NMO | Non-Molestation Order |
| OPG | Office of the Public Guardian |
| PCH | Partners in Care and Health |
| PSW | Principal Social Worker |
| SAR | Safeguarding Adult Review |
| SAC | Safeguarding Adults Collection |
| SAB | Safeguarding Adults Board |
| SANN | Safeguarding Adults National Network |
| SCIE | Social Care Institute for Excellence |
| CPS | The Crown Prosecution Service |
| ONS | The Office for National Statistics |
| VKPP | Vulnerability Knowledge and Practice Programme |
Annex C – Definitions contained within the review Terms of Reference
| Own home | This is where the individual permanently resides, whether rented, owned or provided by the local authority. It is where the adult is fully supported to live independently with care arrangements and pays either full or part towards tenancy. |
|---|---|
| Personally connected | People providing care who are “personally connected” for example family members, intimate partners and people who were or are in a civil partner or married. |
| Unpaid carers | Unpaid carers, for example neighbours or friends who provide care for the person. |
| Paid carers | Paid carers – employed care workers, personal assistants and other paid individuals in a position of trust who provide care for the person. |
| Volunteers | Individuals providing care as part of a voluntary organisation to the person. |
Annex D – Definition of domestic abuse under the Domestic Abuse Act 2021
Section 1: Definition of “domestic abuse”
(1) This section defines “domestic abuse” for the purposes of this Act.
(2) Behaviour of a person (“A”) towards another person (“B”) is “domestic abuse” if—
(a) A and B are each aged 16 or over and are “personally connected” to each other,
and
(b) the behaviour is abusive.
(3) Behaviour is “abusive” if it consists of any of the following—
(a) physical or sexual abuse;
(b) violent or threatening behaviour;
(c) controlling or coercive behaviour;
(d) economic abuse (see subsection (4));
(e) psychological, emotional or other abuse;
and it does not matter whether the behaviour consists of a single incident or a course of conduct.
(4) “Economic abuse” means any behaviour that has a substantial adverse effect on B’s ability to —
(a) acquire, use or maintain money or other property, or
(b) obtain goods or services.
(5) For the purposes of this Act, A’s behaviour may be behaviour “towards” B despite the fact that it consists of conduct directed at another person (for example, B’s child).
(6) References in this Act to being abusive towards another person are to be read in accordance with this section.
(7) For the meaning of “personally connected”, see section 2.
Section 2: Definition of “personally connected”
(1) Two people are “personally connected” to each other if any of the following applies —
(a) they are, or have been, married to each other;
(b) they are, or have been, civil partners of each other;
(c) they have agreed to marry one another (whether or not the agreement has
been terminated);
(d) they have entered into a civil partnership agreement (whether or not the
agreement has been terminated);
(e) they are, or have been, in an intimate personal relationship with each other;
(f) they each have, or there has been a time when they each have had, a parental
relationship in relation to the same child (see subsection (2));
(g) they are relatives.
(2) For the purposes of subsection (1)(f) a person has a parental relationship in relation to a child if —
(a) the person is a parent of the child, or;
(b) the person has parental responsibility for the child.
(3) In this section —
“child” means a person under the age of 18 years;
“civil partnership agreement” has the meaning given by section 73 of the Civil
Partnership Act 2004;
“parental responsibility” has the same meaning as in the Children Act 1989; “relative” has the meaning given by section 63(1) of the Family Law Act 1996.
Section 3: Children as victims of domestic abuse
(1) This section applies where behaviour of a person (“A”) towards another person (“B”) is domestic abuse.
(2) Any reference in this Act to a victim of domestic abuse includes a reference to a child who –
(a) sees or hears, or experiences the effect of, the abuse, and
(b) is related to A or B.
(3) A child is related to a person for the purposes of subsection (2) if –
(a) the person is a parent of, or has parental responsibility for, the child, or
(b) the child and the person are relatives.
(4) In this section –
“child” means person under the age of 18 years;
“parental responsibility” has the same meaning as in the Children Act 1989 (see section 3 of that Act);
“relative” has the meaning given by section 63(1) of the Family Law Act 1996.
Annex E – Eligibility to access care and support under the Care Act 2014
Assessing needs can be done within people’s homes with families and friends or by social workers in the community or in health settings. This typically happens as someone gets older and their needs change incrementally. The statutory responsibility to assess care needs sits with local authorities.
Where the person meets the eligibility threshold to receive care and/or support, the local authority will conduct a means test to determine the cost of care and some people will be entitled to free care. The overarching principle is that people should only be required to pay what they can afford. Payment can also be made through a personal budget, which local authorities fund in part or whole. The individual will then decide how they choose to manage their personal budget.
Where an individual fails to meet the local authority threshold, they may need to purchase care for themselves (self-funders) or, in a number of cases, depend on family for care and support.97 98
97 Informal care and poverty in the UK (npi.org.uk).
98 For more information on charging and financial assessments, access chapter 8 of the Care and Support statutory guidance 2014 (GOV.UK).
How are care assessments made?
Under the Care Act 2014, the local authority must carry out an assessment of anyone who appears to require care and support. The purpose of an assessment is to identify the person’s existing needs and how these impact on their wellbeing, and the outcomes that the person wishes to achieve in their day-to-day life. The assessment is done by measuring how someone is able to do daily tasks including:
- managing and maintaining nutrition
- maintaining personal hygiene
- managing toilet needs
- being appropriately clothed
- being able to make use of the adult’s home safely
- maintaining a habitable home environment
- developing and maintaining family or other personal relationship
- accessing and engaging in work, training, education or volunteering
- making use of necessary facilities or services in the local community, including public transport, and recreational facilities or services
- carrying out any caring responsibilities the adult has for a child
The local authority has a duty to provide assistance if someone is unable to meet two or more of these outcomes.99
99 The Care and Support (Assessment) Regulations 2014 (legislation.gov.uk).
The Care Act 2014 states that a local authority must arrange an independent advocate in certain circumstances to facilitate the involvement of a person in their assessment (section 67).100 The Mental Capacity Act 2005 provides for an Independent Mental Capacity Advocate for all those who lack capacity in certain situations (sections 35-41 of the Mental Capacity Act 2005).
When someone is assessed to need care by their local authority, they will be assigned a ‘personal budget’. In some cases, people will use their personal budget to hire directly from a care agency or someone to provide care from their community or a personal assistant. Skills for Care, a workforce development and planning body for adult social care provides comprehensive information for employing personal assistants. The local authority may not necessarily know if someone has employed someone to provide care for them. People will make decisions to suit their own needs. There are situations where volunteers from charities provide care but the charity itself is paid by the local authority or health body.
100 Care Act 2014 (legislation.gov.uk).
Annex F - Types of abuse and neglect
The table below outlines forms of abuse and neglect as identified in the Domestic Abuse Act 2021 and statutory guidance, the Care and Support statutory guidance and the Equalities Act 2010.101 102
| Type of abuse | Description |
|---|---|
| Physical abuse | Examples include: assault, hitting, slapping, pushing, misuse of medication, restraint and inappropriate physical sanction. |
| Domestic abuse | Domestic abuse can be physical, verbal, sexual, emotional, psychological, economic, a combination of these, and include many other forms of harmful behaviour. There is no one type of domestic abuse, nor is there one solution to remedy it. This is reflected in the statutory definition of domestic abuse as set out in the Domestic Abuse Act 2021, and further explained in the Domestic Abuse Act 2021 statutory guidance. 103 It sets out numerous forms of behaviour, any one of which can constitute domestic abuse, if both the victim and perpetrator are “personally connected”. |
| Sexual abuse | Examples include: rape, indecent exposure, sexual harassment, inappropriate looking or touching, sexual teasing or innuendo, sexual photography, subjection to pornography or witnessing sexual acts, indecent exposure, sexual assault, and sexual acts to which the adult has not consented or was pressured into consenting. |
| Psychological or emotional abuse | Examples include: emotional abuse, threats of harm or abandonment, deprivation of contact, humiliation, blaming, controlling, intimidation, coercion, harassment, verbal abuse, cyber bullying, isolation, unreasonable and unjustified withdrawal of services or supportive networks. |
| Financial or material abuse | Examples include: theft, fraud, internet scamming, coercion in relation to an adult’s financial affairs or arrangements, including in connection with wills, property, inheritance or financial transaction, and the misuse or misappropriation of property, possessions or benefits. |
| Modern slavery | Examples include: human trafficking, forced labour, domestic servitude, sexual exploitation (such as escort work, prostitution, pornography and debt bondage). |
| Discriminatory abuse | Examples include: harassment, slurs or similar treatment because of race, sex, gender identity, age, disability, sexual orientation or religion. |
| Organisational abuse | Includes neglect and poor care practice within an institution or specific care setting such as a hospital or care home, or in relation to care provided in one’s own home. This may range from one off incidents to on-going ill-treatment. It can be through neglect or poor professional practice as a result of the structure, policies, processes and practices within an organisation. |
| Neglect and acts of omission | Examples include: ignoring medical emotional or physical care needs; failure to provide access to appropriate health, care and support or educational services; or the withholding of the necessities of life, such as medication, adequate nutrition and heating. |
| Self-neglect | This covers a wide range of behaviours, neglecting to care for one’s personal hygiene, health or surroundings and includes behaviour such as hoarding. It should be noted that self-neglect may not prompt a section 42 enquiry. An assessment should be made on a case-by-case basis. A decision on whether a response is required under safeguarding will depend on the adult’s ability to protect themselves by controlling their own behaviour. There may come a point when they are no longer able to do this, without external support. |
101 Care and support statutory guidance (GOV.UK).
102 For further information on types of abuse and neglect, access the Social Care Institute for Excellence’s guidance. Types of abuse: Safeguarding adults (www.scie.org.uk).
103 Domestic Abuse Act statutory guidance (GOV.UK).
Annex G – Agencies and organisations with safeguarding responsibilities
Safeguarding responsibilities cut across statutory agencies and government departments. The Care Act 2014 sets out that all public organisations should work together and co-operate where needed to ensure a focus on the care and support of adults (including carers’ support) and health and health-related needs of their local population.
The table below provides an overview of the roles and responsibilities of government departments to oversee safeguarding policy and law in England, as well as the regulators responsible for managing adult safeguarding concerns with their responsibilities outlined.
| Government department | Safeguarding responsibility |
|---|---|
| Department for Education (DFE) | Policy and legislation child safeguarding and protection. |
| Department of Health and Social Care (DHSC) | Responsible for policy and legislation regarding health and social care, including safeguarding adults with care and support needs. The department ensures adults with care and support needs are safeguarded when receiving health and social care services through their work with the following agencies and public bodies: the Care Quality Commission, NHS England and local authorities. The minister responsible for social care reform, including safeguarding adults receiving social care services at home, is the Minister for Care Services. |
| Home Office | Responsible for home affairs, including crime and policing, domestic abuse, and domestic homicide reviews. The Safeguarding Minister and Policing Minister are both situated within the Home Office. |
| Department for Levelling Up, Housing and Communities (DLUHC) | Responsible for housing policy, including homelessness. Works closely with the Local Government Association and includes oversight of the Local Government Body. |
| Public and independent bodies | Safeguarding responsibility |
|---|---|
| Care Quality Commission (CQC) | Ensures all registered health and social care providers, are delivering safe care, to a high standard by registering care providers, monitoring, inspecting and rating services and taking action to protect the lives of people who use the service. |
| Local authority social services | Local authorities have a statutory duty to safeguard and promote adults with care and support needs. This includes carrying out safeguarding enquiries and setting up Safeguarding Adults Boards. Local authorities and clinical commissioning groups already have an equal and joint duty to prepare Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies through health and wellbeing boards. |
| Local Safeguarding Adult Boards (SABs) | Under the Care Act 2014, local Safeguarding Adults Boards must lead adult safeguarding arrangements across its locality and oversee and co-ordinate the effectiveness of the safeguarding work of its member and partner agencies. Each Safeguarding Adults Board should have in place a framework to respond to allegations raised about a person who may have harmed or who may pose a risk to adults. |
| Police | Investigate allegations of criminal abuse against children and adults. The police have powers to initiate specific protective actions which may apply, such as Domestic Violence Protection Orders. |
| Disclosure and Barring Service (DBS) | Helps employers make safer recruitment decisions and prevent unsuitable people from working with adults at risk and children. The DBS maintains the ‘adults’ and ‘children’ barred lists. |
| Office of the Public Guardian (OPG) | Protects people in England and Wales who may not have the mental capacity to make certain decisions for themselves, such as about their health and finance. |
| NHS England | The NHS is a clinical commissioning body. GPs and hospitals provide care and are at the front lines of assessing clinical need. Under the NHS Act, NHS England must encourage partnership arrangements between Integrated Care Systems and local authorities where it considers this would ensure the integrated provision of health services and that this would improve the quality of services or reduce inequalities. |
Annex H – Homecare settings
Specialist types of home settings
The nature of some people’s care and support needs will mean that they need housing that is specifically designed to support independent, healthy living. This is generally known as supported housing.
There are different types of supported housing provision, and they vary according to the user’s care and support needs for independent living. At the end of 2015, there were an estimated 651,500 accommodation-based supported housing units in Great Britain, the majority of which (85%) are in England. An estimated 71% of units across Great Britain accommodated older people; 29% of units accommodated working-age people with a very wide range of support needs. 104
104 Ipsos. 2016. Research estimates the scale, scope and cost of the supported housing sector (GOV.UK).
Shared Lives and Homeshare
Shared Lives is a care and support service that matches people aged 16 and above who want to live independently in their community, with Shared Lives carers. It is a flexible model but generally people move in with their Shared Lives carers and are supported within the context of the carer’s home and family. Pairings are based on shared interests and lifestyles. Fewer than 1% of people drawing on long-term social care in England were supported by Shared Lives in 2020-21.105
Other shared living models include Homeshare programmes, which bring together people with spare rooms and individuals who are happy to lend a hand around the house in return for affordable accommodation.
Social housing
The Social Housing white paper sets out how the government expects landlords to work with other agencies such as local authorities to develop a policy setting out how they should tackle issues surrounding domestic abuse. There is also a government commitment from the housing sector to provide housing-related advice, for example, securing a permanent home and advice on how to live safely and independently and also the provision of counselling and therapy for both adults and children.106
105 Shared Lives Plus. Report: The state of Shared Lives in England in 2020-2021 (- Shared Lives Plussharedlivesplus.org.uk).
106 For more information on homecare settings, access The Department of Levelling Up, Housing and Communities and Ministry of Housing, Communities & Local Government’s guidance on Housing for Older and Disabled People.
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