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Pointers for Practice: From Duty to Report to Adult Protection Conference

The situation Patient is in a community hospital for infection from bed ulcers. They disclose that their main carer a family member:

  • has refused care staff access to their home
  • is not providing adequate basic care
  • is stealing and using the patient’s funds to meet their own needs
  • is not coping

The process Registered nurse makes a duty to report possible abuse and neglect to social services


The situation Patient’s immediate care, support and protection needs identified

Police contacted because of allegations of financial abuse and neglect

Arrangements made with health practitioners to delay discharge

The process Social services, at the screening stage of the process, check facts and accuracy of report and contacts police.

A decision is taken immediate protection is required.

Section 126 enquiries commence


The situation An initial evaluation is completed by a health practitioner who knows the adult at risk.

The adult’s care and support protection needs are identified with participation by the adult at risk who has mental capacity to make decisions about needs and desired outcomes.

The individual remains in hospital whilst a care, support and protection plan is put in place.

Determination 3 the adult is deemed to be at risk and action is required to protect them from abuse and neglect.

The process The initial evaluation commences, and a practitioner is identified to complete the evaluation.

Initial evaluation completed within 7 working days and outcome reached.


The situation The discussion involves social services, health professionals (in hospital and GP) and police.

A care and support protection plan is put in place and all agree that the adult at risk can be discharged from hospital back to their residence. The carer co-operates with the plan.

The patient is deemed to have the mental capacity and has consented to s126 enquiries.

The process The strategy discussion is held within 7 working days of the completion of the initial evaluation.

Care and support protection plan agreed.


The situation Liaison continues between social services and clinical colleagues at additional strategy discussions and discharge arrangements are made.

Despite the plan, the risk continues as the carer, who was initially allowing care staff into the home, is now again refusing them access. The adult at risk agrees to a period in respite care whilst a new period of s.126 enquiries are undertaken.

The process s.126 enquiries commence.


The situation Determination 3 the adult is at risk and longer-term action is needed to protect them. Further strategy discussions/meetings are held prior to a case conference.

The process Outcome of s126 enquiries agreed.


The situation The adult at risk wishes to return home, despite the risks to themselves and it is agreed that they and their carer receive a long-term care and support protection plan. This is a more comprehensive plan and addresses both the adult at risk and carer’s needs.

Police investigate claims of financial abuse but can find no evidence.

The process Conference held and police investigation completed.


The situation Ongoing care and support needs met through services provided within the adult at risk’s home. No ongoing safeguarding issues identified.

The process Review of plan.