All health and social care professionals have a responsibility to protect people from harm, abuse and neglect. It’s part of their role to act when they’re concerned about a patient or carer’s safety. Here, you can find information on spotting the signs of abuse, reporting abuse, and supporting your patients and those around them.
If you or someone else are experiencing, or at risk of, abuse or neglect read our information on how to get help. If you or someone else is in immediate danger, telephone 999.
This information is for health and social care professionals. You can use our My Learning form to reflect on how this page has helped with your continuing professional development. Download the form.
Key points
- It’s everyone’s responsibility to report concerns about a patient or carer’s safety – do not assume someone else will do it.
- Call 999 if you or the person is in immediate danger.
- If the person is not in immediate danger, and it’s safe to do so, speak to them about your concerns.
- Report your concerns to your line manager or safeguarding lead and clearly document all your actions.
- Be aware of different types of abuse and signs someone is being abused.
- Be familiar with mental capacity and how this may affect a person’s ability to consent.
- Involve the person you’re concerned about in decisions.
What is safeguarding in palliative care?
Safeguarding means protecting a person's right to live in safety, free from abuse and neglect.
Safeguarding includes:
- reducing the risk of abuse and neglect to patients and carers
- preventing and stopping abuse or neglect where possible
- supporting patients and carers to make choices and have control over how they live their lives
- providing information so patients and carers know the different types of abuse and how to report concerns about abuse or neglect.
As a health and social care professional, you have a responsibility to report any concerns you have. If it’s safe to do so, you should also speak to the person you’re worried about, and keep them at the centre of any decision making.
Abuse and neglect in palliative care
There are different types of abuse:
- Physical abuse – for example, hitting, slapping or restraining someone.
- Sexual violence – for example, touching someone's body or trying to have sex with them when they have not consented (agreed) to it.
- Psychological abuse – for example, threatening, bullying, or trying to control the person.
- Financial abuse – fraud, theft, or trying to control someone's money without their permission.
- Domestic abuse – if someone's abused by a partner or family member.
- Discrimination – treating someone differently because of things like religion, race or sexuality.
- Modern slavery – for example, forcing someone to work against their will.
- Organisational abuse (called institutional abuse in Northern Ireland) – for example, if the place the person's being cared for, like a care home or hospital, does not give them proper care.
- Neglect – if someone refuses to care for the person properly, like not giving them the medication they need.
- Self-neglect – if someone does not look after themselves, for example refusing to wash or take their medication.
Abuse can be both intentional and unintentional. It can happen to anyone.
Patients might be abused by their family members, friends, carers, neighbours, health and social care professionals or strangers. Abuse and neglect can happen at home, as well as in health and social care settings such as care homes, hospices and hospitals.
Carers and the people around the patient can be abused, too.
A relationship might become abusive over time. For example, if someone’s ability to care for someone changes and they become neglectful.
Some people are more at risk of abuse, including:
- people with care and support needs.
- people who have difficulty communicating
- people who have cognitive impairments, such as people with dementia.
People in these groups might be referred to as vulnerable adults.
Signs of abuse and neglect in palliative care
Being able to recognise signs of abuse and neglect helps to protect patients and prevent harm in palliative care.
Signs that someone might be being abused include:
- changes in their behaviour, like becoming quieter, angrier or more withdrawn
- becoming more tearful or depressed
- not wanting to be left by themselves or alone with a particular person
- being unusually light-hearted or saying nothing's wrong
- looking untidy or dirty – for example, having dirty fingernails or bad hygiene
- unexplained bruises, wounds or injuries which are not being treated
- the same injuries happening more than once
- the person's home being colder or more untidy than usual
- the person being more isolated from family and friends than usual
- changes to their finances, like having less money than usual.
Barriers to someone telling you about abuse
It's also important to recognise the barriers which might stop someone from reporting abuse. These can include:
- being afraid of the abuser and what they might do
- being worried about what will happen to the abuser
- feeling embarrassed, ashamed or scared
- being worried about anyone who's dependant on them, like children or pets
- not knowing who to talk to or who to trust
- having bad experiences with reporting things in the past
- not thinking the person's behaviour counts as abuse
- pressure not to report it from family, or other people close to them
- fear of losing contact with the abuser or with other people.
Reporting abuse and neglect
Patient safety is an important part of providing good palliative care. If you’re worried that a patient or carer is being abused or at risk, it’s important to act as soon as possible. As a health and social care professional, you have a duty of care to protect patients.
It’s everyone’s responsibility to report signs of abuse - do not assume another professional will do something.
Call 999 if you suspect abuse and the person is in immediate danger.
If the person is not in immediate danger, you should report the abuse to your line manager or your organisation’s safeguarding lead.
Follow the safeguarding policy for your organisation and the policy for sharing information about patients. Most organisations will have a place to log safeguarding concerns. Ask your manager if you do not know how to do this, or do not know where to find the safeguarding policy.
If it’s safe to do so, speak to the person you have concerns about first. As a health and social care professional, you should have had training in how to do this. If you think speaking with the person might put them in danger, talk to your line manager or safeguarding lead first.
Consent and confidentiality
When you first start talking to someone you have concerns about, here are a few things to keep in mind:
- Let them know that you might need to report what they say, so they can decide if they want to share anything. This puts them in control of what they tell you.
- Ask for their permission before sharing anything they've told you with other professionals.
- Check if they can give consent for you to share their information. They might not be able to do this if they lack mental capacity.
Mental capacity and consent
Sometimes, patients cannot make decisions for themselves because of their condition or symptoms. This is called lacking mental capacity.
If a patient lacks mental capacity, they might not be able to make decisions about their own situation or give consent for you to share their information. In these cases, decisions will be made for them. If you think a patient might not have mental capacity, talk to your line manager or safeguarding lead.
When and where to have the conversation
When you have the conversation with the person, these are some things to consider:
- Speak to them alone – not with family, friends or children.
- Plan enough time to speak to them properly, and make sure you will not be interrupted. Ask your manager if you need someone to cover your other duties.
- Consider whether they need support with communicating in different ways.
- If they speak a different language to you, use a professional interpreter. Do not ask a friend or family member to interpret.
What to say
It can be hard to know what to say. Here are some tips for having an open conversation:
- Give the person time to talk, and do not rush them.
- Let them know they're being listened to and it's OK to feel how they do.
- Let them know you believe them, and they have done the right thing by talking to you. Tell them it's not their fault.
- Make a note of what the person says, including when and where they said the abuse happened. Try to use the specific language and words they used.
- Tell them what you'll do next – it's important to keep them informed and involved with decisions.
- Make sure you document what has been said, what actions you will take and any follow-up that's required.
Questions to ask
You could ask:
- Has anything happened that's worried you, or made you feel frightened or threatened?
- Where did it happen?
- When did it happen?
- How long has it been going on for?
- Is there anything you want to happen, or do not want to happen, about the abuse?
- What would you like me to do?
Supporting patients and those around them
If you're concerned about a patient, carer, or anyone close to them, speak to your line manager or safeguarding lead. You can also do the following things to support them:
- Encourage them to talk to someone they trust and feel comfortable with, if they have any concerns about their safety or wellbeing. This could be a healthcare professional, a family member, or friend.
- Make sure the patient and those around them are being emotionally supported.
- Give them information on practical caring tasks, like giving mouth care or moving someone.
- Make sure they know about the support they could get, like equipment, having carers come into the home, and respite breaks.
- Encourage them to call the Marie Curie Support Line on 0800 090 2309 if they need someone to talk to.
Getting support for yourself
Reporting a safeguarding concern, being involved in a safeguarding case, or listening to a patient’s experience can be hard. As a healthcare professional, it’s important to remember to look after your own wellbeing.
Here are some things you can do to look after yourself.
- Speak to your safeguarding lead or team. They will be able to offer guidance and support.
- Check if your employer offers an Employee Assistance Programme. This might offer confidential counselling and emotional support.
- Reach out to a professional body that offers advice about safeguarding concerns. This could be the General Medical Council or the Nursing and Midwifery Council.