Disclosure and Raising a Concern

Scope of this chapter

Disclosure: Making something known to others

We all need to understand what to do when someone we support makes a disclosure or when we suspect that abuse or neglect is, has or may occur.

This chapter explains how to support a person that makes a disclosure and when/how to raise a concern to the local authority. It also provides additional guidance for managers/the registered person about notifications.

Relevant Regulations

Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 

Regulation 11: Need for consent

Regulation 12: Safe Care and Treatment

Regulation 13: Safeguarding service users from abuse and improper treatment

Care Quality Commission (Registration) Regulations 2009 (subheading)

Regulation 18: Notification of other incidents

Related Chapters and Guidance

Disclosures can come directly from the person. They can also be made by others using the service. Normally this happens when the person being abused has confided in them, or they have seen something that concerns them. For example, an incident of abuse taking place, an injury or emotional distress.

Disclosures can be made verbally, or through another means of communication e.g., a text, email, letter or drawing.

Disclosures can also be historical. This means they relate to abuse or neglect that has taken place some time ago, which can be years. For example, child sexual exploitation.

All disclosures should be taken seriously.

Making a disclosure can be very traumatic for people, and often they will have spent some time thinking about whether to tell someone what has happened, is happening or what they are worried about.

One of the barriers to disclosing can be the fear that nothing will happen, that they will not be believed or that the abuse will get worse because they have told someone.

It is important that all these potential fears are recognised and the person is supported.

  • Take the person’s disclosure seriously;
  • Accept what the person is saying;
  • Listen to the person carefully;
  • Don't interrupt the person;
  • Try to remember the words used by the person, and anything they want to happen next;
  • Stay calm with the person and avoid reactions such as shock, disbelief or anger;
  • Ask questions of the person to establish the basic facts - when, where, what happened?
  • Establish if the person feels safe now - to help identify any immediate action required;
  • Establish any emotional support the person may need - family, friends, advocate;
  • If a crime may have been committed, ask the person if they wish to report it the police (see below);
  • Seek the person’s consent to raise a concern with the local authority (see below);
  • Explain to the person what will happen next and about the process;
  • Reassure the person that they will be involved in any decisions.
  • Question the person’s motives for disclosing;
  • Interview the person;
  • Make the person repeat the disclosure to another staff member or manager;
  • Make promises to the person about keeping the information confidential;
  • Speculate to the person about the outcome of any safeguarding enquiry or police investigation.

A written record of the disclosure must be made as soon as possible after the disclosure has been made. 
The record should contain all the following information:

  1. The date, time and location that the disclosure was made by the person;
  2. The full name of the person that made the disclosure;
  3. The facts that have been provided by the person;
  4. The evidence that has been seen, including any injuries or witnesses;
  5. The views and wishes of the person.

All records should be legible, signed and dated by the staff member making the record. 
The registered person and any relevant manager should be informed of the disclosure and support the staff member to make decisions about immediate action and the process of raising the concern with the local authority or police.

This section of the chapter applies whenever safeguarding concerns are present, regardless of whether a disclosure has been made.

As soon as we are aware of the concerns, we have a duty to take any immediate action necessary to protect the person from any risk of ongoing physical and emotional harm. We should not wait until a concern has been raised to the police and/or the local authority to do this.

Unless there is a risk to life or to others, any immediate actions should take place in line with the views and wishes of the person about how best to protect them from harm.

Examples of immediate action could include:

  • Call 999 if a crime is in progress;
  • Call 999 in a medical emergency;
  • Call NHS 111 for medical advice;
  • Take the person to their GP or other health professional;
  • Support the person to get home safely;
  • Asking someone to leave the premises;
  • Arrange for someone else to be with the person so they are not alone;
  • Take steps to manage the risk to others.

If a crime has or may have been committed the person should always be encouraged to report it to the police.

If they do not wish to report it to the police and have the mental capacity to make this decision you should not report it unless other people continue to be at risk. This includes other people being supported by the service, staff, visitors and the wider public. If this is the case, you should let the person know that you are going to report it to the police and why. The person may still decide that they personally do not wish to take matters any further, but the police will be able to investigate and take appropriate action to prevent harm to others.

If the person lacks mental capacity to decide whether to report it to the police, this decision will need to be made in their best interests. Unless there is a strong reason not to, a report to the police should always be made as this empowers the person to exercise their basic citizens' right to justice.

Note: When a police report is made, a concern should still be raised to the local authority (see below).

It is important to preserve physical evidence at the scene of any potential crime.

If the police have not already explained how to do this, call them back and ask. They are the experts and are responsible for determining what evidence should be preserved and how to do this. Do not make assumptions about this-if you get it wrong it could jeopardise the whole investigation.

Depending on the nature of the concerns raised, the preservation of physical evidence could involve:

  • Not touching anything that you do not need to touch;
  • Not cleaning surfaces, carpets, door handles etc.;
  • Not washing clothing or bedding;
  • Not throwing anything away;
  • Limiting physical contact with the person;
  • Discouraging the person from washing/bathing;
  • Securing the area where the incident took place and not allowing anyone in.

A concern must be raised as soon as possible whenever the duty to do so applies. Delays in raising a concern can put people at unnecessary risk of harm and reflect poorly on the service.

When the safeguarding duty applies

The person:

  1. Has needs for care and support; and
  2. They are experiencing, or at risk of experiencing abuse or neglect; and
  3. As a result of their care and support needs, they are unable to protect themselves against the abuse or neglect.

If you are not sure whether the above criteria are fully met, you should raise the concern anyway. The local authority will review the information and make the decision about any need to instigate a safeguarding enquiry.

Safeguarding is everyone's responsibility.

Anyone who suspects, or knows that, abuse or neglect is, or may be at risk of occurring, must notify the local authority. This applies to all staff and managers.

Never assume that another person or organisation will raise the concern, even if they tell you they will.

The consent of the person should always be sought before raising the concern, unless one or more of the following applies:

  1. Seeking consent will increase the level of risk to the person, another vulnerable person or a child;
  2. Consent cannot practically be sought. For example, you are being denied access to the person or the person cannot be located in a timely fashion;
  3. The person lacks capacity to consent, and a decision has been made that raising a concern is in their best interests.

Note: A mental capacity assessment must be completed before reaching the conclusion that the adult lacks capacity to consent.

See: Mental Capacity

Withheld consent

Under the Care Act, a safeguarding concern must be raised whenever the duty to do so applies (see above). A failure to do so is against the law.

If the person does not consent to a concern being raised, you should contact the local authority for advice about whether to raise a concern. The local authority should be happy to provide advice on the circumstances without the need to identify the person concerned.

If there is an ongoing risk to the person or anyone else, or if the level of harm caused was serious, it is likely that you will be advised by the local authority to raise a concern. If this is the case the person should be told that a concern has been raised and why. The local authority will then consider whether an enquiry is the most appropriate response. If they decide it is, they will only intervene in ways necessary to reduce the risk of harm.

Concerns should be raised in line with the local multi-agency safeguarding procedures. Information about how to raise a concern will also be available on the local authority's website.

The local authority may want any written evidence emailing. For example, a record of disclosure. This should be done securely.

You should also explain any immediate action that has been taken to safeguard the person and others from ongoing risk of harm.

If a report has been made to the police, the investigation number should be provided so the local authority can liaise with the investigating officer and coordinate their response.

Any advice or instruction given by the local authority should be recorded and implemented in a timely way.

A separate concern should be raised for each person that is experiencing, or at risk of experiencing abuse or neglect. After receiving the concerns, the local authority will review the information and decide whether to make separate enquiries or a single joint enquiry.

If the person has asked for a family member or friend to be notified, then they should be notified. This applies unless a family member or friend is the person causing the harm. If this is the case, always take and follow advice from the local authority or police (if a report has been made). This will likely be different depending on the specific concerns and circumstances.

If the individual holding the Lasting Power of Attorney (LPA) or the Deputy is responsible for making health and welfare decisions, they should be notified as soon as the concern has been raised. Their views should always be regarded by the local authority, as they represent the person.

The registered person may decide that it is appropriate to take immediate action to reduce risk by way of redistributing or even suspending the staff member in question.

At this stage all action against a staff member should be done on a 'without prejudice' basis, and in line with relevant HR procedures and processes. Any bullying or harassment of the staff member by other staff members must not be tolerated.

Once any immediate action has been taken, the service should await instruction from the local authority before carrying out any further internal enquiries.

As soon as the concern has been raised the Care Quality Commission must be notified. This is a legal requirement.

For guidance on CQC notifications see Notifications: Guidance for non-NHS trust providers.

The organisation commissioning the service should also be notified.

If there has been an incident of abuse or neglect and serious physical harm has occurred the duty of candour may apply.

For further guidance see: Duty of Candour.

If the person has died as a result of abuse and neglect, and there is not already a safeguarding adult process underway, then a safeguarding concern should not be raised. This is because an enquiry cannot be undertaken in relation to a person who is deceased.

The service should instead take the following actions:

  1. Notify the police (see below);
  2. Raise a concern/s to the local authority if anyone else remains at risk;
  3. Refer the matter for a Section 44 Safeguarding Adults Review (see below);
  4. Notify the Care Quality Commission (CQC) - this must be done;
  5. Notify the appropriate Commissioning Team - this must be done;
  6. Notify the Coroner, unless the police or attending doctor is doing this.

Notifying the police

The police should be notified as a matter of urgency when the death is potentially attributed to abuse or neglect, and/or there is reason to suspect that a crime has possibly been committed. If this is not the case, the police do not need to be notified.

A Safeguarding Adults Review (SAR) referral must be made if there is a reasonable cause for concern about how the local authority and any other agency involved in safeguarding the person have worked together in either of the following circumstances:

  1. The person has died, and it is known or suspected that abuse or neglect was the reason;
  2. The person is alive, but it is known or suspected they have experienced serious abuse or neglect.

If these circumstances do not apply, a SAR referral does not need to be made.

Each local authority will have its own process for making a SAR referral, including who should make such a referral.

Last Updated: September 12, 2022