Adult Safeguarding (Vulnerable Adults, Domestic Abuse)

SJT Textbook: Adult Safeguarding (Vulnerable Adults, Domestic Abuse)

Adult Safeguarding MSRA

This guide covers the complex legal landscape of Adult Safeguarding MSRA scenarios. In the Professional Dilemmas paper, you must navigate the Care Act 2014, balancing a competent adult’s right to autonomy with your statutory duty to protect them from harm.

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🎯 THE CORE PRINCIPLE

Adult safeguarding protects adults with care and support needs who are experiencing, or at risk of, abuse or neglect and, as a result of those needs, cannot protect themselves. When these criteria are likely met, the local authority has a Care Act section 42 duty to make (or cause to be made) an enquiry to determine what action is needed and by whom.

Practice should follow the six principles of adult safeguarding: Empowerment, Prevention, Proportionality, Protection, Partnership, and Accountability. Making Safeguarding Personal (MSP) means asking the adult what outcomes matter to them and involving them as far as possible, including advocacy where needed.

For domestic abuse, you should use the Domestic Abuse Act 2021 definition (including controlling and coercive behaviour, and recognising children as victims), assess risk with the DASH checklist, and refer high-risk cases to MARAC for multi-agency safety planning. In the MSRA SJT, the highest-scoring options make the situation safe, apply MSP, use s42/DASH/MARAC appropriately, share information lawfully on a need-to-know basis, and document clearly.

⚡ HIGH-YIELD ACTIONS (What Scores Points)

1. Ensure immediate safety: assess risk, consider children in the household, and contact emergency services or police without delay when there is imminent danger or a serious crime.
2. See the adult alone wherever possible to explore domestic abuse, coercive control, and what feeling safe would look like for them.
3. Assess capacity and consider Making Safeguarding Personal, asking about preferred outcomes and offering independent advocacy where they would otherwise struggle to be involved.
4. For suspected domestic abuse, complete a DASH risk checklist and classify the level of risk; for high risk, refer to MARAC for multi-agency planning.
5. Refer or consult for a Care Act section 42 enquiry when criteria appear to be met, involving Adult Social Care and your safeguarding lead.
6. Share information on a need-to-know basis, using the minimum necessary to prevent or reduce harm, and record the lawful basis when sharing without consent.
7. Involve appropriate specialist support such as IDVA/ISVA, domestic abuse services, police, and children’s services where relevant.
8. Record a clear, contemporaneous note of concerns, the adult’s wishes, capacity assessment, DASH findings, agencies contacted, information shared, and the agreed plan with review points.
9. Safety-net and arrange follow-up, including specific triggers for re-escalation, further referrals, or urgent review.

Trap options usually delay action while seeking proof, hide behind an over-rigid view of confidentiality, rely on passive signposting, or share information carelessly. High-scoring answers act on risk, share minimally and lawfully, and use formal safeguarding pathways.

💬 MODEL PHRASES (Use These in SJT Logic)

* “Because I am worried about your safety, I will share limited information with safeguarding and, if the risk is high, with the MARAC team; I will record what I share and why.”
* “What would feeling safe look like for you, and who would you like us to involve in planning that?”
* “I am going to complete a DASH assessment now and refer to Adult Social Care for a Section 42 enquiry today.”
* “If you do not feel able to consent at the moment and I am concerned about serious harm, I may still need to share information to protect you, but I will explain what I am doing.”
* “We can arrange an independent advocate to help you be involved in any safeguarding meetings and decisions.”

Safety now • Ask about abuse, capacity and outcomes (MSP) • Form DASH • Enquire under Care Act s42 • 4: share minimally, record basis, plan, review • 2: DA → MARAC

📋 QUICK FAQ

Does adult safeguarding only apply when someone lacks capacity?
No. Safeguarding duties apply regardless of capacity. Even where an adult has capacity, you may still need a proportionate multi-agency plan, and a section 42 enquiry may be appropriate if criteria are met.

When can I share information without consent in domestic abuse cases?
You may share without consent when there is risk of serious harm or death, to prevent or detect crime, or where public or vital interests apply. You should share the minimum necessary, use secure channels, and record your lawful basis and proportionality.

What is MARAC and when should I use it?
MARAC (Multi-Agency Risk Assessment Conference) is a meeting for the highest-risk domestic abuse cases, usually triggered by a high DASH score or professional judgement. Agencies share relevant information and agree a coordinated safety plan.

What is meant by Making Safeguarding Personal (MSP)?
MSP is a person-led, outcome-focused approach where you ask the adult what they want to happen, consider their capacity and values, and involve them in decisions, using advocacy where needed, while still managing risk.

Do children count as victims in domestic abuse?
Yes. Under the Domestic Abuse Act 2021, children who see, hear, or experience the effects of domestic abuse are recognised as victims in their own right and require safeguarding consideration and possible referral to children’s services.

What must always go in my notes?
Record the concerns, injuries or patterns, what the adult said, capacity assessment, DASH findings, agencies or professionals contacted, information shared and lawful basis, the agreed plan, and any follow-up or review arrangements.

📚 GMC ANCHOR POINTS

* Take prompt action if you think that patient safety, dignity or comfort is being compromised (GMC Good medical practice 2024).
* Share information appropriately for patient protection while respecting confidentiality and legal duties (GMC Confidentiality guidance).
* Work in partnership with social care, police, and other agencies to protect patients and the public (GMC Good medical practice 2024).
* Treat patients fairly and with respect, paying particular attention to those who may be vulnerable or subject to abuse.
* Keep clear, accurate, and contemporaneous records of concerns, information-sharing decisions, and safeguarding actions.
* Raise and escalate concerns through appropriate channels if local systems do not respond adequately to risk.

💡 MINI PRACTICE SCENARIO

A 38-year-old woman with longstanding rheumatoid arthritis and care needs attends with her partner. She has multiple bruises in different stages of healing and appears anxious. When you ask about this, her partner answers for her and refuses to leave the room. She quietly whispers “it is worse at home” when he steps outside briefly to take a phone call.

Best action: See her alone, explore domestic abuse and coercive control, assess capacity and what she wants to happen, complete a DASH assessment, and refer to Adult Social Care for a potential section 42 enquiry, sharing the minimum necessary information (with or without consent if serious harm is likely), considering MARAC and police, and documenting everything clearly.
Why: This balances safety, MSP, Care Act s42 duties, and DA best practice (DASH→MARAC), with lawful proportionate information-sharing and good records.

🎯 KEY TAKEAWAYS

✓ Safeguarding adults focuses on risk and patterns, not certainty or proof.
✓ Care Act section 42 sets a duty to enquire when adults with care and support needs are at risk and cannot protect themselves.
✓ The six principles and MSP should guide all decisions: person-led, proportionate, and protective.
✓ Domestic abuse requires structured risk assessment with DASH and multi-agency planning via MARAC for high-risk cases.
✓ You can share information without consent where serious harm, crime, or public/vital interests are at stake, but you must share minimally and document the lawful basis.
✓ Children in domestic abuse environments are victims in their own right and need safeguarding consideration.
✓ In the SJT, high-scoring answers make safe, apply MSP and s42/DASH/MARAC, share proportionately, and keep clear records.

🔗 RELATED TOPICS

* → Safeguarding Adults at Risk (Care Act s42)
* → Domestic Abuse and MARAC
* → Capacity and Best Interests (Adults)
* → Safeguarding Children and Young People
* → Confidentiality and Information Governance
* → Information Sharing in Safeguarding

📖 FULL PRACTICE QUESTIONS

Example SJT — Best of 3 (8 options; choose three)

A 36-year-old woman with multiple sclerosis receives a care package at home. She attends clinic with her partner, who insists on answering all questions. She has fingertip bruising on her upper arms and a healing rib fracture noted on recent imaging. She looks fearful, avoids eye contact, and says she “falls a lot”. There are two children aged 5 and 7 at home. When the partner briefly leaves the room, she whispers “he gets angry; he says he will kill me if I tell anyone”.

Options:
A. Accept her explanation about falls and continue routine follow-up.
B. See her alone, explore domestic abuse and coercive control, assess capacity and what she wants to happen, and offer an independent domestic abuse advocate.
C. Complete a DASH risk checklist, consider the presence of children, and classify the risk as high if criteria are met.
D. Contact Adult Social Care to discuss a potential section 42 enquiry and safeguarding of both the adult and her children.
E. Wait for written consent before sharing any information with other agencies.
F. Make a MARAC referral for high-risk domestic abuse and share the minimum necessary information with MARAC partners.
G. Post the story in a staff WhatsApp group to see who knows the family.
H. Give her a generic leaflet on relationships and ask her to return if things get worse.

Example SJT — Rank 5 (best → worst)

A 72-year-old man with dementia lives with his adult son, who manages his finances. The bank flags unusual large withdrawals, and a neighbour reports shouting and seeing the son roughly handle him. In clinic, the man appears confused and distressed. When alone, he says “they take my money; I am scared at night”. You suspect financial and physical abuse and know he needs support with daily living.

Options:
A. Speak to him alone, assess capacity regarding finances and safety, explore what he wants, and refer to Adult Social Care for a section 42 enquiry, sharing minimal necessary information and offering advocacy.
B. Document your concerns, contact the bank’s safeguarding team, discuss with your safeguarding lead, and consider referral to police for financial abuse as part of a multi-agency plan.
C. Give him a leaflet on budgeting and advise him to talk to his son about money.
D. Do nothing further because he appears to have some understanding and you do not want to interfere in “family matters”.
E. Secretly share his story, including identifiable details, in a local WhatsApp group for clinicians to “see if anyone else has noticed it”.