Recognising Neglect

SJT Textbook: Recognising Neglect

Recognising Neglect MSRA

This guide covers the subtle but high-risk topic of Recognising Neglect MSRA scenarios. In the Professional Dilemmas paper, you must demonstrate the ability to spot “Cumulative Harm”—understanding that a series of minor concerns often equals one major safeguarding risk.

🎥 Video Lesson (YouTube)

🎧 Podcast Lesson (Spotify / Apple / Amazon)

🎯 THE CORE PRINCIPLE

Neglect is often invisible in single snapshots and becomes clear only when patterns are viewed over time. Child neglect is the persistent failure to meet basic physical, emotional, educational, or psychological needs, leading to significant impairment in health or development. Adult self-neglect involves a wide range of behaviours including not looking after personal hygiene, health, or home environment and may include hoarding; it is an adult safeguarding category under the Care Act.

Your role is to recognise patterns (missed appointments, poor growth, repeated concerns), record them clearly and objectively, and refer proportionately. For children, you use Working Together to Safeguard Children (2023) and Children Act pathways (s.17/s.47). For adults, you consider Care Act s.42 thresholds for self-neglect, capacity, risk, and Making Safeguarding Personal (MSP).

In the SJT, high-scoring options notice trajectories, not isolated incidents; create a structured chronology; share information lawfully on a need-to-know basis; involve multi-agency partners; and refer early rather than “monitoring” indefinitely.

⚡ HIGH-YIELD ACTIONS (What Scores Points)

1. Look for cumulative patterns of neglect rather than judging individual consultations in isolation.
2. Document concerns objectively with dates, times, verbatim quotes, and (for physical findings) body maps according to local policy.
3. Build and maintain a concise chronology that highlights missed appointments, repeated injuries, school or carer concerns, and professional worries.
4. Share information lawfully and proportionately with relevant agencies (e.g. MASH, Adult Social Care, health visitor, school), using secure channels and recording your rationale.
5. Refer early to Children’s Social Care (s.17/s.47) for children and to Adult Social Care for possible Care Act s.42 enquiries in adult self-neglect.
6. Apply Making Safeguarding Personal with adults – explore their views, outcomes, and engagement while still managing serious risk.
7. Involve other services (health visiting, school nursing, housing, fire service for hoarding) to reduce risk and monitor progress.
8. Arrange review points and safety-netting rather than assuming “no news is good news”.

Traps typically minimise risk, rely on “watchful waiting” instead of using chronology and safeguarding pathways, or misuse confidentiality to block appropriate information-sharing.

💬 MODEL PHRASES (Use These in SJT Logic)

* “Because I am worried about safety, I will share the minimum necessary information with Children’s Social Care on secure channels and record my rationale.”
* “Let us talk about what outcomes you would like; we can work with other services to reduce the risks and support you.”
* “I will compile a brief chronology of previous contacts and concerns to share with the safeguarding team.”
* “Although this visit alone may seem minor, when we look at the pattern over time it meets the threshold to refer.”

Notice patterns • Evidence (quotes and body maps) • Get safeguarding help (MASH/Adult Care) • Lawful information-sharing • Engage person/family (MSP) • Chronology • Thresholds (s.17/s.47; s.42)

You can also remember adult self-neglect as CHORE = Cleanliness • Health • Organisation • Risk (fire/safety) • Engagement.

📋 QUICK FAQ

Does adult self-neglect always trigger a Care Act s.42 enquiry?
No. Self-neglect is a safeguarding category but s.42 enquiries are decided case-by-case, based on care and support needs, level of risk, and the person’s ability to protect themselves, taking capacity and engagement into account.

Do I need consent to share concerns about possible neglect?
Not when you are sharing to safeguard a child or adult at risk or to prevent serious harm. You should share the minimum necessary information on secure channels and record your lawful basis and rationale.

What is the difference between “monitoring” and a chronology?
“Monitoring only” without action can allow cumulative harm to continue. A chronology actively collates concerns over time and supports clear decisions about thresholds and referrals.

What is Making Safeguarding Personal (MSP) in self-neglect?
MSP means working with the adult to understand what matters to them, agreeing outcomes, and offering proportionate support, while still acting where risk is unacceptable or others (e.g. neighbours, co-tenants) may be harmed.

When should I move from early help to formal safeguarding?
When cumulative concerns suggest significant impairment or significant harm is likely or occurring (for children) or when adult self-neglect meets Care Act s.42 criteria; persistent risk despite lower-level support is a key trigger.

📚 GMC ANCHOR POINTS

• Take prompt action if you believe a patient or others are at risk of abuse or neglect, including children and adults with care and support needs.
• Share information appropriately, in line with confidentiality guidance, to protect patients from harm.
• Raise and escalate concerns through appropriate channels when systems or individuals may be putting patients at risk.
• Keep clear, accurate, and contemporaneous records, including concerns, information shared, referrals made, and the reasoning behind decisions.
• Work collaboratively with other professionals and agencies to safeguard and protect vulnerable people.

💡 MINI PRACTICE SCENARIO

A 3-year-old has attended your surgery several times over six months. They often arrive hungry and unwashed, with persistent untreated eczema and missed immunisations. The nursery reports poor attendance and frequent tiredness. The parents appear overwhelmed but minimise concerns.

Best action: Document your findings and nursery concerns objectively; compile a short chronology of attendances and missed care; discuss promptly with your safeguarding lead; make a same-day referral to Children’s Social Care (MASH) under s.17/s.47 as appropriate; share the minimum necessary information lawfully via secure channels; and liaise with the health visitor or school nurse.
Why: Neglect is cumulative; Working Together expects you to act on reasonable concern, use chronology, and refer early rather than continuing to “monitor” without escalation.

🎯 KEY TAKEAWAYS

✓ Neglect is usually cumulative – patterns across time matter more than single visits.
✓ High-quality documentation and chronologies are central to safe decision-making.
✓ You can share information without consent when necessary to safeguard or prevent serious harm, using secure channels and recording your rationale.
✓ Children with repeated missed care or adults in severe self-neglect should be referred early to statutory safeguarding pathways.
✓ Making Safeguarding Personal means involving adults in decisions while still managing serious risk.
✓ Multi-agency working (health, education, housing, fire service) is often needed to reduce neglect-related risk.

🔗 RELATED TOPICS

* → Child Safeguarding (s.17 Child in Need; s.47 Significant Harm)
* → Adult Safeguarding and Self-Neglect (Care Act s.42; MSP)
* → Domestic Abuse and the Impact on Children
* → Information Sharing, Confidentiality, and UK GDPR in Safeguarding
* → Record Keeping and Chronology in Safeguarding Practice

📖 FULL PRACTICE QUESTIONS

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

You are a GP. A 4-year-old has attended three times in four months with eczema “flares”, is often unwashed and hungry, and has had two missed immunisation appointments. Nursery has sent a note describing frequent tiredness and poor attendance. Today, the child appears thin and has excoriated skin; the parent says they are “just busy” and declines help.

Options:
A. Prescribe emollients again, advise on diet, and arrange routine review in three months.
B. Document today’s findings in detail, including verbatim comments and a body map; check previous attendances and immunisation history; start a brief chronology.
C. Phone a trusted colleague to have an off-the-record chat without making any notes.
D. Make a same-day referral to Children’s Social Care (MASH) under s.17/s.47 as appropriate, sharing the minimum necessary information lawfully and using secure channels.
E. Wait until there is a clear, single episode of serious injury before referring.
F. Contact the nursery or health visitor to share relevant information and gather more detail, using secure routes and recording the discussion.
G. Decide to “monitor” without telling anyone, as each individual visit seems minor.
H. Post on a staff messaging group with full details to see if anyone else is worried.

Example SJT — Rank 5 (best → worst)

You are a community geriatrician visiting a 72-year-old man with diabetes and COPD. He lives alone. On repeated visits you and the district nurses have found the house cluttered with hoarded items, strong odours, perishable food left out, and blocked exits. He has missed several clinic appointments and has had two recent hospital admissions with sepsis from leg ulcers. He appears ambivalent about help but agrees “things have got out of hand”.

Options:
A. Document the conditions and his comments; assess capacity regarding self-care and risk; discuss with safeguarding lead; make a referral to Adult Social Care for possible Care Act s.42 self-neglect enquiry; and involve housing and fire service as part of a person-centred plan.
B. Note “declines help” in the record and discharge him from follow-up.
C. Tell neighbours to “keep an eye” and report back if they are worried.
D. Do nothing now and wait for “something serious” to happen before raising concerns.
E. Secretly photograph the home on your personal phone to “prove” how bad it is and share the images with colleagues on a group chat.