Safeguarding Adults at Risk

SJT Textbook: Safeguarding Adults at Risk

Safeguarding Adults at Risk MSRA

This guide covers the statutory framework for Safeguarding Adults at Risk MSRA scenarios. In the Professional Dilemmas paper, you must demonstrate a precise understanding of the Care Act 2014, specifically the “Section 42 Enquiry” threshold.

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🎯 THE CORE PRINCIPLE

Safeguarding adults is about protecting a person’s right to live in safety, free from abuse and neglect, while promoting their wellbeing and autonomy. Under the Care Act 2014, local authorities have a duty to make (or cause) enquiries when Section 42 criteria are met: an adult with care and support needs, who is experiencing or at risk of abuse or neglect, and cannot protect themselves as a result of those needs.

For clinicians, safeguarding is not about proving abuse but about noticing risk, acting proportionately, and involving the right partners. You must make the situation safe, take a person-led approach (Making Safeguarding Personal), and understand the Six Principles: Empowerment, Prevention, Proportionality, Protection, Partnership, and Accountability.

In the MSRA SJT, high-scoring responses make timely referrals, seek advice from safeguarding leads, share information lawfully on a need-to-know basis, and document clearly. Low-scoring options delay action waiting for proof, hide behind a rigid view of confidentiality, ignore the adult’s wishes, or overshare information without justification.

⚡ HIGH-YIELD ACTIONS (What Scores Points)

1. Assess immediate risk and take urgent steps to protect life and limb, including emergency medical care or calling police if there is a crime or serious harm.
2. Ensure a private conversation with the adult wherever possible to explore safety, coercion, and what outcomes they want (Making Safeguarding Personal).
3. Consider capacity and consent, and offer independent advocacy where the adult has substantial difficulty engaging and no appropriate informal supporter.
4. Share information on a need-to-know basis, using the minimum necessary to prevent or reduce harm, and explain what you are doing where it is safe to do so.
5. Consult your safeguarding lead and make a timely referral to Adult Social Care for a Section 42 enquiry when Care Act criteria are met.
6. Use multi-agency tools and partners where indicated, such as DASH risk checklist, MARAC, police, domestic abuse services, and fire service home-safety assessments.
7. Record a clear, contemporaneous note: risks identified, the adult’s wishes, capacity assessment, information shared, agencies contacted, and agreed actions with timescales.
8. Safety-net and review: arrange follow-up and specify what would trigger urgent re-escalation or a new referral if the situation worsens.

Trap options usually either delay action until there is certainty, hide behind a narrow view of confidentiality, or overstep into coercive or unprofessional behaviour. The safe path is proportionate action with lawful, minimal information-sharing and clear documentation.

💬 MODEL PHRASES (Use These in SJT Logic)

* “Because I am worried about your safety, I need to share limited information with safeguarding so that we can plan how to protect you.”
* “What would feeling safe look like for you, and who would you like involved in that plan?”
* “I will speak to our safeguarding lead and make a referral to Adult Social Care for a Section 42 enquiry.”
* “I will record exactly what I have seen, what you have told me, and why I have shared information with other agencies.”
* “We can arrange an advocate to help you be involved in decisions about any safeguarding enquiry.”

See risk • Ask outcomes (MSP) • Fact-find • Escalate or Refer (s.42) • Gain consent or justify share • Urgent measures • Adult’s wishes • Record • Duty to review

📋 QUICK FAQ

Does safeguarding adults only apply when the person lacks capacity?
No. Safeguarding duties apply regardless of capacity. Even when an adult has capacity, you should still consider proportionate multi-agency plans to reduce risk, and a Section 42 enquiry may still be appropriate if criteria are met.

Can I ever share safeguarding information without consent?
Yes. You may share information without consent where it is necessary to prevent or reduce serious harm or for wider public protection. You must share the minimum necessary, use secure channels, and record your rationale.

What exactly is a Section 42 enquiry?
It is the local authority’s duty to make enquiries, or cause enquiries to be made, when an adult with care and support needs is experiencing or at risk of abuse or neglect and cannot protect themselves as a result of those needs. The purpose is to decide what action is needed and by whom.

Is self-neglect always a safeguarding issue?
Not automatically. You must consider the adult’s ability to protect themselves, the level of risk, and local policy. However, severe self-neglect, especially with fire or hygiene risks, often warrants a safeguarding response and multi-agency planning.

How do I factor in Making Safeguarding Personal (MSP)?
Ask the adult what outcomes matter to them, involve them as much as possible, offer advocacy if needed, and aim for a plan that balances protection with respect for their wishes and rights.

What should I always record in the notes?
Record what you observed, what the adult said, any capacity assessment, risks identified, who you spoke to, what information you shared, the legal or policy basis for sharing, and the agreed plan including review points.

📚 GMC ANCHOR POINTS

* Take prompt action if you think patient safety, dignity or comfort is being compromised (GMC Good medical practice 2024).
* Share information appropriately for patient protection while respecting confidentiality (GMC Confidentiality guidance).
* Work in partnership with other health and social care professionals and agencies to safeguard patients.
* Treat patients fairly and with respect, taking account of vulnerability, disability, and potential coercion.
* Keep clear, accurate, and contemporaneous records of concerns, information-sharing, and decisions.
* Raise concerns through appropriate channels when you believe a patient is at risk and local systems are not responding adequately.

💡 MINI PRACTICE SCENARIO

A 32-year-old woman with learning disability attends with her partner, who insists on answering all questions. You see fingertip bruising on her upper arm. She avoids eye contact and says she is “just clumsy” but seems anxious when you suggest speaking to her alone.

Best action: See her alone if possible, explore safety and coercion, assess capacity, and explain that because you are concerned about harm you will share limited information with safeguarding and refer to Adult Social Care, documenting your assessment and actions.
Why: This combines immediate safety, Making Safeguarding Personal, lawful minimal information-sharing, and a Section 42 mindset, in line with Care Act duties and GMC expectations.

🎯 KEY TAKEAWAYS

✓ Safeguarding adults is about risk and protection, not waiting for proof.
✓ Section 42 enquiries are triggered by care and support needs plus risk of abuse or neglect plus inability to protect oneself.
✓ Making Safeguarding Personal means centring the adult’s wishes, capacity, and outcomes.
✓ You may and sometimes must share information without consent to prevent serious harm, using the minimum necessary.
✓ Use multi-agency tools such as DASH, MARAC, fire service, and advocacy to manage complex risk.
✓ Clear, timely documentation and rationale are essential for safe safeguarding practice.
✓ In the SJT, act early, proportionately, and collaboratively rather than delaying or oversharing.

🔗 RELATED TOPICS

* → Capacity and Best Interests (Adults)
* → Domestic Abuse and MARAC
* → Confidentiality and Information Governance
* → Safeguarding Children and Young People
* → Recognising Professional Boundaries
* → Learning from Adverse Events

📖 FULL PRACTICE QUESTIONS

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

A 45-year-old man with a learning disability lives in supported accommodation. Staff report that a new “friend” has been visiting frequently. The man has unexplained bruises and has withdrawn from usual activities. Money has gone missing from his account. When you ask about this, he looks to the “friend” before answering and says everything is fine.

Options:
A. Accept his reassurance and discharge him from follow-up.
B. See him alone, explore safety and what he wants to happen, and assess for coercion.
C. Post details of the case in a local clinicians’ WhatsApp group to see if anyone knows the “friend”.
D. Contact your safeguarding lead and make a referral to Adult Social Care for a Section 42 enquiry.
E. Call the police immediately without explaining anything to the man.
F. Share limited relevant information with Adult Social Care and record clearly what you have shared and why.
G. Do nothing because he appears to have capacity to decide about relationships.
H. Tell staff to “keep an eye” and only act if there is definitive proof of physical abuse.

Example SJT — Rank 5 (best → worst)

An 80-year-old man with COPD and mobility problems lives alone. District nurses report severe hoarding with blocked exits and frequent small pan fires. He repeatedly declines help and says “leave me alone; it is my house”. Today he appears to understand the risks but you remain concerned about fire and his ability to escape.

Options:
A. Respect his decision today but create a proportionate multi-agency plan, including fire service home-safety referral, scheduled follow-up, GP review, and low-intrusion supports; record MSP discussion and thresholds to re-escalate.
B. Refer to Adult Social Care for a Section 42 enquiry, sharing the minimum necessary information and offering independent advocacy.
C. Do nothing because he has capacity and you must respect his choice.
D. Secretly photograph his home and share the pictures in a team WhatsApp group to “raise awareness”.
E. Tell him he will be evicted from his home unless he accepts help.