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Safeguarding of Children and Adults at Risk

Last modified: 15 May 2026

  • Safeguarding children and adults at risk of abuse or neglect is a legal and ethical obligation of all healthcare personnel. Safeguarding is a range of activities aimed at upholding a person's fundamental right to be safe. It means protecting patients and their families from all forms of harm, abuse, and neglect, including poor practice
  • Members of the team are not responsible for diagnosing abuse, but for sharing concerns appropriately
  • Abuse is defined as a violation of an individual's human and civil rights by any other person or persons. It may involve a single or repeated act or omission
  • A child is defined as a person under the age of 18. An 'Adult at Risk' is any adult who has needs for care and support by reason of mental or other disability, age, or illness; whether or not the Local Authority is meeting any of those needs); is experiencing, or at risk of abuse or neglect; and as a result of those care and support needs is unable to protect themselves from either the risk of or the experience of abuse or neglect. The Care Act 2014 introduced the term 'Adult at Risk' replacing the phrase 'vulnerable adult', however, the two are used interchangeably
  • Healthcare personnel are expected to recognise the signs of abuse in children and adults at risk and take prompt appropriate actions
  • Firstly, discuss concerns with the Safeguarding Lead at the practice and other professionals in the local Multi-Agency Safeguarding Hub (MASH). The case can be discussed, anonymously as necessary until the decision to refer has been made
  • It is an offence for a person over 18 to have a sexual relationship with a young person under 18 where that person is in a position of trust in respect of that young person (e.g. clinician or nurse), even if the relationship is consensual. This also applies where the young person is in full-time education and the responsible adult is regularly involved in caring for, training, supervising or being in sole charge of such persons
  • The Local Authority has a statutory responsibility to establish the following:
    • LSCB/P – the Local Safeguarding Children Board, who are responsible for child safeguarding
    • LADO – the Local Authority Designated Officer, is consulted if there are safeguarding concerns about a member of the team or somebody who works with children
    • LSAB – the Local Safeguarding Adults Board, who are responsible for adult safeguarding
    • MASH – the Multi-Agency Safeguarding Hub, who are the single point of contact for all safeguarding concerns regarding children and young people and will include Front Door for Families access for Early Help. The MASH may also deal with safeguarding concerns regarding vulnerable adults (you should check your local arrangements)
  • Seek advice and guidance from the above contacts and if you need to report a matter (refer), contact your local MASH or adult/children's social services department. Contact details will be in (M 290E)
  • Safeguarding compliance includes:
    • Appointing at least one Practice Safeguarding Lead (also called the Designated Person, Child and Vulnerable Adult Protection Lead or Safeguarding Champion)
    • Adopting a policy and procedures on safeguarding and safety of children and vulnerable adults; note that you should obtain the policies and procedures from your LSCB/LSAB and adapt the CODE ones as necessary
    • Maintaining records
    • Regular team training
    • Making appropriate referrals
    • Carrying out appropriate safer recruitment processes including team checks with DBS/PVG/Access NI
  • The Care Act 2014 introduced legislation mainly for vulnerable adults, introducing regulations for local authorities with the requirement to set up a Local Safeguarding Adults Board (LSAB)

Responsibility

Every team member is responsible for the safeguarding and promoting the wellbeing of children and adults at risk of abuse or neglect. Healthcare personnel are in a position to recognise possible signs of abuse and neglect or to hear something that causes concerns. Health professionals have a duty to recognise and take responsibility for safeguarding children, young people and adults using appropriate systems for identifying, sharing information, recording and raising concerns, obtaining advice and taking action.

Identifying abuse

Abuse occurs in all socio-economic groups and can be identified as a single event or more often, a number of events, both acute and long standing which interrupt, change or damage the physical and psychological development. There are 4 commonly recognisable categories of child abuse: physical, emotional, sexual and neglect. Someone may abuse or neglect a child not just by inflicting harm but by failing to prevent it.

Examples of child neglect include a poor standard of hygiene that affects a child's health, missed appointments for necessary treatment, particularly in children with disabilities, as well as children who are poorly dressed for the climate or time of year, or their clothes are below acceptable cleanliness. See the NICE guidelines When to suspect child maltreatment

Abuse against vulnerable adults may also include physical, emotional, sexual abuse and neglect and may also include discrimination, financial or material abuse, domestic abuse, organisational/institutional abuse, self-neglect and modern slavery.

Some of the more common signs of abuse that can be noted by healthcare professionals:

  • Multiple bruising or finger marks injuries that cannot be explained easily
  • Sudden deterioration of health
  • Sudden and unusual weight loss
  • Inappropriate or inadequate clothing
  • Withdrawal or mood changes
  • A person's refusal or unhappiness about being left alone with a particular carer

Emergency Response

If you believe that a child or adult patient is at risk or immediate harm either in practice or as they leave, then you should call the Police on 999.

For example:

  • If a child discloses physical abuse in the presence of an abusive parent who will be taking them home.
  • If an adult patient discloses that they are being abused by a carer/care worker who is waiting in reception to take them home.

Missed appointments and 'Was Not Brought' (WNB)

Traditionally practices have used 'Did Not Attend' (DNA) or 'Failed to Attend' (FTA) in their patient management system to describe when children miss appointments. By using 'Was Not Brought' (WNB) encourages dental teams to think about the situation from a child's perspective and to identify potential safeguarding issues. Agilio recommends using the label 'WNB' when a person aged 17 years or younger does not attend an appointment.

Regulators, such as the CQC and HIW have been checking that practices are responding accordingly to WNB scenarios and ensuring that concerns are raised in line with Local Safeguarding procedures. Agilio recommends checking how your LSCB/P would like instances of WNB to be managed and adapting your procedures and flowcharts accordingly. Where you have concerns regarding children under 5 missing appointments. Agilio recommends sending a Letter to a Health Visitor. (M 290D)

Practices may also wish to download and implement the WNB pathway by Jenny Harris, Jen Kirby and Sheffield Teaching Hospitals NHS Foundation Trust.

Local Safeguarding Children Board/Partnership (LSCB/P)

Every local authority has a Local Safeguarding Children Board/Partnership. LSCB/Ps are responsible for the arrangements for protecting children and young people. Practices need to be aware of their local LSCB/P guidelines which can be downloaded from their website.

Local Authority Designated Officer (LADO)

The LADO works within Children's Services and should be alerted to all cases in which it is alleged that a person who works with children or is a member of the team has:

  • Behaved in a way that has harmed, or may have harmed, a child
  • Possibly committed a criminal offence against children, or related to a child
  • Behaved towards a child or children in a way that indicates s/he is unsuitable to work with children

If you need to contact your Local Authority Designated Officer (LADO), contact your local Children's Social Services Dept.

Local Safeguarding Adults Board

Every local authority has a Local Safeguarding Adults Board (SAB), which is responsible for local arrangements for safeguarding vulnerable adults living in the area. If you think that a vulnerable adult has suffered from or may be at risk of suffering from harm you should contact the SAB. If the patient has mental capacity, obtain consent before discussing their situation with any third party.

Multi-Agency Safeguarding Hub

The majority of local authorities have established a Multi-Agency Safeguarding Hub commonly referred to as the MASH. It is the single point of contact for all safeguarding concerns regarding children and young people and will include Front Door access for Early Help. It brings together expert professionals, from services that have contact with children, young people and families, and makes the best possible use of their combined knowledge and resources to keep children safe from harm and promote these and their families' wellbeing. The MASH may also deal with safeguarding concerns regarding vulnerable adults (you should check your local arrangements).

Steps to take If you suspect that there may be abuse from a parent or carer

  • Speak to the vulnerable adult or child and record any signs or symptoms, listen to what they have to say
  • Carefully discuss the situation with the person and, if appropriate, with the parent or carer Don't ask leading questions or make suggestions about how the situation arose. Just try to clarify how the situation arose and record the answers carefully, using the child's own words. Don't probe or push the child for explanations
  • Decide whether you think there may be abuse, discussing with your Practice Safeguarding Lead and if necessary with the MASH or social services, but without naming the person (anonymously at this time)
  • In case of a serious injury you may need to refer to A&E
  • If you think a crime has been committed, you should refer to the police. In England, if you refer to the police you must also notify the CQC
  • If you need to refer, seek the consent of the person and their carer or parent if appropriate
  • If you refer to Children's social services/MASH by telephone, you must confirm full details in writing within 48 hours
  • Keep accurate records of your discussions, observations, decision and actions taken

When not to discuss your suspicions with the parent or carer

  • If the discussion may increase the risk to the child or vulnerable adult
  • If the discussion could hinder a police or social services investigation
  • If the parent or carer is violent or difficult and the discussion may put yourself or others at risk
  • If you suspect sexual abuse
  • If you suspect Munchausen's syndrome, now known as 'fabricated or induced illness'. When a parent or carer, exaggerates or deliberately causes symptoms of illness in a child
  • If the discussion would delay an important referral

Information Sharing

Where there are concerns about the safety of a child, the sharing of information in a timely and effective manner between organisations can reduce the risk of harm. The UK General Data Protection Regulation (UK GDPR) forms part of the data protection regime in the UK, together with the Data Protection Act 2018 (DPA 2018). Whilst the Data Protection Act 2018 places duties on organisations and individuals to process personal information fairly and lawfully, it is not a barrier to sharing information where the failure to do so would result in a child or vulnerable adult being placed at risk of harm, or where the public interest served outweighs the public interest served by protecting confidentiality - for example, where a serious crime may be prevented. Similarly, human rights concerns, such as respecting the right to a private and family life would not prevent sharing where there are real safeguarding concerns.

Allegations against a team member who works with children or vulnerable adults

If there are allegations about a team member, the practice manager (or provider) will carry out an investigation and decide whether to use the internal grievance and disciplinary procedure and/or report the allegations externally. It is advisable to discuss all concerns with the Local Authority Designated Officer (LADO) if concerning a child, or the Lead Person for Safeguarding Adults (LPSA) for general advice and in particular to find out if further actions are required and whether the police need to be involved.

In case of serious injury

  • Refer the person to A&E, with the consent of the parent or carer, telephone A&E to explain that the patient is being referred by you
  • If you cannot obtain consent, contact social services and if necessary the police. In England, if you contact the police you must inform the CQC

Barred lists - the requirement to refer people who work with children and vulnerable adults

If an employee or contractor at the practice has been found to be unsuitable to work with children or vulnerable adults, there is a statutory duty to make a referral to the appropriate organisation. These are:

  • In England and Wales the DBS referral helpline: 01325 953795

Next steps

This module includes the following templates:

  • Action Plan for Safeguarding Children and Adults at Risk (M 290A) – follow this action plan to set up your safeguarding procedures
  • Adopt the Flowchart for Safeguarding Action (M 290B) - what to do if you think there may be safety issues
  • Body Map of Injuries (M 290C) – to use if you see any facial injuries
  • Letter to a Health Visitor (M 290D) – if a child repeatedly misses appointments
  • Contacts for Safeguarding Children and Adults at Risk (M 290E) – for a list of your essential safeguarding contacts

In summary:

  • Be observant
  • Record any concerns, with time, date and signature on an Event Record (G 110A), do not ask probing or leading questions
  • Do not waste time, act quickly
  • Monitor concerns using the Event Register (G 110B)
  • Discuss your concerns with your local MASH or children/adult social services as necessary, anonymously until you have decided to make a referral
  • Dial 999 for the police in an emergency, referring to A&E for any emergency treatment as appropriate.
  • Observe confidentiality and do not discuss matters with your family and friends
  • Keep full and accurate contemporaneous records including the factors leading to the suspicions, the details of any injury or any other sign and the actions taken by the team

Training

Minimum requirements for England and Wales

  • Level 1: for all non-clinical staff
  • Level 2: for all dentists and dental care professionals
  • Level 3: for paediatric dentists and paediatric orthodontists

The guidance states that safeguarding training should be refreshed every three years. Level 1 and Level 2 training refreshers can be undertaken via online training courses. Level 2 refresher training should take a minimum of three hours.

Agilio's recommendation for England and Wales

Unless a higher requirement exists in national guidance or legislation (see above) we recommend that all team members, including receptionists and managers, are trained to level 2 in both adult and child safeguarding.

It is important to note that Healthcare Inspectorate Wales (HIW) consider it best practice for safeguarding leads in Wales to be trained to level 3.

Further information