Safeguarding in palliative care

What is safeguarding?

Safeguarding means protecting a person's right to live in safety, free from abuse and neglect.

Safeguarding includes:

• reducing the risk of abuse and neglect to patients and carers
• stopping abuse or neglect where possible
• supporting patients and carers to make choices and have control about how they live their lives
• providing information so patients and carers know the different types of abuse and how to report concerns about safety.

As a health and social care professional, you have a responsibility to report any concerns you have about a patient or carer's safety. If it's safe to do so, you should also speak to the person about your concerns, and involve them in decisions as much as possible.

Abuse and neglect

There are different types of abuse:

• Physical abuse – for example, hitting, slapping or restraining someone.
• Sexual violence – for example, touching someone's body or trying to have sex with them when they have not consented (agreed) to it.
• Psychological abuse – for example, threatening, bullying, or trying to control the person.
• Financial abuse – fraud, theft, or trying to control someone's money without their permission.
• Discrimination – treating someone differently because of things like religion, race or sexuality.
• Modern slavery – for example, forcing someone to work against their will.
• Domestic abuse – if someone's abused by a partner or family member.
• Organisational abuse (called institutional abuse in Northern Ireland) – for example, if the place the person's being cared for, like a care home or hospital, does not give them proper care.
• Neglect – if someone refuses to care for the person properly, like not giving them the medication they need.
• Self-neglect – if someone does not look after themselves, for example refusing to wash or take their medication.

Abuse is not always intentional, and it can happen to anyone. Patients might be abused by their family members, friends, carers, neighbours, health and social care professionals or strangers. Carers and the people around the patient can be abused, too. A relationship might become abusive over time. And there may be good periods and bad periods in the same relationship.

Some people are more at risk of abuse, including:

• people who have difficulty communicating
• people who have cognitive impairments, such as people with dementia
• people with lots of care and support needs.

Signs of abuse and neglect

Signs that someone might be being abused include:

• changes in their behaviour, like becoming quieter, angrier or more aggressive
• becoming more tearful or depressed
• not wanting to be left by themselves or alone with a particular person
• being unusually light-hearted or saying nothing's wrong
• looking untidy or dirty – for example, having dirty fingernails or bad hygiene
• bruises, wounds or injuries which are not being treated
• the same injuries happening more than once
• the person's home being colder or more untidy than usual
• the person being more isolated from family and friends than usual
• changes to their finances, like having less money than usual.

Barriers to someone telling you about abuse

It's also important to recognise the barriers which might stop someone from reporting abuse. These can include:

• being afraid of the abuser and what they might do
• being worried about what will happen to the abuser
• feeling embarrassed, ashamed or scared
• being worried about anyone who's dependant on them, like children or pets
• not knowing who to talk to or who to trust
• having bad experiences with reporting things in the past
• not thinking the person's behaviour counts as abuse
• pressure not to report it from family, or other people close to them
• fear of losing contact with the abuser or with other people.

Reporting abuse and neglect

If you're worried that a patient or carer is being abused or at risk, it's important to act as soon as possible. It's everyone's responsibility to report signs of abuse – do not assume another professional will do something.

If you suspect abuse and the person is in immediate danger, telephone 999.

If the person is not in immediate danger, you should report the abuse to your organisation's safeguarding lead or your line manager. Follow the safeguarding policy for your organisation and the policy for sharing information about patients. Most organisations will have a place to log safeguarding concerns. Ask your manager if you do not know how to do this, or do not know where to find the safeguarding policy.

If it's safe to do so, speak to the person about your concerns first. You should only do this if you're trained to do so. If you think having a conversation with the person might put them in danger, speak to your line manager or safeguarding lead first. And if you're unsure what to do, speak to someone with more experience.

Consent and confidentiality

At the start of your conversation with the person, these are some things you can do:

• Make sure they understand that you might need to report what they've said. This puts them in control of whether they want to say anything.
• Get their consent to share anything they've said with other professionals.
• Check whether they have the capacity to consent to you sharing information.

Some patients may not be able to make decisions for themselves, because of their condition or symptoms. This is known as lacking mental capacity.

If the patient does not have mental capacity, they may not be able to make decisions about their personal situation. And they may not be able to consent to you sharing any information about them.

If the patient is found to lack mental capacity, decisions will be made on their behalf. If you think the patient might lack mental capacity, speak to your line manager or safeguarding lead.

Read more about what happens if patients can not make decisions.

When and where to have the conversation

When you have the conversation with the person, these are some things to consider:

• Speak to them alone – not with family, friends or children.
• Plan enough time to speak to them properly, and make sure you will not be interrupted. Ask your manager if you need someone to cover your other duties.
• Consider whether they need support with communicating in different ways.
• If they speak a different language to you, use a professional interpreter. Do not ask a friend or family member to interpret.

What to say

It can be hard to know what to say. Here are some tips for having an open conversation:

• Give the person time to talk, and do not rush them.
• Let them know they're being listened to and it's OK to feel how they do.
• Let them know you believe them, and they have done the right thing by talking to you. Tell them it's not their fault.
• Make a note of what the person says, including when and where they said the abuse happened. Try to use the specific language and words they used.
• Tell them what you'll do next – it's important to keep them informed and involved with decisions.

Questions to ask

You could ask:

• Has anything happened that's worried you, or made you feel frightened or threatened?
• Where did it happen?
• When did it happen?
• How long has it been going on for?
• Is there anything you want to happen, or do not want to happen, about the abuse?

Supporting patients and those around them

If you're concerned about a patient, carer, or anyone close to them, speak to your line manager or safeguarding lead. You can also do the following things to support them:

• Encourage them to talk to someone they trust and feel comfortable with, if they have any concerns about their safety or wellbeing. This could be a healthcare professional, a family member, or friend. 
• Make sure the patient and those around them are being emotionally supported. Read more about providing emotional care.
• Give them information on practical caring tasks, like giving mouth care or moving someone. Share our information for carers.
• Make sure they know about the support they could get, like equipment, having carers come into the home, and respite breaks. Share our information on getting social care.
• Encourage them to call the Marie Curie Support Line on 0800 090 2309 if they need someone to talk to.
• Share with them some other organisations which could provide support.

Useful resources

Royal College of Nursing  – information about adult and child safeguarding, and information on the role of healthcare professionals in safeguarding

Social Care Institute for Clinical Excellence  – information and resources about safeguarding

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Disclaimer

This information is not intended to replace any training, national or local guidelines, or advice from other health or social care professionals. 

The Palliative Care Knowledge Zone is not intended for use by people living with a terminal illness or their family and friends, who should access our information for the public.