About This Page
This is a clinician-written, evidence-based summary aligned to the 2026 MLA Content Map. It is intended for medical students and junior doctors preparing for the UKMLA. Always cross-reference with NICE guidance, local protocols, and clinical judgement.
The Bottom Line
- Care Act 2014: local authority duty to investigate if an adult at risk is experiencing or at risk of abuse or neglect
- Adult at risk = person ≥18 who (1) has care and support needs, (2) is experiencing or at risk of abuse/neglect, AND (3) is unable to protect themselves because of those needs
- Types of abuse: physical, sexual, psychological/emotional, financial, neglect, organisational/institutional, self-neglect, modern slavery, domestic violence, discriminatory
- Making Safeguarding Personal: person-centred, outcome-focused approach — involve the adult in decisions about their safeguarding
- Doctor's role: recognise, respond, report (to local authority safeguarding team), record, and refer. Confidentiality may be overridden if adult at risk of serious harm
Overview
The Care Act 2014 provides the statutory framework for adult safeguarding in England. It places a duty on local authorities to make enquiries (Section 42 enquiry) where there is reasonable cause to suspect an adult at risk is experiencing or at risk of abuse or neglect. "Making Safeguarding Personal" is the guiding principle — safeguarding should be person-centred, empowering, and proportionate. Healthcare professionals have a duty to recognise abuse, raise concerns with the local authority, and participate in multi-agency safeguarding processes. Unlike safeguarding children, adults with capacity can refuse safeguarding intervention — though this does not remove the duty to raise the concern.
Epidemiology
Local authorities in England received over 550,000 safeguarding concerns in 2022-23. Neglect and acts of omission are the most commonly reported type (over 30%), followed by physical abuse (approximately 20%) and financial abuse (approximately 15%). The most common settings for reported abuse are the person's own home (45%) and care homes (25%). Older adults and those with learning disabilities, dementia, or mental illness are disproportionately affected. Under-reporting is widely acknowledged — actual prevalence is likely significantly higher.
Recognising Abuse
Symptoms
Physical abuse: unexplained bruises, fractures, burns (especially in unusual patterns or locations), signs of restraint, injuries inconsistent with explanation given
Neglect: malnutrition, dehydration, poor hygiene, untreated pressure sores, inappropriate clothing, unmanaged medical conditions
Financial abuse: sudden changes in finances, missing money/possessions, changes to wills, unusual bank activity
Psychological/emotional abuse: withdrawal, anxiety, fearfulness around certain individuals, low self-esteem, behavioural changes
Sexual abuse: unexplained genital injuries, STIs, behavioural changes, fear of certain individuals
Self-neglect: severe deterioration in personal hygiene, hoarding, refusing essential medical care
Organisational abuse: poor care standards, rigid routines, inadequate staffing, lack of privacy in care settings
Signs
Patient appears frightened or subdued in the presence of a carer/relative
Carer appears overly controlling, speaks for the patient, or refuses to leave during consultation
Frequent attendances at ED with unexplained injuries
Unexplained weight loss, dehydration, or malnutrition in a patient with known care needs
Assessment and Response
First-line
Clinical assessmentThorough history (ask about home situation, care, safety — ideally without carer present), examination, document findings with body maps, photographs (with consent)
Capacity assessmentDoes the adult have capacity to make decisions about their safety? If yes, their wishes must be central to the safeguarding process (Making Safeguarding Personal)
Second-line
Safeguarding referralContact local authority adult safeguarding team if there is reasonable cause to suspect abuse or neglect. Do not delay reporting to investigate further — that is the local authority's role
DocumentationRecord concerns factually, using the patient's own words where possible. Note any injuries with body map diagrams. Record actions taken and by whom
Specialist
Section 42 enquiry (Care Act 2014)Local authority must make enquiries if adult at risk criteria are met. Determines whether action is needed and if so, by whom. Multi-agency involvement (health, social care, police)
Multi-Agency Safeguarding Hub (MASH)Co-located multi-agency teams that share information and coordinate safeguarding responses
1
Doctor's immediate responsibilities
- Ensure the adult's immediate safety — address any urgent medical needs
- Speak to the adult alone if safe to do so (without the alleged abuser present)
- Assess capacity to make decisions about safeguarding
- Raise a safeguarding concern with the local authority safeguarding team
- Confidentiality may be overridden: if an adult at risk is experiencing or at risk of serious harm, disclosure is justified even without consent
2
Making Safeguarding Personal
- Involve the adult in all decisions — ask what outcome they want
- Respect the wishes of adults with capacity as far as possible (but this does not remove the duty to report)
- Proportionate response — least restrictive option
- Empower the individual to make their own choices where they have capacity
3
Multi-agency working
- Participate in strategy meetings and case conferences
- Share relevant information with other agencies (on a "need to know" basis)
- Safeguarding Adults Boards (SABs): statutory multi-agency boards that oversee safeguarding in each local authority area
- Safeguarding Adults Reviews (SARs): mandatory review when an adult dies or is seriously harmed and abuse/neglect is suspected
Complications
- Failure to recognise abuse: Continued harm, potentially fatal outcomes
- Over-intervention: Unnecessary removal of autonomy from a capacitous adult
- Organisational failures: Systemic abuse in care settings (e.g. Winterbourne View) — institution-level failings
- Inter-agency communication failures: Information not shared between health, social care, and police — a recurring theme in SARs
UKMLA Exam Tips
- 1Adult at risk = THREE criteria: (1) care and support needs, (2) experiencing or at risk of abuse/neglect, (3) unable to protect themselves because of those needs
- 2An adult WITH capacity can REFUSE safeguarding intervention — but this does NOT remove the duty to raise the concern with the local authority
- 3Types of abuse: physical, sexual, psychological, financial, neglect, organisational, self-neglect, domestic, discriminatory, modern slavery — know all 10
- 4Making Safeguarding Personal: person-centred and outcome-focused. Always ask the adult what THEY want to happen
- 5Confidentiality CAN be overridden for adult safeguarding if there is a risk of serious harm — public interest justification
- 6Section 42 enquiry: the local authority's duty to investigate — not the doctor's job to investigate, but to report
practicetest your knowledge on safeguarding adultsApply what you've learnt with UKMLA-style questions from the iatroX Q-Bank — ethics & law and beyond.
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