Module 2 of 2 · 75 minutes
Recognising abuse, recording properly and raising a concern
By the end of this module you will be able to
- Recognise the categories of abuse and neglect
- Describe what to do on the day a concern arises
- Write a record that would hold up months later
- Raise a concern, including about a colleague or a manager
Amara Ten categories of abuse. Which ones actually get missed?
Nadia Financial and organisational, by a distance. Everybody spots a bruise with no explanation. Almost nobody spots the two that arrive quietly.
Amara Start with financial.
Nadia It rarely looks like theft. It looks like a helpful nephew who has taken over the shopping and keeps the change. A new name on a bank card. A will changed after a new friend started visiting. It presents as somebody being kind, which is exactly why it runs for years.
Amara And organisational?
Nadia That one is not an incident at all, which is why it is invisible. Everybody in bed by half past six because that is when the shift changes. Nobody chose to harm anybody. But if the routine suits the rota rather than the people, that is organisational abuse, and it is what most serious inquiries have found at the bottom of it.
Amara Right. Mrs Nolan tells me her son takes her pension. What do I do first?
Nadia Make sure she is safe now, report it to your manager this shift, and write down her words. Her words, not your summary of them.
Amara Should I ask her a few questions to get the full picture?
Nadia No, and this is the part people get wrong out of genuine helpfulness. You are not investigating. A well meant question asked the wrong way can contaminate her account so badly it cannot be relied on later, and then she is worse off for having told you.
Amara She asked me to promise not to tell anyone.
Nadia Then you cannot promise that, and you say so gently and immediately. You tell her you will only share it with the people who need to know to keep her safe. That is awkward for about four seconds and it is the difference between a disclosure that can protect her and one that cannot.
Amara Records. What is actually wrong with writing that somebody was aggressive?
Nadia It is a conclusion, and a conclusion cannot be checked. Six months later a coroner reads aggressive and has no idea what happened. Write what you saw: he pushed the door shut and said get out. Now the reader can judge it themselves.
Amara And if I have written something incorrectly?
Nadia One line through it, initial it, correct it beside. Never scribble it out, never use correction fluid, never write over it. An altered record is worth less than no record at all, because now the question is what you were hiding.
Amara Last one, and it is the hard one. What if the concern is about my manager?
Nadia Then you go above them, and the law is on your side. The Public Interest Disclosure Act protects you when you raise a genuine concern, and it protects you even if you turn out to be wrong, as long as you genuinely believed it.
Amara That is the bit people do not believe.
Nadia I know. So keep your own dated note of what you raised, to whom, and when. Not because anybody is out to get you, but because in nine months that note is the only thing that shows you did the right thing at the time.
The written material
What abuse looks like in practice
The Care Act 2014 names ten categories: physical, sexual, psychological, financial or material, discriminatory, organisational, neglect and acts of omission, domestic abuse, modern slavery, and self neglect.
Two of those are the ones missed most often. Financial abuse rarely looks like theft; it looks like a relative who now does all the shopping and keeps the change, or a new name added to a bank card. Organisational abuse is not an event at all: it is a routine that suits the rota rather than the person, everybody being put to bed at half past six because that is when the shift changes.
- Physical, sexual, psychological, financial, discriminatory
- Organisational, neglect and omission, domestic, modern slavery, self neglect
- Financial abuse usually arrives as helpfulness, not as theft
- Organisational abuse is a routine, so nobody experiences it as an incident
What you do, on the day
The sequence is fixed and short. Make sure the person is safe now. Report it to your manager immediately, the same shift, not at the end of the week. Write down exactly what you saw or were told, in the words used. Preserve anything that is evidence and do not tidy, wash or move it. Then let the safeguarding process work.
You do not investigate. That is not caution, it is competence: a well meant question asked in the wrong way can contaminate an account so badly that it cannot later be relied on, and the person who disclosed loses the protection the process would have given them.
You also do not promise confidentiality. If somebody says they want to tell you a secret first, the honest answer is that you will only share it with the people who need to know in order to keep them safe. Saying that is uncomfortable for about four seconds and it is the difference between a disclosure that can be acted on and one that cannot.
Records that survive being read months later
A care record is a legal document. It will be read by people who were not there, possibly years later, possibly at an inquest or a tribunal, and it must still make sense to them.
Write facts and observations, not conclusions. Aggressive is a conclusion; he pushed the door shut and said get out is an observation. Record what you did as well as what happened, note the time properly, and sign it. If you make a mistake, strike it through with a single line, initial it and write the correction beside it. Never overwrite, never use correction fluid, and never add anything later without dating it as a later entry.
Speaking up, including about people senior to you
Whistleblowing in a care setting is protected in law. The Public Interest Disclosure Act 1998 protects a worker who raises a genuine concern about wrongdoing, and it protects you even if you turn out to be mistaken, provided the concern was genuinely held.
Use the internal route first: your manager, then their manager, then the provider's own escalation route. If the concern is about your manager, go above them. If the organisation will not act, the local authority safeguarding team and the Care Quality Commission both take concerns directly.
The thing that stops people is almost never ignorance of the route. It is the fear of being wrong and the fear of what happens next. Both are understandable, and neither is a reason to leave somebody unprotected. Keep your own dated note of what you raised, to whom and when, because that note is what protects you afterwards.
Knowledge check
The knowledge check and your certificate need a free account, so that your progress and results can be saved as evidence.
The learning itself stays free and open. You are reading all of it right now without an account.