INTERCOLLEGIATE DOCUMENT Adult Safeguarding:

INTERCOLLEGIATE DOCUMENT

Adult Safeguarding: 

Roles and Competencies 

for Health Care Staff 

First edition: August 2018 

For review 2021

Published by the Royal College of Nursing on behalf of the contributing organisations:

The British Association of Social Workers 

British Dental Association 

British Geriatrics Society 

Chartered Society of Physiotherapy

College of Paramedics

The College of Podiatry

Institute of Health Visiting

Royal College of General Practitioners 

Royal College of Nursing

Royal College of Midwives

Royal College of Occupational Therapists

Royal College of Ophthalmologists

Royal College of Physicians

Royal College of Psychiatrists

Royal College of Radiologists

Royal Pharmaceutical Society

The Society and College of Radiographers 

ADULT SAFEGUARDING: ROLES AND COMPETENCIES FOR HEALTH CARE STAFF 

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Thanks to the writing group

Nikki Harvey, Head of Safeguarding, Welsh 

Ambulance Services NHS Trust, Chair of 

National Ambulance Safeguarding Group

Alan Taylor, Head of Safeguarding, London 

Ambulance Services NHS Trust, Vice Chair of 

National Ambulance Safeguarding Group

Clare Livingstone, Professional Policy Advisor, 

The Royal College of Midwives

Dr Jane Shears, Head of Social Work and 

Safeguarding, St Andrew’s Healthcare, and 

representing the British Association of Social 

Workers 

Dr Flora Greig, Specialist Registrar, Faculty of 

Old Age Psychiatry

Dr Amanda Thompsell, Consultant Old Age 

Psychiatrist, Chair of the Faculty of Old Age 

Psychiatry 

Dr Dawne Garrett, Royal College of Nursing 

Dr Premila Fade, British Geriatrics Society

Dr Jonathan Leach, Joint Honorary Secretary, 

Royal College of General Practitioners 

Dr Joy Shacklock, RCGP Clinical Champion 

Good Practice Safeguarding, Royal College of 

General Practitioners 

Lauren Harding, Project Manager, Quality 

Improvement, Clinical Innovation and Research 

(CIRC), Royal College of General Practitioners

Nicola Mills, Royal College of Nursing

Susan Masters, Royal College of Nursing

With grateful thanks to all the health and social 

care staff who have contributed to the creation 

of this document.

Supported by NHS England and NHS Wales.

© Copyright is held by all of the above listed organisations. All rights are reserved. Other than as permitted by 

law no part of this publication maybe reproduced, stored in a retrieval system, or transmitted in any form or by 

any means electronic, mechanical, photocopying, recording or otherwise, without prior permission of all parties 

listed above or a licence permitting restricted copying issued by the Copyright Licensing Agency, Saffron 

House, 6-10 Kirby Street, London EC1N 8TS

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Foreword 4

1. Scope of the document 5

2. Key definitions 6

3. Safeguarding principles 9

4. Types of abuse, harm and neglect 10

5. Prevent 12

6. Section A: Competency Framework 13

Level 1: All staff working in health settings 14

 Level 2: All practitioners that have regular contact with patients, their 

families or carers, or the public 16

 Level 3: Registered health care staff who engage in assessing, planning, intervening 

and evaluating the needs of adults where there are safeguarding concerns 18

Level 4: Specialist roles – named professionals 21

Level 5: Specialist roles – designated professionals or equivalent roles 23

Board level 25

7. Section B: Education and training 29

1. Education and training 29

2. Underpinning principles 30

Level 1 33

Level 2 33

Level 3 34

Level 4 36

Level 5 37

Board level 39

8. Adult safeguarding staffing resource 40

References 41

Appendix 1: Relevant legislation to underpin training and education 42

Appendix 2: Competence level required by role 43

Contents

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As professionals we frequently work with people 

in their moments of greatest need, we witness 

health and social inequalities which have a 

direct effect on the lives of the people we care 

for. We endeavour to provide responses that 

are personalised and effective, regardless of 

background, gender, age, culture, sexuality or 

ethnicity. This sensitivity to personalisation is 

particularly relevant to adult safeguarding. 

Increasingly health and social care integration 

necessitates new roles and ways of working. 

This document provides a point of reference to 

help identify and develop the knowledge, skills 

and competence in safeguarding of the health 

care workforce. Education may occur through 

formal training, accredited programmes, 

non-accredited, practice-based learning and 

development opportunities that target not 

only professional, but local service needs. 

Practitioners should also be attentive to any 

adult safeguarding guidance produced by their 

individual professional bodies and professional 

regulators.

One of the most important principles of 

safeguarding is that it is everyone’s responsibility. 

Each professional and organisation must do 

everything they can to ensure that adults at risk 

are protected from abuse, harm and neglect.

This document has been designed to guide 

professionals and the teams they work with to 

identify the competencies they need in order to 

support individuals to receive personalised and 

culturally sensitive safeguarding.

For practitioners, the framework competencies 

may be a useful tool for:

• developing and reviewing job/role 

descriptions

• assessing clinical competence for different 

levels of practitioner

• developing personal goals

• performance appraisal.

Practitioners may find it helpful to use this 

document to:

• identify the current level of practice and 

role expectations/requirements within the 

specific care context 

• identify and develop the knowledge and 

skills in aspects of safeguarding to realise the 

potential of the role

This guidance sets out minimum training 

requirements and there may be national or 

local employment or regulator arrangements 

that pose additional requirements. It is not 

intended to replace contractual arrangements 

between commissioners and providers or 

NHS organisations and their employees. It is 

acknowledged that some employers may require 

certain staff groups to be trained to a higher 

level than described here to better fulfil their 

organisational intent and purpose.

It is a new and ambitious document which will 

develop further over the coming years. The 

colleges recognise it will not be possible for all 

staff to access the training within the first year 

of publication. It is anticipated that organisations 

will reach the required levels of workforce 

training over time. It is expected by the next 

iteration in 2021 all staff will have received 

training to attain the appropriate competencies. 

The education and training principles are set out, 

highlighting flexible learning opportunities to 

enable acquisition and maintenance of knowledge 

and skills. It is acknowledged that many health 

practitioners will need equivalent child and 

young person’s safeguarding training and that 

there are many areas of overlap. This can be 

taken into consideration when documenting the 

training undertaken. 

Foreword

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This document has been produced by 

intercollegiate endeavour and is intended to 

have relevance to all health care professionals 

and social care colleagues. It is designed to 

be used in all organisations that provide or 

commission health care for adults regardless of 

sector, setting or size. The language reflects the 

different legislation, terms and structures within 

the four United Kingdom (UK) countries within 

which intercollegiate colleagues practise. The 

definitions section provides more clarity on the 

terms used.

The document relates to individuals of 18 years 

and over. 

The document is concerned with the 

competencies required to support adult 

safeguarding. It focuses on the knowledge and 

skills needed to undertake this important and 

core professional role. 

To ensure adults receive proactive and high 

quality safeguarding it is important that the 

workforce are also familiar with the relevant 

associated legislation and guidance that supports 

adults to make decisions. Such legislation and 

guidance may be specific to the country in which 

the professional practises and the competencies 

must be applied within the context of that 

legislation. 

Healthcare organisations must ensure that those 

who use their services are safeguarded and that 

staff are suitably skilled and supported. This 

includes private, independent health care and 

voluntary sector as well as statutory providers.

The document sets out a framework that 

will help staff, practitioners, employers and 

commissioners understand the role and level of 

education/competence awareness/systems which 

correlates to a particular job purpose. 

All health care organisations have a duty outlined 

in legislation to make arrangements to safeguard 

and to co-operate with other agencies to protect 

adults at risk from harm abuse or neglect. Chief 

executive officers have a responsibility to seek 

assurance that all staff are able to meet this 

requirement.

In addition to safeguarding training it is 

also essential that staff have training on 

confidentiality, data protection and mental 

capacity legislation (appropriate to their role 

and country of practice) in order to effectively 

respond to the safeguarding needs of adults. 

1. Scope of the document

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2.1 Adult 

An individual who is 18 years of age or over.

2.2 Adult at risk 

In the context of this UK wide document to aid 

inclusion and brevity the composite definition 

has been used – ‘an adult at risk is any person 

who is aged 18 years or over and at risk of abuse, 

harm or neglect because of their needs for care 

and/or support and are unable to safeguard 

themselves.’

2.3 Adult safeguarding 

In the context of this document adult 

safeguarding means to work with an individual 

to protect their right to live in safety, free from 

abuse, harm and neglect. This can include both 

proactive and reactive interventions to support 

health and wellbeing with the engagement of 

the individual and their wider community. The 

aim is to enable the individual to live free from 

fear and harm and have their rights and choices 

respected.

2. Key definitions 

2.4 Case reviews 

DEFINITION OF ‘CASE REVIEW’

For consistency and brevity the term ‘case review’ is used throughout this document and applies to range of 

multidisciplinary adult safeguarding meetings.

COUNTRY: EXAMPLE OF TERMS USED:

England Safeguarding adults reviews

Safeguarding adults board meeting

Serious case review

Section 42 inquiry

Wales Regional safeguarding board meeting

National independent safeguarding board meeting

Adult protection committee

Adult delivery group and Adult strategy meeting

Scotland Serious case review

Learning review and audit

Significant case review

Northern Ireland Northern Ireland Adult Safeguarding Partnership

Case management review

Public protection arrangements

Serious case review

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2.5 Competence

The ability to perform a specific task, action or 

function successfully. It is a combination of skills, 

knowledge and experience expected of individual 

staff and being able to demonstrate the ability 

to be critically reflective and self-aware as 

you analyse, review and evaluate your skills, 

knowledge and professional practice, exploring 

alternative approaches and being open to change 

(Bournemouth University, 2015)

2.6 Deprivation of Liberty 

Safeguards (DoLs) 

(England and Wales only)

DoLs form part of the Mental Capacity Act 

(2005). The Supreme Court judgement 2014 

in the case of Cheshire West clarified the “acid 

test” for what constitutes a deprivation of 

liberty. It states that an individual is deprived of 

their liberty for the purposes of Article 5 of the 

European Convention on Human Rights if they: 

• lack the capacity to consent to their care/ 

treatment arrangements 

• are under continuous supervision and control 

• are not free to leave. 

A deprivation of liberty for such a person must 

be authorised in accordance with either the 

Deprivation of Liberty Safeguards (DoLS – part 

of the MCA), or by the Court of Protection or, if 

applicable, under the Mental Health Act 1983 

(MHA). In addition to hospitals and care homes 

the Supreme Court also held that a deprivation 

of liberty can occur in community and domestic 

settings where the State is responsible for 

imposing such arrangements. This will include 

a placement in a supported living arrangement 

(Department of Health, 2015).

2.7 Designated 

professional or equivalent 

role

The term designated professional denotes 

professionals with specific roles and 

responsibilities for adult safeguarding within 

commissioning organisations, including the 

provision of strategic advice and guidance to 

organisational boards across the health and 

social care community. 

2.8 Forensic

The term forensic refers to clinical tests or 

techniques used in relation to recording or 

collecting/preserving material that may be used 

in court as evidence to establish if a crime has 

taken place. It is important to state that that a 

forensic test may not necessarily be recognised 

as such at the time of examination. Practitioners 

should be aware that routine tests may later 

become part of forensic evidence/safeguarding 

procedures and investigations.

Examples include: 

• the need to preserve evidence by not 

touching, cleaning or removing anything 

that might contribute to an investigation of a 

potential crime scene 

• detailing injuries and recording what is said 

by an individual. 

2.9 Legislation 

Specific legislation relevant to adult safeguarding 

process can be found in Appendix 1 on page 42. 

2.10 Mental capacity 

legislation

The term capacity legislation refers to the 

relevant legislation within the UK countries 

notably:

• Mental Capacity Act 2005 (England and 

Wales)

• Adults with Incapacity (Scotland) 2000 

• Mental Capacity Act (Northern Ireland) 2016.

2.11 Named doctor and 

equivalent UK medical 

role 

The doctor employed by the local health care 

organisation/health board to support them 

in carrying out their statutory duties and 

responsibilities for safeguarding. Activities are 

likely to include, providing teaching and training 

to primary care staff, supporting practice 

safeguarding leads, working alongside other 

adult safeguarding professionals. 

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2.12 Named professional 

and equivalent role

All providers of NHS funded health services 

including NHS trusts, NHS foundation trusts, 

health boards and public sector, voluntary sector, 

independent sector and social enterprises should 

identify a named professional for safeguarding 

within its structure. Named professionals have a 

key role in promoting good professional practice 

within their organisation, providing advice and 

expertise for fellow professionals, and ensuring 

safeguarding training is in place. 

2.13 Professional 

Any health practitioner on a regulatory 

professional register, (Nursing and Midwifery 

Council, General Medical Council, General 

Pharmaceutical Council, General Dental 

Council and Health and Care Professions 

Council). The definition is also extended to 

practitioners who work in health services that 

have commensurate roles and education, for 

example ultrasonographers and nuclear medicine 

technicians. 

2.14 Safeguarding 

legislation 

The term safeguarding legislation refers to: 

The Care Act 2014 (England)

The Safeguarding Vulnerable Groups (Northern 

Ireland) Order 2007

The Adult Support and Protection (Scotland) Act 

2007 

Social Services and Well-being (Wales) Act 2014 

2.15 Staff

The term staff refers to those people performing 

a role in a health care context. This includes 

employees, private/independent contractors or 

practitioners and volunteers.

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There are six principles that underpin adult 

safeguarding and apply to all sectors and 

settings. The principles should inform the ways 

in which professionals engage with people at risk 

of abuse, harm or neglect.

• Empowerment – Personalisation and the 

presumption of person-led decisions and 

informed consent.

 “I am asked what I want as the outcomes 

from the safeguarding process and these 

directly inform what happens.”

• Prevention – It is better to take action 

before harm occurs.

 “I receive clear and simple information about 

what abuse is, how to recognise the signs and 

what I can do to seek help.”

• Proportionality – Proportionate and least 

intrusive response appropriate to the risk 

presented. 

 “I am sure that the professionals will work 

for my best interests, as I see them and they 

will only get involved as much as needed.”

• Protection – Support and representation for 

those in greatest need.

 “I get help and support to report abuse. I get 

help to take part in the safeguarding process 

to the extent to which I want and to which I 

am able.”

• Partnership – Local solutions through 

services working with their communities. 

Communities have a part to play in 

preventing, identifying and reporting neglect 

and abuse. 

 “I know that staff treat any personal and 

sensitive information in confidence, only 

sharing what is helpful and necessary. I 

am confident that professionals will work 

together to get the best result for me.”

• Accountability – Accountability and 

transparency in delivering safeguarding.

 “I understand the role of everyone involved 

in my life.” 

3.1 The aims of making 

safeguarding personal

• A personalised approach that enables 

safeguarding to be done with, not to, people.

• To work with the person to set safeguarding 

outcomes which have meaning to them.

• Practice that focuses on achieving 

meaningful improvement to people’s 

circumstances rather than just an 

‘investigation’ and ‘conclusion’.

• To prevent harm and reduce the risk of abuse 

or neglect to adults with care and support 

needs.

• To safeguard individuals in a way that 

supports them in making choices and having 

control in how they choose to live their lives.

• To promote an outcomes based approach in 

safeguarding that works for people resulting 

in the best experience possible.

• To raise public awareness so that 

professionals, other staff and communities 

as a whole play their part in preventing, 

identifying and responding to abuse, harm or 

neglect.

(Adass, 2018)

3. Safeguarding principles

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Abuse and neglect can take many forms. 

Organisations and individuals should not be 

constrained in their view of what constitutes 

abuse, neglect or harm and should always 

consider the circumstances on a person centred 

basis. Abuse, neglect and harm includes:

4.1 Physical abuse

Including assault, hitting, kicking, slapping, 

punching, pushing, misuse of medication, 

inappropriate restraint or inappropriate physical 

sanctions.

4.2 Sexual abuse

Including rape and sexual assault, sexual 

harassment or sexual acts to which the adult has 

not consented or was pressured into consenting. 

This can include “non-contact” sexual acts 

such as indecent exposure, online abuse, nonconsensual pornographic activities.

4.3 Psychological abuse 

Including emotional abuse, threats of harm 

or abandonment, deprivation of contact, 

humiliation, blaming, controlling, intimidation, 

coercion, harassment, verbal abuse, bullying, 

isolation or unreasonable and unjustified 

withdrawal of services or supportive networks. 

4.4 Financial or material 

abuse

Including theft, fraud and exploitation, coercion 

in relation to an adult’s financial affairs or 

arrangements, including pressure in connection 

with wills, property, inheritance or financial 

transactions, or the misuse or misappropriation 

of property, possessions or benefits. This can 

include “cuckooing” where a person’s property is 

taken over and used for illegal activities.

4.5 Neglect and acts of 

omission 

Including wilfully ignoring medical or physical 

care needs, failure to provide access to 

appropriate health and social care, including 

not supporting a person to access clinical 

appointments and support, the withholding 

of the necessities of life, such as medication, 

adequate nutrition and heating or depriving 

someone of stimulation or company, adaptations, 

equipment or aids to communication.

4.6 Self neglect 

This covers a wide range of behaviour neglecting 

to care for one’s personal hygiene, health or 

surroundings and can include behaviour such 

as hoarding and non-attendance at necessary 

health/dental appointments. Consideration must 

be given to the impact on other family members 

and/or the wider community, mental capacity 

legislation and whether this gives rise to a 

safeguarding concern.

4.7 Domestic abuse

The cross-government definition of domestic 

violence and abuse is: any incident or pattern of 

incidents of controlling, coercive, threatening 

behaviour, honour based violence, violence or 

abuse between those aged 16 or over who are, or 

have been, intimate partners or family members 

regardless of gender or sexuality (Gov.UK, 2013). 

The offence of coercive and controlling behaviour 

in intimate and familial relationships was 

introduced into the Serious Crime Act (2015) and 

recognition of violence against women domestic 

abuse and sexual violence (VAWDASV) is part of 

the Social Services and Well-being (Wales) Act 

2014.

Including Female Genital Mutilation 

(FGM)

FGM comprises all procedures involving partial 

or total removal of the external female genital 

organs or any other injury to the female genital 

4. Types of abuse, harm and 

neglect

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organs for nonmedical reasons. FGM is most 

often carried out on young girls aged between 

infancy and 15 years old. Whilst there is a 

mandatory requirement to report incidents of 

FGM for children and young people this is not a 

requirement for adult women. If a professional 

has safeguarding concerns about an individual 

who has experienced FGM a referral should 

be made in line with usual local safeguarding 

arrangements (GOV UK, 2012).

4.8 Discriminatory abuse

Unequal treatment based on age, disability, 

gender reassignment, marriage and civil 

partnership, pregnancy and maternity, race, 

religion and belief, sex or sexual orientation 

(known as ‘protected characteristics’ under the 

Equality Act (2010). 

4.9 Organisational abuse 

Incident or as a series of incidents involving ongoing ill treatment. It can be through neglect or 

from poor professional practice resulting from 

inadequate structure, policies, processes and 

practices within an organisation, eg, this may 

range from isolated incidents to continuing illtreatment in an institution or in relation to care 

provided in one’s own home.

4.10 Modern slavery 

The Modern Slavery Act 2015 encompasses 

slavery, human trafficking, forced labour and 

domestic servitude. Traffickers and slave masters 

use whatever means they have at their disposal 

to coerce, deceive and force individuals into a 

life of abuse, servitude and inhumane treatment. 

Trafficking is the movement of people by means 

such as force, fraud, coercion or deception with 

the aim of exploiting them. It is a form of Modern 

Slavery. People can be trafficked for many 

different forms of exploitation such as forced 

prostitution, forced labour, forced begging, and 

forced criminality, forced marriage, domestic 

servitude, forced organ removal. Trafficking can 

occur within the UK as well as countries outside 

the UK.

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The Prevent Programme is designed to safeguard 

people in a similar way to safeguarding processes 

to protect people from gang activity, drug abuse, 

and physical and sexual abuse. The Counter 

Terrorism and Security Act 2015 introduced a 

duty on the NHS in England, Wales and Scotland 

– in the exercise of their functions they must 

have due regard to the need to prevent people 

from being drawn into terrorism. Healthcare 

staff will meet, and treat people who may be 

drawn into terrorism. The health sector needs to 

ensure that health workers are able to identify 

early signs of an individual being drawn into 

radicalisation in line with Prevent framework. 

This guidance encourages all staff to ensure they 

are in receipt of the appropriate competency 

training. Further details can be found in 

the Prevent Training and Competencies 

Framework: www.england.nhs.uk/wpcontent/uploads/2017/10/prevent-trainingcompetencies-framework-v3.pdf

5. Prevent

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Level 1: All staff working in health care settings.

Level 2: All practitioners who have regular 

contact with patients, their families or carers, or 

the public. 

Level 3: Registered health care staff working 

with adults who engaging in assessing, planning, 

intervening and evaluating the needs of adults 

where there are safeguarding concerns (as 

appropriate to role).

Level 4: Specialist roles – named professionals.

Level 5: Specialist roles – designated 

professionals.

Board level: Chief executive officers, trust 

and health board executive and non-executive 

directors/members, commissioning body 

directors. This includes boards of private, 

independent and charitable health care 

and voluntary sector as well as statutory 

providers.

Staff groups are identified at each level, these 

are not exhaustive lists. It is recognised that 

there are a plethora of roles which are likely to 

increase over the coming years. The staff groups 

identified are examples of the types of role 

which correspond to the stated level. For further 

detailed information practitioners may approach 

their individual colleges/professional bodies.

6. Section A: Competency 

Framework

Please note: Adult safeguarding competences 

should be reviewed annually as part of staff 

appraisal in conjunction with individual 

learning and development plans and threeyearly refresher training.

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Level 1: All staff working in health settings 

This is the minimum level required for all staff 

working in health settings.

L1.1 Staff groups

All health care staff including, receptionists, 

administrative staff, caterers, domestic and 

transport staff, porters, community pharmacist 

counter staff, peer support workers and 

maintenance staff, board level executives and 

non-executives, non-clinical staff working in 

primary health care settings.

L1.2 Core competences

Competence at this level is about individuals 

knowing the signs which may indicate possible 

abuse, harm or neglect and who to contact 

and seek advice from if they have concerns. It 

comprises:

• recognising potential indicators of adult 

abuse, harm and neglect. (A full description 

of the types of abuse, harm and neglect are 

detailed on page 10.)

• an awareness that adults experiencing 

stressful situations in their own lives may 

have caring responsibilities, for other adults 

or children 

• an awareness of the importance of adults 

rights in the safeguarding context, and the 

essential knowledge of relevant legislation 

eg, human rights acts and mental capacity 

legislation

• an awareness and ability to locate local 

policies and procedures and how to access 

support to respond to safeguarding concerns

• an awareness of appropriate action including 

reporting and documenting concerns safely 

and seeking advice. Particularly if uncertain 

whether a safeguarding need is present

• building personal confidence, skills and 

knowledge to take immediate action through 

local safeguarding procedures. This should 

include the ability to escalate concerns if 

action is not taken. 

• An awareness of consent, information 

sharing, data protection legislation and 

acting safely to share information.

L1.3 Knowledge, skills, 

attitudes and values

This is the minimum entry level for all staff 

working in health care settings. All staff at Level 

1 should be able to demonstrate the following:

L1.4 Knowledge

• Know about adult abuse, harm and neglect in 

its different forms and the potential impact 

on adults at risk of harm.

• Know what constitutes an adult at risk and 

need for a safeguarding intervention.

• Know about the relevance of family and carer 

factors such as domestic abuse, mental and 

physical ill-health, substance and alcohol 

misuse. 

• Know what to do if there are concerns about 

adult abuse, harm and neglect, including 

local policies and procedures around who to 

contact, where to obtain further advice and 

support, and have awareness of how to raise 

concerns.

• Know about the importance co-operation, 

sharing information (including the 

consequences of failing to do so).

• Know what to do if concerns are not being 

taken seriously or they experience any other 

barriers to raising a concern about an adult 

at risk of abuse, harm or neglect.

• Awareness of the principles of mental 

capacity legislation and the relevance and 

impact in adult safeguarding.

L1.5 Skills

• Able to recognise possible signs of adult 

abuse, harm and neglect as this relates to 

their role.

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• Able to identify an adult at risk of harm, 

abuse or neglect.

• Able to seek appropriate advice and report 

concerns, and feel confident that they have 

been understood.

L1.6 Attitudes and values

• Willingness to listen to adults at risk, 

families and carers and to act on issues and 

concerns.

• Recognise how own beliefs, experience and 

attitudes might influence involvement in 

safeguarding work.

• Recognise how own actions impact on others.

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Level 2: All practitioners that have regular contact with 

patients, their families or carers, or the public 

L2.1 Staff groups

This includes administrators for safeguarding 

teams, health students, phlebotomists, 

pharmacists, 111/999 communications centre 

staff, orthodontists, dentists, dental care 

professionals*, audiologists, optometrists, 

nursing associates, clinical researchers, allied 

health professionals, ambulance staff, staff who 

work in virtual/online health settings who provide 

any health care online, registered nurses**, 

medical staff and GP practice managers. 

L2.2 Core competencies

• As outlined for Level 1.

• Addresses the immediate safety of the person 

and ensures that a protection plan is put in 

place immediately when the risk of abuse is 

high. 

• Identifies and refers to appropriate services 

any other associated persons including carers 

and children at risk.

• Practises in a manner that seeks to reduce 

the risk of abuse, harm or neglect.

• Uses professional and clinical knowledge, 

and understanding of what constitutes 

any signs of adult abuse, harm or neglect. 

Including the further recognition of local 

safeguarding priorities, for example, 

financial abuse, Prevent, modern slavery.

• Acts to ensure effective advocacy for the 

adult at risk of abuse, harm or neglect.

• Arranges advocates if required, 

communicating with people about 

safeguarding, risk and protection planning. 

This includes facilitating communication 

with use of interpreters, speech and 

language colleagues and aids to improve 

communication. 

• Understands local safeguarding structures 

and arrangements. 

• Understands mental capacity legislation as 

relevant to the country of practice. When 

DoLS are required/invoked (if appropriate), 

the role of mental capacity advocates, the 

role of lasting power of attorney and the 

role of the public guardian/Office of Care 

and Protection (OCP) and future planning 

arrangements such as court appointed 

deputies, advance decisions to refuse 

treatment, advanced statements and acts in 

best interests of the adult at risk as required.

• Documents safeguarding concerns in order 

to be able to inform the relevant staff and 

agencies as necessary, maintains appropriate 

records, records the wishes and views of 

the adult at risk and differentiates between 

fact and opinion. Registered professionals at 

level two also need to have an understanding 

of forensic requirements. For example, 

radiographers undertaking skeletal survey 

examinations for forensic purposes.

• Shares appropriate and relevant information 

with other teams within relevant information 

sharing protocols.

• Acts in accordance with key statutory 

legislation and non-statutory guidance 

relevant to country of practice. 

• Understands how to support adults at risk 

who do not feel able to participate in service 

support, for example those experiencing 

coercive control, environmental health 

issues.

* Joint statement from BDA/BSPD “the majority of dentists and dental care professionals will require level 2; 

in larger organisations, including hospital and community-based specialist services (special care dentistry or 

other relevant dental specialties) the precise number of dentists and dental care professionals requiring level 3 

competencies should be determined locally based on an assessment of need and risk”.

** In Northern Ireland a specific adult safeguarding competence framework for nurses and midwives is being 

developed and this will be accepted as the competence framework for nurses and midwives in Northern Ireland.

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• Recognise obligations to act when they have 

a safeguarding concern and acting is against 

the expressed wishes of the person.

• Understands own and colleagues’ 

roles, responsibilities, and professional 

boundaries, including what constitutes 

both organisational and professional abuse. 

Is able to raise concerns about conduct of 

colleagues.

• Understands how to access local 

safeguarding supervision, networks and 

support.

L2.3 Knowledge, skills, 

attitudes and values

All staff at Level 2 should have the knowledge, 

skills, attitudes and values outlined for Level 1 

and should be able to demonstrate the following:

L2.3.1 Knowledge

• Understands the ways in which abuse, harm 

and neglect can impact on personal identity 

throughout the life course.

• Understands the significance of health 

deficits on health and wellbeing through 

the life course, for example homelessness, 

loneliness and poverty. 

• Understands the legal, professional, and 

ethical responsibilities around information 

sharing, including the use of assessment 

frameworks.

• Understands the best practice in 

documentation, record keeping, and data 

protection issues in relation to information 

sharing for safeguarding purposes.

• Be familiar with the guidance related to 

participation in safeguarding enquiries and 

reviews.

• Understands the professional duty to report 

crime in line with organisational and 

professional guidance.

• Understands the importance of establishing, 

acting or making a decision in person’s best 

interests as reflected in legislation and key 

statutory and non-statutory guidance.

L2.3.2 Skills

• Able to document safeguarding concerns, 

and maintain appropriate record-keeping, 

recording the wishes and views of the adult 

at risk, differentiating between fact and 

opinion. 

• Able to share appropriate and relevant 

information between teams – in writing, 

by telephone, electronically, and in person 

within relevant information sharing 

protocols.

• Able to identify where further support is 

needed, when to take action, and when to 

refer to managers, supervisors or other 

relevant professionals, including referral to 

social services.

L2.3.3 Attitudes and 

values

• Recognises how own beliefs, experience 

and attitudes might influence professional 

involvement in safeguarding work.

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Level 3: Registered health care staff who engage in 

assessing, planning, intervening and evaluating the 

needs of adults where there are safeguarding concerns 

(as appropriate to role) 

L3.1 Staff groups

This includes safeguarding professionals, 

medical staff, general practitioners, registered 

nurses, urgent and unscheduled care staff, 

psychologists, psychotherapists, adult learning/

intellectual disability practitioners, health 

professionals working in substance misuse 

services, paramedics, sexual health staff, care 

home managers, health visitors, midwives, 

dentists, pharmacists with a lead role in adult 

protection (as appropriate to their role). 

L3.2 Core competencies

• As outlined for Level 1 and 2.

• Draws on clinical and professional 

knowledge and expertise of what constitutes 

adult abuse, harm or neglect to support 

others in fulfilling their adult safeguarding 

duties.

• Undertakes capacity assessments within 

the framework of the relevant legislation (if 

appropriate to role) and is able to understand 

who needs to be included or consulted 

with in making decisions in a person’s best 

interests.

• Discusses the situation with the person, 

documents and reports concerns, recording 

the wishes and views of the adult at risk. 

Undertaking history taking and physical 

examination in a manner that is appropriate 

for safeguarding and legal processes, as 

appropriate to the practitioner’s role.

• Undertakes and contributes to and supports 

inter-agency assessments or enquiries 

particularly when the enquiry needs to 

be undertaken by the person with the 

relationship with the adult. Gathering 

and sharing of information, including the 

person’s views on risk and risk management. 

Where appropriate, analysis of risk including 

supporting others to undertake these 

activities.

• Understands the purpose and process of case 

reviews.

• Contributes to and/or co-ordinates 

protection planning, resolution and recovery 

– as appropriate to safeguarding concern. 

• Undertakes regular documented reviews of 

own (and/or team) safeguarding practice as 

appropriate to role (in various ways, such as 

through audit, case discussion, peer review, 

reflective practice, supervision and as a 

component of refresher training).

• Attends relevant multidisciplinary meetings 

to present supporting evidence within 

relevant information sharing protocols. If 

unable to attend contributes written reports 

or information as required/requested/

relevant in accordance with confidentiality 

and information sharing requirements.

• Contributes to case reviews, panels, internal 

partnerships and local forms of review. 

• Works with other professionals and agencies, 

with adults and their families where 

there are safeguarding concerns in risk 

management and protection planning.

• Applies the lessons learnt from audit and 

case reviews to improve practice.

• Advises others on appropriate information 

sharing.

• Undertakes clinical supervision and provides 

support for other staff (as appropriate to 

role).

L3.3 Knowledge, skills, 

attitudes and values

Knowledge

• Understand the implications of legislation, 

inter-agency policy and national guidance.

• Understand information sharing, 

confidentiality, and consent. 

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• Understand the role, remit and procedures of 

local safeguarding boards and panels.

• Understand inter-agency frameworks and 

assessment processes, including the use of 

relevant assessment frameworks.

• Understand the interface between 

safeguarding and the criminal justice system 

as appropriate to role.

• Understand relevance of multi-agency audits 

and own role in multi-agency inspection 

processes.

• Understands the principles of effective adult 

safeguarding supervision and peer support.

• Understands what constitutes, as 

appropriate to role, forensic procedures and 

practice required in adult safeguarding, 

and how these relate to clinical and legal 

requirements.

• Understands national and local frameworks 

for the assessment of risk and harm.

• Understands the notion of proportionalityrecognising that unforeseen events occur 

and people can take risks and make unwise 

decisions. 

• Understand the effects of carer behaviour 

and family factors on adults at risk of 

abuse, harm or neglect and the inter-agency 

response.

• Know when to liaise with expert colleagues 

about the assessment and management of 

adult safeguarding and adult protection 

planning. 

• Know how to share information 

appropriately, taking into consideration 

confidentiality and data-protection issues 

and record decisions made.

• Know about models of effective clinical 

supervision and peer support.

• Aware of resources and services that may be 

available within health and other agencies, 

including the voluntary sector, to support 

families.

• Know what to do when there is an 

insufficient response from organisations or 

agencies.

• Explains the management of the death of an 

adult in a safeguarding context.

• Understands duty of candour.

• Understand and contribute to processes 

for auditing the effectiveness and quality 

of services for safeguarding including 

audits against national guidelines and local 

safeguarding adults auditing tools. 

L3.3.1 Skills

• Able to act proactively to reduce the 

likelihood of abuse, harm or neglect to adults 

at risk.

• Able to contribute to, and make considered 

judgements about how to act to promote 

wellbeing and to safeguard an adult when 

needed. 

• Able to present safeguarding concerns 

verbally and in writing for professional 

and legal purposes as required (and as 

appropriate to role). 

• Able to work with adults and carers where 

there are safeguarding concerns as part of 

the multi-disciplinary team and with other 

disciplines.

• Able to communicate effectively with adults 

to recognise and to ensure those lacking 

capacity to make a particular decision or 

with communication needs have opportunity 

to participate in decisions affecting them. 

• Able to give effective feedback to colleagues.

• Able to identify (as appropriate to role) 

associated medical conditions, mental health 

needs and other co-morbidities which may 

increase the risk of abuse, harm or neglect 

and be able to take appropriate action.

• Able to assess (as appropriate to the role) the 

impact of, carer and family issues on adults 

at risk of abuse, harm or neglect including 

mental health needs, learning/intellectual 

disabilities, substance misuse and domestic 

abuse and long-term conditions. 

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• Able to challenge other professionals when 

required and provide supporting evidence.

• Able to provide clinical support and 

supervision to junior colleagues and peers.

• Able to contribute to inter-agency 

assessments and to undertake an assessment 

of risk when required.

• Able to contribute to and make considered 

decisions on whether concerns can be 

addressed by providing or signposting to 

sources of information or advice.

• Able to participate and chair multidisciplinary meetings as required (as 

appropriate to role).

• Applies lessons from case reviews.

• Identifies risks and contributes to risk 

assessments.

• Able to contribute to/formulate and 

communicate effective safeguarding plans 

for adults at risk of abuse, harm or neglect.

• Able to complete the audit cycle and/or 

research related to safeguarding as part of 

appropriate clinical governance and quality 

assurance processes (as appropriate to role).

L3.3.2 Attitudes and 

values

• Supports a culture of inclusivity in diversity 

and equality for staff and patients/service 

users.

• Understands the importance and benefits 

of working in an environment that supports 

professionals and colleagues including 

knowing when to seek and offer support.

• Creates and supports a working environment 

that enables professionals to develop skills 

and knowledge in adult safeguarding.

• Understands the potential personal impact 

of safeguarding work on professionals and 

colleagues.

• Recognises when additional support is 

needed in managing adult safeguarding 

including support with all legal and court 

activities (such as writing statements, 

preparing for attending court) and the 

need to debrief in relation to a case or other 

experience where appropriate to role. 

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Level 4: Specialist roles – named professionals 

L4.1 Staff groups

This includes lead doctors, heads of adult 

safeguarding, and named GPs/doctors for 

organisations commissioning primary care. 

Named professionals working in provider or 

commissioning services. 

L4.2 Core competencies

• As outlined for Level 1, 2 and 3.

• Be able to align national guidance to local 

practice.

• Collaborate with workforce partners to 

ensure that the organisation is aligned with 

regulated employment checks under the DBS. 

• Contributes as a member of the safeguarding 

team to the development of internal 

safeguarding policy, guidelines and 

protocols.

• Able to effectively communicate local 

safeguarding knowledge, research and 

findings from audits and challenge poor 

practice. Support and develop improvements 

in care/practice/local responses/services/act 

in response to identified locality knowledge 

needs. 

• Facilitates and contributes to own 

organisation audits, multi-agency audits and 

statutory inspections establish governance 

structure and annual reporting monitoring 

and review.

• Works with the safeguarding team and 

partners in other agencies to conduct 

safeguarding training needs analysis, and 

to commission, plan, design, deliver and 

evaluate single and inter-agency training 

and teaching for staff in the organisations 

covered.

• Undertakes and contributes to case reviews.

• Able to lead investigations on behalf of social 

care organisations when requested to enable 

it to decide whether any action should be 

taken in the adult’s case.

• As appropriate to role undertakes 

chronologies and the development of action 

plans using a root cause analysis approach 

(where appropriate) or other locally approved 

methodologies. 

• In conjunction with designated safeguarding 

lead, co-ordinates and contributes to 

implementation of action plans and the 

learning following reviews.

• Works effectively with colleagues from 

other organisations, providing advice as 

appropriate.

• Provides advice and information about 

safeguarding to the employing authority, 

both proactively and reactively – this 

includes the board, directors, and senior 

managers.

• Provides specialist advice to practitioners, 

both actively and reactively, including 

clarification about organisational policies, 

legal issues and the management of adult 

safeguarding cases.

• Provides safeguarding supervision and leads 

or ensures appropriate reflective practice 

is embedded in the organisation, to include 

peer review.

• Leads/oversees safeguarding quality 

assurance and improvement processes.

• Undertakes risk assessments of the 

organisation’s ability to safeguard/protect 

adults at risk.

• Understands the role and procedures of 

coroner’s courts, court of protection and 

regulators professional bodies. 

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L4.3 Knowledge, skills, 

attitudes and values

Level 4 professionals should have the knowledge, 

skills and attitudes outlined for Levels 1, 2 and 3 

and be able to demonstrate the following:

Knowledge

• Aware of best practice in adult safeguarding.

• Aware of latest research evidence and the 

implications for practice.

• Advanced understanding of legislation, 

information sharing, information 

governance, confidentiality and consent 

including guidance from professional bodies.

• Have core knowledge and legal literacy 

relevant to the range of safeguarding issues. 

Understand court and criminal justice 

systems, the role of different courts, the 

burden of proof, and the role of a professional 

witness in the stages of the court process (as 

appropriate to one’s role).

• Have a sound understanding of forensic 

requirements as it relates to clinical practice, 

including the procedures and investigations 

required in adult abuse, harm or neglect (as 

appropriate to role).

• Have an advanced knowledge of relevant 

national safeguarding issues, policies and 

implications for practice.

• Understand the commissioning and planning 

of safeguarding services where appropriate 

to role. 

• Know about the professional and experts’ 

role in criminal justice and court processes.

• Know how to implement and audit the 

effectiveness of safeguarding practices on an 

organisational level against current national 

guidelines and quality standards.

L4.3.1 Skills

• Able to effectively communicate advice about 

safeguarding policy and legal/assurance 

frameworks.

• Able to support colleagues in challenging 

views offered by professionals and others, as 

appropriate.

• Able to analyse and evaluate information 

and evidence to inform inter-agency decision 

making across the organisation.

• Able to participate in a case review, leading 

internal management reviews as part of this 

function.

• Able to support others across the 

organisation in writing a chronology and 

review about individual adults, summarising 

and interpreting information from a range of 

sources.

• Able to lead service reviews.

• Able to establish adult safeguarding quality 

assurance measures and processes.

• Able to undertake training needs 

analysis, and to teach and educate health 

professionals.

• Able to review, evaluate and update local 

guidance and policy in light of research 

findings.

• Able to advise and inform others about 

national issues and policies and the 

implications for practice. 

• Able to deal with the media and 

organisational public relations concerning 

safeguarding with organisational support 

and guidance. 

• Able to work effectively with colleagues in 

regional safeguarding clinical networks.

• Able to promote research evidence and best 

practice in adult safeguarding. 

L4.3.2 Attitudes and values

• As outlined in level 1, 2 and 3.

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Level 5: Specialist roles – designated professionals or 

equivalent roles 

L5.1 Staff groups

This level applies to designated safeguarding 

professionals (or equivalent roles) in the UK. 

Each nation is responsible for passing legislation, 

publishing guidance and establishing policy 

frameworks. There may be additional specific 

duties relating to designated professionals in 

each nation.

L5.2 Core competencies

• As outlined for Level 1, 2, 3 and 4.

• Provides, supports and ensures contribution 

to safeguarding appraisal and appropriate 

supervision for colleagues across the health 

community.

• Leads training needs analysis, and 

commissions, plans, designs, delivers, and 

evaluates adult safeguarding single and 

inter-agency training and teaching for staff 

across the health community.

• Leads/oversees safeguarding quality 

assurance and improvement across the 

health community.

• Leads innovation and change to improve 

safeguarding across the health economy.

• Takes a lead role in conducting the health 

component of case reviews across whole 

health community.

• Gives appropriate advice to specialist 

safeguarding professionals working within 

organisations delivering health services and 

to other agencies.

• Takes a strategic and professional lead across 

the health community on all aspects of adult 

safeguarding.

• Provides expert advice to increase quality, 

productivity, and to improve health outcomes 

adults at risk and those identified with 

safeguarding concerns.

• Provides expert advice to service planners 

and commissioners, ensuring all services 

commissioned meet the statutory 

requirement to safeguard and promote the 

welfare of adults to include:

• taking a strategic professional lead 

across every aspect of health service 

contribution to adult safeguarding 

within all provider organisations 

commissioned by the commissioners 

within each nation

• ensures that commissioned services have 

robust systems, procedures, policies, 

professional guidance, training and 

supervision are in place in keeping with 

national legislation, procedures and 

recommendations 

• provides specialist advice and 

guidance to the board and executives 

of commissioner organisations on all 

matters relating to adult safeguarding 

including regulation and inspection

• be involved with commissioners, 

providers and partners on direction and 

monitoring of safeguarding standards 

and to ensure that safeguarding 

standards are integrated into all 

commissioning processes and service 

specifications.

• monitors services across the health 

community to ensure adherence to 

legislation, policy and key statutory and 

non-statutory guidance.

L5.3 Knowledge, skills, 

attitudes and values

Level 5 professionals should have the knowledge, 

skills, attitudes and values outlined for Levels 

1, 2, 3 and 4, and be able to demonstrate the 

following:

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Knowledge

• Advanced and in-depth knowledge of 

relevant national policies and implications 

for practice.

• Understanding of court and criminal justice 

systems, the role of the different courts, the 

burden of proof, and the role of professional 

witnesses and expert witnesses in the 

different stages of the court process. Be able 

to support or advise other professionals with 

legal documentation/court responsibilities 

within their organisations. 

• To ensure support for the named 

professionals within partner organisations.

• Know how to lead the implementation 

of national guidelines and audit the 

effectiveness and quality of services across 

the health community against quality 

standards.

• Advanced knowledge of different specialties 

and professional roles.

• In depth understanding of safeguarding 

curriculum and training at both preregistration and post registration level (as 

appropriate to role).

L5.3.1 Skills

• Able to lead the health contribution in 

serious case reviews, drawing conclusions 

and developing an agreed action plan to 

address lessons learnt.

• Able to plan, design, deliver and evaluate 

inter-agency safeguarding training for staff 

across the health community, in partnership 

with colleagues in other organisations and 

agencies.

• Able to oversee safeguarding quality 

assurance processes across the whole health 

community.

• Able to influence improvements in 

safeguarding services across the health 

community.

• Able to provide clinical supervision, 

appraisal, and support for named 

professionals.

• Able to lead multidisciplinary team reviews.

• Able to evaluate and update local procedures 

and policies in light of relevant national 

issues and developments.

• Able to arbitrate and reconcile differences 

of opinion among colleagues from different 

organisations and agencies, escalating 

issues if necessary to board, regional or legal 

colleagues.

• Able to proactively deal with strategic 

communications and the media on 

safeguarding across the health community.

• Able to work with public health officers to 

undertake robust safeguarding populationbased needs assessments that establish 

current and future health needs and service 

requirements across the health community 

as appropriate to country of practice 

• Able to provide an evidence base for 

decisions around investment and 

disinvestment in services to improve 

the health of the local population and 

to safeguard adults and articulate these 

decisions to executive officers.

• Able to work effectively with, and lead where 

appropriate, colleagues in regional and 

national safeguarding clinical networks.

• Able to deliver high-level strategic 

presentations to influence organisational 

development.

• Able to work in partnership on strategic 

projects with executive officers at local, 

regional, and national bodies, as appropriate.

L5.3.2 Attitudes and values

• As outlined in Level 1, 2, 3 and 4.

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Board level for chief executive officers, trust and health 

board executive and non-executive directors/members, 

commissioning body directors including the 

independent and voluntary sectors

It is envisaged that chief executives of 

health organisations take overall (executive) 

responsibility for adult safeguarding strategy and 

policy with additional leadership being provided 

at board level by the executive director with the 

lead for safeguarding. All board members must 

have a level of knowledge equivalent to all staff 

working within the health care setting (level 1) as 

well as additional knowledge-based competencies 

by virtue of their board membership or nonexecutive safeguarding director role, as 

outlined below. All boards should have access 

to safeguarding advice and expertise through 

dedicated designated or named professionals.

Commissioning bodies have a critical role 

in quality assuring providers systems and 

processes, and thereby ensuring they are 

meeting their safeguarding responsibilities and 

working closely with safeguarding partners. 

Designated safeguarding professionals within 

commissioning organisations provide expert 

advice to commissioners.

The roles of chair, CEOs, executive board leads 

and board members will be described separately. 

B.1 Chair

The chair of NHS trusts, health boards, other 

independent and voluntary health providers, 

health boards and commissioning bodies are 

responsible for the effective operation of the 

board with regard to adult safeguarding.

Key responsibilities for chairs

• To seek assurance that the role and 

responsibilities of the organisational board 

are properly discharged in relation to adult 

safeguarding.

• To understand the potential causes and 

consequences of gross negligence.

• To promote a positive culture of adult 

safeguarding across the board through 

assurance that there are appropriate policies 

and procedures for adult safeguarding and 

that these are being followed; and that staff 

and patients are aware that the organisation 

takes adult safeguarding seriously and will 

respond to concerns about the welfare and 

wellbeing of adults at risk.

• To seek assurance that there are robust 

governance processes in place to provide 

assurance on adult safeguarding. 

• To ensure good information from and 

between the organisational board or board of 

directors, committees, council of governors 

where applicable, the membership and senior 

management on adult safeguarding. 

• Boards should appoint a non-executive 

director (NED) board member to ensure the 

organisation discharges adult safeguarding 

responsibilities appropriately. 

B.2 Chief executive officer 

(CEO) or equivalent

The CEO of NHS trusts, health boards and 

commissioning bodies (and equivalent health 

care bodies throughout the UK and independent 

and voluntary providers must provide strategic 

leadership, promote a culture of supporting good 

practice with regard to adult safeguarding within 

their organisations and promote collaborative 

working with other agencies.

Key responsibilities of CEOs

• To ensure the role and responsibilities of 

the organisational board in relation to adult 

safeguarding are met.

• To understand the potential causes and 

consequences of gross negligence.

• To seek assurance that the organisation 

adheres to relevant national/local guidance 

and standards for adult safeguarding.

• To promote a positive culture of adult 

safeguarding ensuring there are appropriate 

policies and procedures for adult 

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safeguarding (including regular updating) 

and that staff, volunteers and patients are 

aware that the organisation takes adult 

safeguarding seriously and will respond to 

concern about the welfare and wellbeing of 

adults at risk.

• To appoint an executive director or 

equivalent lead for adult safeguarding.

• To ensure there are effective adult 

safeguarding processes throughout the 

organisation.

• To ensure there is appropriate access to 

advice from dedicated named and designated 

professionals.

• To ensure that operational services are 

resourced to support/respond to the 

demands of adult safeguarding effectively.

• To ensure that an effective strategy for adult 

safeguarding is resourced and delivered 

including access to support. 

• To ensure and promote appropriate safe, 

multiagency/interagency partnership 

working practices including information 

sharing protocols.

B.3 Executive director 

lead

There should be a nominated executive director 

board member who takes responsibility for adult 

safeguarding issues. The executive director lead 

will report to the board on the performance 

of their delegated responsibilities and will 

provide leadership in the long-term strategic 

planning for adult safeguarding services for the 

organisation supported by named and designated 

professionals.

Key responsibilities of the board 

executive director lead

• To ensure that adult safeguarding is 

positioned as core business in strategic and 

operating plans and structures.

• To understand the potential cause and 

consequences of gross negligence.

• To oversee, implement and monitor the 

ongoing assurance of adult safeguarding 

arrangements.

• To ensure the adoption, implementation and 

auditing of practice, policy and strategy in 

relation to adult safeguarding.

• Within commissioning organisations 

to ensure the appointment of dedicated 

designated adult safeguarding professionals 

or equivalent.

• Within commissioning organisations to 

ensure that provider organisations are 

quality assured for their adult safeguarding 

arrangements.

• Within both commissioning and provider 

organisations to ensure support of named/

designated lead professionals across primary 

and secondary care and independent 

practitioners to implement safeguarding 

arrangements.

• To seek assurance that there is a programme 

of safeguarding training and continuous 

professional development, including 

recognised specific mentoring to support for 

formal adult safeguarding leads.

• Working in partnership with other groups 

including commissioners/providers of health 

care (as appropriate), local authorities and 

police to secure high quality, best practice in 

adult safeguarding.

• To seek assurance that serious incidents 

relating to safeguarding are reported 

immediately and managed effectively 

including the sharing of lessons learnt.

• To ensure that any allegations against staff 

members are appropriately investigated and 

managed.

Key responsibilities of the nonexecutive director board lead

• To ensure appropriate scrutiny of the 

organisation’s safeguarding performance.

• To ensure assurance is provided to the 

board of the organisation’s safeguarding 

performance.

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B.4 Board members core 

competencies

All board members/commissioning leads should 

have Level 1 core competencies in safeguarding 

and must know the common presenting features of 

abuse, harm and neglect and the context in which 

it presents to health care staff. In addition, board 

members/commissioning leads should have an 

understanding of the statutory role of the board in 

safeguarding including partnership arrangements, 

policies, risks and performance indicators; staff’s 

roles and responsibilities in safeguarding; and the 

expectations of regulatory bodies in safeguarding. 

Essentially the board will be held accountable for 

ensuring adults at risk in the organisations care 

receive high quality, evidence based care and 

personalised safeguarding.

B.5 Knowledge, skills, 

attitudes and values

In addition to Level 1 board members/

commissioning leads should have the following:

B.5.1 Knowledge

• Knowledge of health benefits and financial 

impact of adult safeguarding on the local 

health economy. 

• Knowledge of the potential causes and 

consequences of gross negligence.

• Knowledge of agencies involved in adult 

safeguarding, their roles and responsibilities, 

and the importance of interagency co-operation.

• Knowledge about the statutory obligations 

to work with the local or area adult 

safeguarding board and other safeguarding 

partners including the independent and 

voluntary sectors.

• Knowledge of the ethical, legal and 

professional obligations around information 

sharing related to adult safeguarding.

• Knowledge about the statutory 

organisational obligation to be involved, 

participate and implement the learning 

from serious incidents, safeguarding adult 

reviews, domestic homicide and other review 

processes.

• Knowledge about the need for, provision 

of and compliance with staff training 

both within commissioning and provider 

organisations as a statutory requirement.

• Knowledge about the importance of all adult 

safeguarding policies and procedures with 

regard to personnel, and the requirement 

for maintaining, keeping them up to date 

and reviewed at regular intervals to ensure 

they continue to meet both patient and 

organisational needs.

• Knowledge about the regulation and 

inspection processes and implications for 

the organisation if standards are not met by 

either commissioners or providers.

• If working within a commissioning 

organisation, knowledge about the 

importance of regular reporting and 

monitoring of safeguarding arrangements 

within provider organisations.

• Knowledge about board level risk relating 

to adult safeguarding and the need to have 

arrangements in place for rapid notification 

and action on serious incidents.

• Knowledge about the requirement of the 

board to have access to appropriate high 

quality clinical and forensic advice on 

adult safeguarding from dedicated named/

designated professionals or equivalents.

B.5.2 Skills

• To be able to recognise possible signs of adult 

abuse, harm or neglect as this relates to their 

role.

• To proactively to seek appropriate advice and 

report concerns.

• To have the appropriate board level skills 

to be able to challenge and scrutinise 

safeguarding information to include; 

performance data, serious incidents, 

partnership working and regulatory 

inspections to enable appropriate assurance 

of the organisation’s performance in 

safeguarding.

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B.5.3 Attitudes and values

In addition to the attitudes and values at Level 1. 

• Personal commitment to listen and to 

act on issues and concerns, as well as an 

expectation that the organisation and 

professionals within it value and listen to 

adults at risk.

• Commitment to work in partnership with 

other organisations/patients and families/

carers to promote high quality safeguarding.

• Commitment to promote a positive culture 

around safeguarding within the organisation.

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1. Education and training

This section outlines key issues related to 

acquiring and maintaining safeguarding 

knowledge and skills.

It is intended to support practice, education and 

training in all health care settings, sectors and 

countries 

The following text is intended to provide 

guidance for the minimum indicative content 

and time required for practitioners to meet 

their safeguarding responsibilities. We would 

suggest that indicative content also supports 

specific local needs and that scrutiny of local 

adult safeguarding data will also inform content 

and delivery. Provision for adult staff guarding 

training should be made within professionals job 

plans/allocated training time.

7. Section B: Education and 

training

In Northern Ireland this section should be read in conjunction with Northern Ireland Adult Safeguarding 

Partnership (2016) Training Strategy and Framework 2013 (Revised 2016) http://www.hscboard.hscni.net/download/

publications/safeguard-vulnerable-adults/niasp-publications/Adult-Safeguarding-Operational-Procedures.pdf

Link to Northern Ireland Adult Safeguarding Partnership is http://www.hscboard.hscni.net/NIASP

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2. Underpinning principles

• Acquiring knowledge, skills and expertise 

in adult safeguarding should be seen as a 

continuum. It is recognised that students and 

trainees will increase skill and competence 

throughout their undergraduate programme 

and at post-graduate level as they progress 

through their professional careers.

• Training needs to be flexible, encompassing 

different learning styles and opportunities. 

The education, training and learning ‘hours’ 

stated at each level are therefore indicative, 

recognising that individuals learning 

styles and the roles they undertake vary 

considerably. Additionally there is a need to 

recognise new and emerging safeguarding 

issues for which staff need to acquire 

additional knowledge and skills. 

• Inter professional and inter organisational 

training and education is encouraged in 

order to share best practice, learn from 

serious incidents and to develop professional 

networks, this should include both 

independent and voluntary sector health 

providers.

• Those leading and providing multidisciplinary and inter-agency training must 

demonstrate knowledge of the context of 

health participants’ work, provide evidence 

to ensure the content is approved and 

considered appropriate against the relevant 

level, delivered by a registered professional 

(in partnership with other specialists as 

appropriate), who has qualifications and/

or experience relevant to adult safeguarding 

and delivery of education and training and 

should tailor training sessions to the specific 

roles and needs of different professional 

groups at each level.

• The effectiveness of training programmes 

and learning opportunities should be 

regularly monitored. This can be done 

by evaluation forms, staff appraisals 

(encompassing a collaborative review of 

education, training and learning logs/

passport), e-learning tests (following training 

and at regular intervals), and auditing 

implementation, as well as staff knowledge 

and understanding.

• Staff should receive refresher training every 

three years as a minimum and training 

should be tailored to the roles of individuals. 

Individuals should be encouraged to 

maintain their education, training and 

learning log to capture all education, training 

and learning opportunities to demonstrate 

acquisition and up to date knowledge, skills 

and competencies.

• E-learning is appropriate to impart 

knowledge at level 1 and 2. E-learning 

can also be used at level 3 and above as 

preparation for reflective team-based 

learning, and contribute to appraisals and 

revalidation when linked to case studies and 

changes in practice.

• While e-learning is important it should not 

be the only form of learning undertaken. It 

is expected that at least 50% of indicative 

education, training and learning time is 

of a participatory nature. This includes 

for example formal teaching/education, 

conference attendance and group case 

discussion.

• Education and training passports will 

prevent the need to repeat learning where 

individuals move organisations are able to 

demonstrate up to date relevant competence, 

knowledge and skills, except where 

individuals have been working outside of the 

area of practice and the new role demands 

additional knowledge and skill or individuals 

have had a career break and are unable to 

do so.

• In addition to training programmes, named 

professionals should circulate written update 

briefings and literature, as appropriate, 

to all staff at least annually to include, for 

example, changes in legislation, changes 

in local policies and procedures, the risks 

associated with the internet and online social 

networking or lessons from serious case 

reviews.

• Healthcare organisations must ensure all 

staff are able to access safeguarding support 

and expert advice.

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• The learning outcomes should describe what 

an individual should know, understand, or be 

able to do as a result of training and learning.

• It is recognised that many professionals 

also need equivalent child safeguarding/

protection education, training and learning. 

There are several aspects of safeguarding 

training and education that can apply equally 

to child and adult safeguarding/protection 

and that share the same principles. Examples 

of this may include, but are not limited to: 

• safeguarding ethos

• confidentiality

• information sharing

• documentation

• domestic abuse. 

Education and training on these shared aspects 

may contribute to both children and adult 

safeguarding/protection requirements where 

individuals are able to clearly demonstrate 

application within the reflective education, 

training and learning log. Those who are 

providing training on shared aspects must 

ensure that there is equal value given to children 

and adults within the training. Organisations 

using such opportunities for the integration 

of child and adult safeguarding must be able 

to demonstrate they have provided education, 

training and learning covering all elements of 

both adult and child safeguarding as outlined 

in the intercollegiate children and young 

people’s document and the intercollegiate adult 

document, thereby enabling staff to demonstrate 

that they have acquired the relevant knowledge, 

skills and competences. Organisations must also 

able to provide evidence that equal value is given 

to both the adult and child content.

Each level sets out the indicative content and 

time needed by practitioners. Maintaining 

and updating knowledge and skill should be a 

continuous and ongoing process. Regulatory and 

inspection bodies require evidence of completion 

of key refreshing and updating for revalidation 

and inspection purposes. Organisations can, if 

they wish, seek accreditation from a professional 

body (if available) for any programme of study, 

however they must assure themselves that any 

externally contracted provider of safeguarding 

education and training explicitly states how 

any course or learning opportunity meets 

the required intercollegiate framework level. 

Employers must also give consideration to 

assessing learning and the long term impact of 

education and training provided.

2.1 Those providing adult safeguarding 

education and training should also consider the 

requirements of practitioner’s regulatory bodies 

where appropriate and legislative requirements 

for their locality/country. 

2.2 Ultimately employing organisations are 

responsible for assuring that their employees 

have the knowledge, skills and competence to 

undertake their roles in both prevention and 

response to adult safeguarding. Organisations 

must provide support such that learners can 

embed new knowledge and skills into their roles. 

They should be supported by appropriate clinical 

supervision and mentorship as required. 

2.3 Accessible records of formal training must 

be retained in an individual employee’s personal 

file/organisational record. Portable education 

passports are encouraged in order that staff can 

move between organisations without having to be 

repeatedly retrained. 

2.4 Practitioners should be encouraged to 

reflect on safeguarding practice and share best 

practice as part of their professional development 

documenting their key learning and number of 

hours. 

2.5 Inter-professional and inter-organisational 

training and education is encouraged in order to 

share best practice, learn from serious incidents 

and to develop professional networks, this should 

include both independent and voluntary sector 

health providers. It is acknowledged that adult 

safeguarding training and education will draw on 

knowledge and skills from related professional 

and legal guidance, for example mental capacity 

legislation, confidentiality guidance and 

guidance for safeguarding children and young 

people. The inclusion of knowledge from other 

allied subjects is important but cannot replace 

the main focus of the training which must be on 

adult safeguarding guidance. 

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2.6 As principle face to face adult safeguarding 

education and training at all levels should form 

no less 50% of the content. In the absence of a 

national training passport across all sectors, 

arrangements should be developed to assess 

employee’s prior skills, knowledge and 

competence in order to use the training to best 

clinical effect. 

2.7 The delivery of high quality safeguarding is 

an essential role for all organisations who deliver 

care. It is not an addition to clinical practice, it is 

an intrinsic facet of professional practice and is 

core business for all health care organisations. 

2.8 Training needs to be flexible, encompassing 

different learning styles and opportunities, 

where appropriate it should involve service users 

and multidisciplinary colleagues. 

2.9 Royal colleges/professional organisations 

must also play a part in providing advice and 

support particularly where health care 

practitioners are raising concerns about their 

own organisations.

2.10 Healthcare practitioners should take part 

in clinical governance including holding regular 

case discussions, critical event analysis, audit, 

adherence to national guidelines (NSF, NICE, 

SIGN), analysis of complaints and other patient 

feedback and systems of safeguarding 

supervision and/or peer review. There should be 

opportunity to share good practice both in 

preventative safeguarding and responses to 

safeguarding concerns. 

2.11 Governance structures should foster good 

cross sector/agencies relations and open up 

learning and review events to both the voluntary 

and independent sector 

2.12 Information about accredited training and 

education programmes can be found at, including 

links to e-learning (http://www.e-lfh.org.uk) 

(who have agreed to provide some underpinning 

e-learning). 

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Level 1

Over a three-year period, staff at level 1 should 

receive refresher training equivalent to a 

minimum of two hours. This should provide key 

adult safeguarding guidance.

Learning outcomes

The learning outcomes describe what an 

individual should know, understand, or be able to 

do as a result of training and learning.

• Able to recognise potential indicators of 

abuse, harm and neglect.

• To know what action to take if you have 

concerns, including to whom you should 

report your concerns and from whom to seek 

advice.

• To have a basic knowledge of the relevant 

legislation. 

All health staff

A mandatory session of at least 30 minutes 

duration should be included in the general staff 

induction programme or within six weeks of 

taking up post within a new organisation. This 

should provide key safeguarding information and 

appropriate action to take if there are concerns.

Level 2

It is expected that the knowledge, skills and 

competence for level 2 would have been acquired 

within individual professional education 

programmes where appropriate. Training and 

education must be provided for unregistered 

staff who work at level 2 to ensure all staff can 

deliver appropriate preventative and reactive 

safeguarding practice. 

Over a three-year period, professionals at level 2 

should receive refresher training equivalent to a 

minimum of 3-4 hours. 

Training at level 2 will include the training 

required at level 1 and will negate the need to 

undertake refresher training at level 1 in addition 

to level 2.

Training, education and learning opportunities 

should include multi-disciplinary/multi-agency 

and scenario-based discussion drawing on case 

studies and lessons from research and audit. 

This should be appropriate to the specialty and 

roles of participants, encompassing for example, 

the importance of early help, domestic abuse, 

adults with cognitive impairment and individuals 

requiring support with communication.

Organisations should consider encompassing 

safeguarding learning within regular, multiagency or family meetings, clinical updating, 

sharing good practice and clinical audit, reviews 

of critical incidents and significant unexpected 

events and peer discussions. Such participative 

learning time should be documented and a 

reflective record kept by the participant. 

Learning outcomes

• To be able to understand what constitutes 

harm, abuse and neglect and be able to 

identify any signs of harm, abuse or neglect.

• To be able to ensure effective advocacy is 

provided, were required. For example were 

there are mental capacity or communication 

issues, in line with the legislation and 

professional guidance.

• To be able to identify your professional 

role, responsibilities, and professional 

boundaries and those of your colleagues in 

a multidisciplinary team and multi-agency 

setting.

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• To know how and when to refer to social care 

if you have identified an adult safeguarding 

concern in accordance with organisational 

policies.

• To be able to document safeguarding 

concerns in a format that informs the 

relevant staff and agencies appropriately.

• To know how to maintain appropriate 

records including being able differentiate 

between fact and opinion.

• To be able to identify the appropriate and 

relevant information and how to share it with 

other teams.

• Practice will be informed by an 

understanding of key statutory and nonstatutory guidance and legislation including 

Human Rights Act and mental capacity 

legislation in country of practice.

• To be aware of the risk factors for 

radicalisation and will know who to contact 

regarding preventive action and supporting 

those persons who may be at risk of, or are 

being drawn into, terrorist related activity.

Level 3

For those individuals moving into Level 3 adult 

safeguarding posts who have as yet not attained 

the relevant knowledge, skills and competence 

required at level 3 it is expected that within 

twelve months of appointment additional 

tailored education will be completed equivalent 

to a minimum of eight hours of education and 

learning related to adult safeguarding and have 

an appropriate supervision in place. 

Training at level 3 will include the training 

required at level 1 and 2 and will negate the need 

to undertake refresher training at levels 1 and 2 

in addition to level 3.

Over a three-year period, professionals at level 3 

should receive refresher training equivalent to a 

minimum of eight hours.

Training, education and learning opportunities 

should be multidisciplinary and inter-agency. It 

should be delivered in manner which encourages 

personal reflection and may include scenariobased discussion, drawing on case studies, 

serious case reviews, lessons from research and 

audit. This should be appropriate to the specialty 

and roles of the participants

Organisations should consider encompassing 

adult safeguarding learning within regular multiprofessional and/or multi-agency staff meetings, 

continuous professional development activities, 

clinical updating, clinical audit, reviews of 

critical incidents and significant unexpected 

events, and peer discussions. Such participative 

learning time should be documented and a 

reflective record kept by the practitioner/

organisation. 

Learning outcomes

• To be able to identify possible signs of sexual, 

physical, or emotional abuse or neglect using 

a person centred approach.

• To be able to identify adults experiencing 

abuse, harm or neglect who have caring 

responsibilities, for other adults or children 

and make appropriate referrals. 

• To be able to demonstrate a clear 

understanding, as appropriate to role, of 

forensic procedures in adult safeguarding 

and knowing how to relate these to 

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practice in order to meet clinical and legal 

requirements as required. 

• Where undertaking forensic examinations as 

part of their role, to be able to demonstrate 

an ability to undertake forensic procedures 

and demonstrate how to present the findings 

and evidence to legal requirements.

• Able to undertake, where appropriate, a risk 

and/or harm assessment.

• To be able to know how to communicate 

effectively with adults at risk particular 

those with mental capacity issues, learning 

disability or communication need.

• To be able to know how to contribute to, and 

make considered judgements about how to 

act to safeguard an adult at risk.

• To be able to know how to contribute to/

formulate and communicate effective care 

plans for adults who have been/or may be 

subjected to abuse, harm or neglect. 

• To be able to demonstrate an understanding 

of the issues surrounding suspicion of adult 

abuse, harm and neglect and to know how to 

effectively manage uncertainty and risk.

• To be able to know how to appropriately 

contribute to inter-agency assessments by 

gathering and sharing information.

• To be able to document concerns in a manner 

that is appropriate for adult safeguarding 

protection and legal processes.

• To be able to know how to undertake 

documented reviews of your own (and/or 

team) adult safeguarding/as appropriate to 

role. This can be undertaken in various ways, 

such as through audit, case discussion, peer 

review, and supervision and as a component 

of refresher training.

• To be able to know how to deliver and receive 

supervision within effective models of 

supervision and/or peer review, and be able 

to recognise the potential personal impact of 

adult safeguarding on professionals.

• To be able to know how to apply the lessons 

learnt from audit and serious case reviews/

case management reviews/significant case 

reviews to improve practice.

• To be able to know how to advise others on 

appropriate information sharing.

• To be able to know how to appropriately 

contribute to serious case reviews/case 

management reviews/significant case 

reviews, and domestic homicide review 

processes.

• To be able to know how to obtain support and 

help in situations where there are problems 

requiring further expertise and experience.

• To be able to know how to participate in and 

chair multidisciplinary meetings as required. 

• Demonstrate the skills required to 

participate in a safeguarding enquiry. 

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Level 4

Named professionals should attend a minimum 

of 24 hours of education, training and learning 

over a three-year period. This should include 

clinical leadership, appraisal, and supervision 

training. 

Named professionals should participate regularly 

in support groups or peer support networks for 

specialist professionals at a local and national 

level, according to professional guidelines 

(attendance should be recorded).

Named professionals should complete leadership 

education with a focus on clinical leadership and 

change management within three years of taking 

up their post.

Training at level 4 will include the training 

required at levels 1-3 and will negate the need 

to undertake refresher training at levels 1-3 in 

addition to level 4.

Learning outcomes

• Able to contribute to the development of 

robust internal adult safeguarding policy, 

guidelines, and protocols as a member of the 

safeguarding team.

• To be able to discuss, share and apply 

the best practice and knowledge in adult 

safeguarding including:

• the latest research evidence and the 

implications for practice

• an advanced understanding of mental 

capacity legislation, information sharing, 

information governance, confidentiality 

and consent.

• a sound understanding of forensic 

medicine as it relates to clinical 

practice, including the procedures 

and investigations required in adult 

safeguarding

• an advanced knowledge of relevant 

national and international issues, 

policies and their implications for 

safeguarding practice

• understanding the professional and 

experts’ role in the court process.

• To be able to know how to implement and 

audit the effectiveness of adult safeguarding 

services on an organisational level. 

• To be able to effectively communicate local 

safeguarding knowledge, research and 

findings from audits.

• To be able to know how to conduct a 

safeguarding training needs analysis, and 

to commission, plan, design, deliver and 

evaluate single and inter-agency training 

and teaching for staff in the organisations 

covered as part of an adult safeguarding 

team which may partners in other agencies.

• To be able to know how to undertake and 

contribute to case reviews at all levels, this 

will include the undertaking of chronologies, 

the development of action plans where 

appropriate, and leading internal 

management reviews as part of this.

• To be able to work effectively with colleagues 

from other organisations, providing 

advice as appropriate eg, concerning 

adult safeguarding policy and legal 

frameworks, the health interventions of adult 

safeguarding concerns.

• To be able to work effectively with colleagues 

in regional safeguarding networks.

• To be able to provide advice and information 

about safeguarding to the employing 

organisation both proactively and reactively 

– this includes the board, directors, and 

senior managers.

• To be able to know how to provide specialist 

advice to practitioners, both actively and 

reactively, including clarification about 

organisational policies, legal issues and the 

management of adult safeguarding. 

• To be able to support colleagues in 

challenging views offered by other 

professionals, as appropriate.

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• To be able to be a trained provider of adult 

safeguarding supervision and/or support.

• To be able to lead/oversee safeguarding 

quality assurance and improvement 

processes.

• To be able to undertake risk assessments of 

organisational ability to safeguard adults.

• To be able to lead service reviews.

• To be able to deal with the media and 

organisational public relations concerning 

adult safeguarding.

Level 5

Designated professionals should attend a 

minimum of 24 hours of education, training 

and learning over a three-year period. This 

should include leadership, appraisal, supervision 

training and the context of other professionals 

work.

Designated professionals should participate 

regularly in support groups or peer support 

networks for safeguarding professionals at a 

local, regional, and national level according to 

professional guidelines (attendance should be 

recorded).

An executive level management programme with 

a focus on leadership and change management 

should be completed within three years of taking 

up the post.

Training at level 5 will include the training 

required at levels 1-4 and will negate the need 

to undertake refresher training at levels 1-4 in 

addition to level 5.

Learning outcomes

• Able to know how to conduct a training 

needs analysis, and how to commission, 

plan, design, deliver, and evaluate adult 

safeguarding single and inter-agency training 

and teaching for staff across the health 

community.

• Able to know how to take a lead role in:

• leading /overseeing adult safeguarding 

quality assurance and improvement 

across the health community

• the implementation of national 

guidelines, assurance networks and 

auditing the effectiveness and quality of 

services across the health community 

against quality standards

• service development conducting the 

health component of serious case 

reviews, management reviews/significant 

case reviews drawing conclusions and 

developing and monitoring an agreed 

action plan to address lessons learnt.

• strategic and professional leadership 

across the health community on all 

aspects of adult safeguarding

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• multidisciplinary team reviews

• regional and national adult safeguarding 

networks (where appropriate to role).

• To be able to know how to give appropriate 

advice to specialist adult safeguarding 

professionals working within organisations 

delivering health services and to other 

agencies.

• To be able to know how to provide expert 

advice on increasing quality, productivity, 

and improving health outcomes for adults at 

risk.

• To be able to oversee adult safeguarding 

quality assurance processes across the whole 

health community.

• To be able to know how to provide 

expert advice to service planners and 

commissioners, to ensure all services 

commissioned meet the statutory 

requirement to safeguard adults.

• To be able to know how to influence 

improvements in adult safeguarding/across 

the health community.

• To be able to monitor services across the 

health community to ensure adherence to 

legislation, policy and key statutory and nonstatutory guidance.

• To be able to apply in practice:

• advanced and indepth knowledge 

of relevant national policies and 

implications

• advanced understanding of court and 

criminal justice systems, the role of the 

different courts, the burden of proof, and 

the role of professional witnesses and 

expert witnesses in the different stages 

of the court process

• advanced awareness of different 

specialties and professional roles

• advanced understanding of curriculum 

and training.

• To be able to know how to provide, support 

and ensure safeguarding appraisal and 

appropriate supervision for colleagues across 

the health community.

• To be able to provide clinical supervision, 

appraisal, and support for named 

professionals.

• To be able to evaluate and update local 

procedures and policies in light of relevant 

national issues and developments.

• To be able to reconcile differences of 

opinion among colleagues from different 

organisations and agencies.

• To be able to proactively deal with strategic 

communications and the media on adult 

safeguarding.

• To be able to know how to work with health 

staff to undertake robust adult safeguarding 

population-based needs assessments that 

establish current and future health needs 

and service requirements across the health 

community.

• To be able to provide an evidence base 

for decisions around investment and 

disinvestment in services to improve adult 

safeguarding for the local population and 

articulate these decisions

• To be able to deliver high-level strategic 

presentations to influence organisational 

development.

• To be able to work in partnership on strategic 

projects with boards, executive officers and 

the public at local, regional and national 

bodies, as appropriate.

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Board level for chief executive officers, trust and health 

board executive and non-executive directors/members, 

commissioning body directors

Over a three-year period, staff at level 1 should 

receive refresher training equivalent to a 

minimum of two hours. This should provide key 

adult safeguarding guidance.

Board members will require a tailored package 

to be delivered which encompasses level 1 

knowledge, skills and competences, as well as 

Board level specific as identified in this section.

Learning outcomes

• Demonstrates an awareness and 

understanding of adult protection.

• Demonstrates an understanding of 

appropriate referral mechanisms and 

information sharing.

• Demonstrates an understanding of clear lines 

of accountability and governance within and 

across organisations for the commissioning 

and provision of services designed to 

safeguard adults.

• Demonstrates a clear understanding of gross 

negligence as it relates to organisational 

safeguarding activity. 

• Demonstrates an awareness and 

understanding of effective board level 

leadership for the organisations safeguarding 

arrangements.

• Demonstrates an awareness and 

understanding of arrangements to share 

relevant information.

• Demonstrates an awareness and 

understanding of effective arrangements in 

place for the recruitment and appointment of 

staff, as well as safe whistleblowing.

• Demonstrates an awareness and 

understanding of the need for appropriate 

safeguarding supervision and support for 

staff including undertaking safeguarding 

training.

• Demonstrates collaborative working with 

lead and nominated professionals across 

health and social care. 

ADULT SAFEGUARDING: ROLES AND COMPETENCIES FOR HEALTH CARE STAFF 

40

Adult safeguarding is a core health care activity 

in order to deliver high quality preventative 

and proactive safeguarding and to respond to 

safeguarding issues adequate staffing must be 

available. 

Local scrutiny of safeguarding data, research 

and population should determine the levels of the 

required safeguarding practitioners.

As a minimum the staffing resource for 

designated safeguarding role should be based 

on population or on NHS Digital safeguarding 

figures/levels of area deprivation/country 

specific formula”. The ratio should not fall below 

1:220,000 population in any commissioning 

footprint. 

8. Adult safeguarding staffing 

resource

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Adass (2018) [web]. Available at: www.adass.

org.uk/making-safeguarding-personaloutcomes-framework-and-report (accessed 30 

July 2018)

Bournemouth University (2015) National 

Competency Framework for Safeguarding 

Adults, A Comprehensive Guide, Bournemouth: 

University Bournemouth. Available at: 

www.ncpqsw.com/publications/nationalcompetency-framework-for-safeguardingadults-comprehensive-and-concise (accessed 

9 July 2018). 

Department of Health (2015) Guidance: 

Safeguarding women and girls at risk of 

FGM, GOV.UK. Available at: www.gov.uk/

government/publications/safeguardingwomen-and-girls-at-risk-of-fgm (accessed 25 

July 2018)

Department of Health (2015) Department of 

Health Guidance: Response to the Supreme 

Court Judgment/Deprivation of Liberty 

Safeguards, London: DH. Available at: 

https://assets.publishing.service.gov.uk/

government/uploads/system/uploads/

attachment_data/file/485122/DH_

Consolidated_Guidance.pdf (accessed 9 July 

2018) 

Equality Act (2010) [web]. Available at: www.

legislation.gov.uk/ukpga/2010/15/contents

(accessed 9 July 2018).

GOV.UK (2013) Guidance: Domestic violence 

and abuse. Available at: www.gov.uk/guidance/

domestic-violence-and-abuse#domesticviolence-and-abuse-new-definition (accessed 

25 July 2018)

Modern Slavery Act (2015) [web]. Available at: 

www.legislation.gov.uk/ukpga/2015/30/

contents/enacted (accessed 30 July 2018)

NHS England (2017) Prevent Training and 

Competencies Framework. Available at: www.

gov.uk/government/publications/preventduty-guidance (accessed 13 August 2018)

Serious Crime Act (2015) [web]. Available at: 

www.legislation.gov.uk/ukpga/2015/9/

contents/enacted (accessed 9 July 2018). 

Wales Social Services and Well-being (Wales) 

Act 2014. Available at: www.legislation.gov.uk/

anaw/2014/4/pdfs/anaw_20140004_en.pdf

(accessed 9 July 2018). 

References

ADULT SAFEGUARDING: ROLES AND COMPETENCIES FOR HEALTH CARE STAFF 

42

Relevant legislation to underpin training and 

education 

Equality Act 2010 

Human Rights Act 1998 

Crime and Disorder Act 1998 

Sexual Offences Act 2003 

Safeguarding Vulnerable Groups Act 2006 

Terrorism Act 2006 

Forced Marriage (Civil Protection) Act 2007 

Domestic Violence, Crime and Victims Act 2012 

Health and Social Care Act 2012 

Children and Families Act 2014 

Serious Crime Act 2015 

Modern Slavery Act 2015 

Children and Social Work Act 2017 

Counter Terrorism and Border Security Bill 2018 

Mental Health Act

Mental Health (Northern Ireland) Order 1986; 

various capacity legislations; various codes 

of practice that accompany legislations; Dols; 

Mental Capacity Act (Northern Ireland) 2016*

Safeguarding Vulnerable Groups Act 2006

Health and Social Care Act 2012

Serious Crime Act 2015

Modern Slavery Act 2015

Children and Social Work Act 2017

Counter Terrorism and Border Security Bill 2018

www.legislation.gov.uk/ukpga/2014/23/

part/1/crossheading/safeguarding-adults-atrisk-of-abuse-or-neglect/enacted

Part 7/section 126 (1a, b, c) Social Services and 

Well-being (Wales) Act

www.legislation.gov.uk/anaw/2014/4/pdfs/

anaw_20140004_en.pdf

In Northern Ireland, an ‘adult at risk of harm’ 

is a person aged 18 or over, whose exposure to 

harm through abuse, exploitation or neglect may 

be increased by their: a) personal characteristic 

and/or b) life circumstances. https://www.

health-ni.gov.uk/publications/adultsafeguarding-prevention-and-protectionpartnership-key-documents 

Scotland has equally x3 principles that require 

testing for adult safeguarding based on an 

individual’s ability to safeguard (or protect) 

their own wellbeing, property, rights or 

other interests Section 3(1). www.gov.scot/

Publications/2009/01/30112831/3

Part 7/section 126 (1 a,b,c,) Social Services and 

Wellbeing (Wales) Act 2014. www.legislation.

gov.uk/anaw/2014/4/pdfs/anaw_20140004_

en.pdf

Appendix 1

*This legislation has been enacted but is not yet implemented.

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Competence level required by role 

LEVEL 1 All staff working in health care settings.

LEVEL 2 All staff who have regular contact with patients, their families or carers, or the public. 

LEVEL 3 All registered health and social care staff working with adults who engage in assessing, 

planning, intervening and evaluating the needs of adults where there are safeguarding 

concerns (as appropriate to role).

LEVEL4 Specialist roles – named professionals.

LEVEL 5 Specialist roles – designated professionals.

BOARD LEVEL Chief executive officers, trust and health board executive and non-executive directors/

members, commissioning body directors. This includes boards of private, independent 

health care and voluntary sector as well as statutory providers.

NB: It is expected that Level 3 competencies will be met 

within 12 months of induction.

LEVEL OF TRAINING 

(confirmed by Training Passport)

1 2 3 4 5 BOARD

INDUCTION 30 mins. within six weeks of 

commencing post

√ √ √ √ √ √

REFRESHER TRAINING 

HOURS

Duration over a three-year 

period:

2 hours

4 hours

8 hours

24 hours

√

√

√

√ √

√ + Board 

specific

Appendix 2

44

Published by the Royal College of Nursing

20 Cavendish Square

London

W1G 0RN

August 2018 

Publication code: 007 069