Safeguarding children and adults

Why this matters on day one

You do not need to be certain, and you are not the investigator. Your duty is to recognise, document, and refer. The commonest failure is waiting for more evidence.

The sequence

1. 1Recognise in children. Injury inconsistent with the history or the developmental stage. Delayed presentation. Bruising in a non-mobile infant — always significant. Injuries to ears, neck, torso, buttocks, or unusual burns. Repeated attendances. A child who seems frightened or withdrawn. Disclosure.
2. 2Recognise in adults. Physical, sexual, psychological, financial, discriminatory or organisational abuse; neglect; domestic abuse; modern slavery; self-neglect. Consider it in the frail, those with learning disability or mental illness, and anyone dependent on others for care.
3. 3Act. Ensure immediate safety. Document exactly what you saw and heard, in the person's own words, with a body map for injuries. Refer to the trust safeguarding lead the same day. In children, this is the named doctor or nurse for safeguarding.
4. 4Consent and confidentiality. Safeguarding concerns can override confidentiality. For adults with capacity, seek consent to share, but you may share without it where there is risk of serious harm to them or others. For children, the child's welfare is paramount and you do not need parental consent to refer.
5. 5Domestic abuse specifically. Ask when alone, never in front of the accompanying person. Do not push disclosure. Know the local IDVA service and give information discreetly. Ask about children in the household.

What goes wrong

• Waiting for certainty before raising a concern.
• Not documenting verbatim what was said.
• Discharging without checking whether other children in the household are at risk.
• Asking about abuse with a partner or carer present.
• Assuming someone else has already referred.