Complex Safeguarding Risks

Adult safeguarding often intersects with high-risk contexts that may surface in community optics. Recognising credible indicators allows proportionate action without putting staff or patients at further risk.^[1][7]

Recognising complex risks in the optical setting

• Domestic abuse/coercive control: a companion controls speech, money, transport, or access to appliances; frequent cancellations after financial discussion; visible fear or appeasement.^[2]
• Modern slavery/trafficking: individuals accompanied by a controlling "chaperone," lack of personal documents or money, scripted answers, multiple patients registered to the same address with cash payment by one person.^[3][4]
• Radicalisation (Prevent): the adult expresses or displays concerning extremist indicators combined with vulnerability (isolation, recent crisis); escalate via local Prevent pathways, not clinical judgement alone.^[5]

Safe actions for the team

Assess immediate safety and avoid confrontation with suspected perpetrators on site.^[3][7]

Offer private time where feasible and provide discreet information on support (domestic abuse helplines, advocacy).^[2][3]

Seek consent to share when safe; if risk persists, share the minimum necessary information without consent under lawful bases and record the rationale.^[6][1]

For slavery/trafficking, use local National Referral Mechanism (NRM)/Modern Slavery helplines via agreed routes.^[4] In domiciliary contexts, staff safety is a priority: withdrawing and escalating may be the safest option.^[7][3]

Rehearsed scenarios help reception, assistants, and clinicians understand their roles, code words, and exit strategies. Practices can use discreet signage and accessible leaflets; digital materials (QR codes) are useful where carrying paper is unsafe.^[7][2] Complex risks benefit from calm, consistent processes rather than ad-hoc reactions.^[1][7]

References (numbered in text) Why we include references

1. Care and support statutory guidance — Department of Health and Social Care (Care Act 2014 supporting implementation, published 10 March 2016) Find (opens in a new tab)
2. Domestic abuse: statutory guidance — Home Office (Domestic Abuse Act 2021 statutory guidance, published 8 July 2022) Find (opens in a new tab)
3. Responding to the health needs of survivors of human trafficking: a systematic review — Stacey Hemmings; Sharon Jakobowitz; Melanie Abas; Debra Bick; Louise M Howard; Nicky Stanley; Cathy Zimmerman; Siân Oram. BMC Health Services Research, 2016 Find (opens in a new tab)
4. National referral mechanism guidance: adult (England and Wales) — Home Office (Guidance on the National Referral Mechanism for potential adult victims of modern slavery, updated 20 October 2024) Find (opens in a new tab)
5. Prevent duty guidance: for England and Wales (2023) — Home Office Find (opens in a new tab)
6. Information sharing: advice for practitioners providing safeguarding services — Department for Education (published 26 March 2015) Find (opens in a new tab)
7. Roles and responsibilities of safeguarding — Social Care Institute for Excellence (SCIE) Find (opens in a new tab)