Raising a Concern and Escalation

When credible risk of abuse or neglect is identified, optical teams benefit from knowing when and how to act. The aim is not to investigate but to protect, share proportionately, and enable the local authority to coordinate enquiries under the Care Act. Domiciliary services add environmental and lone-working risk that requires pre-planned escalation routes.^[4][2][3]

Thresholds and first actions

• Indicators: injury-story mismatch, controlling companions, financial coercion, neglect signals (missed treatment, repeated appliance loss), unsafe living conditions.^[4]
• Immediate priorities: ensure safety; offer private discussion; avoid promising confidentiality; capture verbatim statements and who was present.^[5]
• Internal escalation: contact the safeguarding lead/deputy; agree whether to consult, refer, or seek urgent help.^[6]

Making a safeguarding adults referral

Provide a clear, factual account with chronology, relevant clinical findings, the adult's wishes, capacity status, and any communication needs. Share the minimum necessary information with the local authority duty team and record recipient details and reference numbers.

If police involvement is indicated (e.g., domestic abuse, theft), contact them directly and note the incident number. For care homes, raise concerns with the provider and commissioner only where safe; do not rely on internal resolution when significant harm is suspected.^[1][5][2][7]

After referral: continuing care and contact

Escalation is not the end of the clinical duty.

Maintain contact with the adult where appropriate, continue necessary eye care, and coordinate with partners to avoid duplication. Where the adult is ambivalent, revisit consent to share as trust builds while keeping risk under review. Document every decision point so colleagues can see why actions were taken and what remains outstanding.^[3][5]

References (numbered in text) Why we include references

1. Care Act 2014, legislation.gov.uk (UK Public General Acts) Find (opens in a new tab)
2. Gaining access to adults at risk of neglect or abuse, Social Care Institute for Excellence (SCIE) (Published: October 2014) Find (opens in a new tab)
3. The domiciliary eye examination, College of Optometrists Find (opens in a new tab)
4. Care and support statutory guidance, Department of Health and Social Care (Care Act 2014: supporting implementation) (Published: 2016) Find (opens in a new tab)
5. Safeguarding (long-read), NHS England (Published: 2023) Find (opens in a new tab)
6. Adult Safeguarding: Roles and Competencies for Health Care Staff, Royal College of Nursing (Published: 29/07/2024) Find (opens in a new tab)
7. Listening, learning, responding to concerns, Care Quality Commission (Published: 29 March 2023) Find (opens in a new tab)