Types and indicators of abuse, neglect and exploitation

Safeguarding concerns can include physical, psychological, sexual, financial or discriminatory abuse, organisational abuse, neglect, self-neglect, domestic abuse, modern slavery or exploitation.

Common categories in first-contact work

Reception staff do not need to assign a precise label before raising a concern. Knowing the types of harm helps staff recognise when an apparently routine request may indicate risk.

• Physical abuse: unexplained injuries, fear of another person, repeated urgent contacts after incidents, or reluctance to attend alone.
• Psychological or emotional abuse: intimidation, humiliation, threats, controlling behaviour, or a patient sounding frightened about consequences.
• Financial or material abuse: pressure for letters, benefits evidence, bank forms, fit notes, or access to patient information.
• Neglect or acts of omission: missed care, medicines not collected, untreated wounds, poor hygiene, missed appointments or insufficient support.
• Self-neglect: repeated concerns about deterioration, unsafe living conditions, refusal or inability to access essential care, or serious neglect of health needs.
• Domestic abuse, modern slavery or exploitation: control, fear, dependency, restricted communication, unsafe accompaniment, or someone else managing all access.

Possible first-contact clues

• Fearful behaviour, unexplained distress or sudden withdrawal.
• Someone else controlling calls, messages, appointments, medicines or money.
• Repeated missed care, poor hygiene, untreated wounds or gaps in medicines.
• Conflicting accounts, pressure to cancel appointments or unsafe requests about contact.
• A patient saying they did not know a letter, prescription, result or referral had been requested in their name.

Patterns matter

A single sign may have a simple explanation. Repeated signs, signs linked with fear, or signs that give another person control over the patient's access to care should be escalated. Record small concerns if they could help the safeguarding lead identify a wider pattern.

One sign may have many explanations, but repeated signs or signs with fear, control or harm should be escalated.

Financial and online access abuse