What Are a Doctor's Adult Safeguarding Duties in the NHS?
An older man with bruises he can't explain. A woman who has "walked into a door" for the third time this year. A care-home resident with a deep pressure ulcer. Every doctor in every specialty will meet adults who are being abused or neglected, often when nobody else has noticed. This guide explains what the NHS and the law expect you to do.
Quick answer
Every NHS doctor must recognise possible abuse or neglect of adults, act on concerns, and share information to protect people at risk. In England the Care Act 2014 gives the local authority the lead. Your job is to notice and ask, keep the person safe, assess mental capacity for the specific decision, find out what the person wants, escalate to your safeguarding team, raise a concern with adult social care, and document clearly.
What you will learn in our free Safeguarding Adults course
Every NHS doctor has adult safeguarding duties, and interview panels ask about them. Know exactly what to do — and say it with confidence. Our free online Safeguarding Adults course is written for NHS doctors and international medical graduates. You study at your own pace in 6 short modules, with worked examples, interactive exercises and a short quiz at the end. There is no sign-up, and your progress is saved so you can stop and come back.
The 6 modules
Foundations: the Care Act and your duties: Who is an 'adult at risk'?, The six safeguarding principles, Autonomy and protection, Your duties as a doctor
Recognising abuse and neglect: The ten categories of abuse and neglect, Red flags — in the ED, on the ward and in clinic, Older adults and people from care homes, Self-neglect, hoarding and financial abuse
Capacity, consent and liberty: The Mental Capacity Act 2005, Best interests, restraint and advance decisions, The patient who wants to leave, Deprivation of liberty
High-risk presentations: Domestic abuse, Non-fatal strangulation, Knife and gunshot wounds, and violence, Exploitation: modern slavery, cuckooing and county lines, Prevent — radicalisation
Taking action: from concern to enquiry: Information sharing — with and without consent, Raising a safeguarding concern, What happens next
Records, colleagues and your career: Documentation, Concerns about colleagues and people in positions of trust, UK practice that may differ from your home country, Safeguarding adults in your CV, portfolio and interviews
By the end of the course you will be able to
Explain who is an 'adult at risk' under section 42 of the Care Act 2014 and apply the six safeguarding principles
Recognise the ten categories of abuse and neglect, including how they present in the ED
Assess capacity for a specific decision and act in best interests — including when a patient wants to leave
Describe how the June 2026 Supreme Court judgment changed deprivation of liberty, and when to use DoLS
Respond safely to domestic abuse, non-fatal strangulation, knife and gunshot wounds, exploitation and radicalisation
Share information lawfully, with or without consent, and raise a clear safeguarding concern
Explain what happens in a section 42 enquiry and a Safeguarding Adults Review
Document well and describe your safeguarding practice confidently at interview
Why it helps your NHS application
Real cases from the ED, wards and clinics: domestic abuse, care-home neglect, capacity and the patient who wants to leave
Up to date with 2026 law, including the Supreme Court's new approach to deprivation of liberty
A clear, structured answer for the safeguarding scenarios interview panels use in every specialty
How to write it on your NHS application
In your CV and on NHS Jobs or Trac: list it under "Courses and CPD" (or in the training and courses section of the form), for example:
Safeguarding Adults, online CPD course, CareerPro UK. Certificate of completion, [month and year]; verifiable online, ID CP-XXXXXXXX.
In your supporting statement: show what you learned and how you use it. For example (adapt it so it is true for you):
"Alongside my mandatory training, I strengthened my understanding of adult safeguarding, including the Care Act 2014 and the Mental Capacity Act, through an online course."
At interview: the course also prepares you for questions such as "A woman attends ED with a facial injury and says she fell. You suspect domestic abuse. What do you do?"
Your certificate of completion
When you pass the quiz, you can download a certificate pack:
A verifiable PDF certificate of completion with your name, the course, your CPD time and a QR code that shortlisters and appraisers can scan
An appraisal-ready reflective note, pre-filled with the course learning outcomes
A ready-to-paste line for your NHS Jobs or Trac application and CV, and a one-click "Add to LinkedIn" button
Studying is free. The certificate pack is a one-off £5, and you pay only after you pass
Online course — does not replace your employer's mandatory safeguarding adults training.
The law in England: the Care Act 2014 and section 42
The Care Act 2014 is the main adult safeguarding law in England. Under section 42, the local authority must make enquiries, or cause others to make them, when it has reasonable cause to suspect that an adult in its area:
has needs for care and support (whether or not the authority is meeting them), and
is experiencing, or is at risk of, abuse or neglect, and
as a result of those needs, is unable to protect themselves against the abuse or neglect or the risk of it.
The adult does not have to be old, lack capacity or already receive services. A young man with a learning disability exploited by "friends", or a woman with a physical disability who depends on an abusive partner for care, may both meet the criteria.
You do not have to decide whether all three criteria are met before acting. If you are worried, raise a concern and the local authority decides whether a section 42 enquiry is needed. People who don't meet the criteria, such as many victims of domestic abuse, still need help through other routes. Each area also has a Safeguarding Adults Board, which arranges Safeguarding Adults Reviews when an adult dies or is seriously harmed and agencies could have worked together better.
Scotland, Wales and Northern Ireland have their own legislation, but the principles are similar.
The six safeguarding principles
The Care and Support Statutory Guidance sets out six principles that should shape every response:
Empowerment: support people to make their own decisions. Ask them what they want to happen.
Prevention: act before harm happens, and don't wait for a serious injury.
Proportionality: use the least intrusive response that matches the risk.
Protection: support and represent those in greatest need.
Partnership: work with the GP, social care, police, housing and community services.
Accountability: be transparent, and record what you did and why.
Behind these sits Making Safeguarding Personal: safeguarding is done with the person, not to them, and focuses on the outcomes they want. Some people want the abuse to stop but want to keep the relationship. Others want the police involved, or just want someone to know.
Recognising abuse and neglect
The statutory guidance describes ten types of abuse and neglect. They often overlap, and the list is not exhaustive:
Physical abuse
Domestic abuse, including coercive control
Sexual abuse
Psychological abuse
Financial or material abuse
Modern slavery
Discriminatory abuse
Organisational abuse (poor care in a care home, hospital or home care service)
Neglect and acts of omission
Self-neglect, including hoarding
Red flags in practice include an explanation that doesn't fit the injury or keeps changing, a delay in seeking help, and repeated attendances. Look for injuries of different ages, grip marks, and bruising on the inner arms, neck or trunk. Be alert to dehydration, pressure ulcers or missed medication in someone who depends on others for care. Watch for a companion who answers every question or won't leave.
The single most useful habit is to see the patient alone for part of every assessment, using a professional interpreter if needed, never a relative or friend. Then ask simply: "Do you feel safe at home? Has anyone hurt you or made you afraid?"
Capacity and choice: the link with the Mental Capacity Act
Adult safeguarding differs from child safeguarding in one key way: adults with capacity can make their own choices, including ones that worry us. Almost every decision therefore depends on the Mental Capacity Act 2005. Its five principles are:
Presume capacity.
Take all practicable steps to help the person decide.
An unwise decision is not, on its own, proof of incapacity.
Act in the person's best interests if they lack capacity.
Choose the less restrictive option.
Capacity is specific to the decision and the time. If an adult has capacity and declines help, you usually respect that. You still offer support and safety advice, record their decision, and keep the door open.
You may still need to share information or act against their wishes when:
other people are at risk, such as children in the home or other care-home residents,
a serious crime has been committed or there is a risk to life,
the person's choice is not really free because they are being coerced or controlled, or
a member of staff or someone in a position of trust is involved.
Discuss these situations with your safeguarding team. If the person lacks capacity for the decision, act in their best interests. Note that relatives cannot consent on an adult's behalf unless they hold a relevant lasting power of attorney or are a court-appointed deputy.
The law on deprivation of liberty also changed after a Supreme Court judgment in June 2026, so follow your trust's current MCA and DoLS policy.
Making a referral: from concern to action
Make the person safe now. Treat injuries, and call 999 if someone is in immediate danger.
Preserve evidence where relevant, and record injuries on a body map.
Discuss with the nurse in charge, your senior and the hospital safeguarding team, or the on-call route out of hours.
Talk to the adult about the concern and what they want, unless that would increase the risk.
Raise a concern with adult social care following local procedure. Include what you saw and heard, the person's own words, their capacity, their wishes and the risks.
Plan a safe discharge. Never send someone back to the person harming them without a plan.
Document who you spoke to, what you shared and why, and any reference number.
Don't confront or investigate the alleged abuser yourself. If you are worried about a colleague or carer, tell your safeguarding lead and manager. Your organisation has a process for concerns about people in positions of trust.
Prevent, domestic abuse and other high-risk situations
Prevent. Under the Counter-Terrorism and Security Act 2015, NHS organisations must have due regard to the need to prevent people from being drawn into terrorism. The current Prevent duty guidance came into force on 31 December 2023. For an individual doctor, this means one thing: if something a patient says or does makes you worried they are being drawn towards terrorism, discuss it with your trust's Prevent or safeguarding lead rather than acting alone. Base concerns on behaviour, not religion, ethnicity or political views. If there is an immediate threat to life, call 999.
Domestic abuse. Ask in private. Use your local risk assessment tool, usually the DASH checklist, and refer high-risk cases to the MARAC (multi-agency risk assessment conference). Always ask about children at home. Take non-fatal strangulation seriously: it is a specific criminal offence and a recognised marker of high risk, even when there are no visible marks.
How this looks on an NHS application and at interview
Safeguarding scenarios come up at interview in every specialty. A strong answer follows this structure:
Immediate safety
Seeing the patient alone, with a professional interpreter if needed
Capacity for the specific decision, and the patient's wishes
Wider risk: children, other residents, other adults
Escalating to the safeguarding team and adult social care
Documentation and follow-up
On your CV, list your safeguarding adults training level and date. Add an anonymised reflection on a case where you noticed something and acted. For help presenting this evidence, see why NHS job applications get rejected and how to write an NHS supporting statement.
Our free Safeguarding Adults course works through cases like these, including the patient who wants to leave, self-neglect and the care-home resident with a pressure ulcer.
Training levels. Employers set mandatory safeguarding adults training using the intercollegiate document Adult Safeguarding: Roles and Competencies for Health Care Staff (second edition, 2024). Level 3 is for registered staff who assess, plan, deliver and evaluate care where there are safeguarding concerns. It expects participatory learning, not only e-learning. Ask your employer which level your post needs. No free online course can replace it.
Start the free course
The Safeguarding Adults course covers the Care Act and the six principles, recognising abuse, the Mental Capacity Act, domestic abuse and exploitation, Prevent, raising a concern and good documentation. It is set out in short modules that are free to study, with a quiz, an optional verifiable certificate and a reflective note for your appraisal. It is not accredited and does not replace your employer's mandatory safeguarding adults training. If you'd like your NHS application reviewed and rewritten (£35), email cvreviewexperts@gmail.com.
Frequently asked questions
What is a section 42 enquiry?
It is an enquiry the local authority must make, or ask another agency to make, when it suspects an adult with care and support needs is experiencing or at risk of abuse or neglect and cannot protect themselves because of those needs. It decides what action is needed and by whom.
What are the six principles of adult safeguarding?
Empowerment, prevention, proportionality, protection, partnership and accountability. They come from the Care and Support Statutory Guidance under the Care Act 2014.
Can I raise a safeguarding concern if the adult does not want me to?
If the adult has capacity, their wishes should usually be respected. You can still share information without consent when others are at risk, there is a serious crime or risk to life, the person is being coerced, or a person in a position of trust is involved. Explain why where it is safe, and record your reasoning.
Does a doctor need proof of abuse before referring?
No. You need a reasonable concern, not proof. Raising a concern is not an accusation; the local authority gathers information and decides what should happen.
Which level of safeguarding adults training do doctors need?
It depends on the role and is set by the employer using the intercollegiate document. Many doctors who assess and treat adults are expected to reach level 3, so check your trust's requirement.
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