Cause for alarm: what can safeguarding data tell us about the challenges facing health and care services?

In a speech at the recent Nuffield Trust Summit, Baroness Louise Casey – tasked with conducting a review of adult social care – called for “a moment of reckoning”. Describing the sector’s many difficulties, she called for action on several key areas. One of these was safeguarding, setting out a concerning lack of accountability and oversight, and calling for a national safeguarding board. 

Safeguarding is a vital part of our health and care system. Broadly, it is the process by which people with care and support needs are kept safe from abuse and neglect through proactive and collaborative partnership working to support people when they need it. Failure to properly prevent, identify and act on safeguarding concerns can have devastating consequences. Conversely, identifying concerns early can mean that action is put in place to prevent someone from coming to harm.

Although it doesn’t tell the full story, safeguarding data can offer some insight into how wider pressures are impacting on people who rely on services and support to stay safe and well, and act as a barometer for how well local systems are functioning. This explainer describes what safeguarding is and highlights the key insights from the latest data, and what it might tell us about the issues facing health and social care. Although safeguarding processes cover adults and children, this piece only covers issues and data relating to adults. 

What is safeguarding?

Safeguarding is about making sure people with care and support needs are kept safe from abuse and neglect, such as protecting someone who is experiencing physical abuse from a family member. Statutory guidance identifies 10 types of abuse and neglect, including physical, financial or organisational abuse, and self-neglect.

Risks can come from family or friends, staff, organisations or even the person themselves, with most risks coming from people known to the individual. Incidents can take place in different settings, for example a hospital, care home or the person’s own home. Anyone can raise a safeguarding concern – family or friends, staff or carers or a member of the public.

The majority of adult safeguarding enquiries relate to people aged 85 and over (2,431 per 100,000 adults in 2024/25). 

The Care Act 2014 introduced specific legal duties on local authorities in England with regards to safeguarding. This includes initiating an enquiry under Section 42 if they become aware that someone with care and support needs is experiencing, or is at risk of, abuse or neglect, and establishing partnerships with other organisations to prevent abuse before it happens. A Section 42 enquiry will entail different things depending on the nature of the concern – it could range from a conversation to a more formal investigation involving multiple organisations. 

The number of safeguarding concerns and enquiries has increased over time

The Department of Health and Social Care publishes annual data on the number and nature of safeguarding concerns and enquiries. In this context, a ‘concern’ is when a sign of suspected abuse or neglect is reported to, or identified by, the local authority.

The number of safeguarding concerns raised to local authorities has been increasing over time. Between 2016/17 and 2024/25, the number of concerns increased by a staggering 76% (from 364,605 to 640,240).

While not every concern will result in an enquiry, the number of enquiries initiated under Section 42 also increased by 39% (from 133,265 to 185,270) in the same period. It is interesting to note that the number of concerns raised is increasing at a higher rate than the number of enquiries. There could be several reasons for this. Multiple concerns can be raised about the same person. But it could also indicate better awareness and improved reporting practice around safeguarding processes, or that the threshold for initiating an enquiry has increased.  

Most enquiries related to risks identified in a person’s own home

Data also tells us more about the nature of concluded enquiries, including the location in which the alleged incident took place. In 2024/25, just over half (51.9%) of concluded Section 42 enquiries related to risks identified in a person’s own home (the largest proportion of all enquiries), and this setting has consistently made up the largest proportion of enquiries when looking at the data over time. 

Most enquiries are a result of neglect or acts of omission 

The most common type of risk identified in concluded enquiries is neglect or acts of omission. This is when someone who is responsible for caring for an adult with care and support needs fails to provide them with the care they need. Examples include failing to provide medication or access to necessities like food, shelter or heating. Neglect or acts of omission can be deliberate but also non-intentional, suggesting people could be having their needs overlooked, due to factors such as inadequate staffing, difficulty accessing appropriate health services, or a lack of support for unpaid carers. 

In 2024/25, neglect or acts of omission made up two-fifths (40.8%) of all concluded enquiries and, when broken down by setting, were the most common type of risk investigated in six out of the nine recorded settings. For instance, in nursing homes, community hospitals and community services, neglect or acts of omission accounted for over half of all concluded enquiries (51.6%, 58.1% and 52.5% respectively). 

Better reporting or a system in distress?

Rising numbers of safeguarding concerns and enquiries don’t necessarily mean more actual safeguarding issues – they may partly reflect better awareness and reporting around safeguarding processes, or be a result of proactive work by local authorities to identify people who may be particularly at risk. But they could also be an indicator of the ripple effect of pressures in the system. Moreover, research suggests that there may be people unknown to services who are also at risk, and the data as such is likely to only be the tip of the iceberg. 

Increasing numbers of concerns have implications for local authorities who are required to investigate, but worryingly there are signs that safeguarding is a casualty of more intense pressures. In the 2025 ADASS Spring Survey, fewer than half (46%) of directors surveyed had full confidence about meeting their safeguarding duties in the current financial year (2025/26). An analysis of safeguarding adult reviews – a mandatory investigation when someone dies or suffers serious abuse or neglect – highlighted issues with management and procedures, staffing levels and workloads as the most prominent shortcomings. 

What we also can’t tell from the data we have is how long it takes a concern to be addressed once it’s been reported to the local authority. The Casey Commission – tasked with making recommendations on reform of adult social care – has recommended that a national safeguarding board be established that would be responsible for, among other things, producing annual reports to draw out learning. 

While cases of abuse in institutional settings rightly receive attention, it is striking that the majority of concluded enquiries actually relate to risks in a person’s own home. This has important implications for government priorities to shift care closer to home, raising concerns about whether there are sufficient structures and support systems in place in the community to prevent people coming to harm. 

Unfortunately, the data only says so much – it does not tell us about the detailed circumstances sitting behind each concern or enquiry. Wider research does provide some insight into the factors that are shaping these figures. 

For example, a Local Government Association report from 2024 highlighted the impact of patients being discharged from hospital without appropriate medication, a lack of suitable accommodation, or care packages not being put in place when someone returned home, as well as the knock-on impact of the cost-of-living crisis on safeguarding. Another report highlighted an increase in calls to advice lines as a result of things such as financial insecurity and difficulty accessing services. As such, safeguarding is not just about what’s happening within health and care services, but the impact of wider social issues, which reinforces the importance of a multi-sector approach.

With health and care services under such pressure, attention often focuses on high-profile metrics such as waiting lists. While these are no doubt important, it’s also important to monitor issues that may be bubbling under the surface. If unaddressed, there can be grave consequences. Effective safeguarding requires early, preventative action and collaboration across services. But when systems are stretched, as they undoubtedly are, there’s a very real risk that people fall through the cracks. Although these figures don’t tell the full story, at the very least they should be cause for alarm.