Neglect and act of omission

Neglect is when a person’s needs and requirements are not fulfilled. This can include not providing care in a way the person likes, ignoring their likes and dislikes and not ensuring they get access to a range of activities and stimulation.

Neglect occurs when people's care and support with basic care needs are not met and could include:

• ignoring emotional or physical care needs like having clean clothes, or being supported with care and help they need in a timely manner
• failure to provide access to appropriate health, care and support or educational services
• not getting medication regularly and on time
• not getting adequate nutrition or heating

Neglect can be intentional, but it can also be unintentional, and harm can be caused by not following proper policies, procedures and support plans, by informal carers being overwhelmed, and by a lack of understanding of what dignity is, and what people need to live a good life.

Some possible indicators of neglect and acts of omission could be

• poor environmental conditions
• inadequate heating and lighting
• poor physical condition of the adult with care and support needs
• clothing is ill-fitting, unclean and in poor condition
• malnutrition
• failure to give prescribed medication properly
• failure to provide appropriate privacy and dignity
• inconsistent or reluctant contact with health and social care agencies
• being isolated because of denied access to callers or visitors

Neglect is different to organisational abuse in that it might be just one person who isn’t having their needs met, perhaps due to a staff member who hasn’t read a support plan properly or been properly trained. Whereas organisational neglect is about a range of failings within an organisation which causes neglect and harm to a number of people.

Case Study

Benjamin’s story

Benjamin is an elderly adult who has highly complex mental health needs, including autism with significant sensory sensitivities, Tourette’s, Obsessive Compulsive Disorder (OCD) with severe ritualistic behaviours, and complex post-traumatic stress disorder (PTSD) stemming from childhood abuse. These conditions significantly affect his ability to communicate, self-advocate, and maintain personal safety. His history of trauma, particularly within care settings, has made it difficult for him to form trusting relationships. Through a patient and adaptive approach, the Advocate was able to build trust with Benjamin, which enabled him to disclose an incident of alleged psychological abuse by a staff member on his ward.

Advocacy Intervention

The Advocate undertook a comprehensive and person-centred approach to support Benjamin. This included detailed conversations to understand the incident, adapting communication methods to engage with another peer involved, and documenting the safeguarding concerns thoroughly. The Advocate liaised with York City Council to ensure all safeguarding processes were accessible and tailored to the adult’s needs, including simplified written materials and adapted meetings. The Advocate supported Benjamin throughout the Section 42 safeguarding enquiry, helped him express his views and desired outcomes, and facilitated his engagement with both hospital investigators and the Care Quality Commission (CQC). A second safeguarding concern was raised during this process regarding another staff member.

Outcome and Reflections

Benjamin’s desired outcome was achieved: both staff members were removed from the ward, and one was dismissed from the hospital. He expressed strong positive feedback, highlighting the importance of being listened to and supported throughout the safeguarding process. This case underscores the critical need for communication adaptations in advocacy work, especially for individuals with complex needs. It also highlights the value of trauma-informed, person-centred advocacy in empowering adults to speak out and seek safety within care environments.