Neglect is where a person who has care needs relies on someone else for specific things, which fail to happen. This can be intentional or unintentional.

Think about someone who needs help to get to the toilet being ignored causing them to wet themselves. Someone who needs help to pay their bills getting into debt because the person supporting them fails to make the payments.

This category will often mean situations where the neglect or omission could reasonably have been prevented, or is intentional, or is persistent. This is because human error or unusual circumstances can mean that things are missed when caring for someone else but is a one-off or temporary issue. The impact of the neglect or failure is also a factor – missing one dose of a vitamin is likely to be different to missing a dose of insulin, for example.

The Mental Capacity Act (MCA) 2005 introduced a new criminal offence under Section 44 of ill-treatment or wilful neglect of a person who lacks capacity, or who is reasonably believed to lack capacity at the time of the offence. The key word here is ‘wilful’, and the act has to be proven to have been intentional beyond all reasonable doubt for a prosecution to be successful.

There are a number of examples showing the difficulty of this in legal cases collected by 39 Essex Chambers. 

In safeguarding adult cases where there is not enough evidence to support criminal investigation or prosecution, then disciplinary or similar processes are able to make a decision on the balance of probability, rather than the higher threshold of ‘beyond all reasonable doubt’ in court cases.

What might it look like?

• Failure to provide or allow access to food, shelter, clothing, heating, stimulation and activity, personal or medical care
• Failure to provide care in the way the person wants
• Failure to administer medication as prescribed
• Not taking account of individuals’ cultural, religious or ethnic needs
• Not taking account of educational, social and recreational needs
• Ignoring or isolating the person
• Failure to allow choice and preventing people from making their own decisions
• Failure to ensure appropriate privacy and dignity.

How might you recognise it?

• Poor hygiene/cleanliness of the person in need of care and support
• Repeated infections e.g. urine or chest infections
• Dehydration, unexplained weight loss, malnutrition
• Repeated or unexplained falls or trips
• Not having the proper items they needs to help them e.g. walking frame, hearing aid, glasses, pressure mat
• Pressure sores or ulcers
• Untreated injuries and medical problems
• Inconsistent or reluctant contact with medical and social care organisations
• Large amount of medication not taken
• Social isolation that is unusual for that person
• Wrong clothing e.g. someone else’s, too big / too small, not right for the weather or situation