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This paper categorises different types of health‐focused safeguarding investigations and offers suggestions, particularly relevant to nurse investigators, on how an investigation can be approached. Suggestions are also offered on how to conduct an investigation, where to find information, how to conduct interviews, writing a report and giving a professional opinion. Criteria for determining whether neglect has taken place in a formal care setting are offered, alongside examples of how these have been applied in practice. The paper concludes with consideration of actions that can be taken following an investigation and some reflections on the experience of professions involved in safeguarding.

Despite widespread development in safeguarding vulnerable adults across legislation, policy, research, education and practice in recent years, some aspects of this work remain relatively ill‐defined. Neglect in formal care settings and the nursing contribution to multi‐agency safeguarding work are two such aspects. This paper offers perspectives acknowledging the current context of safeguarding. It identifies defining attributes of neglect and highlights why older people are particularly vulnerable to the consequences of neglect. The nursing contribution to multi‐agency safeguarding work, specifically health‐focused investigations, is discussed in detail, including when nurses should be involved, the knowledge and skills required and considerations for giving a professional opinion. The paper offers a model of registered nurse involvement in health safeguarding investigations and concludes with suggestions on how investigations can be approached.

The paper seeks to report on an audit undertaken in 2010 to support implementation of the Independent Safeguarding Authority (ISA) processes by National Health Service (NHS) Trusts. The ISA was set up under the Safeguarding Vulnerable Groups Act (SVGA) 2006. Concern has been expressed that some NHS employers are not familiar with their new obligations to consider making referrals to the ISA.

This audit was designed to provide an estimate of possible NHS referrals to the enhanced vetting and barring scheme run by the ISA in England and Wales; and to explore two NHS Trusts' potential decision‐making and referrals to the ISA following disciplinary action or adverse events. The two NHS Trusts that participated engaged in a detailed review of incidents and their relationship to harm as defined in the SVGA 2006.

The simple number of how many incidents have been reported to the ISA by an NHS Trust will not equate to the same number of cases of individual patients being harmed or the number of events that have placed them at risk of harm. There are considerable differences in how reporting an incident is viewed, managed and dealt with among NHS Trusts. Following this audit, the best estimate of the number of potential NHS referrals from England, Wales and Northern Ireland to the ISA over one year is estimated to be about 712.

This is a small audit of self‐selecting Trusts. The information is not examined in detail and the reasons for Trust decisions about disciplinary outcomes are not accessed or scrutinised; the indicative figures of numbers of referrals to the NHS are a simple indication of the levels of referrals that might be expected.

The audit results suggest a need for further work on what is most helpful in making the differential decisions about the type of harm that has occurred from an incident. NHS Trusts may need to assure themselves that their duties under the SVGA are fully understood and implemented.

The strength of the audit, and, therefore, this paper, is that a sample of Trusts have supplied a level of detail about their staff and Human Resource matters that is not generally available, as access to the DATIX system is not generally sought or permissions given.

This paper seeks to present findings from a review of hospital policies and practices in one NHS Trust in England.

The focus of the review was hospital staff policy and practice in safeguarding the rights of vulnerable patients. A sample of staff was surveyed to investigate their knowledge of the Mental Capacity Act 2005 in 2010. Interviews, incorporating discussion of a vignette, were undertaken with a range of staff and findings were analysed thematically. These findings are contextualised by an analysis of Trust policies and the wider literature. The findings of this case study are used to develop recommendations for the hospital and healthcare sectors.

Analysis of survey data and interviews revealed limited confidence and knowledge about the Mental Capacity Act 2005 and uncertainties about its relevance to clinical practice. In relation to safeguarding, there was limited realisation of the potential of the Act to uphold the rights of patients lacking capacity and staff responsibilities. MCA training had not made a great impression; hospital policies were inconsistent and lacked coherence.

This case study was conducted in one Trust and may not be generalisable. Other hospitals may have different training, policy and procedure systems.

The findings of this case study may be applicable to other hospitals and to other providers of health and social care services. The relevance of the MCA could be highlighted and used on several induction and training programmes. The study identifies features of policy and practice that could be investigated in other organisations.

Few studies have investigated the operationalisation of the MCA in hospital settings. This study reveals that there are opportunities to refresh MCA and safeguarding training strategies for hospital staff but these should be accompanied by changes to culture and attention to the coherence of different procedures. Audits of MCA and safeguarding compliance can be undertaken within hospitals and a systems approach could be adopted to address any issues identified and to sustain good practice.