What counts as neglect in adult safeguarding?
In adult safeguarding in England, neglect means failing to meet an adult’s care and support needs: ignoring their medical, emotional or physical care needs, failing to give them access to health, care and support, or withholding the necessities of life such as medication, adequate nutrition and heating. It is one of the harms that can start a council enquiry under section 42 of the Care Act 2014, whether it is deliberate, careless or down to ignorance. Only some neglect is a crime, because the offences need ill-treatment or wilful neglect. Call 999 first if anyone is in immediate danger.
On this page
- 1What counts as neglect in adult safeguarding?
- 2How common is neglect in safeguarding enquiries?
- 3What is the difference between neglect by a carer, organisational neglect and self-neglect?
- 4What are the warning signs of neglect?
- 5When does poor care become a safeguarding concern?
- 6What if the neglect comes from a struggling family carer?
- 7When is neglect a crime?
- 8What do the CQC fundamental standards say about neglect?
- 9What should you do and record if you suspect neglect?
- 10Does this apply in Wales, Scotland and Northern Ireland?
- 11What training helps you recognise and respond to neglect?
- 12Frequently asked questions
- Neglect can be an omission. The guidance includes ignoring care needs, failing to arrange access to care, and withholding medication, nutrition or heating.
- Intent is not needed to raise it. You report what you saw and heard, and the council decides whether the section 42 test is met.
- Crime needs ill-treatment or wilful neglect. Offences cover carers, care workers and providers, with up to five years' imprisonment for individuals on indictment.
- Providers have fundamental standards. Regulations 12, 13 and 14 cover safe care, protection from abuse and improper treatment, and nutrition and hydration.
This guide explains what counts as neglect when an adult has care and support needs in England, how to spot it, when poor care becomes a safeguarding concern and when it can be a crime. It is written for care workers, nurses, housing and support staff and families, and was checked on 4 November 2026. The Care and Support Statutory Guidance (the guidance) was last updated on GOV.UK on 30 October 2026 and is shown as under review. Paragraph numbers below come from the version live on 4 November 2026 and can change, so check the current text. All examples are invented. For the steps after you report, see our guide to what happens after an adult safeguarding concern. General information, not legal advice.
What counts as neglect in adult safeguarding?
Section 42 of the Care Act 2014 applies where a council has reasonable cause to suspect that an adult in its area has needs for care and support, is experiencing or at risk of abuse or neglect, and cannot protect themselves from it because of those needs (section 42(1)). Section 42 does not define neglect. Its only definition is of financial abuse (section 42(3)). The meaning comes from the guidance, which lists “neglect and acts of omission” as one of ten types of abuse and neglect. Its examples are:
- ignoring a person’s medical, emotional or physical care needs;
- failing to provide access to appropriate health, care and support or educational services; and
- withholding the necessities of life, such as medication, adequate nutrition and heating.
| Guidance example | What it can look like (invented examples) |
|---|---|
| Ignoring medical, emotional or physical care needs | A woman says her leg has hurt for a week and nobody arranges a nurse. A frightened, low man is left alone in his room all day. |
| Failure to provide access to health, care and support | Hospital and GP appointments are missed because nobody arranges transport. A care package is agreed but not delivered, and nobody tells the family. |
| Withholding the necessities of life | A meal is left out of reach of a man who cannot feed himself. Medicines are not given. The heating is off in winter. |
Three things follow from this. First, neglect is often an omission: something that should have happened and did not. Second, “at risk of” counts, so a council can act before harm has happened. Third, the list is an illustration. The guidance says the types are not an exhaustive list (paragraph 14.16) and that councils should not limit their view of what counts as abuse or neglect (paragraph 14.17), although the three section 42 conditions must still be met before a matter is treated as a safeguarding concern.
Intent is not required. The Department of Health and Social Care (DHSC) explains that the types of risk it counts may arise from “deliberate intent, negligence or ignorance”. The guidance adds that abuse or neglect may be unintentional and may arise because a carer is struggling to care for another person, which makes the need to act no less important (paragraph 14.40). Criminal law sets a higher bar, as the section on offences below explains.
The duty applies in any setting except prisons and approved premises, and whether or not the adult has mental capacity or the council is meeting their needs (paragraph 14.6). That includes care homes, hospitals, supported housing and a person’s own home.
How common is neglect in safeguarding enquiries?
It is the most common type of risk in the national figures. In 2024 to 2025 councils in England received an estimated 640,240 safeguarding concerns, and an estimated 185,270 section 42 enquiries began. Among section 42 enquiries that concluded in the year, the most common type of risk was neglect and acts of omission, at 40.8% of risks. The most common location of the risk was the person’s own home, at 51.9%. That second figure is for all types of risk, not neglect alone (DHSC statistical commentary, updated 25 March 2026).
Read the figures with care. They are shares of the risks recorded, not of people, and they cover only cases that reached a council, so they do not measure how common neglect is in the population. They do show why recognising it matters for anyone who supports adults at home or in a service.
What is the difference between neglect by a carer, organisational neglect and self-neglect?
The guidance treats these as separate types, and the right response differs. The guidance names organisational abuse and self-neglect as types in their own right. “Neglect by a carer” is our shorthand for the neglect and acts of omission type.
| Type | In plain English | Who may need to act |
|---|---|---|
| Neglect by a carer (paid or unpaid) | A person responsible for the adult’s care does not meet their needs, deliberately, carelessly or because they are struggling. | The employer for paid staff, the council, the police if a crime may have happened, and carer support for a family carer |
| Organisational neglect | Neglect and poor care practice in a care setting, or in care provided at home, from one-off incidents to on-going ill-treatment, caused by the structure, policies, processes and practices of the organisation. | The provider, commissioners, the Care Quality Commission (CQC) and the council |
| Self-neglect | A wide range of behaviour neglecting to care for one’s own hygiene, health or surroundings, including hoarding. It may not prompt a section 42 enquiry. | The adult, supported by the council and others, with the response shaped by the person’s wishes |
Patterns matter most for organisational neglect. The guidance says professionals should look beyond single incidents to identify patterns of harm and that repeated instances of poor care may indicate more serious problems and what it now calls organisational abuse (paragraph 14.18). If three care workers each notice that the same person’s lunch was left untouched, nobody has seen the pattern until it is recorded and shared. Our guide to organisational abuse covers how services drift into poor practice.
The cause also shapes who leads the response. The guidance gives the example of poor, neglectful care resulting in pressure sores, where an employer-led disciplinary response may be more appropriate, but with immediate clinical intervention, a clinical audit of practice and possibly commissioning or regulatory action (paragraph 14.42).
We do not cover self-neglect in depth here. If the concern is that an adult is not caring for their own health or home, see what is safeguarding adults, Making Safeguarding Personal and, for hoarding, hoarding and safeguarding. The guidance says whether self-neglect needs a safeguarding response depends on the adult’s ability to protect themselves by controlling their own behaviour.
What are the warning signs of neglect?
No single sign proves neglect. The Social Care Institute for Excellence (SCIE) guide to types and indicators of abuse (published January 2015, last reviewed December 2020) says evidence of one indicator should not be taken as proof, but should alert practitioners to make further assessments, and that its lists are not exhaustive. Its neglect indicators include a dirty or unhygienic environment, poor physical condition or personal hygiene, pressure sores, malnutrition or unexplained weight loss, untreated injuries and medical problems, an accumulation of untaken medication and inappropriate or inadequate clothing.
| Possible sign | What it may point to | Other possible causes |
|---|---|---|
| Unexplained weight loss, or food and drink left out of reach | Not enough food or drink, or no help to eat or drink | Illness, low appetite, medicines, swallowing difficulty, low mood |
| Signs of dehydration, such as a dry mouth or dark yellow, strong-smelling urine | Drinks not offered or not within reach | Illness, hot weather, medicines, or the person cutting down on drinks to avoid the toilet |
| Pressure ulcers that are untreated or getting worse | Repositioning, equipment or skin checks not happening | Serious illness or immobility, even with good care (see our pressure ulcer guide) |
| Left in soiled clothing or bedding, or unmet continence needs | Help with toileting, changing or continence products not given | A recent change in health, or the person declining help |
| Missed or untaken medication, tablets stockpiled, doses not recorded | Medicines not given or prompted | The person refusing, confusion, side effects, or a recording gap rather than a missed dose |
| A cold home, no working heating or little food in the house | Necessities withheld or nobody arranging them | Unaffordable bills or a broken boiler, which need help rather than blame |
| Poor hygiene, unwashed hair, long dirty nails, clothing unsuitable for the weather | Personal care not provided | The person’s choice, low mood or self-neglect |
| Untreated injuries or health problems, missed appointments, missing glasses, hearing aids or dentures | Not getting access to health care or the aids the person relies on | Appointment or transport problems, or lost items |
| Unpaid care that has broken down: the carer is exhausted, ill or no longer visiting | A carer who is struggling or can no longer cope | A sudden illness in the carer, which calls for support as well as a safeguarding response |
The first, third, fifth, seventh and eighth rows draw on the SCIE indicators. The others are our own illustrations built from the guidance’s examples, and the dehydration signs come from the NHS dehydration page. The table is a prompt for further questions, not a checklist for diagnosis. Look at the whole picture: how long it has gone on, whether it is getting worse, what the person says and whether other people have noticed. Housing staff may see some of these on visits, and our guide to safeguarding adults in housing covers that role.
When does poor care become a safeguarding concern?
Not every lapse in care is a section 42 matter, but the bar for raising a concern is low. The council applies the three-part test. You need only report what you saw, heard or were told, and the guidance says it is not for frontline staff to second-guess the outcome of an enquiry in deciding whether to share a concern (paragraph 14.199). You do not have to decide that it is neglect, or that the adult cannot protect themselves.
These questions help you describe the concern:
- Harm or risk. Has the person been harmed, or is there a real risk they will be, in their health, comfort or wellbeing?
- Pattern. Is it a single event or has it happened before, to this person or others?
- Cause. Is it about the person’s care and support needs not being met, rather than a matter they have chosen?
- Response. Does the provider know and is it already acting, or has it been told and done nothing?
- Wishes. What does the person want, and might they lack capacity to decide?
The table shows how that might play out. These are invented examples to show the reasoning. Local thresholds differ, so follow your employer’s procedure and ask your safeguarding lead.
| Invented situation | Likely route |
|---|---|
| A lunchtime call runs 90 minutes late. The man eats soon after, comes to no harm, and the agency has logged it and apologised. | Record it and tell your manager. This is probably a quality matter for the provider, but watch for it happening again. |
| Calls are missed on three days in one week, leaving a woman with dementia without meals or medicines. | Raise a safeguarding concern through your safeguarding lead. There is a pattern and a risk of harm. |
| A pressure ulcer is getting worse and the repositioning chart has been blank for two weeks. | Get clinical help at once and raise a concern. The employer will also need to look at its practice. |
| A daughter caring alone for her father is worn out, and he has been left unwashed in a cold room for days. | Raise a concern and ask for a carer’s assessment. The focus must still be his safety. |
Serious cases can lead to a review. A Safeguarding Adults Board must arrange a Safeguarding Adults Review when an adult dies as a result of known or suspected abuse or neglect and there is concern that partners could have worked more effectively to protect them (paragraph 14.162), or when an adult who has not died has experienced serious abuse or neglect (paragraph 14.163). See safeguarding adults reviews for how they work. For the process after a concern reaches the council, see what happens after a safeguarding concern.
What if the neglect comes from a struggling family carer?
A family carer may be struggling. The guidance says the response to unintentional neglect by a struggling carer could be a support package for the carer and monitoring, but the primary focus must still be how to safeguard the adult (paragraph 14.40). Under section 10 of the Care Act, where it appears to a council that a carer may have needs for support, it must assess them, whatever it thinks of the level of those needs. Tell the council when you raise a concern that a carer appears to be struggling.
This does not remove criminal liability for wilful neglect. The guidance says the Mental Capacity Act offences can be committed by anyone responsible for the adult’s care and support, including family carers and attorneys (paragraph 14.59). That is for the police and the courts to decide, not for you.
When is neglect a crime?
Three offences matter most. All three need ill-treatment or wilful neglect, not simply poor care.
| Offence | Who it covers | What must be shown | Maximum penalty |
|---|---|---|---|
| Mental Capacity Act 2005, section 44 | A person who has the care of someone who lacks, or is reasonably believed to lack, capacity; an attorney under a lasting or enduring power of attorney; a court-appointed deputy | That the person ill-treated or wilfully neglected the adult | On indictment, up to 5 years’ imprisonment, a fine or both. A lower limit applies in a magistrates’ court. |
| Criminal Justice and Courts Act 2015, section 20 (care worker offence) | A paid care worker who has care of another person, including those who supervise or manage care workers and directors or similar officers | That the care worker ill-treated or wilfully neglected the person | On indictment, up to 5 years’ imprisonment, a fine or both. A lower limit applies in a magistrates’ court. |
| Criminal Justice and Courts Act 2015, section 21 (care provider offence) | A care provider: an organisation that provides or arranges regulated care, or an individual who provides it and employs or arranges for others to help | That someone in its arrangements ill-treated or wilfully neglected a person, that the provider’s activities were managed or organised in a way that amounted to a gross breach of a relevant duty of care, and that without that breach the harm would not have occurred or would have been less likely | A fine (section 23), which can come with a remedial order, a publicity order or both |
Section 20 covers social care for adults and health care for adults and children, and does not depend on the person lacking capacity. A care worker is someone who does this as paid work, so an unpaid family carer falls outside it, though not outside section 44 if the adult lacks capacity. A “gross” breach in section 21 means conduct that falls far below what can reasonably be expected of the care provider in the circumstances. Sections 20 and 21 apply in England and Wales, as does section 44, and some local authority children’s functions are excluded from section 21 by section 22.
The Acts do not define wilful neglect. The guidance says it requires a serious departure from the required standards of treatment and usually means that a person has deliberately failed to carry out an act they knew they were under a duty to perform (paragraph 14.60). That is the guidance’s description, not a statutory test, and a court applies the law. In practice, being overstretched, making a mistake or not knowing what to do is not automatically wilful neglect. But you do not have to decide. The guidance says that where a crime is suspected, early police involvement is likely to help (paragraph 14.83), and that if you are unsure what to do next you should contact the police for advice (paragraph 14.41).
What do the CQC fundamental standards say about neglect?
Registered health and social care providers in England must meet the fundamental standards in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Three are central to neglect.
| Regulation | What it requires |
|---|---|
| Regulation 12, safe care and treatment | Care and treatment must be provided in a safe way. The registered person must assess and reduce risks to health and safety, make sure staff have the qualifications, competence, skills and experience to provide care safely, and manage medicines properly and safely. |
| Regulation 13, safeguarding from abuse and improper treatment | People must be protected from abuse and improper treatment. Systems and processes must prevent abuse and investigate any allegation or evidence of it immediately. Care must not be degrading or significantly disregard the person’s needs for care or treatment. The regulation’s own definition of abuse includes neglect of a service user. |
| Regulation 14, nutritional and hydration needs | Where a provider supplies accommodation or an overnight stay, or meeting these needs is part of the care arrangements, nutritional and hydration needs must be met. That means suitable, nutritious food and hydration adequate to sustain life and good health, and support to eat or drink where necessary, subject to the person’s best interests. |
Regulation 10 adds that people must be treated with dignity and respect (see what is dignity in care). The duties fall on the “registered person”, which means the service provider or registered manager, not directly on each care worker. In practice, a care worker’s neglect shows up as the provider’s failure to train, staff, supervise or investigate.
There is also a criminal offence for providers. Regulation 22(2) makes it an offence for a registered person to fail to comply with regulation 12, 13(1) to (4) or 14 where the failure results in avoidable harm, or exposes a service user to a significant risk of it. It is a defence to prove that they took all reasonable steps and exercised all due diligence to prevent the breach. The penalty on summary conviction is a fine (regulation 23(4)). This sits alongside the section 21 offence above. CQC publishes its own guidance on how it applies the standards, which we have not covered here. For home care, see safeguarding in home care, which discusses abuse and neglect in someone’s own home.
What should you do and record if you suspect neglect?
Your employer’s procedure comes first, but the steps are usually these:
- Deal with danger and medical need. Call 999 if anyone is in immediate danger or needs urgent medical help. Otherwise, get the right professional help for the person promptly and meet immediate needs within your role.
- Ask the person. Ask what they want, in line with Making Safeguarding Personal, and note any doubt about their capacity. The Mental Capacity Act starts from the presumption of capacity.
- Do not investigate or confront. Do not question the person at length or challenge the carer yourself, and do not promise to keep it secret.
- Tell your manager or safeguarding lead. If they do not act, or the concern is about them, use your escalation route. The guidance expects effective, well-publicised ways of escalating (paragraph 14.199), and our guide to whistleblowing protection explains your position.
- Raise the concern with the council through the route in your procedure. If the concern is about a registered provider, CQC also needs to know, and the employer has a duty to inform the council and CQC (paragraph 14.69).
- Record it. Write it up the same day.
The guidance says staff must keep accurate records that state the facts and the known opinions, differentiating between fact and opinion, and that the adult’s views and wanted outcomes should be sought and recorded (paragraph 14.103). A good record includes:
- the date, time and place, and who was present;
- what you saw, in plain words (for example “a dressing was loose and the skin was open”, not “neglected”);
- what the person said, in their own words;
- what you did, who you told and when; and
- the person’s wishes, and anything that suggests they lack capacity.
Never alter or backfill a care record to cover a gap. Say what happened and sign and date any late entry.
Does this apply in Wales, Scotland and Northern Ireland?
Only partly. Section 42 of the Care Act and the guidance are for England. Wales has its own adult safeguarding duty under the Social Services and Well-being (Wales) Act 2014, but section 44 of the Mental Capacity Act and sections 20 and 21 of the Criminal Justice and Courts Act apply in both England and Wales. Scotland and Northern Ireland have separate laws that we have not checked against an official source, so follow your employer’s procedures and local guidance.
What training helps you recognise and respond to neglect?
Three Nexis CPD courses build the knowledge behind this guide:
Together they cost £18 rather than £27 under the pay-for-2-get-3 offer, and employers training 5 or more staff pay £6 a course place on the team plan. These are awareness-level CPD courses, not regulated qualifications, and they do not replace your employer’s safeguarding policy, local procedures or specialist and practical training. If you take one, start with Safeguarding Adults (Advanced) Level 2: 15 questions, 80% to pass, and an instant certificate.
Safeguarding Adults (Advanced) Level 2
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Frequently asked questions
Does neglect have to be deliberate?
No. For safeguarding, neglect can arise from deliberate intent, negligence or ignorance, and it can arise because a carer is struggling. The criminal offences are narrower: they need ill-treatment or wilful neglect.
Is poor care the same as neglect?
Not automatically. A one-off lapse that causes no harm and is dealt with by the provider may be a quality matter. Repeated lapses, or any that put a person at risk of harm, should be reported. You do not have to decide which it is, because the council decides whether the section 42 test is met.
Is a pressure ulcer or weight loss always a sign of neglect?
No. Both can have other causes, including serious illness, even with good care. Treat them as signs that need clinical attention and, where care may have fallen short, a safeguarding concern. See our guide to pressure ulcers.
Can a family carer be prosecuted for neglect?
Yes, in principle. Section 44 of the Mental Capacity Act covers anyone who has the care of an adult who lacks capacity, and the guidance says family carers can commit the offence. It requires ill-treatment or wilful neglect. Where a carer is struggling, the guidance says support for the carer may be the right response.
What should I do if I think an adult is being neglected?
Call 999 if anyone is in immediate danger. Otherwise tell your manager or safeguarding lead and raise a concern with the council as your procedure says. Write down what you saw and heard, in plain words, and ask the person what they want.
Does an awareness course replace my employer’s safeguarding procedures?
No. Awareness CPD is not a regulated qualification. It helps you recognise and report concerns, but you must still follow your employer’s policy, local procedures and any specialist or practical training your role needs.
General information, not legal advice. If someone is in immediate danger, call 999. This guide reflects the Care Act 2014, the Care and Support Statutory Guidance (under review; shown as last updated on GOV.UK on 30 October 2026), the Mental Capacity Act 2005, the Criminal Justice and Courts Act 2015, the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, the DHSC safeguarding adults statistics for 2024 to 2025 and the sources named above as checked on 4 November 2026. Arrangements differ in Wales, Scotland and Northern Ireland, and each employer, council and local Safeguarding Adults Board sets its own procedures. Nexis CPD courses are CPD-accredited awareness training, not regulated qualifications, and they do not replace your employer’s safeguarding policy, local multi-agency procedures or specialist and practical training.