Out of sight, out of mind?

Introduction

By Sarah McClinton  

One longstanding challenge faced by social workers is ensuring the safety and quality of care for people who move into health and care settings out of their local area, where there is a high risk of neglect and abuse if cultures are closed and when communication and coordination break down. It can never be a case of ‘out of sight out of mind’, so continuous information sharing and collaboration across organisations are essential to prevent people being forgotten and to address risks promptly. This blog by Dr Adi Cooper emphasises the importance of leadership and positive organisational cultures in preventing abuse and ensuring high-quality care for people living away from their original homes.

Out of sight, out of mind?

Blog by Dr Adi Cooper OBE

As social workers we take responsibility for the work we do with people who need our support, but what happens when they move out of the area because their care and support needs can’t be met locally? How do we keep them ‘in mind’ when a ‘case’ is closed. What happens if the care that they are receiving isn’t good enough, or if there are safeguarding concerns? 

We know from recurrent enquiries, scandals, Safeguarding Adults Reviews and Panorama exposés, that communication breaks down, agencies don’t share information; we hear that different parts of the system don’t work well together to protect people with care and support needs. We have evidence that individuals placed in institutions, hospitals, care homes, supported or temporary accommodation – any type of care and support setting - away from their family, support or familiar networks, can become more vulnerable to abuse and neglect and there are weaker safety nets (see for example West Sussex SAR Provider Learning Review 2026). 

This isn’t a new problem – it dates back decades – for example to the scandal in Ely Hospital in 1967. Periodically there are initiatives that aim to address challenges in this area, for example the Care Quality Commission’s response to ‘Out of sight – who cares?’, which reviewed the use of restraint, seclusion and segregation in mental health hospitals, with people with a learning disability, mental ill-health and autistic people. The ‘Transforming Care’ programme, in response to the Panorama programme about Winterbourne View, aimed to move people with learning disabilities or autistic people out of institutions into their communities with support, where they would be enabled to live more independent lives.  

However, some people, for a variety of reasons, need care and specialist support that is not available locally or in the community, or need specialist assessment of their needs, and will move away. Then we have to be vigilant and remind ourselves not to forget about them and assume that someone else will care and will provide assurance that they are being properly cared for. We need to make sure that they are not forgotten. So, when someone is living elsewhere and a local authority arranges their care and support in certain types of accommodation, the ‘host’ authority should be informed. Unfortunately, this doesn’t always happen, and then things can go wrong. 

We know that abuse thrives where there are cultures of indifference or disrespect, where people are ‘othered’ and dehumanized. We know that ‘closed cultures’ allow abuse and neglect to thrive, and can be very difficult to identify because abusers use strategies like victim-blaming, and exert their power to silence their victims; so they can ‘hide in plain sight.  

We have to ask ourselves why this keeps happening and what can we do? How can we use our own power in whatever positions we hold? This was the underlying question posed at an initiative of the national Organisational Abuse Reference Group, hosted by Partners in Care and Health in January 2026. A Round Table of key stakeholders, including the Chief Social Worker for Adults, discussed preventing and addressing organisational abuse. A key message was that culture matters, and leadership (at all levels) makes a difference. There are inspirational examples of positive cultures that prevent neglect, abuse and poor-quality care. Learning from what works can be applied elsewhere. Safeguarding risks can be prevented by good quality care and support. 

For social workers working in local authorities, health trusts or any roles where we engage with people living away from their original homes, there may be a range of interactions that provide an opportunity to improve how we support them. For example, when we undertake a review (see for example the Partners in Health Guide). When there is a safeguarding concern, we mustn’t assume that the host authority can do it all. We must ensure that information is shared, everyone works together to mitigate risks and support improvement work when there is provider failure.  

The ADASS Out of Area Safeguarding Adults Arrangements Protocol , agreed with NHS England and the Care Quality Commission, sets out how we can do this. It provides a framework for managing safeguarding concerns when a person's care, commissioned by one authority (Placing Authority), is delivered in another area (Host Authority). It ensures clear responsibilities, for the Host Authority to coordinate safeguarding enquiries while the Placing Authority retains duty of care, cooperates with investigations, shares information, and retains overall accountability for the person's safety. It aims to ensure seamless, collaborative protection, preventing individuals from falling through gaps in services. The protocol was developed to handle the complexity of cross-boundary care, ensuring effective communication and partnership working to protect adults at risk. 

We can all help to prevent risk and harm; we can all work together when there are safeguarding concerns; and we can ensure that people aren’t forgotten when they move out of the local area.