Safeguarding Adults
Guidance for Risk
Management
Tool
DRAFT
Recognise
Alert
Prevent
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Guidance for Risk Management Tool
A note about Mental Capacity
Mental capacity is a vital element in care planning with vulnerable adults at
risk. If there is reason to doubt a person’s mental capacity to consent to the
risks being taken or proposed care plan, an assessment of capacity should be
undertaken and recorded in line with the principles of the Mental Capacity Act
2005 having regard to the Code of Practice. This will include whether the
person understands the potential consequences of refusing support.
If it is established that a person lacks capacity to consent to the care that is
required, care planning and risk management should proceed in the context of
best interest decisions also in line with the principles of the Act.
Risk assessment and management remains an important part of best interest
decision making. It will assist practitioners in formation of the care plan and to
ensure that decisions taken are the least restrictive option in reference to a
person’s rights and freedoms. This may include taking some measured risks.
Promoting positive risk taking
For people who have mental capacity to decide the risks they will take and the
care they will receive, it is important for practitioners to respect the individual’s
right to take risks despite their real or perceived vulnerability.
A person’s right to take risks must be balanced with the practitioner’s duty of
care. This is an on-going challenge for social care professionals.
A 2007 Department of Health publication entitled Independence, Choice and
Risk offers useful guidance on the principles of positive risk taking: Risk is an
inevitable consequence of people making decisions about their lives. Negative
views of risk involve defensiveness, fear of blame, and uncertainty about the
law. Risk aversion by practitioners or management means that vulnerable
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people may be prevented from doing things that most people take for granted
due to perception of risk which may or may not be real. (DH, 2007)
Avoidance of risk aversion includes a change in organizational culture and
attitudes in supporting practitioners to allow vulnerable adults to take positive
risks as part of a robust risk management. This involves applying the
principles of person-centered care planning, effective risk assessment, and a
confident understanding of social care law, duty of care and negligence.
Completing the Risk Assessment
The risk assessment tool can be used at any stage during assessment, care
planning, or review. It is designed to assist the practitioner to identify and
analyse risks to a service user. It will also assist in identifying and recording
actions to be taken in response to the risks.
As with any assessment, the tool can be completed by an individual, but
should always include participation of the service user and consultation with
carers and other professionals involved with the person.
In complex cases, it may be useful to organize a multi-agency riskmanagement meeting. This may be initiated and coordinated by the care
manager. The completed tool may serve as a written record of the meeting.
Record of the meeting should also include a list of those attending. If the
service user did not attend or was not invited, there should be a record of the
reasons for that decision. Recording should also include agreement to any
planned actions and details of any disagreement with the plan.
Risk
Include a short description of the harm that may occur. This is sometimes
divided into hazard (something with potential to cause harm) and risks (the
potential impact and severity of the hazard occurring). Each type of hazard,
there may be several different risks. For example, financial harm may be
separated into risk of cash being taken from a person’s home, risk of person
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being victim of competition scams in the post, and person being overcharged
when in the shop. Each risk may require a separate protective action.
For the purpose of this form, be as specific about risks as is necessary to
ensure that planned actions are clear and targeted. Other examples of risk
may be: falling at home, being unable to call for help in an emergency, being
unable to access the toilet, skin breakdown, inadequate fluid or nutrition.
Likelihood of harm
This section is not intended to be numerical or scientific. Consider realistically
how likely it is the risk or harm will occur. This will give all professionals and
family members a chance to consider whether anxieties are disproportionate.
Make sure to consider the person’s total situation and presentation over time
to avoid placing too much focus on one instance or incident.
Record a brief summary comment on likelihood of harm. This might include a
brief history of events balanced with strengths of the person or environment.
For example,?????? .
Risks may be prioritized by consideration and analysis of the likelihood of the
harm occurring in connection with the worst potential consequence of the risk.
Worst consequence
Considering the worst potential consequence will assist practitioners to
analyse the potential severity of harm. It will also help to uncover people’s
fears around the risks they or their family members face. This will further
assist practitioners to ensure that actions taken to prevent harm are
reasonable and proportionate to the potential harm.
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Serious harm to a vulnerable adult is defined by the department of health as
death or serious injury to a person’s physical or mental health. It is important
to be aware of whether there is a risk of serious harm which will inform the
level of professional intervention as well as information sharing decisions.
Actions to manage the risk
Actions agreed in this column will serve as the risk management plan. It may
be read alongside a person’s care plan to provide additional detail of specific
actions which are being taken to address specific risks. The actions should be
clearly assigned to individuals who have agreed to undertake the actions. This
will include actions to be taken by the vulnerable person. Consideration
should be given to the person’s views about proposed actions. If actions are
time-specific, this should also be clearly recorded.
It is important to consider how the proposed action will address the identified
risk. This is especially important in considering whether effective support can
be provided in the vulnerable adult’s home and whether traditional services
are able to meet the needs of the individual. For example ??? Residential care
does not reduce risk of falling. Delivered meals will only reduce risk of poor
nutrition if the person is willing to eat them.
Remaining Risk
It will never be possible to eliminate all risk of harm in any environment.
Include a brief summary of what risk will remain following the planned action.
Is there a certain level of risk which cannot be addressed due to the lifestyle
choices of the vulnerable person? Record the views of the person, carers and
other professionals about whether that is an acceptable level of risk. If it is
relevant, comment on the vulnerable person’s mental capacity to consent to
taking the risks identified. Record whether the person has made an informed
choice, and whether the remaining risks have been explained and understood.
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Monitoring Plan of Remaining Risk
Record the monitoring and review arrangements for the risk management plan
including timescales. Specifically, how will monitoring arrangements identify if
the remaining risk rises to an unacceptable level? What will that look like for
this individual? Is it necessary to arrange any contingency plans in relation to
this risk? The monitoring tasks should be clearly assigned to individuals who
have agreed to undertake the actions with clear arrangements for reporting.
Tips to manage risk when support is refused
When vulnerable people refuse to accept support designed to reduce risks to
their health and safety, it is important for practitioners to continue to monitor
the situation and show evidence of steps taken to encourage the person to
engage with support. It will be important to involve multi-agency professionals
in this process and to consider what alternative forms of support are available.
It will be useful to consider which professional or family member is best placed
to successfully engage the person. It may be that the person would respond
more positively to a health or a voluntary agency professional.
Having established an alternative risk management plan, the vulnerable
adult’s resistance to engagement should be tested by the re-introduction of
the new plan by the person or the agency most likely to succeed.
If the plan is still rejected, another multi-agency meeting should be held to
discuss the risks remaining, any alternatives that have not yet been tested,
and monitoring review arrangements for the vulnerable person.
It may be necessary to take legal advice to ensure practitioners and
organizations have met their duty of care as far as is reasonable and to inform
the plan for review and monitoring including suitable time scales.
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Interface with VARM process
Practitioners should consider with their line manager whether the risk
assessment /risk management process for an individual service user should
be conducted under the VARM (vulnerable adults risk management)
procedures. This may be necessary in cases involving risk of serious harm to
a vulnerable adult due to self neglect. The VARM procedure should also be
used where it is necessary to organise independent chairing and formal
minute-taking of risk management meetings for particularly complex
situations. If there is doubt about whether to use the VARM procedures, line
managers should seek advice from the safeguarding adults’ manager.
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