November 2011
we’re supporting
people who use
services, and carers
Keeping risk person-centred
An introduction for service providers in adult social care
Adult deemed to be at risk
 Any person 18 years of age and over who is
or may be in need of social care services
(including services due to their role as carer)
by reason of mental or other disability, age or
illness; and who is or may be unable to take
care of him or herself, or unable to protect
him or herself against significant harm or
serious exploitation.
Why focus on risk now?
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Policy drive to give ‘choice and control’
Support for self-directed care
Enabling people to take risks they choose
DH framework for risk management
Concerns about increasing risk
Concerns about risk-averse services
Vision for adult social care seven principles
1. Prevention: empowered people and strong communities
will work together to maintain independence. Where the
state is needed, it supports communities and helps
people to retain and regain independence
2. Personalisation
3. Partnership
4. Plurality
5. Protection: there are sensible safeguards against the
risk of abuse or neglect. Risk is no longer an excuse to
limit people’s freedom
6. Productivity
7. People
Think local act personal
Risk management and protection/
safeguarding should be addressed in a
balanced way across all sections of the
community, avoiding an approach that
views people in receipt of social care
funding as most at risk.
Know the law
CRIMINAL
 Recklessness
 Beyond
reasonable doubt
 Punishment
CIVIL
 Negligence
 Balance of
probabilities
 Compensation
Assessing risk
Vulnerability
Mental
capacity
Wider context
Wishes of
individual
Consent
How serious?
Duration
Intent
Frequency
Legal
framework
Adapted from Hughes J (2006)
Risk to the
person and
others
Impact
Ensuring best practice
Ensure:
 All reasonable steps have been taken
 Reliable assessment methods have been used
 Information has been collated and thoroughly evaluated
 Decisions are recorded, communicated and thoroughly
evaluated
 Policies and procedures have been followed
 Practitioners and their managers adopt an investigative
approach and are proactive
Risk guidance for people with dementia (DH 2010)
Sharing power
 Do you know what good practice looks like?
 How do you involve people who use your service in
running it?
 You want to be innovative and cost-effective – what
steps do you take to engage the practitioner
workforce in judging the risks?
 Do you have a whistle-blowing policy?
 What is the role of managers in setting and
maintaining professional standards?
Tool to audit power
(Braye and Preston-Shoot, Empowering practice in social care, OUP 1995)
Human rights are
upheld
People’s
strengths are
recognised
Difference and diversity
celebrated
People treated with
respect
and dignity
Person-centred services
Access to information
and advice is
given
Negotiation and
fairness about
decisions
Staff are trustworthy
and supportive
There is involvement
in decision-making
Staff are honest
and reliable
Person-centred approach to risk
Smull and Sanderson, Essential Lifestyle Planning, 2005
Differences in power and status affect
the context in which people influence
risk decision-making
Six personalised safeguarding
responses
Alert
Referral and
decision
Monitor and review
Person-centred services
Outcomes
Strategy discussions
Assessment and
investigation
Person-centred risk assessment
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Who is the person?
Where are we now?
Where do we want to be?
What have we tried and learned already?
What shall we do next?
Employers should be alert to:
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Professional standards
Inspectorate standards
Better ways of organising work
Blame
Value conflicts
Retention
Consistency and continuity
Morale and satisfaction
Dangerous people
Continuing professional development
Celebrating good practice
Developing a model risk-taking policy
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Values and principles
A ‘statement of purpose’
Beneficial outcomes anticipated
Professional standards
Identified constraints
Position on controversial issues
Associated procedure
Endorsements
Acknowledgements
Consultation
Review arrangements
Useful links
 Vision for social care
http://www.dh.gov.uk/en/Publicationsandstatistics/Pu
blications/PublicationsPolicyAndGuidance/DH_12150
8http
Person-centred assessment
 http://www.thinklocalactpersonal.org.uk/Browse/safeg
uarding/?parent=8625&child=3681
www.skillsforcare.org.uk