May 2011
we’re supporting
people who use
services, and carers
Learning to live with risk
An introduction for service providers in adult social care
(2) Good practice scenario slides for use in learning
GOOD RISK-TAKING
PRACTICE SCENARIOS
In thinking about each scenario consider how and whether
decisions can be shared, what information is needed, what
action or inaction is desirable and the likelihood of beneficial and
harmful outcomes. Record the process.
People on
budgets
Record here how you
reached a shared
decision about risk
and why:
Mr Godber is a 92 year old who lives alone on
state pension and attendance allowance. He
has limited mobility about the house only, is
partially deaf and needs support with meals
and showering at present. His son and
daughter-in-law live 200 miles away and visit
at weekends. Mr Godber receives a direct
payment to cover an hour of home care a day
(morning and evening) and to assist with
meals. He has used this for a number of years
to buy support from an approved local
authority provider. He has complained on
occasion about time keeping and competence
(‘She can’t boil an effing egg so I sent her
packing!’). Today he phoned the office to
announce that he no longer wants the service
and is going to use the money so the woman
next door can do for him.
What steps do you take to support decision
making?
Commissioning
Record here how you
reached a shared
decision about risk
and why:
The Head of Commissioning has said that
you must stimulate a diverse market that
demonstrates value for money, safety,
innovation, outcomes in procurement and
contracting through building community
skills.
You are aware of some small
neighbourhood groups, variously made up
of Asian elders, local activists and
disabled people, who have a broad
interest in health and well-being.
How do you overcome, among other
things, their apparent lack of track-record,
absence of audited accounts and word of
mouth approach to staff recruitment?
Residential
care
Record here how you
reached a shared
decision about risk
and why:
You are the registered manager of a residential unit and
a supported living network.
A young woman with learning disabilities, Sara, is
temporarily staying in the residential care home in the
independence unit while waiting to move into supported
living with two other people. A tenancy has been
identified but some works are required before the move
can take place. Sara was previously living with her
sister but had to leave. She is fairly independent with
regards to mobility and personal care and is able to
articulate her needs and concerns. Sara is very
personable but lacks confidence. She is known to have
some mental health problems. A senior care worker on
duty has informed you that Sara has disclosed that the
Assistant Manager (male) has been entering her room
at night in the dark. This has happened on more than
one occasion, always when all the staff have gone
home, except for the waking night worker. He doesn’t
put on the light and stays in the room for some time.
Sara is distressed by his actions and doesn’t feel safe.
What steps do you take to weigh the risks and reach
decisions?
Ordinary
living
Record here how you
reached a shared
decision about risk
and why:
A group home accommodates three people with Downs
syndrome, two women and one man. They lived in
residential care for many years before moving . All
three people have limited communication, are not very
agile though can move around the home and manage
the stairs to the bedrooms and bathroom. They carry
out most domestic tasks such as setting the table,
washing up and simple meal preparation but need
prompting to carry out such everyday jobs. They can all
wash and dress themselves but need some supervision
bathing/showering. The group have never been left
alone at night and only for very short periods during the
day time. A member of staff sleeps in every night but is
very rarely called upon, unless some one is ill.
Individuals may get up during the night to use the
bathroom but go back to bed. The group have a
specialist phone with large numbers and a red button
emergency call to the community alarm system.
Knowing the individuals you believe they could manage
periods of time alone and during the day and night. One
of the group members has elderly parents who are in
regular contact. They would not countenance their son
being left without staff supervision.
As owner manager you wish to be innovative and costeffective – how do you tackle the risks involved?
Mental
health
Record here how you
reached a shared
decision about risk
and why:
You are a team manager within a Community
Mental Health Team.
One of your social workers is working with a
woman called Clare aged 36 years. Clare has
a history of a bipolar affective disorder and has
recurrent admissions to hospital. The most
recent episode was within the last twelve
months when Clare was admitted to a hospital
in a neighbouring town, owing to a shortage of
local beds. She was transferred back to the
local infirmary and then discharged with an
enhanced CPA (Care Programme Approach).
Since discharge the social worker has been
able to work with Clare and complete a
wellness and recovery action plan (WRAP).
There has been close involvement with her
husband and family. You have just been
informed Clare is pregnant.
What would be your approach to supported
decision making and risk?
Hospital
social work
Record here how you
reached a shared
decision about risk
and why:
You are a hospital based social worker
at the regional cancer centre and have
been working intermittently over the last
12 months with Geoff. He is diagnosed
with cancer and you have previously
assisted with benefits advice and help to
claim attendance allowance to assist his
wife at home. You have had no
involvement for the last five months. You
receive a referral from the cancer
centre. Geoff is in hospital but requests
discharge home. Ward staff are
prepared for a fast track discharge but
concerned he may not survive the two
hour ambulance journey home.
What would you expect your manager
and employer would want you to do?
Carers
Record here how you
reached a shared
decision about risk
and why:
You are the employer of a number of
carer’s support workers. One of your
workers runs an emotional support
group for carers. It comes to your
attention that he has set himself up as
a ‘handyman’ business. He and his
son are undertaking gardening and
various odd jobs on the estate where
he lives for many of the older and
disabled people who have carers in
his group. Apparently one of the carers
is his business partner.
Identify risks and appropriate action
Volunteers
Record here how you
reached a shared
decision about risk
and why:
You are the manager of a volunteer
coordinator working under a service contract
for a local authority. She has been asked to
recruit, assess, train and support volunteers
who can help promote active citizenship,
health and well-being. She is popular and
credited with cultivating a cohort of
volunteers who support user-led
organisations, assist people to engage in
consultations, participate in community
decision making and advocate to meet
needs.
Your local authority is making some disliked
budget reductions involving closing a day
centre. You are watching the local news on
TV one evening and you spot your volunteer
coordinator carrying a placard among a
group of protesters outside the town hall.
Consider possible actions and decisions
required.
Work
Record here how you
reached a shared
decision about risk
and why:
Through several years’ hard work you
are now the owner of a successful
cardboard box and packaging
company that supplies the NHS and
police in the county. You provide
employment for many local people.
You are approached by a day
opportunities organiser to consider
participating in a supported
employment scheme for disabled
people.
Instinctively you feel some discomfort
with the proposal and, being busy, buy
time by asking for a short business
plan with risk analysis.
What are your expectations here?
Leisure
Record here how you
reached a shared
decision about risk
and why:
You are an active trustee of a voluntary
organisation that has many projects in a
rural northern county. At a sporting awards
ceremony, held by the charity, you meet
19-year old Marvin who is in his last year
at a special educational needs school. He
is the sole carer for his mother who is
diabetic and obese to the extent that her
mobility and balance are problematic.
At the after ceremony buffet Marvin
confides in you that his ambition is to
represent Great Britain at the Paralympics
in two years’ time. He asks for your help
as his social worker, teacher and project
worker have all said he is dreaming. His
sport is power-lifting.
Where do you go with this?
10 things to do and not to do
DO
 Adopt the Common Core
Principles to Support Self
Care as the foundation values
for your practice standards
 Put a risk-taking policy in
place
 Keep records of shared
decision making about risk
 Take action whenever
practice standards are broken
– even if there is no harm
 Learn from mistakes
DON’T
 Think that avoiding taking
action is the safest thing
 Assume the public and media
will understand when things
go wrong – prepare in
advance
 Underestimate the role that
people who use services, and
staff, can have in shared
decision making
 Over rely on procedures
 Blame people for risk-taking –
establish the facts
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