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6.
Promoting Independence and
Choice Policy
Last updated: July 2010
Principles of positive risk taking
What is risk?
6.1. Risk is the management of uncertainty, and risk decisions are made
without having all the knowledge available on which an accurate prediction
could otherwise be made. Risk is usually seen as the possibility that an event
will occur, with harmful outcomes for an individual or for others. Such an
event may be more likely because of risks associated with:
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disability or impairment
health conditions or mental health problems
activities while out in the community, or in a social care setting
everyday activities, which may be increased by a disability
delivery of care and support
use of medication
misuse of drugs or alcohol
behaviours resulting in injury, neglect, abuse or exploitation by self or
others
self harm, neglect or thoughts of suicide
aggression or violence of self or others
6.2. The type of event will depend on the needs of the person, their
relationship with others, and their circumstances, such as the environment in
which they live.
6.3. Risk is often perceived in terms of danger, loss, damage or injury.
However, as well as potentially negative outcomes, taking risks can have
positive benefits for individuals and their communities.
7.
Principles of working positively with risk in social care
7.1.
A pure health and safety approach to risk identifies 5 key steps:
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Identify the hazard
Identify the risk (who may be harmed and how)
Evaluate the risks and decide on precautions
Record findings and implement them
Review the risk assessment and update if necessary.
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7.2. In social care, risk assessment and risk management must be
seen in the context of people living their lives and making choices, with
potential benefits as well as harms.
“Positive risk-taking is weighing up the potential benefits and harms of
exercising one choice of action over another. This means identifying the
potential risks involved, and developing plans and actions that reflect the
positive potentials and stated priorities of the service user. It involves using
available resources and support to achieve desired outcomes, and to
minimise potential harmful outcomes” (Morgan, 2004)1
7.3. The decisions made must therefore take into account the desired
outcomes of the person, and the agreed outcomes of their assessment,
and the steps described above at 7.1 need to be adapted so that good
decision making can be supported.
7.4. Throughout this policy it is required as essential that risk
assessment and risk management is carried out in partnership with
people and their carers, wider support network and other involved
professionals. In almost all circumstances, this is subject to the wishes of
the individual. The decision to involve others or not is in itself a decision
which may give rise to risk, and the individual may need support to make this
decision.
7.4.1. In certain circumstances it may not be possible to comply with the
wishes of the person in this regard, for example where there are child
protection risks or safeguarding risks.
7.4.2. Where the person is subject to Section 31 or Section 47 of the Mental
Health Act, or MAPPA procedures, there are specific requirements which
must be followed and which may mean that the service user will not be
consulted, or their wishes may be overridden. Any such legal requirements
must be followed and will take precedence over any guidance in this policy.
The key steps in supporting positive risk taking:
7.5. In the provision of social care, as in life, it is not possible to
eliminate all risk; risk is a part of life and is normally a good thing.
Morgan, S. (2004) ‘Positive risk-taking: an idea whose time has come’, Health Care Risk
Report, 10(10), pp.18-19.
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Taking risks can help people to learn and gain experience and confidence in
leading their lives. Not taking risks can mean that people are not able to
develop and grow, and may be prevented from doing things which make them
happy. Therefore people should be supported to make real choices, even
when these choices may sometimes be unwise or could lead to harm:
provided that the assessment and support planning has been undertaken in
partnership with the person, has taken all the relevant factors into account
and enabled the person to weigh up the advantages and disadvantages of a
proposed course of action, and they are able to make an informed choice. It
is important when doing this to find out why the person wishes to make a
particular choice, what this will bring to their life, and how their life may be
adversely affected if they are prevented from making this choice.
“Social care provision is generally a risk averse activity. The requirement to
complete risk assessments inadvertently supports risk aversion… Without
management oversight it will be a natural default position to consider activities
which might pose a challenge to carers as too risky and frame the risk
assessment accordingly…. This tendency needs to be guarded against”
(Voluntary sector provider, 2008)2
7.6. In order to ensure that risk assessments support positive risk
taking, it is essential that they evidence consideration of the balance of
risk between benefit and harm. In social care, the relationship between the
individual and the people involved in assessing their needs or helping them to
arrange their support is a relationship which gives rise to a duty of care.
Therefore it is essential that risk assessments are carried out in a transparent
way, in partnership with people and their carers, and that agreement is
reached about the risks, how they will be managed, and who will be
responsible for them.
7.7
To support this process, the following key steps for supporting
positive risk taking in social care are identified:
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Identify the proposed choice or decision to be made
Identify the potential benefits of the choice or decision and the
likelihood of these being achieved
Identify the potential harms of the choice or decision and the
likelihood of these occurring
Hampshire County Council (2008) Getting personal – a fair deal for care and support: Report
of the Commission into the future services for adults in need of support and care, Winchester:
Hampshire County Council, p.92.
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Principles of positive risk taking
Evaluate the likely benefits against the likely harms, and the
likelihood of these occurring
Agree a course of action which:
 Increases the likelihood of benefit being achieved
 Decreases the likelihood of harm occurring
Review the risk assessment and actions.
7.8
This approach to risk assessment and decision making should be
used in any situation relating to social care where a decision involving
risk needs to be made. It is the foundation of risk assessment in the
Safeguarding Adults procedures, but can also be applied in other situations,
for example:
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Making decisions in planning support and care where different choices
are possible
Managing situations where there are differences of opinion about how
support can best be provided
Evaluating support plans for Self-directed support
Dealing with incidents which arise while support is being provided
Making decisions when concern is expressed by a third party about a
vulnerable person who is reluctant to accept intervention.
7.9
Learning from implementation of the Mental Capacity Act 2005 in
Adult Services has shown that identification of the specific decision to
be made is crucial to the assessment process. Managers must ensure
that practitioners are supported in identifying the choices or decisions to be
made before a risk assessment is carried out, and that people and, where
appropriate their carers, are actively involved in defining the choice or
decision.
7.10 By carrying out risk assessments in this way, and ensuring that
these are recorded, it is more likely that defensible decisions will be
made. Using this approach, and recording the discussions, will also help to
support people in making informed choices.
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How positive risk taking can be supported
8.1
The following are examples of what support for positive risk taking
involves:
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Principles of positive risk taking
Empowering people by listening to them, making sure they have the
information they need, responding to them in a way which is
meaningful for them, sharing power with them and being clear about
what this means for them and what the limits of this are
Working in partnership with people and their carers, using a personcentred approach
Understanding a person’s strengths and motivation
Understanding the person’s perspective about what they will gain from
what they wish to do, and what they may lose if they cannot do it
Considering the potential benefits of taking risks where this may lead to
positive outcomes for the person
Helping people who use services to learn from their experiences
Knowing what has worked or not worked in the past
Where problems arise, understanding why
Reaching an understanding about the responsibilities of each party
Helping people to access opportunities and take worthwhile chances
Helping people to understand the consequences of different actions
Reaching decisions based on good information about the choices
available
Ensuring that support and advocacy is available to people, especially
when things begin to go wrong for them
Sometimes supporting short term risks, in consultation with the person
and their carers, in order that a long term gain may be achieved
Through good support planning and reviews, ensuring that services are
provided in a way which does not create dependency
Having an understanding of the different perspectives and views of
people with disability and their carers, practitioners, advocates, service
providers and other professionals
Ensuring that agreed guidance, procedures and risk assessment tools
are used, and that appropriate support and supervision is provided by
managers.
8.2
When carrying out risk assessments and risk management, the
following factors should be considered:
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The identification, assessment and management of risk should
promote independence and social inclusion
Risks may be minimised, but not eliminated
It may not be possible to manage all risks
Identification of risk carries a duty to do something about it, i.e. to
manage the risk
Risks may change as circumstances change, and should be reviewed
– an assessment is a snapshot, whereas risk assessment is an
ongoing process
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Promoting Independence and
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Principles of positive risk taking
Information used in risk assessment should be as comprehensive and
accurate as possible
Involvement of individuals, their carers, advocates and practitioners
from all involved services will support good quality risk assessments,
risk management and decision making
Defensible decisions are based on clear reasoning, with regard to
appropriate legislation, policies and procedures. They are clearly
recorded, and where appropriate and possible, include signed consent
or evidence of consent if the person is able to give this, but is unable to
sign: for example where someone else signs under instruction from the
person, and this is witnessed by a third party
Where signed consent is not possible in an emergency situation,
decisions which are made should be based on all the information
available, and must be recorded. The decision should be reviewed and
more comprehensive risk assessment and planning should take place
as soon as possible
Where signed consent is not possible because the person lacks
capacity, any decisions which are made must be in the person’s best
interests, in accordance with the principles of the Mental Capacity Act
and Code of Practice, and must be recorded
Confidentiality is a right, but not an absolute right, and in exceptional
circumstances information may be shared without consent, provided
the reasoning is in accordance with the Data Protection Act, and is
recorded
Support for positive risk taking should be embedded in practice and
decision making at all levels of Adult Services and should be owned by
all staff and supported by managers
Where it is not possible to support the choice of the individual, the
decision should be based on good evidence of the likelihood of harm to
the person or others, having explored all possible options for mitigating
this, and should be shared with the person and their carers whenever
possible, as long as the sharing of information in itself would not cause
harm. Where the decision is made in consideration of Adult Services
duty of care, this should be made clear in the recording and in the
sharing of the decision.
8.3
Planning including crisis planning can support good, proactive risk
management. Encouraging people to think about what they would need in
situations where they may be less well, and could be more dependent on
others, can be a positive step for people to help them to remain in control of
their own lives and take responsibility for their own care. An example of this is
the Wellness Recovery Action Plan (WRAP) self management tool used in
Mental Health services http://www3.hants.gov.uk/wrap.htm . The use of
WRAP is now being promoted across Adult Services and training is available.
A WRAP crisis plan may form a valuable part of a person’s risk management
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Principles of positive risk taking
planning, and provide an important motivation for the person to manage risks
in a way which suits them.
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