Taking Risks
Innes Turner, East Renfrewshire Council
Kelly Gainty, East Dunbartonshire
Council
The Risks We Take?
• If you’re happy to – share with us a big risk
that you have taken in your life.
• Now tell us about a daily risk that you take.
So what is Risk?
• “Risk is often seen as a negative thing with negative
consequences…in taking an outcomes focused
approach people’s desired outcomes may well involve
them undertaking a certain amount of risky
behaviour…practitioners themselves may find applying
an outcomes approach risky…it is important to move
away from more traditional attitudes to risk that centre
around avoiding all risks to people…towards the
concept of taking risks in a positive and mindful way to
allow…achieve their desired outcomes”
• (IRISS Leading for Outcomes: A Guide)
SCIE (Social Care Institute for
Excellence) (2010)
• “Providing real choice and control for people
who use social care means enabling people to
take the risks they choose particularly in the
use of Self Directed Support
Why are we Councils/Support
Providers risk averse?
• Need to find someone to blame.
• Support providers sued and found negligent.
• Not understanding what the choices and
associated risks are.
• Questioning whether a person has capacity to
make judgements about risk.
• Unwelcome media attention
• Are we the only ones that are risk averse?
SDS – Personalisation
What stops us taking it forward?
• Increased risk to those already at risk of abuse or
neglect.
• Reluctance to take advantage of new
opportunities because of fear of potential risks.
• Risk aversion – families, professionals,
organisations – hinders choice and control
• Lack of confidence from all parties re sharing
responsibility of risk
• (DOH 2010 – Nothing Ventured, Nothing Gained)
Independence, Choice and Risk
• Choice and control are what everyone wants for themselves
and those they care for, but sometimes the decisions they
make may seem to others as too risky. Risk is a concept that
tends nowadays to have mainly negative connotations. We
live in a world where, when things go wrong, the media and
society in general are quick to look for someone to blame and
this is particularly the case when people using health and
social care services are involved. Avoiding risk altogether
would constrain the choices people can make.
• (Department of Health 2007)
What happens?
• What happens if organisations take a safety
first approach?
• No real choice and control?
• Will people achieve good outcomes if
prevented from taking risks?
• Become dependent?
• Losing skills?
Difference between perception and
reality of risk
• Level of knowledge different people have about support,
choices, risk.
• Personal relationships i.e. children of older adults being overly
protective out of fear – curbing independence.
• Perceiving a greater degree of risk than really exists.
• “Services are good at highlighting the downside of risk but poor at
thinking about the great opportunities that facing up to risk and finding
positive solutions in a creative and mindful way could mean for people,
their families and their communities. A POSITIVE APPROACH TO RISK
REQUIRES PERSON CENTRED THINKING!
• (JRF 2012 – The Right to take Risks)
SCENARIO FOR DISCUSSION
• Mr James Gainty, 80 year old man;
• Previous hobbies – walking the dog, hillwalking, keeping
active in all ways;
• Not a socialiser, likes his own company;
• Diagnosed with Alzheimers;
• Lives alone (except for his beloved companion Tammy the
dog);
• When out walking dog he has – fallen 3 times, got lost and
had to ask for directions, been returned home by the police;
• Sometimes forgets to take his medication;
• Still likes cooking for himself but sometimes leave the electric
ring on the cooker;
• HOW CAN WE SUPPORT JAMES?
So what were we asked to do for
James
• Look at a dog walking service – to take dog out
not James (in case he falls while he is out!);
• Look at opportunities to attend day centre –
socialisation and activities;
• Put in home carer to make all meals in
microwave and isolate cooker;
• Consider long term residential care.
So how did we support James?
• Referred to a befriending service – requesting a
befriender who had a dog and could go walking a couple
of times of week with James;
• Installed a Buddy System – GPS, set it for the route and it
also included a fall sensor;
• Installed a temperatures extreme sensor – detected a
build up of heat when electric cooker was left on;
• Set up a medication reminder using the community
alarm – voice recorded by his daughter.
• The use of Assistive Technology can greatly reduce risks
and alert to instances of concern much earlier.
SCENARIO FOR DISCUSSION
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Ella Turner, frail elderly lady;
Lives with her daughter and grandchildren;
Home care – visit daily – dressing/personal care;
Mrs Turner – confused – resisting home care;
Demanding of daughter’s time and attention;
Daughter feeling stressful – relationship
breakdown;
• SW considering nursing home placement.
Original Service – Ella Turner
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2 Home Care Workers twice daily;
Several workers involved;
Mrs Turner is distressed and refusing care;
Daughter has to pick up on tasks as well as
deal with intrusion of the carers on her busy
family life.
New Service – Ella Turner
• Daughter suggested undertaking personal care tasks
herself;
• Use some of budget to purchase laundry and cleaning
services for family;
• Practical, inexpensive and freed up time to look after
her mother as unpaid carer;
• Home care withdrew;
• Relationship greatly improved;
• Mrs Turner, more settled, less demanding;
• Nursing home placement avoided;
• Family feel more in control.
SCENARIO FOR DISCUSSION
• Fiona Devers, in her 50s, early diagnosis of
dementia;
• Lives alone;
• Physically active, healthy and independent in
her home;
• Lack of road safety awareness;
• Walked out into traffic several times.
Original Service – Fiona Devers
• Emergency reactive services in place temporarily;
• Home carers and family attempting to manage
risk through increased visits;
• Specialist risk assessment being carried out;
• Support is discouraging Fiona from leaving the
house;
• Could have negative effect on physical and
mental health given she is otherwise
independent.
New Service – Fiona Devers
• Family considering specially trained guide-dog (with
road safety skills);
• Part of overall support plan;
• Allows Fiona to get out safely, independently and still
physically active;
• Hoped dog will provide therapeutic support;
• May create structure/routine to Fiona’s day (important
for people with dementia);
• Initial costs and training expenses;
• More effective and cost effective way of supporting
Fiona and her family to manage risks.
Was that too easy?
• Duty of Care
• Local Risk Management Procedures/Policy
• Risk Enablement Planning – Identifying Risks
and Impacts
– What would be the impact if harm happened?
– How Likely – (H/M/L) to service user/others
– How severe – (H/M/L) to service user/others
Risk Enablement – what’s the way
forward?
• What do we need to do to enable people to
take risks?
Risk Enablement (Carr, 2011)
• Ensure to include risk and safeguarding as part of the
outcome focused support planning and review - INTEGRAL;
• EVERYONE – work together to identify risk enablement
opportunities and issues;
• Sharing responsibility;
• Training – are staff confident – we need to equip staff to
respond to risk enablement and personalisation;
• Well informed – information, support, advocacy;
Enabling Risk in Outcomes Focused
Working – SSKS
• The fear of risk by supported individuals, families,
professionals and organisations which support them is
potentially the greatest barrier to genuine outcomes
focused/person centred working;
• Any attempt to remove all risk from our lives disabled us
from playing a full and active part in our lives and in our
communities;
• The assessment, support planning and reviews should focus
on outcomes identified by the individual…process enables
the individual to make an informed choice regarding their
support, including considering potential risks and agreeing
a plan how these risks will be addressed.
People with dementia and their
carers can still experience a good
quality of life
Risk can be minimised, unlikely to be
eliminated!
What’s happening in EDC/East
Renfrewshire
• Will be aware of the 5 pillars model of
support:
• Supporting community connections;
• Peer support;
• Plan for future care;
• Understanding illness and managing
symptoms;
• Plan for future decision making
8 Pillar Model
• Dementia Practice Coordinator leading care,
treatment and support;
• Support for Carers;
• Personalised Support;
• Community Connections
(social networks, peer
support);
• Environment – aids,
technology etc
• Mental Health and Care
Treatment – psychiatric
and psychological
services;
• General health –
wellbeing, physical
health;
• Therapeutic interventions
– tackling symptoms,
dementia specific
therapies, maximising
independence.
EDC/East Renfrewshire- Locally
• Working with JIT (Joint Improvement Team)
and Governance International – Co-Production
and Dementia – Community Assets etc
• Social Enterprise – making EDC dementia
inclusive
• Dementia Dogs
• Post Diagnostic SDS Pilot