Taking Risks

Innes Turner, East Renfrewshire CouncilKelly 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

• 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

• 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 lifeRisk 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 Co-

ordinator 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