we’re supporting people who use services, and carers

November 2011

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?

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

CIVIL Negligence Balance of

probabilities Compensation

CRIMINAL Recklessness Beyond

reasonable doubt Punishment

Assessing risk

Wider context

Wishes of

individual

Duration

Frequency

Legal

frameworkImpact

Intent

Risk to the

person and

others

Consent

Mental

capacity

Vulnerability

How serious?

Adapted from Hughes J (2006)

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

Access to information

and advice is

given

There is involvement

in decision-making

Staff are honest

and reliable

Staff are trustworthy

and supportive

Negotiation and

fairness about

decisions

People treated with

respect

and dignity

Difference and diversity

celebrated

Person-centred services

Person-centred approach to riskSmull 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

Monitor and review

Outcomes

Assessment and

investigation

Strategy discussions

Referral and

decision

Alert

Person-centred services

Person-centred risk assessment

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:

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

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/Publications/PublicationsPolicyAndGuidance/DH_121508http

Person-centred assessment http://www.thinklocalactpersonal.org.uk/Browse/safeg

uarding/?parent=8625&child=3681

www.skillsforcare.org.uk