we’re supporting people who use services, and carers May 2011 Learning to live with risk (1) An introduction for service providers in adult social care

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

Shouldn’t a good service avoid risks? What reasons could there be to avoid supporting people who use services to take risks?

WHERE ARE THERE RISKS? Wariness of lurking conflict!

Know the law CIVIL  Negligence  Balance of probabilities  Compensation CRIMINAL  Recklessness  Beyond reasonable doubt  Punishment

Some key concepts Evidence  Facts  Record keeping Blame  Liability  Vicarious liability Sue Insurance Complaints Inquiries Professional misconduct

Good practice – sound and safe  Vicarious liability Employer risk  Good practice Beneficial outcomes  Good practice Best defence  Good practice Professional standards  Good records Risk decisions show standards met  Employer action Poor practice even if no harm done

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)

Some key concepts Supported decision making:  choice  rights and responsibility  consent  capacity (mental) Action and inaction Outcomes Benefit Harm Likelihood

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?

Complex decision areas  Safeguarding  Carers  Mental capacity  Health and safety

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