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 How serious?Vulnerability Mental capacity Consent Risk to the person and others IntentImpact Legal framework FrequencyDuration Wishes of individual Wider context 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) Person-centred services Difference and diversity celebrated People treated with respect and dignity Negotiation and fairness about decisions Staff are trustworthy and supportive Staff are honest and reliable There is involvement in decision-making Access to information and advice is given People’s strengths are recognised Human rights are upheld

Person-centred approach to risk Smull 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 Person-centred services Alert Referral and decision Strategy discussions Assessment and investigation OutcomesMonitor and review

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 blications/PublicationsPolicyAndGuidance/DH_ http Person-centred assessment  uarding/?parent=8625&child= uarding/?parent=8625&child=3681