The risk-averse social care sector

Last week I was contacted by a manager for support who’d undertaken an activity in her service that was frowned upon by her local authority. Even though she’d completed a risk assessment that deemed the activity as low risk, it landed her in hot water for future placements.

A bit of background

So, what’s all the fuss about?

In 2014, the House of Lords Select Committee completed an inquiry into the implementation of the Mental Capacity Act 2005. This stated that “risk-averse” and “paternalistic” health and social care practice has prevented the Act from achieving its objective of empowering vulnerable adults to make decisions for themselves.

This has led to a lot of scrutiny around activities and finding the perfect balance between empowering people and taking risks, especially amongst local authorities who all have different views on this and what is ‘unsafe’.

Mitigating risks

Plan

Planning is key. We need to ensure that we support people to live as much of an independent life as possible, weighing up the risk that the person chooses against the likelihood of any significant harm occurring.

I personally believe that if you’re managing a service that puts safety first, then you’re preventing people from achieving a good outcome.

No decision should be over-ruled by one person, whether that be a social worker, carer or family member – a collaborative approach with the person should always be taken.

I’d recommend taking the following steps to support someone:

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Remember, as a care provider, you also have a duty placed on you as an employer to ensure that you’re protecting the safety and welfare of your employees, and this should also be considered.

"Supporting people to take risks is the right thing to do, both morally and legally."

Document

I say planning is key, but documentation is crucial. This not only protects the person you’re supporting but also protects your service in the event of any complaints or litigation.

I’d recommend keeping the following information on a person’s file:

• Any discussions about the activity/choice that carries the risk, including what advice has been offered, any signposting, any literature etc.
• Any alternatives that have been offered
• Copies of risk assessments
• Copies of any mental capacity assessments
• Copies of any Deprivation of Liberty Safeguards assessments and outcomes
• Updates to care and support plans
• Communication of the activity/choice with staff members supporting the person (if applicable).

Manage feedback

There are many things that I’ve supported people to do that other people haven’t agreed with and you may find the same.

You may have care workers tell you “I told you so!” (especially if something goes wrong), family members/next of kin being angry that you’re not listening to them and social workers/local authorities stating that you’ve been negligent and not acted appropriately.

But, if you’ve followed the advice above, involved everyone that supports the person and most importantly, the person you’re supporting wants to be involved, then this should avoid most negative feedback.

Of course, there’ll be day-to-day decisions about activities that you’ll need to make with the person you’re supporting where you don’t involve others. And like most things, accidents could happen. But it’s important to remember that if you’re supporting someone to live the best life possible, where they have as much control over their decisions, then managing the fallout after is just part and parcel of the process.

Benefits of not being a risk-averse care provider

I personally always promote positive risk-taking. If I support someone with something that carries a risk, I always seek permission from them as well as taking photos, getting statements, and promoting this to family members, social workers etc., showing how benefits outweigh the risks.

There are many other benefits to supporting people to live life and manage risks well, including:

• Confidence building
• Leading a more fulfilled life
• Allowing people to learn from mistakes and know what consequences there can be if something does go wrong
• Reducing boredom, frustration, behaviours that can challenge
• Preventing/reducing feelings of low self-worth/self-esteem
• Increasing satisfaction
• Developing new skills
• Broadening people’s knowledge and experiences
• Forming new friendships and life pathways.

And of course, above all, the biggest benefit to someone is that they have control over their decisions and life.

Supporting people to take risks is the right thing to do, both morally and legally.