4.1.7 Assessing and Managing Risk

1. Introduction

Risk is part of everyday life and “people with disabilities, both mental and physical, have the same human rights as the rest of the human race. It may be that those rights have sometimes to be limited or restricted because of their disabilities, but the starting point should be the same as that for everyone else” (Lady Hale, 2014) (1) P v Cheshire West & Chester Council & another; (2) P & Q v Surrey County Council (39 Essex Chambers)

Risk management is part of everyday practice in adult social care; it enables practitioners to help to keep people safe and support them to live full and rewarding lives. Within any risk assessment framework, the aim is to support adults so that they can achieve the outcomes that matter to them most and live the lives they want to lead. Strengths based risk assessment helps to promote individual wellbeing and support adults to make their own decisions and choices,

SCIE recommend a risk assessment process based on four steps:

• understanding the person’s circumstances;
• identifying their risks;
• assessing the impact and likelihood of risks on them;
• managing risk through risk enablement and planning. (Risk Assessment Process and Key Points to Risk Identification in Virtual Interactions, SCIE)

By adopting a positive risk-taking approach, practitioners can support adults to take risks safely.

2. Managing Risks

Responses to risks must be proportionate and use the least restrictive option/s available.

Points to consider include:

• What is the issue which a restriction on the person’s rights seeks to address?
• Will the restriction reduce the risk of likely harm?
• Does a less restrictive alternative exist, and has it been tried?
• Does that restriction involve a blanket policy, or does it allow responses to be tailored to individual adults and their own risks and circumstances?
• Have the views of the adult been taken into account?

All adults have human rights, and these can only be restricted where there is a lawful basis for doing so. Adults with care and support needs should be supported to be as independent as possible, so they can take full part in leisure and sporting activities, go to college or work, and spend time with their friends and families. Finding the balance between risk and protection is vital if people are to live fulfilling and rewarding lives.

3. Positive Risk Taking

Positive risk taking is about identifying the potential benefit or harm which could result from an adult’s choice or decision, and looking for ways to reduce the risk of any harm identified. It then involves weighing up the expected benefits against the risk of harm which remains.

Positive risk taking requires:

• recognising the adult’s right to make their own decisions and to take risks;
• involving adults, families, carers and advocates;
• understanding and building on the adult’s strengths;
• helping adults to learn from their experiences and understand the consequences of different actions;
• being honest about potential risks and benefits;
• taking a proportionate response, which is tailored to the adult’s individual wishes and circumstances;
• making informed choices based on all the information available.

See also “What good is it making someone safer if it merely makes them miserable?” A contested hearing and delayed trial of living at home – Promoting Open Justice in the Court of Protection (Open Justice Court of Protection)

4. Assessing Risks

Risk assessments do not intend to eliminate risk, however there needs to be a balance between protecting the adult and supporting risk taking. The likelihood of the risk and its potential consequences for the individual adult should be considered. The aim of the process is to enable the adult to live the life they want, as independently as they can.

4.1 Strengths based approach

The adult should be fully involved in the risk assessment process. Practitioners should support them to identify any risks and possible solutions; this will include discussion about why the activity associated with the risk is important to them and the impact it would have on them if they could not do it.

The risk assessment should start with the adult’s strengths and include information from a variety of sources (including their family, carers and any advocate appointed) and other agencies who also know the adult where appropriate. This helps to ensure a balanced approach, which is person centred. Any historic information that practitioners receive is important but should always be considered alongside the adult’s current wishes and likely risks.

4.2 Identifying risks

Possible risk can include:

• concerns about the adult’s physical environment, for example unsafe home conditions;
• issues related to mental health or mental capacity such as confusion, wandering away from where they should be, leaving the gas on;
• health issues, including not managing medication, poor nutrition and risk of falls;
• poor care / possible breakdown in caring arrangements;
• abusive relationships and exploitation including emotional, physical, financial or sexual abuse or neglect.

Risk should be considered in terms of their likely impact on:

• the adult;
• others including care staff, family and friend carers, visitors and social workers;
• the wider community including neighbours or other residents of the area or care home.

Any concerns that an adult may be experiencing, or at risk of, abuse or neglect should be dealt with under the Central Bedfordshire Safeguarding Adults Procedures.

In situations where adults have complex lives, it is important that the risk does not become normalised. For example: ‘X was in frequent contact with a number of agencies, making 41 999 calls in the eleven months prior to his death. This, combined with his alcohol use, appeared to result in the normalisation of risk, missed opportunities to identify self-neglect and the risk of harm from others and the inability to see him as a whole person or to recognise how vulnerable and isolated he was’ (taken from Second National Analysis of Safeguarding Adult Reviews: April 2019 – March 2023, Local Government Association).

4.3 Review

Risk assessments should be regularly reviewed. Practitioners need to respond to change, as an adult – or their carer’s – circumstances can change. Interventions can increase risk as well as decrease it highlighting the importance of regular reviews

4.4 Recording

Recording of the risk assessment should be structured with the identification of each risk in order of priority, and the likelihood of the risk and its impact.

5. Risk Management Plan

Not every adult will require a risk management plan, but they are useful where there are serious concerns. The risk management plan should:

• identify each risk and detail the measures agreed in response;
• identify who is responsible for each aspect of the required monitoring;
• identify and plan the frequency of reviews;
• identify who is responsible for coordinating reviews;
• identify the role and contribution of each agency in the management of the identified risk/s;
• contain a contingency plan in case of emergency or in response to risks identified.

6. Further Reading

6.1 Relevant chapter

Personalisation

6.2 Relevant information

Risk Assessment Process and Key Points to Risk Identification in Virtual Interactions (SCIE)

Second National Analysis of Safeguarding Adult Reviews: April 2019 – March 2023 (Local Government Association)