10.4 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) ( P v Cheshire West & Chester Council & another; (2) P & Q v Surrey County Council (Supreme Court).

Risk management is part of everyday practice when working with adults who have care and support needs; 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.

Not all risks can be eradicated, but they can be managed to prevent or reduce the impact of harm.

Some risks are general and some specific, but risks should be defined in relation to a specific situation, that is, what is the presenting risk and /or who or what is the risk. Undertaking a comprehensive risk assessment involves collating and evaluating evidence – balancing possible positives of a course of action against potential drawbacks – and using professional judgment to ascertain the potential for the occurrence of harm.

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.

4. 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 the likely risk to:

• the adult;
• others including care staff, 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 shared with the Safeguarding Adults Team.

In situations where adults have complex lives, it is important that the risk does not become normalised. For example, the Second national analysis of Safeguarding Adult Reviews: April 2019 – March 2023 (Local Government Association) notes:

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’.

4.1 Involving the adult

Making Safeguarding Personal (MSP) stresses the importance of keeping the adult at the centre of the process. Under MSP the adult is best placed to identify risks, provide details of their likely impact and whether or not they find the mitigation acceptable. Working with the adult to lead and manage the level of identified risk creates a culture where:

• adults feel more in control;
• adults are empowered and have ownership of the risk;
• there is improved effectiveness and resilience in dealing with a situation;
• there are better relationships with professionals;
• good information sharing to manage risk, involving all the key stakeholders;
• key elements of the adult’s quality of life and wellbeing can be safeguarded.

5. 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.

5.1 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.

If the adult lacks mental capacity to make decisions, the risk assessment must take account of the views of family members or friends important to the adult and who have an interest in their welfare or, where appointed, their Attorney or Independent Mental Capacity Advocate (see Independent Advocacy and Independent Mental Capacity Advocates and Independent Mental Health Advocates).

A multi-disciplinary approach should form the basis of the risk assessment process. Information should be collated from a variety of sources and agencies. Contributions from agencies such as the police, probation and the adult’s GP should always be considered at each stage in the process.

Assessment of risk is dynamic and ongoing, and a flexible approach to changing circumstances is needed. The primary aim of a safeguarding adults risk assessment is to assess current risks that people face and potential risks that they and other adults may face. Specific to safeguarding, risk assessments should encompass:

• the history including patterns of behaviour/previous incidents, non-compliance with services;
• the severity of the risk;
• the views and wishes of the adult and their motivation to manage the situation;
• the person’s ability to protect themselves;
• factors that contribute to the risk, for example, personal, environmental
• the risk of future harm from the same source;
• identification of the person causing the harm and establishing if the person causing the harm is also someone who needs care and support;
• deciding if domestic abuse is indicated and the need for a referral to a MARAC (see MARAC Referral Form);
• deciding if a multi-agency complex panel meeting is needed;
• identify people causing harm who should be referred to MAPPA;
• it may increase risk where information is not shared.

5.2 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.

5.2 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.

6. Risk Management

The focus must be on the management of risks not just a description of risks. Employers need to take responsibility for the management of risk within their own organisation and share information responsibly where others may be at risk from the same source. The local authority may be ultimately accountable for the quality of Section 42 Care Act enquiries, but all organisations are responsible for supporting holistic risk management, with the adult and in partnership with other agencies.

It is the collective responsibility of all organisations to share relevant information, make decisions and plan interventions with the adult. A plan to manage the identified risk and put in place safeguarding measures includes:

• what immediate action must be taken to safeguard the adult and / others;
• who else needs to contribute and support decisions and actions;
• what the adult sees as proportionate and acceptable;
• what options there are to address risks;
• when action needs to be taken and by whom;
• what the strengths, resilience and resources of the adult are;
• what needs to be put in place to meet the on-going support needs of the adult; What the contingency arrangements are;
• how will the plan be monitored?

Positive risk management needs to be underpinned by widely shared and updated contingency planning for any anticipated adverse eventualities. This includes warning signs that indicate risks are increasing and the point at which they become unacceptable and therefore trigger a review.

Effective risk management requires exploration with the adult using a person-centred approach, asking the right questions to build up a full picture. Not all risks will be immediately apparent; therefore risk assessments need to be regularly updated as part of the safeguarding process and possibly beyond.

7. Risk Management Plan

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

8. Risk Disputes

Throughout these policies and procedures, risk assessment and risk management is carried out in partnership with the adult, wider support network and others.

Professional views of risk may differ from the views of the adult. Perceived risks have implications for the safety and the independence of the individual, but they also have implications for the accountability of professionals.

Professionals need to embrace and support positive risk taking by finding out why the person wishes to make a particular choice, what this will bring to their life, and how their life may be adversely affected if they are not supported in their choice. The promotion of choice and control, of more creative and positive risk taking, implies greater responsibility on the part of the adult and greater emphasis on keeping them at the centre of decision making.

It may not be possible to reach agreement, but professionals need to evidence that all attempts to reach agreement were taken. Where there are concerns about people making unwise decisions, or there is high risk that requires wider collaboration; a referral to the Complex Risk Management Process should be considered (see Complex Adult Risk Management (CARM) Policy).