May 2020: Changes in relation to Coronavirus
During the COVID-19 outbreak, additional measures to reduce risk need to be taken to further prevent the spread of the virus. This is especially important where face to face contact with adults, their families or other staff is required. Your line manager will give you information about how to keep yourself safe at this time.
Click on the link for information from the UK Government: How to protect yourself and others – Coronavirus (COVID-19): what you need to do and Responding to COVID-19: the ethical framework for adult social care (Department of Health and Social Care).
Risk taking is part of daily life and does bring benefits, including wellbeing (see Promoting Wellbeing). The evaluation and management of risk, therefore, is an essential part of the assessment process and is a necessary for identifying an adult’s level of need and eligibility for services. 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 in each case risk 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 evidence based information, evaluating that information – balancing possible positives of a course of action against potential drawbacks – and using professional judgment to ascertain the potential for the occurrence of harm.
Within organisations, lines of accountability with other agencies should be established for high risk areas, and a clear management reporting structure should be in place.
Staff undertaking risk assessments should be competent and able to evaluate and act upon a risk of danger, harm or abuse. Staff should therefore know how to reduce or remove risk. Ongoing risk management tasks include staff supervision.
In high risk situations staff should be debriefed on the outcomes of the assessment, enabling them to gain insight into their work, their personal stress, their decisions and the appropriate plan of action.
2. Types of Risk
Professionals undertaking the risk assessment should be aware of the different types of risk that may exist. These may include risks in four main areas:
- physical health;
- mental health;
- emotional wellbeing;
- social circumstances.
Risk should be considered in terms of the likely risk to:
- the person;
- others including care staff, carers, visitors and social workers;
- the wider community including neighbours or other residents of the area or care home.
Types of risk may include the following:
- the physical environment, for example an unsafe home conditions;
- mental health issues which result in, for example confusion, wandering, leaving the gas on;
- the adult’s behaviour, for example fire setting or aggression;
- major life changes, such as bereavement / loss, moving to residential care;
- health issues refusing medication;
- a poorly managed service;
- sharing accommodation or services with people who have violent behaviour;
- relationships including emotional, physical, financial or sexual abuse or neglect.
3. 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 its impact and whether or not they find the mitigation acceptable. Working with the adult to lead and manage the level of risk that they identify as acceptable 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 (see Information Sharing, as above);
- key elements of the person’s quality of life and wellbeing can be safeguarded.
4. Identifying Risk
Not every situation or activity will entail a risk that needs to be assessed or managed. The risk may be minimal and no greater for the adult, than it would be for any other person.
- Risks can be real or potential;
- Risks can be positive or negative;
- Risks should take into account all aspects of an individual’s wellbeing and personal circumstances.
Sources of risk might fall into one of the four categories below:
- private and family life: the source of risk might be someone like an intimate partner or a family member;
- community based risks: this includes issues like ‘mate crime’, anti-social behaviour, and gang-related issues;
- risks associated with service provision: this might be concerns about poor care which could be neglect or organisational abuse, or where a person in a position of trust because of the job they do financially or sexually exploits someone;
- self-neglect: where the source of risk is the person themselves.
5. Risk Assessment
Risk assessment involves collecting and sharing information through observation, communication and investigation. It is an ongoing process that involves persistence and skill to assemble and manage relevant information in ways that are meaningful to all concerned. Risk assessment that includes the assessment of risks of abuse, neglect and exploitation of people should be integral in all assessment and planning processes, including assessments for self-directed support and the setting up of personal budget arrangements.
Adequate risk assessment can rarely be done by one person alone and a coordinated approach is required. Good relationships between professionals and the adult and their carers makes the assessment easier and more accurate, and may indeed reduce risk.
A risk assessment needs to identify and balance different perceptions of risk, including the adult, their carers and professionals; the adult’s right to make informed choices about taking risks should be safeguarded and encouraged. Decisions about risk, however, do need to balance any risk to the public and the needs and wishes of the adult.
If the adult lacks 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).
The professional undertaking the assessment must be supported throughout the process by their manager, to ensure all aspects of the situation have been understood, evaluated and the views of the adult, their Attorney and / or Advocate where appointed and other agencies and service providers have been considered. The professional undertaking the assessment should ensure a referral for an IMCA is made, where appropriate, to protect an unsupported person who lacks capacity to make a decision.
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.
It is important that organisations ensure that appropriate tools are available to support staff to evidence professional judgement during their decision making. Issues around information sharing may be relevant in this context (see South Tyneside Information Sharing Protocol).
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.
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 intervention 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. Decision Making and Risk Management Plan
The professional should conclude how serious the risk is, how specific it is and its immediacy.
Not every adult will require a risk management plan, but where there are concerns, a plan should be developed. The risk management plan should:
- identify each risk and detail the measures taken or services applied to remove or reduce it;
- 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. Reviewing Risk
Individual need will determine how frequently risk assessments are reviewed and wherever possible there should be multi-agency input. These should always be in consultation with the adult at risk.
9. 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. The decision to involve others or not is in itself a decision which may give rise to risk, and the individual may need support to make this decision.
The 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. This highlights the importance of training and/or regular practice in making independent decisions by adults. Accessible knowledge through information and advice, assertiveness through the right kind of advocacy and support may be appropriate.
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 Multi-Agency Risk Panel is one model used to support safeguarding adults processes.