Self-directed Support: Practitioners Guidance

Risk

When discharging duties under the Act, consideration of risk needs to remain central to the process. Risk should be considered at the support planning stage and across all four options. Effective risk assessment is a core requirement and is equally important to arranged service provisions as it is to a direct payment arrangement.

Effective risk assessment and management is fundamental to achieving the right balance between protection and empowerment in current and new duties. Risk is an everyday part of life; it is the skill and professional judgement of the practitioner that helps people balance risk, protection and freedom of choice.

This guidance acknowledges the tension between individual rights and the wider needs of society, including the need for public protection. The ongoing challenge for practitioners is how to identity and manage risk in genuine partnership with the supported person and others.

When we hear the word ‘risk’ we tend to think of something to be avoided. However, risk is present in every life.

The duty within the Self-Directed Support Act 2013 to offer ‘four options’ (described more fully in the next section) for the delivery of support, has highlighted this debate around risk enablement. In particular, the debate has focused on concern over the person’s ability to manage a direct payment, to use the budget as agreed to achieve intended outcomes or that the practitioner believes the person will be placed at increased risk of exploitation by others. There may be particular risks associated with a direct payment arrangement. Similarly, there may be risks associated with services arranged on the person’s behalf by the authority. Practitioners need to be able to openly discuss all potential risks with the person and their own local authority – throughout the various processes involved.

The balance between care and control is a defining feature of statutory duties and influences practice, workload, priorities and public perception of the role. The implementation of the Self-Directed Support Act does not change this.

Assessing risk is a highly-skilled and complex task – made even more complex when faced with complicated family dynamics, when people are in crisis or where a person’s capacity may be impaired. Collaboration and partnership allows for exploration of risk factors and clearly identifying where responsibility lies for supporting or diminishing that risk. This is a key element in the support planning process.

Risk and direct payments

There are a range of steps that the practitioner should take in order to ensure that risk is identified and managed. Good risk identification/management should act as an aid to supporting the direct payment option and ‘making it work’ for the person. For example, the direct payment can only be agreed after a full assessment and agreement on how the money should be used have been negotiated. The local authority has a responsibility to ensure that public funds are used in line with assessed need. Equally, the supported person should be able to expect the appropriate amount of support and advice from their authority to help them to actively manage risk on a day to day basis. Local monitoring arrangements need to be robust but proportionate. It should be clear to both the supported person and the practitioner how the main risks will be managed.

A variety of strategies and agreements on how a direct payment is paid can be explored if there are concerns about the management of large sums. The aim is to find ways to achieve this safely and not to avoid the direct payment option simply because it is perceived as being “too risky”.

“there is no current evidence that direct payments holders are experiencing greater abuse in contrast to recent abuse scandals in traditional settings. Empowering people can in fact reduce their vulnerability to abuse…”
(Fox 2012 pp15-5)

Risk: the main things to consider

Whilst adults have the right to make their own decisions about risk, this must be balanced with the authorities’ duty of care . The local authority should feel confident in challenging particular forms of support or particular decisions under the person’s desired Option. If, after assessment and detailed discussion with the supported person, they identify risks that cannot be safely managed in these circumstances, the local authority has the authority not to support the person’s preferred option:

• risk enablement needs to be based on detailed, shared discussions (the ’skilled conversation’) not only with the individual but also with other key family members, carers and professionals involved.
• assessment through co-production recognises the capacity, capability, strengths and personal assets people possess, which in turn informs risk assessment and, where appropriate, risk enablement.
• supporting positive risk taking requires the ability to effectively balance the benefits and positive outcomes against the potential negative outcomes of having measures in place that restrict or seek to avoid risk.
• shared agreement about what constitutes risk will not always be possible. They often have ‘personal’ or ‘organisational’ elements that have been built up over time. Practitioners should be aware of their own values and assumptions and the impact these have on others.
• a shared understanding of the views of all those affected is important, however, articulated through efficient and relevant case recording and available for scrutiny and review.
• different organisations and sectors operate within different cultures. This in turn affects thresholds of risk. These differences will require to be carefully navigated and will undoubtedly be assisted by effective communication and sharing of values – both on behalf of the individual and on a wider, ongoing basis.

Risk: considerations for practitioners

• positive risk taking or risk enablement is central to the philosophy of self-directed support but practitioners are still required to balance empowerment for the individual whilst fulfilling their statutory duties to protect from harm and to ensure rights are safeguarded. The exercise of professional judgement is a key factor.
• evidence suggests that an effective relationship built on trust with the supported person is required to both promote risk enablement as part of self-directed support as well as detect and prevent harm as part of safeguarding duties. Risk enablement and safeguarding in relation to self-directed support involves supporting people to contribute to the assessment of the impact of risk and explore ways to minimise and manage risks, assessing if they are acceptable.
• a more person-centred and collaborative approach to managing risk is crucial in helping to move aware from inappropriate risk averse policies and procedures.
• in all our practice, we need to be confident that the decisions and actions to support risk are appropriate. Practitioners need to ensure their decisions are sound and relate to the assessed needs of the person and they need to ensure that the reasons for decisions are evidenced appropriately.

Risk: considerations for organisations

• practitioners need to be supported by an organisational culture that enables and values best practice. This should recognise the need for sufficient time to be spent with the person so that a good working relationship can develop.
• self-directed support and protection policy need to be re-enforced and aligned through planning, training and briefings, to further explain where duties work together.
• local authorities and social care providers need to foster a culture of positive risk taking which supports practitioners to work in a risk enabling way. This requires a culture of supportive learning not least from serious incidents, from reflective supervision and an emphasis on evidence-based practice.