More information about positive risk taking can be found on the Practice Based Evidence website.
- 1. Introduction
- 2. What is Positive Risk Taking?
- 3. Why do We Need a Policy?
- 4. Principles of Working With Risk
- 5. Positive Risk Taking Framework
- 6. Safeguarding Vulnerable Adults
- Appendix 1: Defensible Decisions
- Appendix 2: Professional Competency
- Appendix 3: Legislation and Legal Principles
- Appendix 4: Risk Management Template
- Appendix 5: Types and Levels of Harm (includes Risk Assessment and Decision Making Matrix)
‘Risk is no longer an excuse to limit people’s freedom.’
Risk is everyone’s business. It is an essential part of everyone’s life and for people using services, positive risk management is an essential part of the support they receive from every person who works with them. The saying ‘nothing ventured, nothing gained’ makes the point that unless someone takes a risk and tries new activities, they will never know of the positive benefits that might result. In our society, people are encouraged to travel widely, take part in regular leisure and sporting activities, go to college, develop careers and have families. These are all activities that don’t just happen, but mean people have to take risks to achieve their aspirations.
For many people risk is an accepted part of life. But disabled adults and older people are often discouraged from taking risks. Either because of their perceived limitations or fear that they or others might be harmed, resulting in criticism or compensation claims against health, social care and other community based services.
Changes in disability, social care and health policy now mean that disabled adults and older people are being actively encouraged to increase their independence by being fully involved in mainstream society through education, work and leisure. As with anyone else, this involves a degree of risk taking. This policy sets out the approach that Hull City Council expects all staff in Adult Services to adopt towards the issue of risk when they work with disabled adults and older people.
When implementing this policy in day to day practice, Hull City Council recognises that any positive risk taking approach must be balanced with its common law duty of care and the multi agency guidelines on safeguarding vulnerable adults.
Everyone has a right to personalised care and as much choice and control as possible, including the most vulnerable and those who lack capacity. Effective personalisation requires effective but positive risk management to help people exercise choice as safely as possible, but also help people to realise when a choice is simply too risky to be reasonable. Finding the balance between risk and protection is vital if people are to be empowered to live fulfilling and rewarding lives.
2. What is Positive Risk Taking?
Risk is the chance that something will happen with either harmful or beneficial (or both) outcomes for a particular person or for others. Positive risk taking is a process which identifies the potential benefit or harm which could result from a particular choice being exercised, reduces the risk of harm and then weighs up the expected benefits against the risk of harm which remains. It is not reckless, it is not negligent dismissal of potential harm, it is a carefully planned strategy for supporting choice.
Positive risk taking requires several things:
- Recognising a person’s right to make their own decisions and to take risks in pursuit of their choices;
- Risk management being part of everyday practice, not a specialist job for ‘someone else’;
- Working in equal partnership with adults who use services, family carers and advocates, building trust and recognising different perspectives and opinions;
- Understanding and building on a person’s strengths;
- Helping adults who use services to learn from their experiences and understand the consequences of different actions;
- Being honest about potential risks and benefits;
- Making informed choices based on all the options available and accurate information;
- Developing an understanding of the responsibilities of each party;
- Empowering people to access opportunities and take worthwhile chances;
- Sometimes supporting short term risks for long term gain;
- Ensuring support is available to disabled adults and older people, particularly if things begin to go wrong for someone, and working out why;
- Developing person centred and transition planning for both young people and adults which supports their involvement and that of their families in decision-making alongside practitioners;
- Ensuring all staff use the guidance, procedures and risk assessment / management tools adopted by their service, and receive appropriate support and supervision from their immediate line manager.
3. Why do We Need a Policy?
The effective management of risk and review of incidents is supported through policy, procedures and practical tools that can be used by all practitioners. Hull City Council has a Corporate Risk Management Policy in place to outline the structures in place to manage the broad range of financial and organisational risks encountered in delivering complex service arrangements. Its principal requirements are:
- Processes must be in place to identify and assess risk and to evaluate measures that reduce the chance of something going wrong;
- Training must be provided for staff and managers;
- Risk assessments should be carried out and regularly updated by competent staff for all identified risks;
- Assessment should involve a level of management that is appropriate to the nature and scale of the risk. This means that serious risks need to be agreed through the line management chain, but it also means that everyday risks should be managed by the people working most closely with the adult – the keyworker and other front line staff;
- Decisions should be clearly recorded and the resulting actions implemented through prescribed local procedures;
- Clear reporting procedures must be established for each service where the identification of risk and risk management actions are recorded;
- Services must ensure that appropriate, cost effective actions are taken to manage and control risks.
This policy contributes to the overall framework of the Council’s response to the issue of risk and particularly deals with situations encountered in a social care or community context between practitioners, disabled adults and older people and family carers.
4. Principles of Working With Risk
A number of important issues need to be considered by Adult Services staff when carrying out risk assessments and risk management:
- Risk assessment and management is part of everyone’s job;
- Everyone, including vulnerable people, have the right to take risks but this does not give them the right to put others at risk;
- The identification, assessment and management of risk should promote the independence and social inclusion of disabled adults and older people;
- In any given course of action, some risks can be acceptable where they are outweighed by the potential benefits of that course of action;
- Risks change as circumstances change, and risk management must keep pace;
- Risk can be minimised, but not eliminated;
- Information will sometimes be incomplete and possibly inaccurate. The duty of care dictates that reasonable checks should be made to verify information, but some decisions may need to be made prior to all information being available;
- Identification of risk carries a duty to do something about it, i.e. risk management;
- Involvement of adults who use services, their advocates and where appropriate, their family is vital to the quality of risk assessments and decision-making;
- ‘Defensible’ decisions are those based on clear reasoning and made through proper process;
- Risk management must involve everybody working together to achieve positive outcomes;
- Confidentiality is a right, but not an absolute right and may be breached in exceptional circumstances when people are deemed to be at serious risk of harm or it is in the public interest;
- The standards of practice expected of practitioners must be made clear by their team manager / supervisor to give them the confidence to support decisions to take risk;
- Sensitivity should be shown to the experience of people affected by any risks that have been taken, particularly if things go wrong.
5. Positive Risk Taking Framework
‘The goal is to manage risks in ways which improve the quality of life of the person, to promote their independence or to stop these deteriorating if possible. Not all risks can be managed or mitigated but some can be predicted.’ Nothing ventured, nothing gained; risk guidance for people with dementia – Department of Health, 2010.
There are four basic stages of positive risk management: i) identification, ii) assessment, iii) management and iv) review. It is vital that staff supporting people to take risks follow a structured approach in which the rationale for taking risks is clearly recorded. Decision making on the management of risk should be at a level proportionate to the level of risk and staff should seek clarification from their manager or supervisor if they are confused or unsure about what is expected of them. A person centred approach should be used to identify, assess and manage risk.
5.1 Information gathering
Information gathering and sharing is important. It is not just an essential part of risk assessment and management, but also key to identifying a risk in the first place. However, the use and sharing of information must respect the principles outlined in the Data Protections Act 1998. When gathering information, it is important to tell the person or family affected the purpose of the data collection, why information gathering is necessary and whom it will be shared with. Written consent should be obtained.
Numerous methods can be used to gather information:
- Access to past records;
- Feedback during assessment or reviews;
- Feedback from significant others;
- Observing discrepancies between verbal and non-verbal cues;
- Rating scales or other actuarial methods;
- Clinical judgement based on evidence based practice;
- Predictive indicators derived from research.
Because decisions may need to be defended, staff must ensure that information shared or gathered is properly recorded.
5.2 Risk identification
Identification of risk should involve a balanced approach, which should be based on a disabled adult or older person’s aspirations and which aims to support them to get the best out of life. It should be proportionate and realistic while being comprehensive enough to identify all risks which might reasonably be expected to occur.
5.3 Risk assessment
- Positive risk taking may sometimes need to distinguish between the short term, and long term position. Short term heightened risk may need to be tolerated and managed for longer term positive gains.
- There should be a focus on a person’s strengths to give a positive base from which to develop plans that will support positive risk taking. Consider the strengths and abilities of the adult, their wider social and family networks, and the diverse support and advocacy services available to them.
- Relevant historical information should be included, but should be concerned with learning lessons from the past, and not used as an excuse not to try something again with better safeguards.
- An assessment needs to be clear if it is to protect the individual or others. It should consider the likelihood of something happening and the potential level of harm if it did happen. It should include a review date and the signatures of everyone involved in the assessment process.
5.4 Risk management
Risk management is the exercise of the duty of care where risks are identified. It includes a wide range of activities which are closely linked to the wider process of support planning. Some activities will be supportive, some will be preventative and some will be responsive. All should have the aim of reducing either the likelihood or the degree of harm or of promoting the potential benefits of taking appropriate risks. The activities should include a contingency plan which may include more restrictive measures and crisis responses where the identified risks have an increased potential for harmful outcomes. Any decisions need to be negotiated, agreed and understood by all parties.
When carrying out risk management, the following must be considered:
- Decision making in relation to risk must be clearly evidenced on relevant documentation;
- Managers / supervisors have a key role in the successful application of the Positive Risk Taking Policy and need to recognise that there is joint accountability and ownership of risk decisions. They have a responsibility to ensure that their approach to supervision is conducive to supporting practitioners in risk decisions;
- Risk management is enhanced by limiting the duration of the decision i.e. working to shorter timescales and with smaller goals broken down. This is supported by having mechanisms in place to check on progress; and an ability to quickly change previous decisions when needed, including intervening in a more restrictive way where necessary;
- Risk management should become part of a practitioner’s ongoing work with an adult and events should be reflected in people’s case notes where appropriate;
- The rights of adult users of services to make decisions are fully acknowledged. However, in certain circumstances these can be overruled, particularly when the individual is regarded as lacking in mental capacity in relation to a specific decision. Where someone lacks mental capacity, anything done for or on their behalf must be in their best interests
- Where this happens, practitioners should refer to guidance on best practice in dealing with decision-making and incapacity, and on the principle of best interests of the person who lacks capacity;
- Positive risk taking needs to be underpinned by contingency planning for the ‘fears’ and possibilities of failure. This will help to prevent some harmful outcomes, and minimise others. Risk taking should be pursued in a context of promoting opportunities and safety not negligence. Therefore, adult users of services, their families and practitioners should be encouraged to learn to think about ‘what ifs’ and contingencies as part of their day to day thinking;
- Where people are behaving recklessly, risk management may include the setting of explicit boundaries to contain situations that are developing into potentially dangerous circumstances for all involved. If a person or their carer makes a decision to continue behaviour that is reckless, a record should be made of their decision and when it was taken. If Council staff are affected by this decision, any support service being provided will be reviewed to ensure that how it is delivered guarantees the safety of any worker involved;
- Positive risk taking should be ingrained into the working culture and be reflected in the content of team training. It is not a one off experiment, but the natural first line of thinking.
5.5 Risk management review
Reviews should take place regularly to assess whether the risk management process is working, to see what can be learned from the process so far and whether any changes need to be made to improve outcomes. The level and frequency of these should be proportionate to the level of risk. The review should always include the person using services and, with their consent, other relevant people.
The review should include a reassessment of identified risks and an opportunity to identify any further risks. These should be addressed in the same way as any other risks identified.
5.6 Review of incidents
In the context of this policy, an incident is something which results in physical, emotional or psychological harm to any person as a result of positive risk taking.
When positive risk taking has a negative consequence, it is necessary to identify what has gone wrong and how the assessment and management of the risk contributed to this. The Council recognises that the point at which a risk becomes an incident is a traumatic time for practitioners, as well as everyone else involved. It is recognised that to fail to support practitioners and officers after an incident would have a negative impact on morale within a service.
In situations where incidents of serious concern occur that involve Council staff or users of its services, the following steps will be taken:
- The Head of Service and other appropriate managers will be notified as soon as is reasonably practical after an incident has occurred;
- The Head of Service will identify whether an examination of the incident should be managed through Safeguarding or Multi-Agency Public Protection Arrangements procedures (and their timescales), by another agency or through an internal investigation;
- If an internal investigation is to be carried out, the Head of Service will set up a Review Team within three working days of the incident;
- The Review Team will report within 20 working days;
- The Head of Service will ensure the Review Team’s report and recommendations are circulated within three working days to appropriate agencies and practitioners.
Following an incident, whatever its degree, the Council will:
- Start an investigation from a ‘no blame’ standpoint;
- Offer any support or supervision that staff involved feel are appropriate following an incident and through any investigation process;
- Keep all parties affected fully involved and informed throughout the investigation process that will try to determine the sequence of events that led to the incident;
- Deal appropriately with any case of negligence or bad practice that is identified;
- Provide support and information to those affected (victims, adult users of services and their families or practitioners) by the loss and trauma associated with a serious incident;
- Disseminate the findings from investigations and reviews following an incident. Within the Council and to other partner agencies and those affected by the incident and their advocates. This will promote the positive lessons learned from the information gathered and not just the recommendations relating to failings in processes and procedures.
6. Safeguarding Vulnerable Adults
Risk assessments undertaken to safeguard people should follow the same process and principles of positive risk management and should likewise be intended to promote opportunities and safety, not negligence. However, there is an important consideration which arises from the level of control and decision making the person has at the outset. In most cases where it is suspected that abuse or negligence may have occurred, the person is not in control of what is happening to them. Something is being done to them by a third party. Positive risk taking should balance the need to protect the vulnerable adult with the need to empower them. Different levels of risk require different responses, from support through to criminal prosecution, see Appendix 5, Types and Levels of Harm which contains the Risk Matrix and Decision Making Tool.
Action should be taken in response to the level of risk which remains after control measures have been put in place, not the original level of risk. For example, if a person living in a residential home has been subjected to attacks from another resident, it is clearly a matter of grave concern. But if the residential home has put in place control measures which effectively keep the person and their attacker apart without depriving either of their liberty, then the level of risk is greatly reduced. When the person was still subject to attack, their risk score would dictate that a safeguarding referral would need to be made. After the control measures have been implemented, the managed risk score is lower and would call for internal controls only. For further guidance, see Part 4 of the Safeguarding Adults Partnership Board Procedures.
Appendix 1: Defensible Decisions
The decision making involved in the assessment of risk and its management is generally effective in avoiding harmful situations from arising. But it is not infallible. If harm occurs to someone because of their actions, any practitioners, officers or agencies involved in the assessment or management of risk might need to defend the decisions they made and their reasoning.
A defensible decision is one where:
- All reasonable steps have been taken to avoid harm;
- Reliable assessment methods have been used;
- Information has been collected and thoroughly evaluated;
- Decisions are recorded and subsequently carried out;
- Policies and procedures have been followed;
- Practitioners and their managers adopt an investigative approach and are proactive.
Appendix 2: Professional Competency
For a practitioner, empowering a person to decide the level of risk they are prepared to take with their health and safety involves working with the tension between promoting safety and positive risk taking.
In order to practice in a way which promotes safety and positive risk taking, the practitioner concerned should be able to:
- Develop harmonious working relationships with users of services and carers, particularly with those who may not wish to engage with services;
- Promote an understanding of the factors associated with risk of harm to self or others through violence, self-neglect, self-harm, suicide or hate-crime;
- Demonstrate the ability to educate disabled adults and older people, and family carers about the role, function and limitations of support services in relation to promoting safety and managing risk of harm;
- Contribute to accurate and effective risk assessments, identifying specific risk factors of relevance to the individual, their family and carers and the wider community;
- Contribute to the development of risk management strategies and plans that clearly identify the agreed actions to be taken and the goals to be achieved;
- Contribute to the safe and effective management and reduction of any identified risks;
- Develop a knowledge and understanding of national and local policies and procedures for minimising risk and managing harm to self and others;
- Understand the importance of multi-agency and multidisciplinary working in promoting safety and positive risk taking;
- Have an awareness of the available spectrum of individual and service responses to help manage crises and minimise risks as they are happening;
- Contribute, if appropriate, to the use of medical and psychosocial interventions with the expressed goal of managing a person’s risk behaviours in the long term, e.g. through the use of medication, anger management, supportive counselling, etc.