Fair access to care services (FACS): prioritising eligibility for care and support

Initial contact - Managing risks and safeguarding

Giving people more choice and control inevitably raises questions about risk, both for individuals exercising choice over their care and support, and for public sector organisations who may have concerns about financial, legal or reputational risk ... Councils should take steps to ensure that an effective risk management strategy is embedded at every level of their organisation ... [and] build support for a cultural shift away from risk-aversion towards genuine user control and supported decision-making. This will require agreement from all relevant parties about what proportionate safeguarding measures should be put in place for each individual requiring support

(‘Personalisation and support planning ...’, DH, 2010, paras 133/134)

James’ story – risks and concerns arising from family changes

James, aged 34, has a long-term mental health condition and lives with his parents. Without one of them accompanying him he gets into trouble in the community, and this is now happening regularly. Both parents are in their mid-seventies. His father had a mild stroke 15 months ago which seriously undermined his confidence, is now mainly housebound and does not like to be left alone. Three times in the past 15 months James has been arrested because of his behaviour, and detained under the Mental Health Act.

The Department of Health’s 2010 policy guidance ‘Prioritising need in the context of “Putting people first”’recognised that some people coming forward, or referred, for needs and risk assessment could be at risk of, or subject to, abuse, neglect or exploitation. It is important to raise awareness of this issue, and how to respond to it, among staff involved in assessment.

The Department went on to publish in 2011, [29] and refresh in 2013, [30] a statement of policy on adult safeguarding. Its aim is to give people at a local level – councillors and communities as well as professionals and agencies – the national context for their own responsibilities and activities. It also acts as a bridge between the current No Secrets guidance [31] and the duties and powers contained in the Care Bill. the government believes that safeguarding is everybody’s business, with communities playing a part in preventing, identifying and reporting neglect and abuse. Measures need to be in place locally to protect those least able to protect themselves.

The statement sets out six cross-agency Safeguarding Adults principles:

It also provides examples from an individual’s point of view of how the outcomes of effective safeguarding could be experienced:

The section of the 2010 DH Guidance on ‘Personalisation and support planning’ linked together two aspects of risk in practice: safeguarding; and risk assessment and management. The 2013 policy statement argues for a clearer distinction:

In order to support those people most vulnerable to abuse and neglect, it is vital that agencies agree collectively those issues that require a safeguarding response, as opposed to issues, which relate to standards and quality of care more widely.


Staff involved in assessment will need to:

The White Paper ‘Caring for our future’ [3] sets out the government’s proposals to strengthen local safeguarding arrangements and processes. It underlines the need, when abuse does occur, or there is the possibility of abuse occurring, to identify it quickly and take appropriate action. Local authorities will have a responsibility for convening a statutory multi-agency safeguarding adults board, parallel to the safeguarding children board, and responsible among other things for developing inter-agency safeguarding strategies and conducting safeguarding adults reviews. The core members of the board are nominated by the local authority, clinical commissioning groups in its area and the chief police officer. The Care Bill contains the legislative provisions for reforming adult safeguarding.

Risk assessment and management

Risk assessment and management are core features of the local authority’s assessment responsibilities. Staff will need to:

Limitations on an individual’s right to have control over their lives

The Mental Capacity Act seeks to define and limit the circumstances in which an individual is judged to lack capacity. It sets out five principles which must be met, and the procedure which must be followed. The principles are:

The Care Bill sets out a number of matters to which the local authority must attend in carrying out its functions under the Bill. These include the importance of beginning with the assumption that the individual is best placed to judge his or her own wellbeing; attending to the individual’s views, wishes and feelings; and ensuring that any restriction on the individual’s rights or freedom of action is kept to the minimum necessary for achieving the purpose for which the function is being exercised.


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