SCIE Report 36: Enabling risk, ensuring safety: Self-directed support and personal budgets
'The effective integration of safeguarding and personalisation contains the seeds for a transformation of care, not just the prevention of abuse and neglect'. (Warin, 2010).
Click on the links to see the key messages from three areas of research as well as lessons from innovative practice in this area.
Messages from research
Organisational transformation and culture changeOpen
- The promotion of choice and control implies the need for changes in the way risk is understood, managed and negotiated with people using services. This is particularly relevant in the use of self-directed support and personal budgets or direct payments. It also implies the need for organisational change to respond to new person-centred ways of working.
- Risk enablement should become an integral part of the transformation of adult social care into a system which puts the person in control. It cannot be a 'bolt-on' solution to existing systems which do not have the person at the centre.
- Personal budgets have sometimes been misunderstood, leading to the idea that people will be left unsupported in organising their own services and will have to take full responsibility for managing risk alone. Practitioners may not be confident about sharing responsibility for risk if their organisation does not have a positive risk enablement culture and policies.
- A supportive system is one which clearly incorporates self-directed support with safeguarding policy and practice, abuse detection and prevention. Risk enablement and safeguarding training for staff, people using services, carers and families is important.
- There is evidence that social work skills and relationship-based working with the person using the service is required, both to promote risk enablement as part of self-directed support and to detect and prevent abuse as part of safeguarding.
- Practitioners need to be supported by local authorities to incorporate safeguarding and risk enablement into relationship-based, person-centred working. Good quality, consistent and trusted relationships and good communication is particularly important for self-directed support and personal budget schemes.
- Research evidence is showing that corporate risk approaches can result in frontline practitioners becoming overly concerned with protecting organisations from fraud when administering direct payments. This reduces their capacity to identify safeguarding issues and enable positive risk taking with people who use services.
- Emerging research suggests that rebalancing social work resources towards frontline activity with people using services, their carers and families could enhance overall organisational risk management and safeguarding.
- 'Positive risk taking' or 'risk enablement' is central to the philosophy behind self-directed support and personal budgets, but social care practitioners can be concerned about how to both empower the individual and fulfill their duty of care. However, research shows that risk management dilemmas are an inherent part of social work practice and existed well before the recent reforms associated with personalisation were clear.
People who use services, their carers and families Open
- With the support of frontline staff, people using services should be enabled to define their own risks and empowered to recognise, identify and report abuse, neglect and safeguarding issues. Communication which supports risk enablement and safeguarding should be led by the language and understanding of the person using the service. This approach should be a core part of self-directed support, including assessment and regular review of outcomes.
- Informed choice is vital for risk enablement. Personal budget holders need access to information and advice about safeguarding, employment, legal aspects, reporting, peer support and accredited people and organisations.
- The views of people who use services are largely absent in the literature and there are very few research studies and evaluations of risk management systems and interventions. More research on how practitioners 'do' risk is also needed.
- Certain studies, particularly those about older people and people with learning disabilities, show that some people who use services may withhold information on 'risk taking' from the practitioner or their families in order to remain independent and in control of their own decisions.
- Being risk averse has resulted in some frontline practitioners making decisions about direct payments for people based on generalised views about the capacity or 'riskiness' of certain groups (particularly people with mental health problems). This has been done without adequate engagement with the individual or understanding of their circumstances.
Messages from emerging practice
Lessons from practiceOpen
- All risk enablement approaches should be person-centred and focus on the perspectives and understandings of the person using the service (and their carers and family, where appropriate). The person may be at risk if they become lost in a complex, over technical 'risk management' process which does not listen to their voice or account for their individual situation.
- Social workers and frontline social care practitioners need to be supported by organisational cultures and systems. These should allow them to spend time with the individual and focus on their safety concerns and achieving their chosen outcomes, rather than going through unnecessary auditing processes. Duty of care means supporting an individual to achieve their chosen outcomes whilst staying safe.
- Personalisation and adult safeguarding practice and policy need to be more closely aligned and inform each other. They should be underpinned by the principle of person-centred practice and the promotion of choice, control, independent living, autonomy and staying safe. A shared adult 'personalisation and safeguarding framework' can support this. This should be developed by all those involved, including safeguarding leads and stakeholders, people who use services and their organisations, social workers and personalisation leads.
- Local authorities and social care providers need to foster a culture of positive risk taking which will support frontline practitioners to work in a risk enabling way with the person using the service.
- Social work skills are particularly important for risk enablement and safeguarding in self-directed support. These include helping people assess, manage and take appropriate risks, and assisting with more person-centred ways of managing risk.
- Positive risk taking and safeguarding needs to be an integral part of the self-directed support process, including support planning and review and decisions on how best to manage a personal budget.
- Risk enablement panels are beginning to emerge as a way of helping with challenging or complex decisions which may arise as part of signing off a person's support plan. They show how local authorities can implement self-directed support and personal budgets in ways which empower individuals while ensuring risks are managed and responsibility is clear. The emphasis is on shared decision making which supports person-centred frontline practice and improves practitioner confidence. Duty of care decisions can be made in a shared and informed way, with transparent, shared responsibility.