Report 47: User involvement in adult safeguarding
Safeguarding and personalisation
Risks need to be weighed up alongside benefits. Risk should not be an excuse to restrict people's lives
The question of how personalisation policies can work alongside safeguarding is a key issue for policy makers and practitioners, bringing together issues of risk and empowerment into close scrutiny. This section examines the links between the two policy developments, and reports that research evidence supports the case for positive risk-taking alongside self-directed support.
The Department of Health has produced guidance on how personalisation can work together with safeguarding adults. The guidance states:
Personalisation is about enabling people to lead the lives that they choose and achieve the outcomes they want in ways that best suit them. It is important in this process to consider risks, and keeping people safe from harm. However, risks need to be weighed up alongside benefits. Risk should not be an excuse to restrict people's lives.(31)
The Department of Health are of the view that personalisation and risk management can work together, 'empowering people to speak out, enabling them to make informed choices and encouraging communities to look out for one another', with the aim of building stronger communities where people can lead the lives they choose, free from harm.(31)
Examples of good practiceOpen
The Department of Health's guidance sets out practical examples of how local councils have worked across agencies and disciplines with people who want to direct their own support using direct payments. They show how risk assessment itself can be largely self-directed, using tools such as the Lincolnshire risk matrix. Lincolnshire Social Services found that:
By shifting the focus of quality assurance from paperwork to building supporting relationships, practitioners and independent living support staff will be in a much better position to help service users manage the most important risks, which are the risk of somebody coming to harm, and the risk of care outcomes not being met.(31)
The guidance promotes other positive examples, including Stockport's multidisciplinary risk enablement panel for situations where the care coordinators and individuals have been unable to reach agreement on managing risk. The person receiving support can attend the panel which aims to have a common approach to risk and shared responsibility. Warwickshire's 'Keeping safe' plan provides a framework for discussion between the care worker and the person wanting to manage their own care, to support the successful management of the direct payment while minimising risks.
Another model to support adults at risk, especially older people, to lead on their own protection planning and find workable solutions, is a 'family group conference'. Developed in New Zealand, this has now been piloted in England and Wales.(32) Family group conferences are facilitated by an independent coordinator, and an advocate or support person is offered to help the person voice their opinions at the meeting. Tapper says that this approach appears to result in better safeguarding and less abuse. Feedback from families is very positive, though it is too soon to report on the outcomes for adults at risk.
Lessons from researchOpen
Carr reviewed the main research findings on risk enablement in the self-directed support and personal budget process, with regard to the wider context of adult safeguarding.(33) Her findings reinforce the Department of Health message that positive risk-taking can be integrated into self-directed support, if responsibility is shared through techniques such as risk enablement panels:
Risk enablement panels are beginning to emerge as a way of helping with challenging or complex decisions that may arise as part of signing off a person's support plan. They show how local authorities implement self-directed support and personal budgets in ways that empower individuals while ensuring risks are managed and responsibility is clear. The emphasis is on shared decision making that 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.(33)
However, Boxall et al warn that the system of individual budgets being introduced in the UK is an untried policy.(34) They argue that the original ideas for direct payments came from the disability movement, and were meant to provide flexible systems of self-directed support, but that if the system implemented becomes a top-down system designed to cut the costs of social care, it could lose flexibility and the potential to empower people.