SCIE Report 36: Enabling risk, ensuring safety: Self-directed support and personal budgets
'Importantly, respondents wanted clear policies about what should happen when safeguarding issues arise and self-directed care may be terminated abruptly.' (Department of Health 2009).
The corporate level relates to how a whole organisation is responding to the challenge of providing choice and control at the frontline and ensuring that practitioners, people who use services and carers are enabled to take positive risks while staying safe. It covers how the sorts of risk associated with direct payments, care and support planning and management, self-directed support and personal budgets are being managed by local authorities.
Click on the links below to explore findings in the three areas below:
Policy and practice: personalisation and adult safeguardingOpen
Key points from the literature:
- in many places, adult safeguarding and personalisation systems and practice have developed separately
- where systems don't join up, fragmented guidelines and working practices may pose a risk for the effective implementation of personal budgets
- agencies may have empowerment, safeguarding and health and safety policies, but they are rarely integrated
- adopting a uniform approach to personalisation and adult safeguarding is important
- there can be confusion over who is responsible for what when it comes to risk management and safeguarding in general
- at present a legislative framework is only available for direct payments and is not yet widely understood for personal budgets, resulting in caution from some local authorities
- at local authority level a better understanding and awareness of adult protection needs to be built into social care systems from the beginning. However, it is not yet clear how this is happening in relation to self-directed support and personal budgets
- this lack of clarity and integration can be a risk in itself and will certainly influence frontline practice
- adult protection leads in the IBSEN study identified several ways to safeguard people that were developed for direct payments and that could be extended for personal budgets, such as:
- firming up of adult protection policies
- identifying risk factors for abuse and how these could be recognised in an individual's support plan
- preparing a guide for social workers about co-working issues, protection and risk management
- preparing an information pack for service users about Criminal Records Bureau (CRB) checks and the Protection of Vulnerable Adults (POVA) List to ensure they are fully informed
- using support brokers to assist individuals with their employment responsibilities, CRB checks and POVA List
- Asking people who use services to confirm that they have understood the CRB process and agree to it – for use when an employee was a friend
- incorporating direct payments into adult protection training
- developing proportionate audit trails.
Key messages for organisations on risk assessment (from the evaluation of the adult social care self-directed support network) include:
- Recognition that a person-centred approach to risk assessment is required.
- Risk assessment is a vital aspect of the self assessment process. It will not remove all risks, but it should ensure they are identified and managed.
- There are also risks for local authorities in terms of reputation. These risks can only be reduced by ensuring good public awareness of the objectives and processes of self-directed support, and ensuring that risk assessment procedures are in place.
- Support systems are essential for personal budget implementation and risk management.
- Equally important are: monitoring of any safeguarding issues as well as outcomes, new financial structures, proportionate auditing, communication and professional relationships.
System barriers and risk averse frontline practiceOpen
Key points from the literature:
- The success of personal budgets in giving people greater choice and control (and eventually better outcomes) depends on councils (as well as individuals and their families) being willing to take properly considered risks.
- Frontline practice can avoid issues and be defensive in relation to personal budgets and self-directed support. Practice is often geared towards protecting organisations from potential financial and reputational risks.
- Practitioners may control decision-making in order to avoid risk to the organisation.
- This focus, rather than the promotion of choice and control for the individual, may compromise how personal budgets are offered and administered.
- The audit and administration systems associated with direct payments can focus skill and resources on managing 'financial' risk to the organisation, This is often technical and out of proportion. This may impact on staff capacity to work with people who use services to identify and manage risk.
- One study indicated how 'insufficiently robust' mechanisms for auditing expenditure were a major source of resentment among frontline staff. They were not only potentially time consuming, but jeopardised the professional-user relationship by involving social workers in 'debt collection'.
- In order to improve the quality of practitioner contact and communication with people using personal budgets, Denmark has embarked on a programme of 'de-bureaucratisation'. This allows frontline staff to spend more time in direct contact with people who use services and less time on administration.
- Effective approaches to risk assessment, professional autonomy and recognition of the skills and experience of workers should not be dismissed in favour of administrative convenience or managerial 'back covering.'
- Care plan documentation may be inappropriately regarded as a 'legal safeguard that could be useful in minimising professional and corporate risk.'
- Simply offering new mechanisms for enhanced choice and user involvement may not be sufficient to ensure that frontline practice is successful in implementing personalised social care.
Organisational system change and practitioner confidenceOpen
Key points from the literature:
- Professional anxieties can translate into risk averse or controlling frontline practice.
- For the UK, the emphasis on total system transformation and organisational culture change is extremely relevant for the effective implementation of self-directed support, personal budgets and associated risk enablement practice.
- There is concern about risk being used as a factor for resisting change and the suggestion that there needs to be 'a fundamental rethinking of the system from a consumer perspective.'
- The risk management associated with personal budgets and self-directed support cannot develop as a 'bolt on' to existing systems.
- UK research has shown that this development has already limited the use of direct payments.
- For organisations to become more person-centred, new methods of working are required at the macro as well as micro level.
- When organisations have trust from managers, clear goals, less red tape and less political oversight, they tend to engage in more [positive] risk-taking the management of risk and risk perception should be addressed as part of overall organisational change. Frontline practitioners, people who use services and carers should all be part of the discussion.
- Organisations involved in risk assessment and management have to adopt a participative, holistic and proactive approach, which allows dialogue between workers, users and managers and organisational flexibility and performance incentives.
- Glendinning C et al (2008a) Evaluation of the individual budgets pilot programme: final report York: York University Social Policy Research Unit
- Manthorpe J, Stevens M, Rapaport, J, Harris J, Jacobs S et al (2008) Safeguarding and system change: early perceptions of the implications for adult protection services of the English Individual Budgets Pilots: a qualitative study, British Journal of Social Work
- Rowlett, N. and Deighton, S. (2009). Simplifying direct payments: how Lincolnshire County Council utilised risk management to deliver genuine improvement. Journal of Care Services Management, 3(2)
- Department of Health (2009) Safeguarding adults: response to consultation on the review of the No Secrets guidance London: Department of Health