SCIE Report 36: Enabling risk, ensuring safety: Self-directed support and personal budgets

Messages

'….users should be seen as equal partners in the process and outcomes of risk assessment and management, giving greater respect to [their] views, rights and needs…' (Barry 2007).

Service user level

The service user level relates to how people using adult social care services are experiencing choice and control while staying safe as part of the self-directed support and personal budgets process. This includes how people who use services are identifying their own risk and safeguarding issues and being supported to take positive risks as part of person-centred assessment and support planning.

Although the research base suggests that personal budget schemes can work well for people who use social care and support services, specific research focusing on how people using those services and their carers perceive and manage risk is lacking.

There are questions about whether current approaches to identifying and managing risk in adult social care consider the individual, their unique circumstances, life history and perspectives on risk and safeguarding.

Research also suggests that current statutory arrangements are not supporting older people to report abuse or neglect (older people from black and minority ethnic communities are especially unlikely to seek help from statutory services).

Now click on the two links below to look at the research in more detail:

• Being in control and staying safeOpen

  Key points from the literature:

  • 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.
  • Research shows that some people who are using social care and support (particularly older people) will take risks but not disclose them, in order to maintain a sense of independence and control (which indicates the shortcomings of existing practice for individual 'risk enablement').
  • The evaluation of the Australian Attendant Care Program (ACP) direct funding pilot showed the importance of maintaining consistent channels of communication, providing good information and a responsive approach to people using personal budgets and self-directed support.
  • The recent report on the consultation on the review of No secrets contains a very clear message that people want to be able to choose what they think is right for them. Many people reported they were offered 'safety' at the expense of other qualities of life, such as dignity, autonomy, independence, family life and self-determination. Many older people and people with learning disabilities said this was 'a very high price to pay.'
  • The report also emphasises that safeguarding must be built on empowerment – on listening very carefully to the voices of individuals who are at risk, and those who have been harmed. Without empowerment, without people's voices, safeguarding does not work.
  • People want support to deal with difficulties in their own way. This includes help with information, options, alternatives, suggestions and mediation.
  • User views collected by In Control suggest that individual approaches to risk enablement and staying safe in self-directed support are compatible. A significant number of social workers also reported no change in risk management where people were given personal budgets.
  • User-led research (carried out as part of the development of a safeguarding and personalisation framework for the South West Region) concluded that:
    • People can be reluctant to report abuse due to their anticipation of the response. Having a person they know and trust would help, and authorities may need to find ways of building relationships so that people believe staff will act appropriately.
    • A large majority did not approve of misuse of local authority funds by other service users, but some felt that such people should still be able to direct their care choices, either through the local authority or third party, or with closer checks.
    • Peer support groups received strong support, provided that they are run well and do not turn into 'gripe sessions.'
    • Telephone helplines and know/named professionals or peers were felt to be the best methods of obtaining information.
    • The question of whether personalisation meant greater risk received no consensus of opinion, although people obviously feel there are currently risks under both systems.

• Training, awareness and reportingOpen

  Key points from the literature:

  • There is evidence that people receiving direct payments or personal budgets (and their carers and families) need:
    • training on recognising abuse and where to get support
    • awareness training in safeguarding, how to identify abuse and who to contact.
  • As noted earlier, for people from black and minority ethnic communities, access to community and appropriate advocacy organisations is vital for this type of support.
  • The IBSEN researchers noted that stakeholders in the USA saw consumer training as the most effective way of reducing the risks of exploitation and fraud, though they were alert to the danger of over-complicating schemes designed to provide flexibility.
  • In the UK, external regulation has been the main method of deterring actual and predicted harm, but this does not necessarily support person-centred approaches.
  • The role of risk prevention as part of self-directed support is one that is emerging from the literature. Effective risk prevention for individuals will be enhanced if people using the service, their carers, families and friends are enabled to assess, identify and report risk and safety concerns during the process and as part of the support plan.
  • Some authors have argued that new forms of social care (involving personalisation and self-directed support) are emerging to meet the policy goal of early intervention and prevention and it may be timely for prevention and safeguarding to be linked.
  • A preventative approach to risk should consider risk of loss of independence and control. This can be a consequence of risk averse practice which may mean that someone is left without appropriate care and support.
  • The former Disability Rights Commission argued that disabled people and their organisations should seek out, highlight and oppose risk-averse policy and practice, especially where this constrains independence and opportunities and where it results in a waste of resources.
  • In keeping with this recommendation, an international research review showed that traditional risk management approaches can undermine the decision‐making processes underpinning consumer directed support arrangements and need to change. Agencies should consider implementing an enabling risk management approach (focusing on how something can be done, rather than on whether something can be done) that directly involves consumers.

Further reading

• Barry, M. (2007) Effective approaches to risk assessment in social work: An international literature review, Edinburgh: Scottish Executive Social Research
• Disability Rights Commission (archived site)
• Johnson F, Hogg J & Daniel B (2010) Abuse and protection issues across the lifespan: Reviewing the literature Social Policy and Society 9(2)
• Tyson A, Brewis R, Crosby N et al (2010) A report on In Control's Third Phase – Evaluation and learning 2008-2009 London: In Control
• Ottmann G, Laragy C, & Haddon M (2009) Experiences of disability consumer-directed care users in Australia: results from a longitudinal qualitative study Health and Social Care in the Community 17(5)
• Department of Health (2009) Safeguarding adults: response to consultation on the review of the No Secrets guidance London: Department of Health
• Manthorpe J & Bowes A (2010) Age, ethnicity and equalities: Synthesising policy and practice messages from two recent studies of elder abuse in the UK Social Policy and Society 9(2)