SCIE Report 36: Enabling risk, ensuring safety: Self-directed support and personal budgets
'An essential part of support planning is to consider acceptable levels of risk… Options range from a light-touch approach, through risk enablement panels, to a full adult safeguarding process.' (Rowlett 2009)
Risk enablement panels
Risk enablement panels are a way of helping with challenging or complex decisions which may occur as part of the support plan validation process. The emphasis is on supporting positive risk taking while maintaining duty of care and decisions are made in a shared and informed way, with transparent, shared responsibility.
Local authorities which have been at the forefront of establishing self-directed support and personal budgets as part of standard social care and support, such as Essex, Oldham, Stockport, Manchester, Hartlepool and Newham, have set up risk enablement panels as part of developing a culture that is more accepting and enabling of risk.
In their risk enablement policy, Essex County Council recognise that a major factor inhibiting achieving good outcomes for people in relation to choice and control is operating within a system where there is a fear of putting the organisation at risk (financially, in terms of public relations, reputation or in breach of the law).
Therefore it is important to spend time with the individual to develop a good support plan with a completed risk assessment. High quality and clear information is required to help people make informed choices. Appropriate intervention and advocacy services should be used for those with language or sensory needs to ensure the best possible outcomes.
Explore the links below to learn more about risk enablement panels:
Risk enablement panels can facilitate best possible outcomes, including safeguarding. In their factsheet on self-directed support and personal budgets for people using services, Oldham say that the purpose of the risk enablement panel is to discuss, record, and minimise the risk and share the responsibility of the decisions taken.
In Control, along with participating local authorities, have developed a template 'terms of reference' and procedure for the establishment of risk enablement panels.
Essex emphasise the importance of multi-agency and multi-professional working, particularly with Adult Safeguarding. They say that the specific role of the risk enablement panel is:
- deal with disputes arising from the escalation process as part of validation
- co-ordinate risk management across ASC and potential links with other directorates
- provide a forum to support service risk co-ordinators and other key stakeholders in a 'blame free' learning environment
- monitor developments nationally in risk management, and consider their relevance to the council
- provide a forum to consider how risk management can support corporate initiatives
- ensure effective co-ordination and promotion of other risk management options such as health & safety, insurance, business continuity, emergency planning and disaster recovery.
Objectives and purposeOpen
The In Control template gives the objectives of a risk enablement panel:
- to ensure a consistent approach is taken to considering complex decision making, where the risk to independence or safety is balanced with the risk of not supporting the individual's choices
- to come to a shared responsibility when dealing with complex risks between the local authority, its clients, their carers, providers and staff
- to ensure there is a written record of discussions and decisions.
Essex County Council are clear that all the other processes should be in place as part of support plan validation to identify, enable and manage risk and to highlight and respond to any safeguarding issues. They say that risk enablement panels should only be convened in exceptional circumstances and do not have the authority to provide extra resources to manage risks.
In Control also make it clear that:
- the panel will not act where Adult protection/safeguarding Procedures or Multi-Agency Protection Plans (MAPPA) take precedence
- that the Mental Capacity Act provides essential guidance as to how to facilitate and support informed decision making for individuals who have difficulty communicating, or for whom there are issues around capacity to make decisions.
In their policy document Essex County Council outlines the purpose of the risk enablement panel:
- to guide, advise and support individuals, (including third parties) to minimise risks and manage complex risk situations, including cases involving differences of opinion
- to seek positive solutions and outcomes for individuals and resolve issues regarding the sharing of risk between individuals, third parties and the organisation
- to ensure that no individual is left to make a difficult decision without support and that the council can demonstrate it has fulfilled its duty of care around the support of people who use services
- to provide a forum where staff at different levels of the organisation can share risk decision making where there is concern about the level of risk
- to take the final decision on issues involving risk, in conjunction with senior managers where necessary
- to promote a consistent approach to managing complex risk decision making.
In order to involve all those concerned with the support planning, risk management and safeguarding for an individual, In Control have advised that the following people should make up a panel:
- the individual and/or their advocate
- any carers requested by the individual to represent them, or who the panel consider to be affected directly by the decision being considered
- an independent chairperson, ideally drawn from the local Safeguarding Adults Board
- the local authority Safeguarding Adults Lead
- the social worker/care manager responsible for the case and/or their team manager
- any relevant multi-disciplinary staff, such as social worker/care manager or health professional
- any relevant specialists involved such as a consultant psychiatrist or criminal justice advisor
- a note taker
- a contingency list of staff that can deputise for primary panel members.
In addition, Oldham Council have said that membership of each panel is made up of specialists who have relevant experience and knowledge. For example, where health agencies are involved, there is a relevant representative from the health service. This encourages multi-disciplinary and multi-agency discussion and decision-making. It also encourages partnership working.
In Control recommend that the panel can be requested by anyone involved in signing off a support plan after all other attempts to reach a decision with the individual have been exhausted.
They make it clear that it is important the individuals and their representatives are made aware of the panel's existence and role when being given information about the support planning process.
Hartlepool Borough Council risk enablement panel will consider cases where there is a large discrepancy between proposed cost and those of existing services.
Oldham Council have outlined their referral policy and process. A referral to the Risk enablement panel is made after discussion with the appropriate team/line manager when an individual has a complex risk assessment requiring multi-professional discussion.
People who use services may be referred to a Risk enablement panel if they:
- have complex health care needs
- have complex challenging behaviour
- need complex risk assessments involving family, carers, or the community
- require physical intervention
- have risks in relation to moving and handling
- have health and safety issues
- require isolation
- have forensic needs
- need to be assessed due to ethical dilemmas around individual care
- have a paid carer, adult placement or volunteer who has had a criminal records bureau (CRB) check that has returned issues for discussion.
In Essex, examples of referrals to the risk enablement panel would include the following:
- Does the individual have capacity to consent to the decision regarding the potential risk?
- Are the risks to the individual such that cannot be resolved through care planning or normal safeguarding or POVA processes?
- Could the risk cause endangerment to other people (third parties)?
- Could the risk expose the council to political or reputational risk?
- Legal and regulatory issues – including the status of measures in a support plan or compliance issues.
- Suspected fraud.
- Risks arising from the availability of services or facilities.
- Risks that are not specific to the individual or their support plan but relate to wider organisational issues, including potential service failure or the suitability of equipment or facilities.
- Financial or budgetary risks that cannot be resolved through the validation process.
Decision-making and outcomesOpen
In Control recommend that the meeting is conducted and decisions are made in a supportive, open and inclusive way.
The role of the chair is to explain and oversee the process, enable the individual or their representative to present their case to the panel and to facilitate constructive discussion. This discussion should enable the individual or their representative and panel members to fully explore and understand the issues and for potential consequences of any decision to be identified and explained.
The chair will help broker an agreement with reference to the local authority's duty of care and any relevant legislation (such as the Human Rights and Mental Capacity Acts). All processes and decisions should be fully recorded as risk enablement panels need to have written records to support transparent decision making and shared accountability.
Importantly, the individual must be made aware of the consequences of not abiding by the decision. This should be communicated to them in an appropriate way so they can make fully informed choices.
Finally, Oldham note the importance of working with Adult Safeguarding to make fully informed shared decisions, including how to deal with instances of fraud, theft or financial abuse.