SCIE Report 36: Enabling risk, ensuring safety: Self-directed support and personal budgets
'The role of care managers acting as ‘gate-keepers' and concerns about subjectivity in interpreting a user's ability to give consent, and assessing capacity to manage [are barriers].' (Arksey & Kemp 2008)
Taking and controlling risks
Mitchell and Glendinning's 2007 research review also helps define some common risk control strategies used in adult social care:
- controlling personal behavior – what an individual can and cannot do
- controlling the information and/or knowledge given to or received by others
- controlling the physical and/or social environment experienced and access by others.
Several studies, particularly those on older people, showed that some people who use services may withhold information on their 'risk taking' from the practitioner or their families in order to remain independent and in control of their own decisions. This may therefore leave them without support to take the risks that are important to them.
Conversely some practitioners did not share risk-related information with the person using the service, leaving the individual ill-informed about their decisions and choices.
As an extension of this, some care managers simply withheld information about direct payments to potential recipients because they thought this to be in the individual's best interests.
This finding is supported by the research which showed how views of risk can inform resource allocation:
'…..the type and level of support received can rest on perceived level of risk rather than the concept of “need”. Risk may have become a means to judge and evaluate perceived “need”.' (Mitchell & Glendinning, 2007)
Finally, the perception of risk that practitioners might hold in terms of allocating resources is demonstrated in a specific study of care management practice (Postle, 2002) and the quote at the top of this page from Arksey and Kemp.
- Arksey H & Kemp P (2008) Dimensions of choice: a narrative review of cash-for-care schemes Working paper No DHP 2250 York: University of York, SPRU (158kb PDF file)
- Mitchell W & Glendinning C (2007) A review of the research evidence surrounding risk perceptions, risk management strategies and their consequences in adult social care for different groups of service users: Working Paper No. DHR 2180 01.07 York: University of York SPRU
- Postle K (2002) Working 'between the idea and the reality' – ambiguities and tensions in care managers' work British Journal of Social Work 32