Over the last few weeks when talking to colleagues about the Self-Directed Support Bill which is winding its way through Parliament, one of the commonest issues raised is that of risk and safeguarding. Indeed for many practitioners and families the relationship between adult protection/safeguarding and personalisation can appear a challenging one.
A major Department of Health consultation south of the border which examined their approach to adult safeguarding, No Secrets, highlighted some of the issues, thus:
‘A balance needs to be established between empowerment and protection and between the rights for self-determination and the duty to ensure safety of people and safety of public money
- We want to support people to be citizens and take risks that they understand
- Empowerment in all aspects of life is a protective factor against abuse
- We are looking for new approaches to safeguarding
- The interface issues have not been sufficiently addressed as yet
- We firmly believe that personalisation and safeguarding can work together in a complementary way
- We are developing empowering risk frameworks
- We have evidence that shifting the power balance within families and between service users and professionals can have very positive safeguarding outcomes…… ‘
All are ostensibly reasonable concerns and issues. How do you enable people to have greater choice and control over their lives but not to be put at greater risk of abuse or harm? How do you ensure that giving individuals control over their personal support budgets will not be open to abuse by others, whether family members or organisations? How do you protect without suffocating? What is risk empowerment and enablement all about – just another set of tools and models or a new way of working with and alongside individuals?
Another English report had this to say:
‘The governing principle behind good approaches to choice and risk is that people have the right to live their lives to the full as long as that does not stop others from doing the same. Fear of supporting people to take reasonable risks in their daily lives can prevent them from doing the things that most people take for granted. What needs to be considered is the consequence of an action and the likelihood of any harm from it. By taking account of the benefits in terms of independence, well-being and choice, it should be possible for a person to have a support plan which enables them to manage identified risks and to live their lives in ways which best suit them. ‘
Independence, choice and risk: a guide to best practice in supported decision making. – DH May 2007.
Good adult protection and safeguarding is about balancing risk. We all live within environments which are not risk neutral but we have developed the skills and tactics to minimise, control and live in the face of such risks. That is part and parcel of what good support should be.
Risk enablement is about proportionality. It’s about nurturing within those who might be more vulnerable the insights and abilities which enable us to live in the world. It’s about ensuring that as professionals we do not become any more risk averse and fearful of the consequences with self-directed support.
Over the next few months risk and self-directed support will be much discussed here and elsewhere. What does risk mean to you? What is positive risk enablement?
Dr Donald Macaskill