Positive Risk Taking for People Who Use a Care Service (Scotland) Policy

Aim and Scope

{{org_field_name}} is committed to the idea of “positive risk taking” which it understands to mean a “can do” as opposed to “cannot, too risky” approach to supporting its people who use {{org_field_name}} to lead satisfying, fulfilling lives.

To show its commitment it will help its people who use {{org_field_name}} to take balanced, deliberate and reasonable decisions about activities and behaviour that have the potential to benefit as well as to harm the person.

This policy then sets out the values, principles and procedures underpinning {{org_field_name}}’s approach to “positive risk taking” by its people who use {{org_field_name}}. It is written in line with the national health and social care standards set out in My Support, My Life, particularly Standard 2: “I am fully involved in all decisions about my care and support”, which includes:

2.24: I make informed choices and decisions about the risks I take in my daily life and am encouraged to take positive risks which enhance the quality of my life.
2.25: I am helped to understand the impact and consequences of risky and unsafe behaviour and decisions.

The policy should be used in relation to other policies that share common values and principles in line with the service’s registration requirements on:

Personal Plans and Support
Risk Assessment and Management
Support and Protection for People Receiving Care Who Cannot Take a Decision Because of Mental Incapacity in Care Homes
Commitment to and Upholding of Human Rights
Support and Protection of Service from Harm.

The principle of “positive risk taking” applies to all risk assessments carried out with or on behalf of people who use care services, but more specifically to people who engage in activities that entail elements of risk that need to be assessed against the benefits of their potentially risky actions.

{{org_field_name}} recognises that people’s involvement in a wide range of physical, emotional, psychological, intellectual and social activities can have benefits, but also incur risks of short- and longer-term harm and damage.

It also recognises how people perceive and experience the benefits and risks involved in any activity will vary from individual to individual. Individual perceptions of both potential benefits and risks will influence their decision making and support in implementing the decisions taken.

In supporting a person in their decisions to engage in potentially beneficial activity that also incurs risks {{org_field_name}} aims to take a balanced, realistic, evidence-based approach.

This should enable it, on the one hand, to exercise its commitment to person and human rights centred care and support, on the other hand, to exercise its duty of care to keep people safe from avoidable harm.

Principles of Positive Risk Taking

The service understands that “positive risk taking” will involve the following.

Every decision about a future action contains some uncertainty as to whether its outcome will be as anticipated, expected or predicted.
The uncertainty is stated in terms of risk and can be small or great, and, because it is impossible to control every aspect, can have results that were not foreseen or planned.
The uncertainty or risk involved might suggest that the decision if enacted will result in harm and should not be enacted because of this.
This also means any positives or benefits that could also result from enacting the decision will be lost.
The positives or benefits of following up the decision could be greater than the risks involved, particularly if these are small or can be controlled.
Any assessment of risk should consider the positive and negative effects on an individual’s wellbeing as a whole, not only on the specific actions that are subject to risk.

What is meant by “benefits”

• By “benefit” is meant an outcome of a decision and subsequent actions that contribute positively to a person’s wellbeing, which have been based on their life goals, aspirations and wishes.
• The actions can be small-scale such as going outside, to the toilet, to a shop, café, social event, etc, independently or with support, which might have been difficult because of physical or emotional impairments. Or, the actions might be incremental steps leading to a longer-term goal with each being a positive achievement if completed as planned.
• The actions can be specific such as:
– climbing a mountain
– doing a parachute jump
– running a marathon
– swimming a mile
– meeting a favourite celebrity.
• Or they might represent the need for longer-term effort such as:
– becoming a paralympian athlete
– obtaining an educational qualification
– being employed in a full-time job.
• Benefits can be described as physical, emotional, psychological, social, and together contributing to a person’s overall wellbeing, for example, self esteem, improved physical and mental health and satisfaction with life.

What is meant by “risks”
• The risks are those that if present in the actions taken or are not well controlled, could result in the person not experiencing the benefits sought, and possibly coming to harm. For example, a risk of failure could result in abandonment of the goal and others that require similar efforts. (A “what’s the point” reaction.) Support therefore might need to be built into the plan to overcome initial or temporary failures.
Policy Statement
{{org_field_name}} will apply these principles as follows.
• {{org_field_name}} recognises that people have the right to take their own decisions and assess any risks associated with them free from restraints and restrictions imposed by others, except where these might be required by law, eg with the wearing of seat belts when driving.
• {{org_field_name}} has a legal duty to promote people’s wellbeing, which includes respecting their decisions with the risks involved.
• It also has a duty of care over its people who use {{org_field_name}} to keep them safe from harm as well as to promote their wellbeing.
• This requires them to not only assess any risks of their coming to harm in the taking of decisions about their care and support but also to the benefits that could result from those decisions.
• The decisions will always be made and agreed jointly between the person using {{org_field_name}} (together with their families and representatives) and {{org_field_name}}.
• Agreement will also be reached on who will bear responsibility for the outcomes of the decisions that are being taken and who will not.
• People who use {{org_field_name}} who might lack the mental capacity to decide and/or assess and manage the risks associated with their decisions. They will have their rights protected through the taking of decisions and risk assessments that are required by mental capacity law, including where the decision involves potential loss of liberty.

Procedures

To agree receipt of service and on admission or start of service we use pre-existing needs assessments to support our own assessments in order to develop a person’s care and support plan.
{{org_field_name}} develops its care and support plans in person-centred ways, fully involving the person who uses {{org_field_name}} and others responsible for their wellbeing as co-producers.
Every care and support plan, which is developed from their needs assessment, identifies the person’s life goals, choices, wishes and aspirations and personal resources and resilience to fulfil them.
{{org_field_name}} will work with the person to see how it can support them to meet their different goals and aspirations in the short, medium and, where necessary, longer term.
{{org_field_name}} in partnership with others who are acting on the person’s behalf and in their interests will consider the feasibility of each potential plan of action and the resources required.
To support the person in achieving their goals and aspirations {{org_field_name}} and others, who in practice will usually form a multi-disciplinary team, will identify the potential benefits to the person, the resources required and any risks that could prevent the sought outcomes from being achieved.
To agree to supporting the person with their plan {{org_field_name}} and partners working with them will systematically weigh the potential benefits against any risks.
{{org_field_name}} will ensure that the plan is fully recorded and includes arrangements for its monitoring, reviewing and any subsequent changes.
The plan will include:
– how the decisions have been taken and the key factors in the decisions taken
– a determination of the benefits to the person
– a determination of the risks of harm to the person
– why it has been decided that the benefits outweigh the risks (ie a benefits-risk ratio)
– how any significant risks are being managed to ensure the person obtains the benefits.
{{org_field_name}} will then only withhold their support to the plan if all involved consider that:
a. the risks outweigh the benefits
b. they cannot be adequately controlled
c. there are extenuating factors such as costs, lack of resources or suitable opportunities and facilities that would make the plan unworkable or it might need to be put on hold.

Decision Making and Mental Capacity Issues

To develop a care and support plan {{org_field_name}} will ensure that the person can consent to the arrangements being made. If it is evident that the person might lack the mental capacity to consent, it will carry out or ensure that a capacity assessment is carried out.

The person is involved as fully as possible in the assessment receiving the support of an advocate where required.

{{org_field_name}} does not assume that a person lacking capacity cannot engage in positive risk taking, including anyone whose deprivation of liberty has been authorised, and will always respect their choices and wishes by carrying out a positive risk assessment taking mental capacity into account.

People will be supported to take the decisions that are right for them in terms of their current wishes and knowledge about them. The decisions taken will always reflect the potential benefits resulting to the person weighed against the risks of their coming to harm and the appropriate measures to control the risks will be put in place.

Acceptance of Risks

Once a benefit-risk assessment has been carried out {{org_field_name}} will reach an agreement with the person using {{org_field_name}} and their representatives on the plan to be followed and the support needed to implement the plan.

The service will remain aware of the possible consequences of the risks outweighing the benefits if all does not go to plan and its responsibilities for any failure, which could result in the person coming to harm.

{{org_field_name}} management will review all decisions and plans to ensure that it:

has taken all reasonable steps to avoid the person coming to harm
has been diligent and thorough in its assessment and planning
has collected and used enough reliable information to make its assessment and arrive at decisions
fully recorded and carried out all decisions taken including those to control the risks
has followed its agreed policies and procedures for care and support plans and assessing risks.

Expectations on Staff

The service expects its staff to:

consider the benefits of any ideas or proposals to the person with whom they are working together with any risks and weigh them up
receive training and ongoing supervision in all aspects of assessing and managing positive risks and in reporting procedures
be aware of what support is available to them and how to obtain it so that they can support the person using their care service in positive risk taking.

Training

New staff receive training at induction onwards in all aspects of assessing and managing positive risks in line with {{org_field_name}}’s policies and procedures and training guidance and resources provided by the Scottish Social Services Council (SSSC).

Further specialised training in different areas of positive risk assessment and management is provided as required by individuals’ roles and responsibilities.

Needs for refresher training are assessed during supervision and appraisals.

Managers should learn about concepts and methods of positive risk taking in their leadership and management training.

Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}

Reviewed on: {{last_update_date}}

Next Review Date: {{next_review_date}}

SCH181. Positive Risk Taking for People Who Use a Care Service