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24th April 2015

Remove risk and remove opportunity?

Giraffe balancing on a tightropeAn article in Community Care this month suggests that by being highly risk-averse, providers may be doing people with learning disabilities more harm than good.

Anyone who has been around in the world of care and care management for a few years will be aware of the growth in use of the risk assessment. This is not to suggest, of course, that previous services were carrying on in wildly hazardous circumstances, without due regard for the safety and wellbeing of services users (oh, wait, maybe we were…..). No, it’s just that everywhere we seem to turn these days we feel the need for a risk assessment.

I work in a regulated service where this has been taken to ridiculous extremes by over-zealous staff. We have so many risk assessments in circulation, whole forests are at risk of being wiped out. We have risk assessments for every activity of every minute of every day for every service user. I have finally cracked – its time to address the attitude of staff to the management of risk.

Can we remove risk?

You note that I say the management of risk, which is not to suggest the avoidance of it. I don’t believe this can ever be achieved and, in fact, I would go so far as to suggest that a bit of risk is a useful thing. Taking risks is part of life. Interestingly, the Community Care article seems to support this view. It points out that by being too risk- averse, providers may be in danger of restricting the liberty and independence of service users.

It gives some examples of this, which I won’t report here since it bears reading on its own, but I know that you will be able to recognise these in your own services. A recent example in my workplace is the restriction we have placed on the use of Skype. In removing the risk of exposing vulnerable adults to the horrors of online abuse, we have effectively prevented a young woman from face-to-face contact with her parent who lives abroad.

Too cautious to care

Another of my current gripes is the business of toenails. (I can imagine you are thinking I need to get out more…..) My trusty office bloodhound alerted me to the sudden increase in invoices from a rather fancy chiropodist. We seemed to be moving from occasional use of this service to a situation where we were financing her annual trip to Tuscany. I investigated.

At some point in the recent past, some keen individual had written a risk assessment to support the care of a diabetic service user. This included ensuring that foot care was overseen by a specialist. Somehow, over time and the telling, this had become an instruction for all service users. No one was being helped to look after their own feet any more and care staff would refuse to trim nails as part of providing personal care.

Of course we risk assessed the business of reintroducing nail care as part of our service. We made it happen through training, awareness and protocols. This reinforces my point that a risk assessment is not to provide us with a convenient excuse to avoid doing something that may lead to harm, but instead to allow us to think about the potential pitfalls and plan to protect against them. It enables us to do something safely. A risk assessment is one of the most useful tools in our toolbox, if done well and in the spirit of encouraging independence. If we don’t see it in this way, we open ourselves up to the risk of being unfairly restrictive.

Community Care article

Ginny Tyler – QCS Learning Disability Expert Contributor

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