Risk Assessment

In many cases family members will not classify or identify themselves as carers. They may not receive allowances or support for the role they are playing. In some cases, carers will be managing complex, risky situations on an ongoing basis, which can result in the person with care and support needs becoming ‘invisible’ and not known to health and social care services until there is a breakdown of the situation, a crisis or a serious incident. Early recognition of the carer and support can help to reduce the risk.

If the risk assessment is being carried out as part of a care and support process under the Care Act (including safeguarding) and the person/carer is likely to have substantial difficulty being involved, the duty to provide an independent advocate will apply if there is no other suitable representation available.

See: The Duty to Provide an Independent Advocate for further guidance about when the advocacy duty applies under the Care Act.

If there are concerns that the person may lack capacity to be involved in the risk assessment, then a mental capacity assessment must be carried out to determine whether this is the case.

For further guidance see the Mental Capacity Act 2005 Resource and Practice Toolkit.

If the person/carer has capacity to decline to be involved you should encourage them to be a part of the process, but ultimately the decision is theirs to make.

You should proceed to carry out the risk assessment based on the information available.

The person's refusal to be involved should be clearly recorded, and a copy of the completed risk assessment should be provided to them. They should then have the opportunity to review and amend any plan to manage risk.

If the risk assessment is being carried out in relation to a person with care and support needs as part of a formal care and support process under the Care Act (including safeguarding), the duty to involve any carer applies, even if the person does not consent to their involvement unless:

1. The risk assessment relates to possible abuse or harm of the person caused by the carer; and
2. The carers' involvement in the risk assessment is likely to increase the risk of further harm or abuse occurring.

When a person has not consented to the carer being a part of the risk assessment you should agree the most appropriate way to involve the carer and how information can be shared.

Consideration may need to be given to whether an advocate is needed.

If an independent advocate has been appointed to support the person/carer to be involved in the risk assessment, their contribution must be regarded.

See: The Duty to Provide an Independent Advocate for further guidance about when the advocacy duty applies under the Care Act

All information sharing that takes place must be in line with Data Protection Legislation (namely the UK General Data Protection Legislation and the Data Protection Act 2018) and local policy.

Please also see: Providing Information about the Person or Carer

Risk is a normal everyday experience, from which we all learn and grow.

Unless the risk is abuse or neglect the purpose of risk assessment is to:

1. Maximise the positive impact of taking the risk; and
2. Reduce the negative impact; and this
3. May or may not lead to the elimination of risk.

If the risk is abuse or neglect the risk assessment should seek to eliminate the risk wherever possible.

Wherever possible you should take a positive approach to risk assessment unless taking the risk will increase the risk of abuse or neglect of the person (or another vulnerable adult or child).

This involves taking steps to:

1. Actively encourage and support a person to take a risk; when
2. Taking the risk is likely to achieve personal change, growth and promote individual wellbeing.

Conversations with the person/carer about risk should be from a strengths based perspective. This means supporting them to explore whether there is:

1. Anything within their own power that they can do to manage the risk; and
2. Anything within the power of their family, friends or community that they can use to manage risk.

Other options to consider if available, include:

1. What steps providers of services can take; and
2. What steps professionals can take or put in place.

It is important that the measures to manage risk are:

1. Appropriate and proportionate to the overall level of risk present looking at the likelihood and consequences of something going wrong;
2. The least restrictive that they can be.

When working with people virtually, managing risk can be more difficult as the information gathered from observations is reduced. Closer consideration is needed to what or how questions and what other sources of information are available to aid the assessment and management of risk. For further guidance, see: SCIE: Risk assessment process and key points to risk identification in virtual interactions.

In the Care Act people are seen as experts in their own lives, and as such are best placed to make their own decisions if they are able to do so. Supporting people to make their own decision about how best to manage risk can: 

1. Be empowering; and 
2. Increase the likelihood of positive engagement with any plan to manage risk; and 
3. Build resilience, confidence and independence. 

Therefore, if a person (with capacity) or a carer has a clear view about how best to manage risk any risk management plan should be based upon this unless: 

1. The method to manage risk is not available; or 
2. The method does not reduce the risk of abuse or neglect; or 
3. The method increases the risk of abuse or neglect; or 
4. The method places another vulnerable adult (or child) at risk of abuse or neglect. 

If any of the above circumstances apply you must explain to the person/carer why the plan cannot reflect their wishes, and then make risk management decisions that: 

1. Are evidence based; and 
2. Have regard for their views, wishes and feelings; and 
3. Are appropriate and proportionate to the overall level of risk present; and 
4. Are the least intrusive that they can be; and 
5. Are the least restrictive of the person's human rights, particularly their right to liberty and their right to family life. 

Unwise decisions 

The Mental Capacity Act 2005 protects a person’s right to make decisions, and they cannot be deemed to lack capacity purely because the decision is unwise.

An unwise decision is any decision that you, or anyone else thinks is not the best decision for them. 

There may be cause for concern if someone: 

1. Repeatedly makes an unwise decision that puts them at serious risk of harm, abuse or exploitation; or
2. Makes an unwise decision about risk that is obviously irrational or out of character. 

In this situation you must carry out an assessment of capacity where it is appropriate and relevant to do so before making any decision about risk on their behalf. 

If a person lacks capacity to make a decision about the best way to manage risk this decision must be made in their Best Interests using the 4th and 5th principles of the Mental Capacity Act. 

In particular, any decision must: 

1. Be evidence based; and 
2. Have regard for their views, wishes and feelings; and 
3. Be appropriate and proportionate to the overall level of risk present; and 
4. Be the least intrusive that it can be; and 
5. Be the least restrictive of the person's human rights, particularly their right to liberty and their right to family life. 

See the Mental Capacity Act 2005 Resource and Practice Toolkit, which provides comprehensive guidance about making best interests decisions. 

Risk can be dynamic and constantly changing. Arrangements should be made to monitor a risk assessment and detail who will take on this role.

Risk assessments should be reviewed in line with any timeframes that were agreed when the assessment was completed.

A review of the risk assessment should also take place when there is evidence that indicates either:

1. The level of risk has changed;
2. The risk management strategies are not effective;
3. The risk management strategies are no longer required; or
4. There may be a less restrictive way of managing risk.

Any review of risk should establish whether:

1. Risks continue to be well managed by any plan;
2. There have been changes to risk;
3. There is any risk of abuse or neglect; and
4. Whether there is a risk to the Care and Support Plan/Support Plan’s effectiveness.

If risks have not changed and are well managed

If the review identifies that risks have not changed and the measures in place are effectively reducing risk this should be clearly recorded, and the current plan should continue subject to further review or monitoring.

If risks have changed or are not managed

If the review identifies a change in risk, or that risks are not working, you will need to explore:

1. What is working and not working with current measures;
2. What steps can be taken to resolve any issues with the current measures to reduce risk; and
3. Any new measures to manage risk; and
4. If risks have changed, carry out any new assessment of risk.