Risk Assessment

Risk assessment is name given to the combined processes of:

1. Identifying risk;
2. Identifying the likely impact of the risk (positive and negative); and
3. Identifying how to reduce the negative impact and maximise the positive.

Wherever possible, risk assessment should be proactive. This means it should take place before any harm has occurred.

The person/carer's involvement in risk assessment 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.

As such it is important that, whenever it is practicable to do so, the person/carer is directly involved in risk assessment. This includes:

1. Providing information to them about the purpose of risk assessment;
2. Carrying out the risk assessment in an accessible way;
3. Supporting the person with advocacy where appropriate;
4. Talking with them about all of the risks that exist;
5. Talking with them about all or the benefits and potential harmful consequences of taking the risk;
6. Exploring with them all of the available options to manage risk; and
7. Supporting them to make an informed decision about whether to take a risk, or how best to manage 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 proportionate mental capacity assessment must be carried out to determine whether this is the case.

See the Mental Capacity Act 2005 Resource and Practice Toolkit, with guidance about assessing mental capacity.

If the person has capacity

If the person has capacity following the mental capacity assessment they should be encouraged and supported to be involved in the risk assessment.

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 is likely to have substantial difficulty being involved, the duty to provide an appropriate 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 the person lacks capacity

If the person lacks capacity following the mental capacity assessment then:

1. They must be appropriately represented during the risk assessment; and
2. Their views, wishes and feelings in relation to risk must be ascertained and regarded.

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

If the risk assessment is not being carried out as part of a care and support process under the Care Act, the nature of representation will depend on the context in which the risk assessment is being carried out, and the duty to provide an independent mental capacity advocate may apply.

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

Carers

If the carer declines to be involved in a risk assessment about them you should encourage them to be involved, but ultimately the decision is theirs to make.

Where there is a statutory requirement to complete the risk assessment it should be completed based on the information available, and with regard for any views expressed by the carer about risk.

The carer'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.

A person with capacity

If the person has capacity to decline to be involved you should encourage them to be involved, but ultimately the decision is theirs to make.

You must proceed to carry out the risk assessment based on the information available, and with regard for any views expressed by the person when:

1. There is a statutory requirement to complete the risk assessment; or
2. The risk assessment is being carried out to manage the risk of harm or abuse to the person.

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 a person requests that somebody is involved in the risk assessment then you should involve that person unless you have evidence that doing so would place the person (or another vulnerable adult or child) at increased risk of harm or abuse.

If a carer requests that somebody is involved in the risk assessment about them then you should involve that person unless you have evidence that doing so would place the person being cared for (or another vulnerable adult or child) at increased risk of harm or abuse.

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 (for example a separate meeting with the carer).

If the person has requested particular information not relating to needs is withheld from the carer, and they have capacity to do so normal confidentiality rules apply unless doing so would put the person at risk of abuse or neglect.

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

It may be relevant to consult with, or involve others in one or more of the stages of risk assessment:

1. Identifying risk;
2. Identifying the likely impact of the risk (positive and negative); and
3. Identifying how to reduce the negative impact and maximise the positive.

You can involve anyone in any way at any stage, so long as:

1. It is relevant for them to be involved; and
2. Doing so will not increase the likely risk of harm or abuse; and
3. The person has consented; or
4. The carer has consented (when the risk assessment relates to a carer);
5. Or, if the person lacks capacity a best interests decision is made to this effect.

Examples of people it may be relevant to involve include, but are not limited to:

1. Service providers;
2. Family members, friends or neighbours;
3. Health professionals;
4. Another Local Authority; and
5. The police.

Under the Care Act anyone that you ask to be involved in the risk assessment has a duty to co-operate with the request unless doing so would prevent them from carrying out their own duties under the Care Act or other legislation.

In all cases the consent of the person to share information with others should be sought unless:

1. They lack capacity to consent (in which case information sharing must only be carried out if it is in their best interests); or
2. Information sharing is necessary to protect the person (or another vulnerable adult or child) from abuse or neglect (in which case the person must be notified but information should be shared regardless of consent).

All information gathering and sharing should take place with regard to the Caldicott Principles, Data Protection Legislation and local information sharing policies.

It is your responsibility to familiarise yourself with:

1. The local templates that you are required to use when carrying out a risk assessment; and
2. The local risk assessment tools that are available.

These should always be used unless:

1. They are not appropriate to the risk being assessed; or
2. The person is to be involved, and they are not accessible to them.

Examples of alternative formats could include:

1. Picture or drawing formats;
2. Video or audio formats;
3. Alternative written formats.

You should discuss the use of an alternative format with your line manager, and ensure that a formal record of the risk assessment is made on the person's electronic file, regardless of the template used.

tri.x has developed a tool that can be used as required to support risk assessment.

See: Balance Sheet for Risks and Benefits.

Risk is broadly defined as 'the probability that an event will occur with beneficial or harmful consequences'.

When identifying risks you need to consider all of the following:

1. Risk to the person;
2. Risks to a carer;
3. Risks to another vulnerable adult;
4. Risk to a child;
5. Risk to the public;
6. Risk to providers of care and support/support; and
7. Risk to property and belongings.

Every situation is different, but the table below sets out some examples of risk that may be present.

When risks have been identified, and both positive and negative likely impacts agreed you should:

1. Explore all of the available options to manage risk; and
2. Consider all the benefits and risks associated with each option; and
3. Agree the best way to manage risk.

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.

Wherever possible, every conversation with a 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.

A strengths based approach is empowering for the person and gives them more control over the situation and how best to manage risks in the best way for them. Strengths based approaches are often more sustainable and can help to build the resilience of the person and their informal networks.

It is important that the measures to manage risk are:

1. Appropriate and proportionate to the overall level of risk present;
2. The least intrusive that they can be; and
3. The least restrictive of the person's human rights, particularly their right to liberty and family life.

When deciding the best way to manage risk it is important to identify all of the available options, including:

1. What the person/carer can do for themselves;
2. What others in the person's informal network can do (for example family members, friends);
3. What steps providers of services can take; and
4. What steps professionals can take.

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 permits any person or carer with capacity to make an unwise decision.

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 is dynamic and constantly changing. Appropriate and proportionate arrangements should be made to monitor a risk assessment when:

1. The risk of abuse and neglect is high;
2. The plan to manage risk is unstable;
3. The likely effectiveness of the plan to manage risk is unclear;
4. The risk may be short term;
5. The level of risk is likely to change; or
6. Other less restrictive or intrusive ways to manage risk may become available.

The timeframe for review

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

If specific timeframes to review the risk assessment were not been agreed the review should take place as part of:

1. A Protection Plan review;
2. A Care and Support Plan review;
3. A Support Plan review;
4. A reablement plan review;
5. A reassessment of need; or
6. Any other statutory function being carried out.

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.

The purpose of review

Any review of risk should establish explicitly whether:

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

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 well managed 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 proportionate assessment of risk.