Bev Maybury, head of modernisation for adults and community services at Oldham Council, is project lead for the authority’s individualised budgets pilot. Here she explains how the pilot is taking a practical approach to risk management.
Oldham is taking a radical and transformational approach to changing services for all adults and older people. It is an exciting and challenging time. However, using self-directed supports – including direct payments and In Control – to help people get support in a way they want, while acknowledging our duty of care, is fraught with risks.
Our solution has been creating a risk enablement panel that responds to high risk situations, with a less intrusive approach. There is a tendency to make all people go through procedures designed for the most complex situation rather than modify our approach.
We set up the panel last April as a response to the changing nature of services, whereby people themselves will be organising and controlling their own services meaning we no longer have the degree of control we had previously.
So far we have worked with/been approached by 55clients, of whom seven were from learning difficulty service, 15 used adult placement, five were mental health service users, 23 people from physical and sensory services, one from the older peoples services and one person via our allocation panel.
Initially the risk enablement panel met fortnightly. In the last two months we changed the frequency to weekly meetings in order to meet customer demands.
The panel is based on the following principles:
• The person is at the centre of all planning. They are entitled to attend the panel, as are their families, if appropriate
• It is a partnership that seeks to find positive outcomes and solutions, and not leave one person to make the decision alone. It includes health and social care staff, plus those from the voluntary and independent sectors
• It has to be empowering, while protecting the most vulnerable
• We believe shared decision making is the most effective and open way to take what are often life or death decisions. We recognise that alongside rights, people have responsibility to share risks and often those risks stay with the person wherever and however they are supported.
Helping people address and manage risk is a situation we face on a daily basis. Some of the people we have seen via the panel include an ex-drug user, who was afraid of being put under pressure from a partner who believed she has money for support. The panel arranged for her to have her support organised by a third party broker, which means she retains control but without the pressure of directly managing her money.
Another is a woman who is artificially fed and wanted to taste food again. This person is in the end stage of Multiple Sclerosis and although tasting food may lead to her choking, it has to be seen in the context of that she has little time left to live so it was agreed. However, staff have been supported as they do not want to be the person who may cause her death.
In another case a domiciliary agency pulled out of a service on a Friday evening because of a dispute between them and a client regarding a moving and handling issue which left her in a vulnerable and dangerous position with no care over the weekend. To avoid such a crisis, this would now come to panel for a proactive resolution before any action is taken.
None of these situations are unfamiliar. The potential risks involved should not prevent the client having the opportunity to experience real choice and control in the way support fits with their lifestyle.