Editorial comment: finding the balance between choice and safety

Balance safety and choice

The personalisation agenda is about handing over more choice and control to service users. But how much choice should an individual have to put themselves at risk and what if they do not have the capacity to take control themselves.

Department of Health regulations on extending direct payments to people who lack capacity seek to address some of these issues but in fact raise more concerns. Under the guidance, where a legally appointed attorney or deputy was not in place, a family member or close friend involved in the service user’s care could be appointed to manage their direct payments.

However, this friend or family member would not require a Criminal Records Bureau check and neither would any personal assistant they appoint. This approach would seem to contradict the calls for safeguarding vulnerable adults by leaving this group of direct payment recipients open to greater risk.

While it may be unreasonable to insist on CRB checks on partners and close family, these carers may be vulnerable to unscrupulous types. The plans in effect push safeguarding responsibility down the line to those who may not be best equiped to deal with it.

This is an area of personalisation that could affect many as the numbers of older people with later-stage dementia increases. The DH must review its recommendations now to ensure the best balance of choice and safety. ➔ See page 5

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