(Picture: A personal budget and support plan can help recipients train for a career or trade. Credit: Alamy)
The Social Care Institute for Excellence has produced guidance for social workers on self-directed support and personal budgets to help service users make decisions and manage the risks safely
Personal budgets, including the option of direct payments, are one way to ensure people who use services can make their own decisions about the risks they take. Social workers and care support workers must therefore support the person to identify their own risks and evaluate them. Relationship-based working is vital: in order to understand what positive risks the individual can take, the carer must understand the individual’s history, their wants and needs, and their families and friendships.
The Scie guide promotes this level of independence, choice and control for the people using services, highlighting the need for both risk enablement and safeguarding to be a core part of personalisation.
Research shows that a risk-averse attitude among practitioners can lead to generalisations about certain service user groups, but Andy’s story (see case study, below) shows how a positive risk-taking philosophy is working in practice. Andy was allowed to write his own support plan and, although his carers were worried about the risk involved in taking a course, the benefits to the individual in the long run were worth it.
This approach to safeguarding adults fits with the Putting People First agenda, which was launched by the Department of Health in 2007 and calls for the transformation of adult social care to enable people to shape and control their own services. This agenda will end in March 2011, but personalisation remains a key element of the Think Local, Act Personal partnership agreement, which is being finalised.
David Walden, director of adults’ services at Scie, says the report provides a practical, evidence-based guide for staff and managers: “Giving people who use services choice and control over the care they receive is important if personalisation is to become a reality. However, there must be support for family carers, social workers and other care staff so they feel comfortable enabling people to take risks.”
The responsibility for encouraging risk-taking can make professionals feel they are being put in a difficult position trying to balance personalisation with their duty to keep people safe. It is therefore important that they feel confident and equipped to support people they are caring for to assess and evaluate their own risks.
The personal budgets team at Hull Council has undergone personalisation training, and is now putting this into practice every day. The team developed best practice statements, including “We help you to develop a support plan that is individual to you”, as Andy’s social worker did.
Helen Sanderson, who runs her own consultancy, worked with the Hull team. She says: “It’s not enough to just say ‘be person-centred’. Most of us need some ways of doing that. So in Hull the first thing they did was give everybody that fundamental training on person-centred thinking tools that they can use in their role.”
Social work skills are core to delivering this vision, particularly in helping people assess, manage and take measured risks in a person-centred way, support planning and review, and decisions on how best to manage a personal budget.
The report concludes that people using services need to be supported to define their own risks and be empowered to recognise and identify abuse and neglect, and need clear information and advice from frontline staff about what to do if they have concerns.
The team at Hull Council is already putting this guidance into practice. Social worker Wendy Curry says: “Through the process of support planning, I can get to know the person in depth. It enables me to work in a different way – it’s more about sitting back and letting them talk more about their lives and what’s more important to them, rather than going in and solving the problems for them.
“Under the old system you would meet their basic needs. You would put social stimulation in to a degree, but not the finer things that you and I take for granted, like going out independently.”
On a day-to-day basis, Curry asks her service users and their families about what they enjoy doing, and makes suggestions for how they use their personal budgets to do these things while still being supported.
Advice is available for practitioners facing difficult cases in the form of risk enablement panels, which can share responsibility for making complex decisions when signing off a person’s support plan. The panel would usually involve the individual or any advocates or carers representing them; members of the local safeguarding adults board; the allocated social worker; and specialists such as a psychiatrist.
For people such as Andy, having the right support to be independent and take their own risks can be life-changing. But, as the social workers at Hull have found, it’s not just the service users who benefit. Assessment officer Ellie Namih says: “The rewards for me would have to be seeing the difference in people’s lives.”
Andy lives with his family in Cumbria. He has autism and a learning disability. After leaving college, he was offered a place at a day centre for adults with learning disabilities, but he knew he could do much more and wanted a job working with cars. Andy found a course but people around him were worried that he would be vulnerable to abuse or exploitation and that he might not cope with the course, managing money, meals and day-to-day life. Andy took a personal budget and wrote a support plan, which made it clear that the course was so important that the risks were worth it.
However, during his first months at college, he lost several hundred pounds, and his games console, which he thought were “loans” to people he could trust. He received support to speak to the police and his supporters helped him to learn from this experience. Andy completed his course and now has a part-time voluntary job at Halfords and a paid part-time job as a project co-ordinator for People First Cumbria.
Andy says if he had been completely protected from risk, he would never have learned about trust and gained the confidence to deal with people trying to take advantage.
“People learn by making mistakes,” he said. “I needed to make mistakes so I could learn.”
Key Scie guidance messages
● Social work skills and relationship-based working with the person using the service are essential to promote risk enablement as part of self-directed support and to detect and prevent abuse as part of safeguarding.
● Practitioners need to be supported by local authorities to incorporate safeguarding and risk enablement into relationship-based, person-centred working. Good quality, consistent and trusted relationships and good communication are particularly important for self-directed support and personal budgets.
● Corporate risk approaches can result in frontline practitioners becoming overly concerned with protecting organisations from fraud when administering direct payments. This reduces their capacity to identify safeguarding issues and enable positive risk-taking with people who use services.
● Rebalancing social work resources towards frontline activity with people using services, their carers and families could enhance overall organisational risk management and safeguarding.
● While risk assessment tools can be useful they should not replace professional judgement and communication with the individual.
At a glance summary: Enabling Risk, Ensuring Safety: self directed support and personal budgets
View the digital version and download the full report of Enabling Risk, Ensuring Safety
Find out more about Putting People First and Think Local, Act Personal
In Control is a national charity working to create a fairer society where everyone needing additional support has the right, responsibility and freedom to control that support.
What do you think? Join the debate on CareSpace
Keep up to date with the latest developments in social care Sign up to our daily and weekly emails
This article is published in the 3 February 2011 edition of Community Care under the headline “Successful risk-taking with budget holders”