Martin Hodgson takes a look at the fresh guidance on risk assessment in health and social care published by the Health and Safety Executive (HSE).
Aimed principally at residential care services, but relevant to domiciliary services as well, much of the guidance relates to the autonomy of service users and their right to live their lives as they wish, taking the risks that they consider acceptable. In health and social care settings such freedom, which is an important part of living with dignity and independence, must often be weighed against the duty of services to care for people and to protect them from danger.
The guidance comes against a backdrop of the Government’s “Red Tape Challenge” which has sought to remove “burdensome” and “bureaucratic” health and safety rules. In keeping with the spirit of simplifying rules wherever possible, the guidance points out that risk assessment should not involve creating large amounts of paperwork. Instead it should be about identifying real risks and taking “sensible and proportionate” measures to control them.
Risks in health and social care
The results of getting the balance wrong may not only result in overprotective care where a person’s independence and autonomy is affected, but can also result in tragic accidents.
There are a whole range of health and safety risks that can threaten staff and users of health and social care services. Typical hazards identified in the guidance include:
moving and handling
slips and trips
violence, aggression or challenging behaviour
falls from windows and balconies
scalding and burning
The HSE produces additional guidance in each of these areas and all should be addressed in a care service’s health and safety policy. All should also be made subject to appropriate risk assessment.
New guidance on “sensible” risk assessment
The new guidance acknowledges the importance of these risks and recognises the need for service users to live safely. However, the guidance also states that their freedom and dignity must be taken into account, and this includes their right to take the risks they consider reasonable.
In this respect, the guidance says that the provision of care and support should be tailored to meet the needs of the individual and should encourage them to do what they can for themselves. Where an activity is seen to put a service user at some level of risk, then a balanced decision must be made weighing up the needs, freedom and dignity of the individual and their safety.
In order to protect and care for their service users, the HSE warns that some care providers find it hard to maintain a reasonable balance and find themselves adopting a “risk adverse” and over-protective approach. Care assessments, the HSE points out, should enable people to live fulfilled lives safely, rather than be a means of restricting their autonomy.
Provided a “suitable and sufficient” risk assessment has been carried out, in the new guidance the HSE states that it will generally support decisions by care managers, wherever possible, to allow everyday activities to be undertaken. All risk assessments should be documented and reviewed as necessary and should identify and implement any sensible precautions to reduce the risk of significant harm to the individual concerned.
The guidance is clear that copious paperwork is not a requirement, although adequate records should be kept. It also reminds providers that in the health and social care sector many health and safety risks identified for individuals are already assessed and recorded as part of their personalised care plan.
Balancing risk and freedom
The HSE guidance provides four key points for health and social care managers and providers to consider when balancing risk.
Providers should concentrate on “real risks” where there is a realistic risk of harm.
Managers or risk assessors should liaise closely with individuals, carers and families when carrying out risk assessments — this is essential to achieve outcomes that really matter to people.
They should try to consider how the risks flowing from an individual’s choice can best be reduced, so far as is reasonably practicable, by putting in place sensible and not overly restrictive controls.
When organising group activities, managers should think how the most vulnerable service users can be protected without unnecessarily restricting the freedoms of the most capable.
Providers are also asked to consider different elements of risk, including:
risks common to service users, eg from falls from height or scalding
individual risks to particular staff, eg expectant mothers and young workers
individual risks to particular service users, eg the risk of an individual falling out of bed.
Examples provided by the HSE
The HSE guidance provides a number of useful examples to illustrate what it means by a “sensible and proportionate” approach, including the following.
Provision could be made of a single cup hot water dispenser for a young person with learning disabilities so they can make their own cups of tea and other hot drinks whenever they wish, while at the same time minimising the risks of scalding from handling a standard kettle.
Measures could enable a person who develops dementia to continue going independently to the local shops for their newspaper. Such measures, designed to address the risk of getting confused and lost, could include the shopkeeper helping to point the service user in the right direction each time, and additional checks by the home.
Similar measures could be made for a person with dementia whose risk assessment identifies a risk of walking long distances and getting lost. Proportionate control measures could include a modern telecare tracking system that can be worn by the person with dementia and provides a GPS positioning signal so that their whereabouts can be monitored.
Measures could be made to enable a person with learning difficulties to ride a horse despite the danger of falls and injury. Such measures could include the selection of a reputable leisure provider, use of protective clothing, safe supportive seating, the selection of a suitable horse, and close supervision.
The guidance, Sensible Risk Assessment in Care Settings, as well as guidance on how to conduct a risk assessment, is available on the HSE website
Last reviewed 23 January 2014