Increasingly people are deciding to use less traditional ways of having their eligible social care and health care needs met. Many are taking the opportunity to exercise greater choice and control over what kinds of services they receive, who provides them and the way in which they are delivered. This revolution brings with it opportunities and challenges from the perspective of risk enablement and safeguarding.
Regardless of the person’s preferred method of managing a personal budget (for example, council managed account, direct payment, individual service account or a combination of these), the local authority still retains its duty of care with regard to the person and their protection from abuse. However, the balance of power and consequently how risk is managed can be significantly different from previous, traditional, models of social care management. This model is more about the co-production of risk enablement, with the person having a greater say and therefore greater control over how risk is managed. This is therefore an inherently less risk averse arrangement than before.
2. Managing Risk
Throughout the process, from self-assessment (supported or otherwise) through to personal budget setting, arranging direct payments or other personal budget management arrangements, to final sign off of a care and support plan, appropriate risk assessment should be taking place with the individual and their supporters.
At the various key stages in the process, risk and safety should be considered.
- Self-assessment: Initial identification of any safeguarding issues, either one off or ongoing. If these needs are being met, how is this being done? If they are not being met, they need to be clearly identified.
- Budget-setting: If significant safeguarding risks are identified as unmet needs, will the amount of the personal budget be sufficient to reduce or mitigate them?
- Support planning: How will the support plan meet the safeguarding needs in outcome terms? What services are best suited to meet the person’s needs and how will they be delivered in a person centred way?
- Sign-off: Authorisation of the support to ensure it is legal, safe and affordable.
In this arrangement people using personal budgets, to a greater or lesser degree, are the commissioners of their own services, particularly where they are using direct payments to manage them.
3. Care and Support Arrangements
Different arrangements exist to support people through the process of setting up a care and support package. In some areas this may be the responsibility of local authority adult social care staff, independent brokerage services or user led organisations (ULOs). The kinds of support available may include:
- advice about safe recruitment;
- advice about safeguarding and dignity;
- using approved or accredited providers of services;
- employment advice and services;
- advice and support in relation to the quality of services;
- contractual issues.
It should be remembered that, where someone has capacity to make their own decisions in these matters, they may choose not to seek or use such advice or support services. This does not necessarily have a detrimental impact on the legality or safety of the support plan.
People with personal budgets and care and support plans which utilise direct payments are subject to the same reviewing arrangements as those in receipt other services (that is a minimum of once per year).
4. Those who fund their own Care Arrangements
People who fund their own care arrangements (also known as self-funders) are legally entitled to receive support if subject to abuse or neglect in exactly the same way as those supported or funded by the local authority.