Equality and Human Rights Commission

This document is designed to support the involvement of adults with learning disabilities in assessing risk. It was developed by Mersey Care NHS Trust in conjunction with service users and can be used to identify people who may need the support of a risk management plan or a more thoroughgoing assessment. It examines four areas of risk: risks to self, risks to others, risks from others and risks to property. For each area, common risks are identified and an explicit connection is made to the human rights which might be affected. The format includes pictures, accessible language and a 'traffic light' system to support service users to express their own perceptions of risk. There is also a 'risk matrix', allowing the practitioner to consider the likelihood and the potential impact of the risky behaviour. The comprehensive guidance notes encourage creative engagement with service users, for example through role plays. Note: The manual may be copied for use within NHS organisations if suitably credited to Mersey Care NHS Trust.

• A human rights based approach to risk means ensuring service users are as involved as they can possibly be in their own risk assessment process.
• A human rights based approach to risk assessment balances the human rights of service users, their carers, and members of their communities.
• Actively involving the service user in their own risk assessment will increase accessibility, engagement and, ultimately, ownership of the service user's care.
  

Involving service users in risk assessment

Traditional approaches to risk assessment often exclude the perspective of service users, focusing instead on professional views of risks and challenging behaviour. This manual takes a different approach; it applies a human 'lens' to risk assessment in order to balance the human rights of service users, their carers, and members of their communities.

It suggests that doing so increases a person's engagement with and 'ownership' of their care.

The manual explains that a person's capacity to play a part in their own risk assessment may vary over time. Some involvement will almost always be possible. The 'gold standard' is for the service user to lead and be fully involved with the process.

When involvement is not possible, or is minimal, practitioners would work through the risk assessment on the service user's behalf with the help of family members, the person's advocate or chosen support staff.

Legal and policy context

Human rights principles are now explicit in the NHS constitution and inform the approach of the Care Quality Commission. The fullest possible involvement of service users is an essential part of a 'human rights based approach' to healthcare; it also fits well with government policy for service user involvement and the 2010 White Paper, 'Equity and Excellence: Liberating the NHS'.

How to use the manual

The manual takes a step-by-step approach to risk management, and includes:

• record forms for each service user, containing a shared summary sheet
• a picture booklet to support communication
• a traffic light picture card to support the service user to assess their own risk.
• a traffic light scoring sheet to record the service user's assessment of their risk

It is designed to be personalised, and offers creative ideas - road tested by service users and clinicians - to support people to assess their own risk. For example, the traffic light can be used by the assessor as a prompt to explain the different levels of risk.

The manual explains that some service users might prefer to work collaboratively to produce shared pictures. For example, if the service user has a risk relating to asthma, they might draw a picture of an inhaler.

For each common risk area, there are:

• prompt questions for the assessor, grouped according to the human rights that might be affected, and
• prompt questions for the person being assessed

The manual allows the assessor to produce a numerical score for any given risk, taking into account the likelihood of the risk occurring and the severity of the consequences. A worked example shows clearly how this is done.

Above a certain level, it indicates that a risk management plan will be needed.

When the score reaches a higher level still, it indicates that a Human Rights Joint Risk Assessment and Management Plan (known as HR-JRAMP) will be necessary; this is a separate tool created by Mersey Care to assess and manage risk associated with people with a learning disability who present a likely and serious risk of harm to either themselves or others. Download the HR-JRAMP here.

The manual does not contain an explanation of human rights principles that might underpin decision-making such as proportionality and the balancing of rights in specific circumstances. In this sense, it assumes a basic knowledge of human rights as a decision-making tool.

If readers do not feel confident that they have this knowledge, the HR-JRAMP contains a useful guide to these principles, with case examples.

Other important information

Requires a basic knowledge of human rights as a decision-making tool, although can be used in conjunction with the Human Rights Joint Risk Assessment and Management Plan (HR-JRAMP) which explains these principles, with examples.

Date of review

April 2011

• Ministry of Justice, A Guide to the Human Rights Act: a booklet for people with learning disabilities
  http://www.justice.gov.uk/guidance/docs/human-rights-act-learning-disabilities.pdf
• Dr Beth Greenhill et al (2011) Human Rights Joint Risk Assessment and Management Plan (HR-JRAMP) (Mersey Care NHS Trust)
• Debbie Bannister et al (2011) Benchmarking Tool (Mersey Care NHS Trust)