Sensible risk assessment in care settings

People who work in health and social care constitute a large and diverse workforce looking after a predominantly vulnerable population. Employees have the right to work in a healthy and safe workplace, and the people using services are entitled to care and support that is safe and takes their needs, freedom and dignity into account.

Managing these different needs can sometimes present unique and complex situations which can, if not effectively managed, result in serious harm to employees, people using care services and others. The typical hazards include:

• Moving and handling
• Slips and trips
• Violence, aggression or challenging behaviour

Whilst specific hazards to people using care services may also include:

• Falls from windows and balconies
• Scalding and burning
• Bedrail entrapment
• Legionella

The risk assessment process is not about creating huge amounts of paperwork; it is about identifying and taking sensible and proportionate measures to control the risks. You may already be taking steps to control the risks, but the assessment process will help you decide whether you should be doing more. You may need to consider different elements of risk when producing your assessment, including:

• the common risks to everyone on the premises, for example, risks from legionella, asbestos, electrical equipment and transport
• the common risks to people using services, for example, from falls from height or scalding. Whilst you may have some individuals who are not at risk you must implement measures to prevent harm to the most vulnerable
• the individual risks to particular staff, for example expectant mothers and young workers
• the individual risks to particular people using services, for example the risk of an individual falling out of bed, or needing help to safely mobilise

When considering the individual risks for particular people using a service, you must also bear in mind that health and social care is regulated by other organisations who may expect some form of care assessment. Usually the health and safety risks identified for the individual will be recorded as part of this 'care assessment' or 'support plan'.

Making sensible risk assessment decisions

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. This is particularly important in the provision of social care but also applies to people receiving longer-term healthcare.

Often when assessing the care and support needs of an individual, everyday activities are identified that will benefit their lives, but also put them at some level of risk. This requires a balanced decision to be made between the needs, freedom and dignity of the individual and their safety.

Care assessments should enable people to live fulfilled lives safely, rather than be a mechanism for restricting their reasonable freedoms. Many care providers find it hard not to slip towards a risk adverse approach for a multitude of reasons, for example, resources, bad experiences and a fear of the consequences if things go wrong.

HSE will support decisions to allow everyday activities to be undertaken provided a suitable and sufficient risk assessment has been carried out, documented and reviewed as necessary. This should identify and implement any sensible precautions to reduce the risk of significant harm to the individual concerned (see examples below).

Key points to consider when balancing risk include:

• Concentrating on real risks where there is a realistic risk of harm
• Close liaison with the individual, carer and family when carrying out risk assessments which is essential to achieve outcomes that matter to them
• How the risks flowing from an individual's choice can best be reduced, so far as is reasonably practicable, by putting in place sensible controls
• When organising group activities, think how the most vulnerable can be protected without unnecessarily restricting the freedoms of the most capable.

Examples of sensible and proportionate management of risk

Individual risks for making a cup of tea

A young person with learning disabilities is vulnerable to the risk of scalding but will benefit from being able to make their own cup of tea. Assessment identifies that the size, weight and volume of water in a standard kettle puts them at risk of serious harm. A single cup hot water dispenser is a reasonably practicable solution. Owing to the resident's physical condition and tendency to shake, a cup with a limited opening (spill resistant) is provided.

Individual risks for walking to the local shop

A resident who has walked to the local shop on a daily basis to collect their newspaper develops Alzheimer's. They become confused and start to forget how to get back to their care home. Having considered different possibilities, the shop owner agrees to give a gentle reminder of the route home every time the resident purchases their paper. This, coupled with checks by the home, allows the resident to continue with their daily routine – subject to regular review. Other control measures may be appropriate, dependent on the individual.

Individual risks for a person with dementia walking away from the care setting

A person with dementia develops a tendency to walk away from the care setting. They were formerly employed in a job where they walked long distances on a daily basis. Assessment indicates the main risk is from getting lost. The professional team, family and person agree to the use of a tracking and personal alarm system, which will alert the care setting if they become lost.

Individual risks for helping to cook in a care home

A person wishes to help in the kitchen at a home. The individual has dementia and is able to carry out certain activities without much support and helping in the kitchen will provide great benefits to the individual and will reduce boredom. An assessment of the kitchen identifies that some of the equipment presents a significant risk. However, it is decided that the individual can undertake a number of tasks under supervision. 

Individual risks for outdoor activities

A person with Down's syndrome wishing to ride horses may be vulnerable to the risk of falling and may not have the capacity to appreciate the potential danger. The benefits and enjoyment gained from carrying out the activity are felt to outweigh the risks. An assessment identifies suitable measures to reduce the risk, including the selection of a reputable leisure provider, use of protective clothing, safe supportive seating, the selection of a suitable horse, and close supervision.

Further information

Further information on sensible and proportionate approach to the management of risk and carrying out risk assessments can be found on the HSE website.