Personalisation and risk in practice
As you have seen, the Adults with Incapacity (Scotland) Act 2000 provides a framework for safeguarding the welfare and managing the finances of adults who lack capacity to make decisions due to, for example, a learning disability or dementia, or because they cannot communicate their decisions to other people. The principles and application of the Adults with Incapacity Act are very relevant to personalisation.
Activity 4.8 Raymond’s money
Watch the video Adults with Incapacity (Scotland) Act 2000: A Short Guide to the Act or the easy-read guide It’s Your Decision .and read either
Note down in your learning log the five principles (called ‘Rules’ in the easy-read guide) of the Act and then apply them to the scenario in the video. Make notes in the principles worksheet provided below.
If Wendy has doubts about the right thing to do or the extent to which Raymond has capacity, she should talk to her line manager (if she has one). For someone who is directly employed by the holder of an individual budget, however, there may not be a line manager to consult. In this case, what do you think should be done? You might suggest that Wendy makes a note or keeps a record about this in case there are any later accusations that she has stolen the money. She might like to show this to someone, so that she has some proof of what she said has happened. If she had concerns about risk of harm to Raymond (e.g. about the impact of his decision-making on his health or safety), then you may suggest that Wendy should inform someone, perhaps his GP or social worker, about her concerns. It would be good practice for Wendy to discuss this with Raymond first and explain what she is going to do, and why.
There is no simple answer to this case study, of course. Your answer will partly depend on whether you think Raymond understands the implications of his decision to spend a large sum of money on lottery tickets. The Act says that capacity is not ‘all or none’, and depends on what kind of decision is being made (and people may vary in their decision-making capacity depending on their mood, or health, for example). Even if Raymond were assessed as lacking the capacity to make this kind of decision, Principle 2 of the Act says that any action or decision taken on behalf of someone else should be the minimum necessary to achieve the purpose. It should be the option that restricts the person’s freedom as little as possible – this is also known as ‘proportionality’, or ‘a proportionate response’.
You might also suggest that Wendy would benefit from some training in how to support Raymond more effectively. For example, one of the principles of the Act is about encouraging people to use their existing skills and develop new ones: following this principle, Wendy might arguably be able to support Raymond to engage in a greater range of satisfying activities.
Proportionality is an important concept when we are considering risk: weighing up the potential outcomes in terms of harms and benefits is a feature of many decisions. There is always likely to be tension between harms and benefits, and the difficult task for those involved in health and social care, as users and/or providers of services, is finding the right balance between the two. This involves thinking about processes that reduce the likelihood of harm while not having a disproportionate impact on personal choice. Practitioners are required to adhere to codes of practice in this respect. For example, social service workers are required to:
Promote the independence of service users while protecting them as far as possible from harm.(SSSC Codes of Practice, 2009)