DIGNITY & SAFEGUARDING A Balancing Act Dr Tony Romero, CEO of Cygnet Health Care, discusses how combining

safeguarding with positive risk-taking is key for care organisations to ensure the wellbeing of their patients/residents.

Safeguarding; or the need to protect patients from harm, abuse and neglect remains a critical element in the provision of quality mental health care. It is well established that excellence in safeguarding requires a thorough assessment of ‘process versus personalisation,’ in which an individual’s long-term outcomes can be improved if their care and support planning is focused on their particular needs. It also requires a careful balancing of patient safety and a measure of risk-taking as well as meeting the nationally prescribed statutory safeguarding requirements.

While it is universally agreed that safeguarding requires processes, systems and checks to ensure that care providers are accountable and transparent and that patients remain safe from harm; it is also true that no two patient cases are the same, and it is therefore equally important to adapt care and support to suit the individual through personalised care and, more specifically, positive risk-taking.

Fundamental to a personalised approach to care and safeguarding is adaptive and collaborative shared risk- taking, where service users, together with care providers, make choices about what represents risk to the individual. Well handled, this therapeutic approach to risk taking can empower patients and ultimately facilitate their personal recovery and development.

In the care environment, risk is usually used in association with potential harm, so it is unsurprising that important questions arise in the assessment of risk and how to keep patients safe. It is a delicate balance of providing patients with independent lives to take the risks they choose and weighing it carefully against the likelihood of significant harm arising from the situation in question.

To make safeguarding and risk-taking - 24 -

more personal and coordinated requires an approach that involves the whole care ecosystem and must be adopted by care providers at a cultural level. Personalised care must be promoted at every stage of care planning and risk assessment, encompassing all decision makers including doctors, nurses, patients and their families in order to deliver a truly tailored approach to patient safety and care.

Fundamental to a personalised

approach to care and safeguarding is adaptive and collaborative

shared risk-taking.

Incorporating personalisation and risk-taking also requires a shiſt in how care outcomes are evaluated. A truly individual care plan should incorporate both quantitative and qualitative measures. Beyond box ticking, we must set out qualitative outcomes that allow care practitioners to make decisions in collaboration with individuals. For example, it is essential that healthcare staff have open dialogue with patients and their families to understand their specific stressors, risks and pain points. When all parties are engaged in the care plan process, we can work towards reducing patient harm and improving long term outcomes.

This kind of care and support planning requires skills in shared decision- making, behaviour change, coaching, goal setting and action planning in

partnership with service users and their carers. To build effective decision relationships between parties, it is also important for health practitioners to offer good quality, consistent and trusted relationships as well as ongoing, open communication. To do this, service providers must offer the training and tools that nurses and other health professions need to develop these skills and work in closer partnership with their patients.

This level of training becomes even more necessary as we continue towards a step-down, community care approach to mental health. The services required to help people manage their physical and mental health care and risk tolerance in the community are complex and varied. Ongoing training, specifically those detailed in the Intercollegiate Safeguarding Training guide is essential if we are to ensure that patients can safely leave our facilities to be supported to live independent lives in the community.

Whether in a care home or community setting, appropriate safeguarding and risk management could have positive funding implications. Currently, a large portion of funding is spent on reactively investigating situations that have arisen through poor risk / safeguarding assessment and planning, but all too oſten, these recommendations are not implemented properly, making incidents likely to occur again. Instead, we should consider addressing some of the fundamental issues, learn lessons from the incidents and also invest in preventative strategies, such as appropriate training and facilities, to contribute to risk reduction for patients requiring mental healthcare. By taking this more enlightened approach, it could lead to better facilities and outcomes for patients; an outcome we all hope to achieve.

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