- Providers must assess and do all that is reasonably practicable to mitigate risks to service users.
- Risk is the likelihood of harm being caused by a hazard.
- It is vital that the provider’s risk management plan and care plan are consistent with each other.
- Regulation 12 requires providers to mitigate risk as far as reasonably practicable. This does not mean they should completely eradicate risk, as this might compromise person-centred care.
- Risk assessment should start with identifying hazards. A hazard is anything that may cause harm.
The fundamental standards are now law. They are set out in Regulations 8–20A of the Health and Social Care Act 2008 (Regu-lated Activities) Regulations 2014. Regulation 12 covers safe care and treatment, and this article looks at how care providers might design and deliver care that meets Parts 2(a) and (b), which deal with risk management.
The part of Regulation 12 relating to risk management states:
Safe care and treatment
12. — (1) Care and treatment must be provided in a safe way for service users.
(2) Without limiting paragraph (1), the things which a registered person must do to comply with that paragraph include—
- (a) assessing the risks to the health and safety of the service users of receiving the care or treatment;
- (b) doing all that is reasonably practicable to mitigate any such risks;
Defining safe care and treatment
The regulations do not define the term ‘care’, but Regulation 2, Part 2 defines ‘personal care’ as both physical assistance and prompting with any of the following:
- eating or drinking
- washing or bathing
- oral care
- skin care.
Regulation 2, Part 2 also defines ‘treatment’ as:
- diagnostic or screening procedures
- the on-going assessment of a service user’s physical or mental state
- nursing, personal and palliative care
- the giving of vaccinations and immunisations.
From the above definitions it is clear that most aspects of the work of the health and social care sector are covered by ‘care and treatment’; hence, providers are legally obliged to comply with Regulation 12. The term ‘safe’ is not explicitly defined in the regulations, but the Oxford Dictionary definition is ‘protected from or not exposed to danger or risk; not likely to be harmed or lost’. This is consistent with the provisions of Regulation 12.
" Once the risk has been assessed, the provider needs to put risk mitigation measures in place."
Assessing and mitigating risk
Regulation 12 requires the registered person to assess the risks to the health and safety of service users and to do all that is reasonably practicable to mitigate these risks. Risk assessment should be an integral part of the care planning process. From examination of CQC inspection reports of services rated as ‘requires improvement’ or ‘inadequate’, it is clear that in many cases risk assessment is a tick-box exercise bolted on to the care plan. Risk assessment should start with identifying hazards. A hazard is anything that may cause harm.
A number of hazards will apply to all service users, such as eating and drinking, mobility, and mental health. There will also be hazards that are specific to the person, such as diabetes or hearing impairment.
Risk is the likelihood of harm being caused by a hazard. It is the sum of the severity of the risk and the likelihood of it happening, and can be represented by the following formula:
Risk = Severity + Likelihood
So to assess risk, providers should assess the potential severity of the harm that could be caused by the hazard. This is best done using an objective numerical scale – for example 1 to 5. Then the likelihood of the harm occurring can be assessed using a similar methodology. The scales and the assessment of risk are illustrated in the risk scorecard.
If a hazard is assessed as likely to occur once every six months then it would be likelihood 2; if the potential severity was a trip to A&E this would be severity 5. The calculation would be 5 + 2 = 7. This is a high risk and requires a risk management plan so that control measures can be set up to reduce the likelihood as far as possible. In this case the risk can only ever go as low as 6 (5 + 1). It is almost impossible to reduce the potential severity.
Once the risk has been assessed, the provider needs to put risk mitigation measures in place. If the overall risk is low, then these can be incorporated into the care plan. If the risk is medium or high then a separate risk management plan is recommended. If the risk is critical then the provider should seek urgent specialist advice and incorporate this into the risk management plan.
In all cases it is vital that the risk management plan and the care plan are consistent with each other. In most cases it will not be possible to reduce the severity of the harm; hence risk mitigation should focus on reducing the likelihood of the harm occurring. Risk mitigation measures are sometimes called control measures and these should be incorporated into the service user’s care plan. Often risk mitigation measures are developed at three levels, which are illustrated in the table below. The examples relate to a service user who is assessed as being at risk of falling when mobilising.
Reviewing and revising risk assessments
The risk assessment should be reviewed and if necessary revised:
- when the service user’s needs change
- in response to every incident or accident involving the service user
- at planned reviews of the care plan
- whenever the service changes, for example premises changes, staffing changes and new admissions.
Mitigate risk, not eradicate risk
However, it is important to remember that Regulation 12 requires providers to mitigate risk as far as reasonably practicable – this does not mean they must eradicate risk. To attempt to eradicate risk is likely to lead to risk-averse care provision which will compromise the principles of person-centred care (Regulation 9). If there is a potential conflict between the rights of the service user to make life choices and the associated risk, especially if mental capacity is in doubt, then advice must be sought from other professionals via a multi-disciplinary team meeting.
In this article we have considered the risk management aspects of Regulation 12 and safe care and treatment. Care providers must familiarise themselves with all of the regulations in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. In future issues we will explore other aspects of Regulation 12: premises and equipment, infection control and management of medicines.
Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: http://bit.ly/HCA2008Regulations.
Use the following item in the Toolkit to help you to put the ideas in this article into practice:
- Form - Audit for compliance with the fundamental standards: Regulation 12: Safe care and treatment (all providers).doc63 KB
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