Analysis of Risk

The aim of this essay is to introduce the aspect of risk and some highlighting on the theories that support this aspect of risk assessment and will briefly discuss existing risk assessment schedules and at the end it will critically analyze national and local reports related to risk assessment (Faisal). Royal Society (1983) states that, risk assessment which axiom as the probability that a particular adverse event occurs and social services has been concerned predominate with risk assessment to prevent harm. They may also suffer further if they have to deal with seeing their perpetrator on a regular basis, and may be subject to further assaults in retaliation of their initial complaint. In addition to the risks to existing victims, poor responses may result in increasing numbers of people being abused.

The Oxford Dictionary define 'risk' as meaning a hazard, a dangerous, exposure to mischance or peril, as verb it also similar which means ''hazard, to danger, to expose to the chance of injury or loss''( Parsloe, 2005). Risk is closely linked to dangerousness, resulting in harm which seems to be agreed means harm to self or others and extend of harm which constitutes a risk in various situations especially adult with learning disabilities.

Every human being becomes vulnerable during their lifetime for many of reasons they all respond differently to events that happen to them because of who they are and the lack of support that they have around them (Jacki, 2001).

People with learning disabilities are one of the most vulnerable groups in the society (Department of Health 2001). Learning disabilities may be more at risk not only because their own difficulties in understanding or communication but also because of the way they receive services and the fact that they may be actively targeted or taken advantages (Jean and Anthea, 1997).

Increasingly responding to the risks of others, preventing risks to vulnerable adults or running risks to themselves is all in day's work for the busy practitioners and manager in the field of social care (Brearley, 1982).

"Any criminal offence which is perceived to be motivated because of a person's disability or perceived disability, by the victim or any other person." [Association of Chief Police Officers].

According to Home Office----- Any incident, this constitutes a criminal offence, which is perceived by the victim or any other person as being motivated by prejudice or hate.

People with learning disabilities are subject to risk all time due to their vulnerability they sometimes abused by those who have control over them or by those who realize that they are vulnerable because of their disabilities they often find it very much more difficult to assess risk the way most of social carer and services do (Vaughn and Fuchs, 2003).

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However, take risks because they feel vulnerable to a point approaching hopelessness (Fischhoff et al., 2000). In either case, these perceptions can prompt adults to make poor decisions that can put them at risk and leave them vulnerable to physical or psychological harm that may have a negative impact on their long-term health and viability.

According to Kemshall and Pritchard (2001) states that, there has been much debate about a welfare model or a criminal justice model should be adopted. In order to fully appreciate the process of risk assessment, here identify the one of particular serous case review murder of Steven Hoskin after the recent death 39year's young man who has been dead by numbers people. Adult's vulnerable protection systems are likely to come under close scrutiny (Jacki, 2001). Steven Hoskin had learning disabilities and he was 39 young man who was been killed and his body was found at the base of the St Austell railway viaduct on 6th of July 2006. Two principal perpetrators, Darren Stewart (aged 29 years) and Sarah Bullock (aged 16 years), and the manslaughter conviction of Martin Pollard (aged 21 years). Steven Hoskin was 39 years old. Born to a single woman who herself had a learning disability, Steven's learning disability became apparent in his early childhood. At 12 years of age he left a local primary school and became a weekly boarder at Pencalenick special school, returning to his mother (on the Lanhydrock Estate, outside Bodmin) at weekends. Steven did not read. After leaving school at 16, Steven was unable to secure employment and was admitted as an inpatient to Westheath House, an NHS 'Assessment and Treatment' unit for people with learning disabilities and mental health problems. Although he remained there for 14 months, the therapeutic purpose of his stay is unknown. While at Westheath House, Steven participated in youth training activities in the Bodmin area. This was an unhappy time for Steven as he was 'victimised by the other trainees.'(ref...)

Steven's relationship with his mother deteriorated and ultimately became characterised by conflict and violent outbursts. In September 2003, Steven was charged and convicted with common assault and he was subject to a Probation Order. An Adult Protection Plan confirmed that Steven's mother should move.(ref...)

Even the initial meeting of the Serious Case Review Panel confirmed there was no lack of information about Steven and his circumstances and that with better inter-agency working; Steven Hoskin would have been spared the destructive impacts of unrestrained physical, financial and emotional abuse in his own home. While this knowledge cannot change, erase or soften what happened to Steven, it was an impetus for Cornwall Adult Protection Committee and its partner agencies to analyse what went so badly wrong. As uncomfortable as this process has been, it leads to learning, i.e. our purpose has not been one of judgement but of correction and improvement (Dixon 1999).

It is important that adult protection is triggered when someone is believed to be at risk of harm/abuse and not only at the point where there is demonstrable evidence of harm. In order to conform to their obligations under human rights law, agencies have to be proactive in undertaking risk assessments (e.g. Monahan et al 2001) to ensure that preventive action is taken wherever practicable.

The Disability Rights Commission (2005) confirmed that the health of people with learning disabilities is likely to be worse than that of other people, (even before taking into account specific health needs or disability related barriers to accessing health care), as they are likely to live in poverty and are exceptionally socially excluded.

Young People and Adults have to 'look out' for young people. They must be alert to the possibility that the same young people may be harming those more vulnerable than themselves (ref....). Valuing People (2001) identified Independence as a key principle and helpfully confirmed that: While people's individual needs will differ, the starting presumption should be one of independence, rather than dependence, with public services providing the support needed to maximize this. Independence in this context does not mean doing everything unaided (p23).

It is essential that health and social care services review the implications of acceding to people's 'choice' if the latter is not to be construed as abandonment (e.g. Flynn, Keywood and Fovargue 2003). Steven's murder has confirmed that the choices of adults with learning disabilities in relation to their health care decision-making (Flynn, Keywood and Fovargue, 2003).

Valuing People (2001) defines 'choice' as follows:

`Like other people, people with learning disabilities want a real say in where they live, what work they should do and who looks after them. But for too many people with learning disabilities, these are currently unattainable goals. We believe that everyone should be able to make choices. This includes people with severe and profound disabilities who, with the right help and support, can make important choices and express preferences about their day to day lives'. (p24).

Protecting 'Vulnerable Adults,' Valuing People states:

`People with learning disabilities are entitled to at least the same level of support and intervention from abuse and harm as other citizens. This needs to be provided in a way that respects their own choices and decisions'. (p 93)

The difficulty for people with learning disabilities is that carers often do feel often they are expected to make these choices for them. The law of negligence can appear to inhibit decision making 'personal freedom and choice sit uncomfortably next to the concepts of duty of care and professional liability' (Fuchs, 2003).

The police reported Steven's circumstances in the months preceding his murder as follows:

`Steven Hoskin had lost all control of his own life within his home. He had no say, choice or control over who stayed or visited the flat. He had no voice or influence over what happened within the premises. Darren Stewart had recognised the clear vulnerability of Steven Hoskin and had 'moved in' on him…he recognised the opportunity for accommodation and removed from Steven Hoskin the little ability he had to make his own choices and decisions. Darren Stewart was fully aware of Steven's vulnerability and learning difficulties and took advantage of those facts to control both Steven and the premises'.

Margaret (2007) identifies the following factors in what went wrong for Steven:

Youths use Steven's bedsit to drink and take drugs where they steal his money and assault him.

Steven cancels his weekly community care assistant service.

Tortured after admitting their involvement in shoplifting.

Assaulted, made to wear dog collar, cigarettes stubbed out on him

.Forced to falsely confess to being paedophile and to swallow 70 painkillers.

Marched to top of viaduct and forced over edge - falls to his death.

Safeguarding adults: To be vulnerable is to be in circumstances defined by the continuous possibility of harm or threat (e.g. Flynn 2005). 'No Secrets' makes it clear that monitoring safety is a multi agency responsibility. The key to protecting and safeguarding vulnerable adults is sharing information, so any professional - who comes into contact with a vulnerable adult should be able to determine immediately if, and when, other agencies are involved and has a duty to share concerns. There were no such consequences arising from the numerous instances when Steven and Darren came to the notice of NHS services or the police.

Flynn (1989) confirmed that adults with learning disabilities living in their own tenancies were vulnerable to victimisation, most particularly in localities of 'hard to let' tenancies; that these men and woman were wary and scared of young people; and that most experienced loneliness and isolation. Departments of Adult Social Care cannot be expected to 'look out' for all citizens with learning disabilities without the resources to do so. Fair Access to Care criteria are known to be rendering more and more vulnerable adults ineligible for ongoing support (ref...)

It forcibly brings the commissioners and providers of health services and the police to the foreground. They were Darren's first port of call and, perhaps under his influence, they became Steven's as well. Steven's murder presses the case for ever-greater investment in partnership working in safeguarding adults (Perkins et al., 2007).

The stated primary aim of No Secrets (2007) is 'to create a framework for action within which all responsible agencies work together to ensure a coherent policy for the protection of vulnerable adults at risk of abuse and a consistent and effective response to any circumstances giving ground for concern or formal complaints or expressions of anxiety. The agencies' primary aim should be to prevent abuse where possible but, if the preventive strategy fails, agencies should ensure that robust procedures are in place for dealing with incidents of abuse.(p....)'

This statement clearly indicated that No Secrets was intended to encompass both a safeguarding 'preventative' approach, in addition to an adult protection 'intervention' one; although we would acknowledge that the intervention role has taken precedence in reality (ref....).

Risks change constantly and people grow, change, and develop. It is important to review risk assessment regularly, and aim always to increase choice and freedom for the people with learning disability (Sellars, 2003 p.155).

In considering the effectiveness of No Secrets as a mechanism to provide a level of intervention that could protect adults at risk of abuse, it would seem sensible to consider what has failed to work successfully within adult protection, whether such failures were a consequence of the nature of guidance or instead insufficient/inappropriate application of that guidance, and whether such failings could only be overcome by the introduction of legislation. An obvious mechanism that could be used as part of this evaluation process would be the consideration of Serious Case Reviews relating to adults.(ref...).

People may make an informed choice to accept a particular risk today, but circumstances and people change. A risk considered acceptable today, may be a problem tomorrow, and statutory agencies have a consequent responsibility to regularly monitor and respond to changing circumstances. Personalisation does not mean a statutory agency has permanently discharged its duty of care on the basis of an informed decision taken at a single point in time. This was a key point of the Serious Case Review into the death of Steven Hoskin,

'Steven wanted friends. He did not see that the friendship he had so prized was starkly exploitative, devoid of reciprocity and instrumental in obstructing his relationships with those who would have safeguarded him.'(ref....)

'Disability hate crime' fails to recognise the duration of Steven's contact with his persecutors; the counterfeit friendship; the background to Steven's perilous disclosures to Darren; the joyless enslavement; or the motivations of all of his persecutors. Steven's murder has profound implications for the support of vulnerable adults in our communities. It challenges the 'principle', or dogma, of 'choice' for adults who are apparently 'able;' it unstitches some certainties about communities -their capacity to 'look out' for others, their familiarity and permanence; and it requires us to question why the ever- tightening eligibility criteria of services are rendering very vulnerable men and women so unprotected. The fact that individuals in all agencies knew that Steven was a vulnerable adult did not prevent his torture and murder (ref...).

This does not imply that these agencies are without merits or strengths or that they are wholly culpable, but is intended to convey their acknowledgement of their individual and collective under-performance, and what has to change in the light of the magnitude of cruelty experienced by Steven (ref...).

There is the role of care providers in adult protection intervention work, how they are engaged in investigations, and what role commissioning has in the overall process. And the commissioning role can be crucial, as noted by the joint investigation into the Cornwall Partnership NHS Trust, which stated,

'The trust has blamed the three PCTs in Cornwall for failing to commission appropriate services for people with learning disabilities and, while this does not lessen the trust's culpability, the criticism is accurate'.

This is the other side of the coin; we are inclined to believe that 'it won't happen', even when the objective statistics suggest otherwise the difficulty that now exists for people with learning disabilities, especially those with greater disability, and those who care for and support them, is that the law specifies that many such people are vulnerable, and not able to make this choice for themselves (Daniel, 2003).

The onus of assessing risk and making the decision therefore often rests with carers. Because it is such a difficult decision to make for someone else, carers often take the simple way out, and avoid letting situations arise where learning-disabled people in their care have the opportunity to develop sexual relationships: if a person cannot make an 'informed choice' then perhaps it is easier not to offer them that choice (Lindsay 2004). This is the current dilemma for those who work in community care situations. According to David J. Thompson,(2000) the issue of sexual relationships is perhaps the most difficult and complex, but this problem of balancing risk and choice is a constant one for carers and professionals, in relation to many aspects of everyday life. In the background is the ogre of the law (and/or local management), ready to jump on the unwary, should they get it wrong. No wonder, perhaps that many are cautious about enabling such choices to be made.

Get higher in the information of vulnerable adults referred to them for the reason that they are at risk of physical and sexual mistreatment, in addition to financial fraud, a study has found in Social services departments have seen (Simon, 1997. So where adult with learning disabilities have more complex problems, such as behaviour problem, mental illness, or others any physical or mental disorder they will need additional care and support to cope with their everyday lives (Hawks, 1998). Sometimes these problems impose additional risks, and these do need to taken into account when assessing and managing risks for each person/adult.