Liz Jones, Deputy Chief Executive and Policy Director at National Care Forum and Maria Mills, Chief Executive of Active Prospects, explore how providers, commissioners and professionals can balance safety, autonomy and empowerment — and why positive risk-taking depends on genuinely shared responsibility.
Given the importance of practice-based insight in exploring risk and responsibility, when NCF were invited to contribute an article on this topic we felt it was essential to hear from one of our not-for-profit members. As the membership body for not-for-profit care and support providers, we see daily the convergence between protection and freedom — not only for people being supported, but for staff as well. The idea of shared risk between providers and local authority commissioners is central to this conversation. Nothing comes without risk, but where risk is genuinely shared, better outcomes and better lives can be achieved for everyone.
We are grateful to Active Prospects for sharing their perspective on how risk and responsibility are approached in their services.
Active Prospects supports more than 300 people each year, many with multiple diagnoses, long or repeated hospital admissions, and a history of failed placements. As a community-based social care provider, we are often tasked with balancing risk and responsibility; safety and freedom; and choice and empowerment. We are proud to be a national leader in this work, with a 99% success rate in supporting people with complex lived experience to live aspiring lives in their communities. However, this success sits alongside significant challenges within the current systems and frameworks in which we operate.
Tensions between risk, choice and capacity
Risk in social care rarely fits neatly into policy frameworks. People may be assessed as having the mental capacity to make decisions about their care yet still choose options that carry serious health or safety risks. For example, an autistic young adult may refuse medication support from staff they do not know or trust, while being unable to self-medicate safely.
Some people experience fluctuating capacity, where decision-making ability changes depending on emotional state or environment. An adult with ADHD and autism might usually attend medical appointments independently but refuse essential healthcare when sensory overload at a GP surgery becomes overwhelming.
We also support people who are deemed to lack capacity and are subject to legal frameworks such as Court of Protection or deprivation of liberty safeguards, but who do not agree with or comply with imposed restrictions. One example is a young person with learning disabilities and mental health needs who regularly does not return to their supported living home at night and cannot be contacted.
These situations challenge simplistic interpretations of capacity and demand flexible, compassionate responses. Without a shared understanding of this complexity among providers, commissioners, regulators and partner organisations, providers can feel isolated in managing risk.
Complex care is not for the faint-hearted. Skilled providers are in short supply, margins are tight, operational pressure is high, and burnout among managers is common. These realities shape both practice and risk appetite.
Positive risk-taking: what works
Despite the challenges, where positive risk-taking is genuinely supported, outcomes can be extraordinary.
One young woman with a learning disability, autism and a psychotic disorder experienced five hospital admissions and three failed placements over six years, each breakdown compounding trauma and mistrust. After discharge into a new supported living home with Active Prospects, she struggled to settle, testing staff, routines and care plans constantly. It took a full year before she felt secure enough to unpack her belongings.
Through consistent, patient practice and the use of assistive technology that allowed her to request support remotely, trust developed. Two years on, she studies part-time at college, volunteers, and has built a supportive friendship group.
Another example is a young man with a learning disability, autism and ADHD who had experienced three failed placements and required 3:1 staffing due to physically challenging behaviour. Moving to his own flat involved extensive multidisciplinary planning, with the accommodation and service model designed around his needs. In the early months, positive risks were taken carefully and collaboratively, informed by his views, those of his family, and the staff team.
Two years later, he is thriving. He leaves the house several times a day, drives regularly, cooks and cleans for himself, and enjoys social activities. He recently joined a fundraising walk and continues to grow in confidence, choice and independence.
Conditions that enable positive risk-taking
Where positive risk-taking works well, several conditions are consistently present.
Strong multidisciplinary working is essential.
Shared ownership of risk underpins success. Providers cannot and should not hold risk alone, especially where people sit across learning disability, autism and mental health pathways. Regular multidisciplinary reviews involving social care, health professionals, emergency services, police, families, the individual and the provider create alignment and confidence. Shared care plans are powerful only when responsibilities are clearly understood and risk is explicitly shared.
Leadership matters at every level.
Frontline staff require clear guidance, consistent protocols and ongoing support. Acceptable risk varies from person to person, demanding dynamic rather than static risk assessment. The emotional impact of this work is significant, making high-quality supervision, debriefing, wellbeing support and strong team cultures essential. These approaches also require advanced skills in judgement, communication, emotional intelligence and trauma-responsive practice.
Patience and timing are often overlooked.
Progress is rarely linear. Supporting people with trauma histories, institutionalisation or disrupted education can feel like “one step forward, two steps back”. Knowing when to advance, pause or pull back slightly can make the difference between success and another damaging placement breakdown. This calls for strengths-based, trauma-informed support, sound professional judgement and the ability to adapt in response to changing needs, risks and levels of trust.
Trauma-informed approaches underpin everything.
Empathy, consistency, co-production and trust are not optional extras. Involving people as collaborators in their care, rather than passive recipients of plans created without their involvement, is essential. This is particularly important in designing pathways from hospital to home, creating the sense of safety needed for growth.
Shared risk, shared responsibility
Ultimately, progress depends on commissioners, providers, families and professionals being willing to understand risk and share responsibility. When they do not, risk is pushed downwards; innovation is stifled; staff burn out; and people remain in restrictive environments designed to contain rather than enable.
At Active Prospects, we see people thrive every day. Getting the right support around someone, in the right home, with skilled staff and strong multi-agency working does work. Investing early, appropriately and sustainably not only improves lives but prevents the compounded harm of repeated service failure and provides the best long-term value for the public purse.
