Risk, Restriction and Enablement: Applying Positive Risk-Taking to Moving and Handling Decisions
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Moving and handling is one of the areas where risk aversion most commonly overrides person-centred practice in physical disability services. Following a fall, near miss or staff concern, handling plans are often tightened quickly, with hoists introduced or independent movement discouraged “for safety”. While these responses may reduce immediate anxiety, they frequently increase long-term risk by reducing strength, confidence and independence. Commissioners and inspectors increasingly expect providers to evidence how moving and handling decisions balance safety with enablement rather than defaulting to restriction.
This article explores how positive risk-taking can be applied to moving and handling decisions in physical disability services. It should be read alongside Positive Risk-Taking & Risk Enablement and Just Enough Support & Least Restrictive Practice.
Why moving and handling becomes restrictive
Risk restriction often emerges incrementally. A fall may trigger increased assistance “temporarily”, which then becomes embedded practice. Staff confidence drops, independence reduces, and over time the restriction is justified by the decline it helped create.
In physical disability services, this cycle can be particularly harmful where maintaining movement is critical to long-term outcomes.
Commissioner and inspector expectations
Two expectations are increasingly clear:
Expectation 1: Evidence of least restrictive practice. Inspectors expect providers to show that restrictive handling methods are justified, time limited and reviewed.
Expectation 2: Proportionate risk enablement. Commissioners expect providers to demonstrate how risks are mitigated without removing autonomy unnecessarily.
Applying positive risk-taking to handling decisions
Positive risk-taking in moving and handling means supporting people to move in ways that carry managed risk because of the benefits to independence, dignity and function. This requires clear discussion, documentation and review.
Handling plans should explain not just what staff must do, but why, and under what conditions support can be stepped back.
Operational example 1: Stepping back from hoist dependency
A provider identified that a hoist was being used routinely after a fall, despite the person previously completing assisted standing transfers. A review introduced grab rails, adjusted pacing and agreed confidence-building support. Hoist use became a contingency rather than the default.
Mobility improved and staff confidence increased without additional incidents.
Risk enablement and staff confidence
Staff often restrict movement because they fear blame if something goes wrong. Providers must explicitly support positive risk-taking through supervision, training and management backing.
Operational example 2: Clarifying acceptable risk
A service introduced guidance defining acceptable levels of risk in moving and handling. Staff were reassured that supporting agreed independent movement was expected and supported.
Safeguarding and restrictive handling
Overly restrictive handling can itself become a safeguarding concern where it limits autonomy or causes distress. Providers should treat restriction as a safeguarding issue requiring justification and review.
Operational example 3: Reviewing restriction as a safeguarding concern
A provider flagged long-term hoist-only transfers as a potential restrictive practice. A multidisciplinary review reintroduced supported standing where possible.
Governance and assurance
To evidence balanced practice, providers should implement:
- Audits identifying restrictive handling methods
- Management oversight of higher-risk enablement decisions
- Clear review timelines linked to outcomes
From restriction to enablement
In physical disability services, moving and handling decisions shape long-term independence. Providers that apply positive risk-taking to handling practice are better placed to evidence quality, meet commissioner expectations and support sustainable mobility.
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