There’s a note I wanted to take for myself. Just so I won’t forget.

picture 1000 words

I mentioned some of the risk assessments done here in the house before to make sure that none of the carers could injure themselves while working and subsequently sue their employers. When we got the tilt table ourselves (because it took months to get the stand-up bed), for example, a carefully carried out risk assessment established that the carers could under no circumstances hold Pádraig’s head when he was standing up in the tilt table – as they would have to stretch out their arms to hold his head and could do themselves and their arms damage in the process.

At the time I noted in a meeting with the HSE where this was discussed that no risk assessment had ever been carried out to establish the risk for Pádraig when he couldn’t stand up for months because of a lack of access to equipment that he needed to stand up. (It is normal hospital practice to get patients to stand up within days of an intervention to avoid one of dozens of the possible negative consequences for their health if they didn’t.)

Something slightly different happened recently. We wanted Pádraig to use the MOTOMed arm trainer, one he had been using in Germany on medical prescription (and under the eyes of a physio who worked with Pádraig at home for four double sessions a week) for months. A recent risk assessment determined that his shoulders have now become too weak to properly support the weight of his arms when being moved in the MOTOMed arm trainer and that there was a risk of doing damage to his shoulders if he used it. Our attempt to buy such an arm trainer was stopped. The one and only distributor of MOTOMeds in the country would not sell us the equipment.

There has never been a risk assessment in relation to the number and frequency of therapy Pádraig is getting currently versus the number of therapy sessions he would require just to maintain his current physical condition – or, even better, to support his enormous efforts to improve physically and recover functions.

In other words, ‘How much damage is the lack of therapy doing to his body?’ or ‘To which extend does the lack of therapy affect a meaningful recovery?’ are risk assessment questions that don’t seem to be asked. What does it mean for his arms, for his legs, for his upper body, for his lungs, for his head, for his brain, for his blood pressure, for his general health if he receives therapy just once a week (for short periods) or, more likely, once a month in the form of an ‘assessment’, or maybe not at all over long periods? How will it effect his health and chances of recovery if he works with carers on stretches instead of with therapists on a coordinated neuro rehabilitation programme? What are the risks that this will affect his current physical condition or prevent a meaningful recovery? What is the likelihood that he will acquire contractions instead, that his body generally will deteriorate without what would be considered by any standards the minimum amount of therapy necessary just to maintain his physical integrity, never mind to support a meaningful recovery?

Are risk assessments just carried out to *stop* something that could potentially do damage (but might not)? Or should risk assessments also be carried out to determine what will most likely happen if something that *should be done* is not being done?