Introduction, Legal Requirements and Tools

This procedure should be used by anyone that has been allocated or asked to carry out any process that establishes the eligible needs of a person/carer under the Care Act, including any formal assessment or reassessment of need.

Additional practice guidance that can support the processes of establishing needs, Care and Support Planning / Support Planning and review when the person/carer has specific or complex needs can be accessed in the tri.x Resources.

A range of local good practice guidance, case studies and flow charts can also be found in the Local Resource area by clicking here.

Under the Care Act any method of establishing needs is known as an assessment and this is the legally recognised term. Assessment is an integral part of adult Care and Support.

The term 'assessment' covers:

1. The range of methods that can be used to establish needs, some of which are formal (for example, a face to face assessment) and some of which are not so formal (for example, a short telephone conversation); and
2. The range of models and frameworks used to support or shape the process of information gathering.

Unfortunately the word 'assessment' is all too often associated with outdated practices to gather information that do not support the ethos of the Care Act. For example, being:

1. A process led by the assessor;
2. A structured process involving the use of forms and arbitrary questions;
3. An 'interview' of the person being assessed; and
4. A gateway to funding and services, the nature of which is decided by the assessor.

As a mechanism to promote and support new practices around assessment that are in line with the Care Act ethos and duties, these procedures intentionally use the phrase 'Establishing Needs' alongside the legal term 'assessment'. This supports users of the procedures to think more flexibly about what an 'assessment' can, and may need to involve so that it is:

1. Proportionate, only being formal or lengthy when it needs to be;
2. Led by the person with care and support needs;
3. Appropriate to the person and their situation; and
4. A method of supporting the person to find their own solutions to issues identified.

Under the Care Act the main purpose of any assessment is:

1. To provide a full picture of the person's/carer's needs, with a particular focus on the impact that those needs have on their Wellbeing and the outcomes they want to achieve in their day-to-day life; so that
2. The Local Authority can put in place appropriate, proportionate and timely arrangements for that person/carer in order to meet their needs and promote individual Wellbeing. This response might range from offering guidance and information to arranging for services to meet the needs.

A good assessment will also:

1. Support people to understand their strengths and capabilities within the context of their situation;
2. Support people to understand the support that may be available to them within the community or through other networks and services; and
3. Support people to consider some of the different ways that the Local Authority may be able to support them (other than through a formal service).

The information gathered will help the Local Authority to:

1. Make a determination about eligibility (where eligibility is a factor in meeting assessed needs); and
2. Understand the kind of service provisions that could be explored when Care and Support /Support / Reablement planning.

Referrals to Occupational Therapy often describe specific equipment or an adaptation as the reason that the assessment is being requested, for example:

1. To adapt a bathroom into a wet room;
2. To obtain specialist seating;
3. To lower the units in the kitchen; or
4. To fit grab rails around the home.

Assuming the outcome of the assessment in this manner suggests that the person making the referral may not understand the purpose of an assessment under the Care Act as a mechanism to assess needs (not services), and may have unrealistic expectations about the whole process that you will need to manage.

There should not be any assumptions made prior to an assessment that the provision of equipment or an adaptation will always be the outcome. Instead the assessment must identify:

1. All of the needs that a person appears to have;
2. Whether any of the needs that the person appears to have can be prevented, reduced or delayed; and
3. If so, whether the provision of low level equipment or minor works is the most appropriate and proportionate way to do so; and
4. Whether any of the needs that the person appears to have are on-going (in which case an eligibility determination must be made and eligible needs met); and
5. Whether the provision of equipment or adaptation is the most appropriate and proportionate way to meet on-going needs.

Failing to assess in a holistic way increases the risk that:

1. Not all needs will be identified;
2. Unmet needs will remain after assessment;
3. Needs will not be met in the most proportionate and appropriate way;
4. Opportunities to prevent, reduce and delay needs (and promote independence) may be missed;
5. Opportunities to work jointly with others to achieve better outcomes for the person may be missed;
6. Ways to meet needs may not be explored from a strengths based approach; and
7. Opportunities to identify and support carers could be missed.