This is the third post in my series about Care Act assessments of need. The first post explored the issues to be considered at the beginning of the assessment, and the second post talked through the eligibility criteria. This post will discuss how authorities tailor their assessment process to the individual being assessed.
The care and support statutory guidance makes it very, very clear that the assessment process should be ‘person-centred’. A lot of that will be achieved by core ‘social work’, through interacting sensitively and with empathy with the individual being assessed. But there is an art to how that is recorded, so that when the assessment is read by the individual (and it MUST be sent to the individual once completed) they can see that they have been listened to.
In some cases it will also be necessary to consider whether a referral to advocacy services is needed to enable the person to be involved in the assessment process as per s67 Care Act 2014. This is needed where the person will require support to engage in the process and there is no other appropriate person to provide that support. Note though, that the word ‘appropriate’ is there for a reason. A family member or friend who is getting involved but not putting the individual at the centre of the process and motivated by their own reasons may well not be ‘appropriate’ and so a referral to advocacy service should still be considered.
There is more to it than that though, and so we are going to talk through some of the other phrases used in the guidance, and what that means in practice. I am primarily going to focus on the terms ‘appropriate’ and ‘proportionate’ as these appear a lot in chapter 6 of the guidance. You will notice that both these terms relate to processes being followed. That is for a reason. The outcome will need to be individual to the person, so the guidance can’t say much on that which would have any really meaning, so instead it focuses on helping practitioners follow the right process to reach that outcome. That should then result in a robust and personalised assessment.
For an assessment to be ‘appropriate’ it must be carried out at by a suitably qualified and experienced practitioner. What those qualifications will look like will depend on the needs of the person. If their needs are primarily linked to the learning disability, then a social worker with 20 years experience in addiction might not be the appropriate person to carry out the assessment. And the right professional might not be a social worker at all, depending on the issues at hand. Social care workers are not prevented from carrying out these assessments, and occupational therapists often complete needs assessments on cases where their expertise is required. Some local authorities operate ‘trusted assessor’ arrangements where staff employed by another organisation complete assessments on their behalf, such as hospital staff during discharge from hospital or carer’s organisations conducting carer’s assessment. All of this will be appropriate in some circumstances and not others. It is all about what that particular individual needs.
There are also plenty of ways an assessment can be completed. Face-to-face assessment has the tendency to be the default for local authorities, but it is not the only option. The guidance also states that remote assessment, using online or telephone technology can be appropriate in some circumstances. And this has been used to great effect for people who communicate better through technology than they do in a face-to-face scenario. Supported self-assessment is also discussed in the guidance but this is used to mixed effect by many local authorities. The concept of ‘self-assessment’ makes many local authorities nervous, as they seem to find it difficult to incorporate this into their decision making process. Whilst a supported self-assessment doesn’t mean the practitioner is abdicating all responsibility, it can be interpreted in that way by local authorities, so is not used as widely as the guidance perhaps anticipated.
Self-assessment can also be interpreted in an unhelpful way by individuals too. Indeed, the whole principle of being ‘person-centred’ and starting from the assumption that the individuals understands their own needs can sometimes lead to a ‘you have to give me what I want’ mentality. But that isn’t necessarily true. We’ll talk about how to deal with that in my next post.
The guidance also references joint and combined assessments, which can help prevent individuals from feeling like they are answering the same questions over and over. It can help practitioners ensure consistency as well. So an assessment for an adult’s care and support needs might be combined with an assessment of the carer’s needs. Care Act needs assessments can also be combined with reviews of an Education, Health and Care plan, or a continuing healthcare assessment. But again, it won’t always be appropriate to conduct assessments in a joint or combined way, it will all be about working out what is best for the individual, and what they want.
Which leads us into the issue of proportionality. Again, this is something that local authorities can struggle to embed. Because most of the time, assessment forms are lengthy documents with lots of questions. These are usually electronic forms which do not allow irrelevant sections to be bypassed. Yet proportionality is about the time taken and the effort needed to complete an assessment. An individual with low level, fairly straightforward needs will not want an assessment that takes 3 visits and is written up over 12 pages before they get the support they need. Meanwhile somebody with complex, fluctuating physical and mental health needs will not feel like they have been listened to or understood if the whole process takes only 45 minutes.
The level of input needed from other professionals also needs to be proportionate. There will be times when it is entirely appropriate to seek input from a suitable medical professional before finishing an assessment, but saying this this is required in all assessments is not likely to be proportionate.
Assessments are tailored, not off-the rack.
The proportionality also can extend to the writing up of the assessment, ensuring that all relevant information is captured, but limiting irrelevant information included. But we will talk about that more next time.
In case it isn’t obvious from the fact that i still haven’t identified the authority that I work for, the views expressed on this blog are my own opinion and not the opinion of that local authority.